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When You Don’t Feel at Home With Your Assigned Gender

Medically Reviewed by Brunilda Nazario, MD on May 20, 2021

Gender dysphoria is a condition that causes distress and discomfort when the gender you identify with conflicts with the sex that you were assigned at birth. You may have been assigned a male sex at birth but feel that you’re female, or vice versa. Or you may believe yourself to be neither sex, or something in between or fluid.

This disconnect between how society regards you and how you feel physically and mentally can cause severe distress, anxiety, and depression. Gender dysphoria used to be called  “gender identity disorder.” But it’s not a mental illness.

Gender dysphoria is not the same as sexual orientation.

Gender nonconforming (GNC) is a broad term that includes people whose gender identity isn’t strictly female or male or moves between the two. Other terms for this include genderqueer, gender creative, gender independent, bigender, noncisgender, nonbinary, and third sex.

Symptoms and Diagnosis

You have gender dysphoria if you have persistent distress or problems over your assigned gender that lasts 6 months or longer.

In children, these symptoms include at least six of the following:

  • Insisting on or strongly desiring the gender that differs from one that was assigned at birth
  • Wanting to wear the clothing of the gender with which they identify
  • Strongly preferring friends of the gender with which they identify
  • Strongly preferring toys, activities, and games typically aimed at the gender with which they identify
  • Preference for cross-gender roles during play or make-believe
  • Refusing masculine or feminine toys, games, and activities that don’t match their gender identity
  • Deep dislike of the genitals they were born with
  • Strong desire for sex characteristics, such as breasts or penis, that match their gender identity

In teens and adults, a diagnosis requires at least two of these traits:

  • Certainty that their gender doesn’t match with their physical body
  • Strong desire to be rid of their genitals and other sex traits
  • Deep urge to have the sex characteristics of the gender with which they identify
  • Strong want to be a different gender
  • Strong desire to be treated as a different gender
  • Deep conviction that their feelings and reactions are typical for their gender identity

Children or adults might dress and present themselves like the gender they believe they are.

Undiagnosed or Untreated Gender Dysphoria

Gender dysphoria isn’t an illness. But the distress from it may be linked to mental health problems, such as anxiety disorders, schizophreniadepressionsubstance abuse disorder, eating disorders, and suicide attempts. Some estimates say that 7 out of 10 people with gender dysphoria will have some other mental health diagnosis in their lifetime.

Treatment

The goal is not to change how the person feels about their gender. Instead, treatment is to address their distress and other emotional harm.

“Talk” therapy with a psychologist or psychiatrist is for a key part of treatment for gender dysphoria. Many people also decide to take at least some steps to bring their physical appearance in line with how they feel inside. They might change the way they dress or pick a different name. They may also take hormones and other medication or have surgery. Treatments include:

  • Puberty blockers. These are hormones that suppress physical changes of puberty. For someone who is an assigned female, the blocks may hold back the growth of breasts.
  • Hormones. Teens or adults may take the sex hormones estrogen or testosterone to develop traits of the sex that they identify with.
  • Surgery. Some people choose to have sex-reassignment or gender-affirming surgery after a year of hormone treatment. This used to be called a sex-change operation. Experts recommend surgery only after age 18 and after the person has lived in their desired gender for 2 years.

With the help of therapists and doctors, people can choose the treatment that’s best for them. That may depend in part on if they’re satisfied with their new social role, hormonal side effects, and whether they want surgical changes.

After transitioning to their desired gender, the person may benefit from therapy. Friends, family, and others sometimes may not fully understand or support the changes. The person also will need to continue to see their doctor for hormone therapy and transition.

Children and Gender Dysphoria

Children as young as 2 can start showing cross-gender behaviors. Not all of them will continue to feel gender dysphoria into their teens or adulthood. Kids who express strong views that they’re in the wrong gender (such as a boy who says, “I’m a girl”) are more likely to become transgender adults.

Experts advise that you take the lead from your child. Let your child be who they are, and get help if you or your child needs it.

If gender dysphoria goes past puberty, studies show that the young person will likely continue to feel that way. For them, their internal sense of gender is not a choice. It is who they are, and they need professional and social support.

WebMD Medical Reference

Sources

SOURCES:

Randi Kaufman, PsyD, clinical psychologist, The Gender & Family Project of The Ackerman Institute for the Family, New York.

American Psychiatric Association: "Gender Dysphoria."

Center of Excellence for Transgender Health.

National Health Services (UK): “Gender dysphoria.”

University of Maryland Medical Center.

StatPearls: “Gender Dysphoria.”

 

 

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