Gender Dysphoria: Definition, Symptoms, and What You Can Do

All about gender dysphoria, including symptoms, treatment, and the controversy surrounding the condition.

If you are questioning your gender identity, you may be wondering what gender dysphoria means and what the symptoms are.

It's not just the feeling that the sex you were assigned at birth doesn't match the gender you identify with. That is part of being transgender, gender fluid, or nonbinary. Instead, gender dysphoria is when this mismatch causes you discomfort.

"Gender dysphoria is a set of internal experiences that are defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to highlight the psychological and physical discomfort one has with the outward appearance of their sex and the internal experience of one's gender identity," Louise Newton, MSW, co-founder of Obsidian Care Collective in North Carolina, told Health. [Published by the American Psychiatric Association (APA), the DSM-5 is considered the "bible" for diagnosing mental illness.]

gender-dysphoria Female portrait with collaged face parts
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Does Gender Dysphoria Have Symptoms?

Gender dysphoria can start at a young age—as early as three years old, Newton said, with a peak around puberty as secondary sex characteristics develop. But not everybody who fits the diagnostic criteria for gender dysphoria will have the experience so early in life.

There also are no universally agreed-upon signs of gender dysphoria. This is because so much of how people experience their gender is informed by external forces such as culture, religion, and ethnicity.

However, according to New York-based mental health counselor GinaMarie Guarino, LMHC, many people with gender dysphoria experience anxiety, depression, and stress as a result of their internal conflict with their biological sex—which can significantly affect how they cope with everyday life. This stress can seriously affect social skills, the ability to form and sustain relationships, mental health, emotions, and academic or work performance.

"The struggles may include feelings of discomfort in their own skin or fantasizing about being another gender," Guarino told Health. "A person with diagnosable dysphoria may also feel discomfort or distaste toward their sexual anatomy or biology—this is most often seen during puberty and carries through adulthood."

People with gender dysphoria can respond to this condition in different ways. Some people may want to socially transition (including transitioning to the affirmed gender's pronouns and bathroom), while others may choose to medically transition via hormone therapy and/or sex-change surgery. Others may not choose either option. Ultimately, the choice is up to you and what you feel comfortable doing.

Why Is It So Controversial?

In 2013, when releasing the DSM-5, the APA replaced the term "gender identity disorder" with gender dysphoria. The new term was intended to be more descriptive, focusing on discomfort as the issue rather than identity and therefore destigmatizing the condition. The APA hoped that this would help people access more effective treatment for this discomfort.

However, the listing remains controversial. "While many people in the transgender and gender expansive community feel affirmed by the diagnosis (and the subsequent recommended course of treatment), many others believe that having a gender identity or expression that is different from the sex you were assigned at birth should not be considered a form of mental instability," Newton said. "Both camps are correct, as people experience gender dysphoria in very different ways."

The controversy doesn't end with the DSM-5 classification. "Many transgender and gender expansive community members feel very real discomfort in how others regard them—and at times police them—for falling outside of the more expected gender expressions," Newton said. "Some people are able to perform the gender expression that matches the sex they were assigned at birth quite well but have a general internal sense of unease. In some cases, transgender and gender expansive people may identify as gay or lesbian before they identify as transgender, but not always."

Does Gender Dysphoria Mean That You're Gay?

Gender dysphoria is not the same as identifying as a different gender or sexual orientation, such as gay or bisexual. It is also different from gender nonconformity, which is when people have behaviors that do not match the gender norms or stereotypes of their sex. Some examples of gender nonconformity can include girls behaving and dressing in ways more socially expected of boys, or adult men who occasionally wear stereotypically female clothing.

Gender Dysphoria vs Gender Euphoria

In response to the continued DSM-5 classification, many transgender and nonbinary people are trying to emphasize the feeling of "gender euphoria" instead. According to a 2021 International Journal of Transgender Health article, gender euphoria is the joyful feeling from an experience that affirms your gender identity. These experiences can include physical changes, internal affirmation, or social exchanges.

Can Gender Dysphoria Be Treated?

Because gender dysphoria affects people in so many different ways, treatment options also vary. Physical changes include counseling, hormone therapy, puberty suppression, and gender reassignment surgery, according to the APA. However, it's also possible to have a strong desire to be of a different gender than the one that corresponds with your biological sex—and to be treated as such—without seeking medical treatment or making physical changes.

Public awareness and understanding of gender dysphoria are also crucial, to avoid adding significant external stress to the internal stress the person is bound to be experiencing already.

"In the case of children, it's most important for family members and teachers to resist the temptation to steer them—be it gently or harshly—as this can cause lifelong trauma-related stress," Newton said.

Where Can I Go for Support or Counseling?

If you think you might have gender dysphoria, help is out there. Newton suggested seeking out a local LGBTQ community support group and/or a psychotherapist through the World Professional Association on Transgender Health (WPATH). The free Trans Lifeline hotline can point you in the direction of resources in your community, and also provide help and support during times of crisis.

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