Simply Psychology Logo


What Is Gender Dysphoria?

By Olivia Guy-Evans, published March 22, 2022

by Saul Mcleod, PhD


Definition

Gender dysphoria refers to the feelings of distress and discomfort that a person experiences when their assigned gender does not match their gender identity.

Those with gender dysphoria may feel uncomfortable and/or distressed over the conflict between their physical sexual characteristics and how they feel and think about themselves.

For instance, an individual may feel distressed over their physically female characteristics if their gender identity is male.

This contrasts with cisgender individuals – those whose gender identity aligns in a traditional sense with the gender or sex assigned to them at birth.

Gender dysphoria often begins in childhood and may be identifiable as children expressing a wish to be of the opposite gender or wanting to express themselves in a gender non-conforming way.

Although gender dysphoria usually begins early in life, some may not experience this dysphoria until after puberty or much later. 

Many people experiencing gender dysphoria may identify as transgender, which is an umbrella term describing individuals whose gender identity or gender expression differs from the sex or gender they were assigned at birth.

Some of those who are transgender do not consider themselves as matching a binary gender category of strictly male or female. Terms such as gender non-conforming and gender fluid are increasingly being used for those who are non-binary.

It is worth noting that not all people who are transgender experience gender dysphoria. Gender identity and expression is different from sexual orientation (the type of people one is sexually attracted to) which is just as diverse for those who are transgender and gender non-conforming, as it is for cisgender individuals. 

Those with gender dysphoria may also experience distress over traditional gender norms. Gender norms can be psychosocial factors such as verbal labelling (e.g., using terms ‘boy’ or ‘girl’), non-verbal gender-cuing (e.g., gender-specific clothing and hairstyles), and gender role expectations (e.g., getting pregnant).

‘Masculine’ and ‘feminine’ gender norms are culturally defined and vary across time and different cultures. Although these gender norms may be imposed on people from a young age, it has been found that these factors are not determinative for those with gender dysphoria.

For instance, if a child has been encouraged to play with traditionally ‘boys’ toys throughout childhood, they may still experience a desire to identify as female. 

It has been found in many studies that there are brain similarities between those who experience gender dysphoria and the gender which they identify with (Byne et al., 2018; Ristori et al., 2020).

Likewise, in foetal development, as sexual differentiation of the genitals takes place in the first two months of pregnancy, and sexual differentiation of the brain begins in the second half of pregnancy, it has been suggested that these two processes can be influenced independently.

This implies that this is likely to result in gender dysphoria and that these feelings stem from a biological cause (Swaab & Garcia-Falgueras, 2009). 

Symptoms and diagnosis

Below are some of the signs that may indicate that someone is experiencing gender dysphoria:

  • They may have a strong dislike of their sex characteristics and wish to have the sex characteristics of another gender.

  • They may have the desire to be treated as another gender.

  • They may have a preference for clothing or hairstyles of another gender. 

  • They may reject toys or activities which are stereotypical of their assigned gender.

  • They may express discomfort or distress of being treated as their assigned gender. 

  • They may reject gender norms and stereotypes.

  • They may have the desire to be addressed by pronouns which are not traditional of their assigned gender. 

  • They may wish to be addressed by a new name that is not traditional of their assigned gender. 

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnoses gender dysphoria under two classifications: one for children, and one for adolescents and adults. 

For adolescents and adults, the DSM-IV criteria defines gender dysphoria as a marked incongruence between one’s experienced/expressed gender and their assigned gender, lasting for at least 6 months and as manifested by at least two of the following:

  • A significant incongruence between one’s experienced/expressed gender and their primary and/or secondary sex characteristics. 

  • A strong desire to remove one’s primary and/or secondary sex characteristics.

  • A strong desire for the primary and/or secondary sex characteristics of the opposite gender.

  • A strong desire to be of a different gender.

  • A strong desire to be treated as another gender.

  • A strong belief that they have the behaviours, feelings, and reactions that are characteristic of their preferred gender.

In order to meet these criteria, the condition must also be associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning. 

The DSM-IV defines gender dysphoria in children as a marked incongruence between one’s experienced/expressed gender and assigned gender, which must have also lasted for at least 6 months and is manifested by at least 6 of the following:

  • A strong desire to be of another gender or insistence that they are of another gender.

  • A strong preference for clothing that is typically associated with the opposite gender.

  • A strong preference for cross-gender roles in make-believe play or fantasy play. 

  • A strong preference for toys, games, or activities that are stereotypically used by another gender.

  • A strong preference for playmates of another gender. 

  • A strong rejection or avoidance of toys, games, or activities which are stereotypical of their assigned gender.

  • A strong dislike of one’s sexual characteristics.

  • A strong desire for the physical sex characteristics that matches their experienced gender.

As with the diagnostic criteria for adolescents and adults, the condition must also be associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning. 

