Summary
Gender dysphoria is a state of emotional distress caused by incongruence between a person's gender identity and assigned gender. Transgender individuals who experience distress due to factors such as discrimination are not considered to have gender dysphoria. Manifestations of gender dysphoria (e.g., a desire to mask or eliminate secondary sex characteristics) vary among age groups and sociocultural environments. DSM-5 TR diagnostic criteria include clinically significant impairment in important areas of functioning (e.g., social, school, or work settings). Management should be provided by a multidisciplinary team specializing in gender identity and includes psychotherapy and, in some cases, gender-affirming care.
See also “Sexuality and sexual medicine” and “Principles of transgender health care.”
Clinical features
Features of gender dysphoria [1]
- Emotional distress about the incongruence between a person's gender identity and assigned gender at birth
- Manifestations vary among age groups and sociocultural environments.
- Adults and adolescents
- Attempts to eliminate or hide primary and/or secondary sex characteristics, e.g., binding penis or breasts, shaving body and/or facial hair, wearing loose clothing
- Adopting stereotypical behaviors, hairstyles, and clothing of their experienced gender
- Hiding or avoiding contact with their genitals during sexual activity
- Children
- Adults and adolescents
Behaviors typically associated with another gender usually begin at ∼ 2–4 years of age and do not always persist through adolescence or adulthood. [1]
Associated conditions [1][2]
- Disorders of sex development, e.g.:
- Psychiatric conditions, e.g.: [2]
Some transgender individuals experience gender dysphoria. Do not confuse other causes of distress (e.g., discrimination, inability to access gender-affirming care) with gender dysphoria.
Diagnosis
The diagnosis of gender dysphoria should be made by an experienced multidisciplinary team. [3][4]
DSM-5 TR diagnostic criteria [1]
| DSM-5 TR diagnostic criteria for gender dysphoria | ||
|---|---|---|
| Gender dysphoria in children | Gender dysphoria in adolescents and adults | |
| Primary features |
|
|
| Functional impairment |
| |
| Specifiers |
| |
Management
Refer; all individuals with suspected or confirmed gender dysphoria for evaluation by a multidisciplinary team specializing in gender identity. [1][4]
-
Psychotherapy [1][4]
- Indicated for all individuals with gender dysphoria
- The goal is to alleviate distress and reduce impairment of function.
- Psychotherapy is not used to persuade the individual to accept their assigned gender.
-
Gender-affirming care, e.g., gender-affirming hormone therapy, gender-affirming surgery [1][4]
- Offered to individuals with consistent and persistent gender dysphoria, as determined by a comprehensive biopsychosocial assessment
- May be actively sought by adults and adolescents with gender dysphoria
A transgender or gender-diverse identity is not a mental disorder but may cause distress potentially leading to psychiatric disorders due to stigma, discrimination, and/or gender dysphoria. Provide educational resources as needed. [1][3][4]