A person with gender dysphoria may experience conflict with their sex assigned at birth and their gender identity. It is not the same as being transgender or gender-nonconforming.
According to the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5), gender dysphoria is a condition where people struggle with their assigned (birth) gender identity.
A person may feel uncomfortable with their body or with the gender roles society assumes they will play. Some people may experience these feelings long-term, while for others, they are temporary.
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This article explains what gender dysphoria means, why some people experience it, and discusses management techniques.
According to the APA, gender dysphoria is a condition in which individuals feel uncomfortable with their physical sex and assigned gender.
They may want to express or affirm themselves according to the gender or genders with which they identify or live by, also known as experienced gender.
They may affirm their identity by changing their behavior, how they dress, style their hair, or which toys they play with as children.
Over time, some people may stop experiencing these feelings of gender dysphoria altogether. Others socially transition by changing their names and pronouns, and some individuals medically transition to the gender with which they identify.
However, this does not mean that every transgender person has experienced gender dysphoria. Transgender is an identity, and gender dysphoria is a condition.
People who are gender-nonconforming can also experience gender dysphoria. Gender-nonconformity is also not a condition; it is a gender expression that does not fit the norms and stereotypical behaviors of a person’s assigned gender.
People who identify in the following ways may also experience gender dysphoria:
- Cisgender: Those whose gender identity matches their physical sex.
- Nonbinary: People who may identify as having no gender or having two or more genders.
- Gender fluid: People who identify as different genders at different times.
According to the DSM-5, gender dysphoria affects 0.005–0.014% of adults born male and 0.002–0.003% of adults born female.
To receive a gender dysphoria diagnosis, a person must experience significant distress or problems functioning in their everyday lives due to the differences between their assigned and experienced gender.
The APA state that a person must experience these feelings for at least 6 months. A specialist will use different criteria to diagnose children than they will for older people.
According to the APA, adolescents and adults with gender dysphoria might experience:
- a notable difference between the gender they identify with and their physical sex
- a strong desire to live within another gender role or to be treated as another gender
- a strong desire to change their assigned sex characteristics
Symptoms in children
In children, gender dysphoria may cause:
- a strong desire to be another gender
- a dislike of their sexual anatomy
- a strong preference to wear clothes of a different gender
- a strong desire to play another gender in fantasy play, or to have toys or games that have stereotypical associations with another gender
- rejection of toys and activities that have typical associations with their assigned gender
- a strong desire for their sex characteristics to be those of another gender
A person may begin to develop these feelings in childhood, and they may continue into adulthood. Sometimes, a person may not experience these until puberty or later, and they may also come and go. Some people may stop experiencing these feelings altogether.
The exact reasons why a person experiences gender dysphoria remain unclear. It may result from a complex mix of factors, including biological, psychological, and social factors.
- being born with a condition that affects the sex hormones
- fetal exposure to chemicals that disrupt hormones, such as phthalates
- faulty development of some neurons related to gender
- having a psychiatric condition, such as schizophrenia
- having autism spectrum disorder (ASD)
- a history of childhood abuse or neglect
- having a close family member with gender dysphoria
However, it is difficult to attribute gender dysphoria to any specific cause.
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There is no one-size-fits-all approach to helping people with gender dysphoria. What works for one person may not work for another. Options include:
Therapy can give individuals a space to explore their feelings and emotions. For some people, it may resolve their gender dysphoria. For others, it may confirm that they wish to live in another gender role.
Therapy can also help people manage issues that arise at school, work, or in relationships. It can reduce feelings of depression and anxiety and boost self-esteem.
Therapy can take place individually or as a couple or family. Peer support groups are also available and can help those with gender dysphoria connect with others who have similar feelings and experiences.
Changes in gender expression
Some people may decide that they would like to live part-time or full-time in another gender role. This may include using a name and pronouns typically associated with that gender.
Other ways that a person can change their gender expression include:
- attending voice therapy to develop different vocal characteristics
- removing hair or having hair transplants
- tucking or packing genitals
- binding or padding breasts
- applying makeup and hairstyling
Some people may want to take further steps to help them live in another gender role. These steps may include:
- hormone therapy to help develop different features, such as facial hair
- surgery to add or remove breasts or to make changes to the genitals
Self-care and management
People with gender dysphoria are at higher risk of other mental health issues, so they must practice good self-care and look after their physical and mental health. The following tips might help:
- eating a balanced diet, get enough sleep, and exercise regularly
- practicing stress-management techniques, such as yoga and meditation, where possible
- connecting with other supportive people, such as family, friends, or other people who experience gender dysphoria
- seeing a mental health professional, if necessary
Children can show signs of gender dysphoria between the ages of 2–4, although many may not express feelings and behaviors until much later. Some children may begin to reject their biological sex when they go through puberty.
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However, many children display gender-nonconforming behavior, and it does not necessarily mean that they have gender dysphoria. Also, many children who meet the criteria for gender dysphoria do not continue to do so as they grow up.
According to some research, only 10-20% of children with gender dysphoria will continue to experience it in adolescence.
The APA note that children with more intense symptoms and levels of distress and have more persistent and consistent symptoms may be more likely to become transgender adults.
A 2018 article in BioMed Research International, suggests that children experiencing gender dysphoria might benefit from psychological therapy and support.
The APA explain that this typically involves a multi-disciplinary team, comprising a pediatrician, a psychiatrist, and a pediatric endocrinologist who specializes in hormones in children.
The APA state that people with gender dysphoria often experience high levels of stigmatization, discrimination, and victimization. The social stigma can increase a person’s risk of developing another mental health disorder and harm their self-esteem.
Children may experience bullying or peer pressure at school, and they are more likely to develop anxiety and depression.
It is essential that people with gender dysphoria get support from loved ones. When speaking with someone with gender dysphoria, keep the following in mind:
- Listen to and validate the person’s experience and how gender dysphoria affects them. Acknowledge their distress and pain.
- Do not trivialize the person’s experiences or emotions.
- Ask how you can help. Ask them what they need and what would make things easier.
- Encourage them to seek help, especially if they display symptoms of mental health issues, suicidality, or substance misuse.
- Use their preferred pronouns. Some people may prefer gender-neutral pronouns, such as “them” and “they.” Others prefer people to refer to them as another gender (whether that is he, him, she, or her).
People with gender dysphoria who have the support of loved ones may be less likely to experience depression, anxiety, and other adverse effects. Ways to support a person with gender dysphoria include:
- offering to accompany them to appointments
- seeking immediate help if serious self-harm or suicidal ideation or attempts occur
- taking children with gender dysphoria to see their doctor or a child psychologist for support
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can call 800-799-4889.
The outlook for those with gender dysphoria depends on many factors, including the severity of symptoms and the availability of support. Many children with gender dysphoria will no longer experience it by the time they reach adolescence. Others may experience it into adulthood.
Treatment and management techniques may reduce potential complications of gender dysphoria, such as depression and suicidal ideation.
However, even after some people with gender dysphoria have transitioned, they may still experience suicidal ideation and other difficulties due to the social stigma associated with the transition.