Challenges

Individuals throughout history would have been considered as transgender today.

There are also cultures around the world which recognise more than two genders, therefore people who do not identify as a different gender to their assigned gender have always existed throughout time and places.

However, there is often still a stigma attached to those individuals, especially in western cultures. 

Those with gender dysphoria who choose to pursue medical treatments such as hormone therapy or breast removal may face some challenges.

Depending on the country they live in, they may have difficulty accessing appropriate healthcare or insurance to cover their medical costs. There may also be a long waiting list, or they may not be able to afford the treatment in general. 

19th and 20th century take on gender variance and views of appropriate treatment were pathologizing and highly stigmatising to trans people.

Whilst mainstream psychiatry is more affirming of gender variance today, trans people may still experience health professionals who still adhere to outdated and stigmatising theories and approaches to treatment. 

As there still exists a stigma associated with trans people, or anyone experiencing gender dysphoria, this can provide many challenges for these individuals. There is often an increased risk of bullying, violence, and discrimination.

People with gender dysphoria may be faced with offensive comments and language from those who have outdated views, which could be damaging to the mental health of these individuals.

Those who are of school age may refuse to attend school for fear of bullying from other students or being discriminated by teachers, whereas adults may not attend their job for fear of comments from co-workers. 

Some people who experience gender dysphoria may also lack the social support from their family or peers. Some may be too afraid to discuss their discomfort with members of their household for fear of losing those relationships.

Family members or friends may not accept the individual or be reluctant to believe that gender dysphoria is real. Some individuals, especially those who are younger, may find themselves stuck in a household where they do not feel accepted or that they cannot be their real self. 

Due to all the challenges that may be experienced, it is not uncommon for those with gender dysphoria to have accompanying mental health issues such as anxiety disorders, depression, or substance misuse disorders.

They may also have a negative self-image and feel uncomfortable about their appearance if what they see about themselves does not match their gender identity.

There is also a higher risk of suicide and self-harm for those who experience gender dysphoria. One study found that 48.3% of these individuals had experienced suicidal thoughts, and 23.8% had attempted suicide at least once (Garcia-Vega et al., 2018). 

Treatment

Treatment for those with gender dysphoria focuses on helping the individual explore their gender identity and find a gender role that is comfortable for them and eases distress.

Treatment needs to be individualised as what may help one person may not help another. Some people may choose to change their gender expression, such as wearing clothing they feel best represents their gender, changing their hairstyle, or changing their name.

However, some people may choose to have medical procedures, hormone therapy or behavioural therapy as their choice of treatment. 

Medical treatment

Medical treatments of gender dysphoria can include hormone therapy. This involves taking either masculinising or feminising hormones (testosterone or oestrogen) which can work to minimise secondary sex characteristics such as breasts or facial hair. Hormone treatment can help to lessen the feelings of gender dysphoria but can also come with some side effects.

There may be changes in libido, such as this increasing for those taking masculinising hormones, and reducing with feminising hormones.

In rarer cases, these hormones can bring about manic and hypomanic symptoms, as well as psychotic symptoms if there is an underlying psychiatric condition. 

Another medical treatment is surgery. This can include feminising or masculinising surgery to change the breasts, genitalia, facial features, and body contouring.

There are treatments available that could enable individuals to fully transition to another gender if they so wished. Not everyone who experiences gender dysphoria will want to completely transition to another gender, some may want to only change secondary sex characteristics and not change their genitalia. 

Depending on the healthcare in each country will determine the procedure of opting for surgery. Usually, an in-depth discussion with health professionals is required to determine whether gender dysphoria is present.

Physical and mental health examinations may take place, including a look into personal and family medical history and whether the individual is likely to manage surgical procedures.

The health professionals may want to see evidence that gender dysphoria is persistent and well-documented, and that the individual has the capacity to make fully informed decisions and consents to treatment. 

Behavioural therapy

The aim of behavioural therapy is not intended to alter the individual’s gender identity but to improve their psychological well-being and quality of life.

Behavioural therapy can be used alongside other types of treatment, or it can be used on its own if the individual does not want to undertake any medical treatments.

This therapy can include individual, couple, family, and group counselling and is tailored depending on the needs of the individual. This therapy may help individuals to:

  • Explore their gender identity

  • Build a support network

  • Become comfortable expressing their gender identity

  • Learn to accept themselves

  • Tackle any psychological or emotional impacts of gender dysphoria

  • Make informed decisions about any medical treatments they may wish to have

  • Find a safe way to come out to their family, friends, colleagues, or other contacts

As well as helping individuals with their gender dysphoria, behavioural therapy can also help to treat some of the mental health conditions which individuals may have alongside their dysphoria such as anxiety and depression. 

Improving the well-being of those with gender dysphoria

There are many ways that someone with gender dysphoria may improve their well-being alongside, or without treatment. Again, these can be dependent on the person as they may be suitable for one person but not another. 

