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

By Claire Gillespie
February 27, 2020

If you've been hearing the term gender dysphoria lately and wonder if it describes you, you're probably not alone. What does this term mean, exactly? If you feel strongly that the sex you were assigned at birth doesn’t match the gender you identify with, then you may have gender dysphoria. 

“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, clinical director of psychotherapy at MindPath Care Centers at Carolina Partners in Mental Health Care, PLLC, tells Health. [Published by the American Psychiatric Association, the DSM-5 is considered the "bible" for diagnosing mental illness.]

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Gender dysphoria can start at a young age—as early as three years old, Newton says, 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. Also, gender dysphoria can manifest in different types of behavior. Some people may cross-dress, some may want to socially transition (in other words, transition to the affirmed gender’s pronouns and bathroom), while others may choose to medically transition via hormone therapy and/or sex-change surgery. 

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Does gender dysphoria have symptoms?

There are no universally agreed-upon signs of gender dysphoria, because so much of how people experience their gender is informed by external forces such as culture, religion, and ethnicity. 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 are able to cope with everyday life. 

“The struggles may include feelings of discomfort in their own skin or fantasizing about being another gender,” Guarino tells 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.” 

Additionally, social skills, the ability to form and sustain relationships, mental health, emotions, and academic or work performance are often seriously affected. 

Why is it so controversial?

In 2013, the term gender dysphoria replaced “gender identity disorder” in the DSM-5. The new term was intended to be more descriptive, focusing on discomfort as the issue rather than identity, and to help people access more effective treatment for that discomfort. 

However, the listing remains controversial, says Newton. “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,” she says. “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,” says Newton. “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 identity as gay or lesbian before they identify as transgender, but not always.”

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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. Nor is it the same as gender nonconformity, which the American Psychiatric Association (APA) refers to as “behaviors not matching the gender norms or stereotypes of the gender assigned at birth,” such as girls behaving and dressing in ways more socially expected of boys, or adult men who occasionally cross-dress. 

Can gender dysphoria be treated?

Because the gender conflict affects people in so many different ways, treatment options also vary. There include counseling, cross-sex hormones, puberty suppression, and gender reassignment surgery, according to the APA. It’s possible to have a strong desire to be of a different gender than the one the corresponds with your biological sex—and to be treated as such—without seeking medical treatment or making physical changes. But others may want hormone treatment and gender reassignment surgery to achieve a full transition to the opposite sex. 

Public awareness and understanding of gender dysphoria is 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 warns. 

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Where can I go for support or counseling?

If you think you might have gender dysphoria, help is out there. Newton suggests 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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