People who have gender dysphoria feel strongly that their gender does not match their biology.
For example, a person who has a penis and all other physical traits of a male might feel instead that they are actually a female. That person would have an intense desire to have a female body and to be accepted by others as a female. Or someone with the physical characteristics of a female would feel their true identity is male.
Feeling that your body does not reflect your true gender can cause severe distress, anxiety, and depression. "Dysphoria" is a feeling of dissatisfaction, anxiety, and restlessness. With gender dysphoria, the discomfort with your male or female body can be so intense that it can interfere with your normal life, for instance at school or work or during social activities.
Gender dysphoria used to be called “gender identity disorder.” But the mismatch between body and internal sense of gender is not a mental illness. Instead, what need to be addressed are the stress, anxiety, and depression that go along with it.
The condition has also been called “transsexualism.” But this term is outdated. Some consider it offensive. Now “transgender” is often used to describe someone who feels their body and gender do not match.
Gender nonconforming (GNC) is a broader term that can include people with gender dysphoria. But it can also describe people who feel that they are neither only male or only female. Informally, people who identify with both genders or with neither gender might call themselves "genderqueer."
Gender dysphoria is not homosexuality. Your internal sense of your gender is not the same as your sexual orientation.
Symptoms & Diagnosis
To be diagnosed with gender dysphoria, a person has to have symptoms that last for at least 6 months.
In children, these symptoms may include:
- Consistently saying they are really a girl even though they have the physical traits of a boy or really a boy if they have the physical traits of a girl
- Strongly preferring friends of the sex with which they identify
- Rejecting the clothes, toys, and games typical for boys or girls
- Refusing to urinate in the way -- standing or sitting -- that other boys or girls typically do
- Saying they want to get rid of their genitals and have the genitals of their true sex
- Believing that even though they have the physical traits of a girl they will grow up to be a man; or believing if they have the physical traits of a boy they will still be a woman when they grow up
- Having extreme distress about the body changes that happen during puberty
In teens and adults, symptoms may include:
- Certainty that their true gender is not aligned with their body.
- Disgust with their genitals. They may avoid showering, changing clothes, or having sex in order to avoid seeing or touching their genitals.
- Strong desire to be rid of their genitals and other sex traits.
Children or adults might dress and otherwise present themselves like the gender they believe they are.
Undiagnosed or Untreated Gender Dysphoria
Diagnosis and treatment are important. People with gender dysphoria have higher rates of mental health conditions. Some estimates say that 71% of people with gender dysphoria will have some other mental health diagnosis in their lifetime. That includes mood disorders, anxiety disorders, schizophrenia, depression, substance abuse, eating disorders, and suicide attempts.
The goal is not to change how the person feels about their gender. Instead, the goal is to deal with the distress that may come with those feelings.
Talking with a psychologist or psychiatrist is part of any treatment for gender dysphoria. "Talk" therapy is one way to address the mental health issues that this condition can cause.
Beyond talk therapy, many people choose 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 go by a different name. They may also take medicine or have surgery to change their appearance. Treatments include:
- Puberty blockers. A young person in early puberty with gender dysphoria might ask to be prescribed hormones (testosterone or estrogen) that would suppress physical changes. Before making that decision, the young person should talk with a pediatrician and sometimes a psychiatrist about the pros and cons of taking these hormones, especially at a young age.
- Hormones. Teens or adults may take the hormones estrogen or testosterone to develop traits of the sex that they identify with.
- Surgery. Some people choose to have complete sex-reassignment surgery. This used to be called a sex-change operation. But not everyone does. People may choose to have only some procedures done in order to bring their looks more in line with their feelings.
With their therapists, people choose the treatment that is right for them based on what they want and what they already look like.
After transitioning, a person may no longer feel dysphoria. But the person may still need therapy. Friends, family, co-workers, potential employers, and religious groups can sometimes have a hard time understanding when someone's gender appears to change. This and other challenges of transitioning can call for professional help.
Is It Just a Phase?
One of the most common questions that parents of children with gender dysphoria ask their pediatricians is, "Is it just a phase?"
Unfortunately, there is no way to know for sure. Not all young children who feel this way do so in their teenage years or in adulthood.
So how do parents know if they should let their son carry a girls' lunchbox or let their daughter wear boys' clothes? 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.
Some young people and even adults may have mixed feelings about their physical gender. They often find it useful to talk with a counselor before or after taking steps to become who they feel they truly are.
If gender dysphoria continues past puberty, studies show that the young person will likely continue to feel that way. For people who feel long-term that their body does not match their internal sense of gender, it is not a choice. It is a burden they didn't choose, and they need professional and social support.