Some people with gender dysphoria may wish to change their name to one that matches their gender identity. This can be completed legally with parental permission or when they reach an age where they can do this themselves.

They may not want to change their name legally but will ask others to refer to them by a new name they have chosen anyway. Some people with gender dysphoria may also choose to adopt a new pronoun.

These can be varied from switching to she/her, he/him, or some people may prefer gender-neutral pronouns such as they/them. As a family member, friend, co-worker or other contact, using the chosen name and pronouns of an individual can help them feel validated and supported. 

As close contacts of someone with gender dysphoria, it may really benefit the well-being of the individual to discuss with them how they are feeling and what they may or may not wish to change in their lives to ease their dysphoria.

This discussion could include asking questions as to the correct way to address the individual and what, if any treatments they may wish to undergo.

Having a supportive network around the individual could improve their well-being so as they do not feel isolated. Individuals with gender dysphoria may wish to join support groups specifically for gender dysphoria, transgender, or non-binary individuals.

This can be a good way to meet similar individuals who can give each other advice, make new friends, or listen to any issues they may be facing. 

Below is a list of some other steps people with gender dysphoria can take to ease their dysphoria and promote their well-being:

  • Voice and communication training to match the vocals of their gender

  • Breast binding or padding

  • Hair removal or transplantation 

  • Genital tucking or packing

  • Changing aesthetics such as applying makeup or changing clothing to match their gender identity

Fact Checking
Simply Psychology content is rigorously reviewed by a team of qualified and experienced fact checkers. Fact checkers review articles for factual accuracy, relevance, and timeliness. We rely on the most current and reputable sources, which are cited in the text and listed at the bottom of each article. Content is fact checked after it has been edited and before publication.

About the Author

Olivia Guy-Evans obtained her undergraduate degree in Educational Psychology at Edge Hill University in 2015. She then received her master’s degree in Psychology of Education from the University of Bristol in 2019. Olivia has been working as a support worker for adults with learning disabilities in Bristol for the last four years.

How to reference this article:

Guy-Evans, O. (2022, March 22. What Is Gender Dysphoria?. Simply Psychology. www.simplypsychology.org/gender-dysphoria.html

APA Style References

American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70(9), 832-864.

Bernard Fournier, A. (2021, August 2). What does Gender Nonconforming Mean? Very Well Mind. https://www.verywellmind.com/gender-nonconforming-definition-4582878

Boskey, E. (2020, December 12). What Is Gender Non-Conforming? Very Well Health. https://www.verywellhealth.com/gender-non-conforming-5087006

Craig, S. L., Austin, A., Levenson, J., Leung, V. W., Eaton, A. D., & D’Souza, S. A. (2020). Frequencies and patterns of adverse childhood events in LGBTQ+ youth. Child abuse & neglect, 107, 104623.

Ferguson, S. (2021, January 13). What Does It Mean to Be Gender Nonconforming? Healthline. https://www.healthline.com/health/gender-nonconforming

Jacobson, R., Cohen, H., & Diamond, G. M. (2016). Gender atypicality and anxiety response to social interaction stress in homosexual and heterosexual men. Archives of sexual behavior, 45(3), 713-723.

MacMullin, L. N., Bokeloh, L. M., Nabbijohn, A. N., Santarossa, A., van der Miesen, A. I., Peragine, D. E., & VanderLaan, D. P. (2021). Examining the Relation Between Gender Nonconformity and Psychological Well-Being in Children: The Roles of Peers and Parents. Archives of Sexual Behavior, 50(3), 823-841.

PBS. (2015, August 11). A Map of Gender-Diverse Cultures. https://www.pbs.org/independentlens/content/two-spirits_map-html/ 

Roberts, A. L., Rosario, M., Corliss, H. L., Koenen, K. C., & Austin, S. B. (2012). Childhood gender nonconformity: A risk indicator for childhood abuse and posttraumatic stress in youth. Pediatrics, 129(3), 410-417. 

Spivey, L. A., & Prinstein, M. J. (2019). A preliminary examination of the association between adolescent gender nonconformity and suicidal thoughts and behaviors. Journal of abnormal child psychology, 47(4), 707-716.

Toomey, R. B., Ryan, C., Diaz, R. M., Card, N. A., & Russell, S. T. (2013). Gender-nonconforming lesbian, gay, bisexual, and transgender youth: school victimization and young adult psychosocial adjustment.

Warnes, O. (2019, December 3). Not just a trend: A brief history of gender non-conforming. Her Campus. https://www.hercampus.com/school/exeter/not-just-trend-brief-history-gender-non-conforming/

Home | About Us | Privacy Policy | Advertise | Contact Us

Simply Psychology's content is for informational and educational purposes only. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

© Simply Scholar Ltd - All rights reserved