Gender Dysphoria: Symptoms, Causes, Diagnosis, Treatment and Management

Gender dysphoria is the psychological distress experienced when an individual’s gender identity does not align with the sex assigned at birth. This condition affects anyone, particularly transgender individuals, who feel discomfort due to the mismatch between their internal gender identity and their physical characteristics or societal expectations associated with their assigned gender.

The main symptoms of gender dysphoria include a profound sense of unease or dissatisfaction with one’s sex assigned at birth, leading to significant emotional distress. Individuals experience a strong desire to be rid of their primary and secondary sex characteristics, a longing to possess attributes of another gender, or a desire to be treated as a different gender. This distress manifests in various ways, including anxiety, depression, and difficulties in social, occupational, or educational settings. 

Symptoms of this condition begin in childhood and persist into adolescence and adulthood, with some individuals experiencing fluctuating feelings of dysphoria over time. While the exact causes of gender dysphoria are not fully understood, several factors contribute to its development, according to Garg G, Elshimy G, and Marwaha R’s 2024 “Gender Dysphoria” StatPearls.These include biological influences, such as genetic or neurobiological factors, and environmental factors, such as societal norms and cultural rigidity surrounding gender identity. 

The experience of gender dysphoria is often worsened by the stigma and discrimination faced by transgender individuals, which can lead to feelings of isolation and mental anguish. Diagnosis of gender dysphoria typically involves a comprehensive assessment by a healthcare professional, often guided by criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 

For adolescents and adults, a diagnosis requires a marked incongruence between experienced gender and assigned gender lasting at least six months, along with the presence of specific symptoms that cause clinically significant distress or impairment in functioning. In children, the diagnosis is based on observable behaviors and expressed feelings regarding gender identity.

Treatment for gender dysphoria is centered on gender-affirming care, which aims to alleviate the distress associated with the condition. This can include psychological support, such as therapy to explore feelings about gender identity and expression, as well as medical interventions. 

Medical treatments involve hormone therapy to develop secondary sex characteristics that align with the individual’s gender identity, and surgical options may be pursued for those seeking permanent changes. Access to gender-affirming care is crucial, as it improves the quality of life for individuals experiencing gender dysphoria, helping them achieve a sense of alignment between their gender identity and physical appearance.

What is Gender Dysphoria?

Gender dysphoria is a clinically significant distress or impairment related to a strong desire to be of another gender, which includes a willingness to change primary and secondary sex characteristics, as reviewed by Cooper, K., Russell, A., Mandy, W., & Butler, C. (2020). The phenomenology of gender dysphoria in adults: on Clinical Psychology Journal.

The prevalence of gender dysphoria ranges from 0.6% to 2.7% of the population, depending on the specific cohort studied, according to a Hormones Research in Pediatrics study titled “Gender Dysphoria in Young People: A Model of Chronic Stress ” by  Avril Mason (2023). According to this research, there has been a significant increase in young people seeking treatment for gender dysphoria over the past decade, with one study noting an “exponential” rise in referrals. 

Gender dysphoria involves a difference between one’s experienced/expressed gender and assigned gender and significant distress or problems functioning, according to the American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. It is characterized by persistent discomfort with one’s biological sex or assigned gender, often leading to significant emotional and psychological distress. While gender dysphoria is listed in the DSM-5, it is not classified as a mental illness. Instead, the psychological distress component is the issue requiring treatment, not the gender identity itself. 

Recent trends show a shift towards more birth-assigned females presenting with gender dysphoria, many of whom are post-pubertal and have higher rates of co-occurring mental health issues like anxiety and depression, as seen in Morandini, J. S. & Dar-Nimrod’s 2023 report on  Archives of Sexual Behavior Journal. Gender dysphoria begins at various ages but often emerges or intensifies during puberty when secondary sex characteristics develop. While it affects individuals of any gender, there’s an increase in cases among birth-assigned females. 

According to Morandini’s report, the onset and prevalence vary widely, with some individuals experiencing gender dysphoria from a very young age. In contrast, others do not recognize or express these feelings until adolescence or adulthood. 

 Individuals with gender dysphoria turn to substances like alcohol, marijuana, and stimulants to alleviate their emotional pain and social anxiety. These substances provide temporary relief but often lead to dependency and exacerbate mental health issues.

What are the Symptoms of Gender Dysphoria?

The most common symptoms of gender dysphoria are experiencing gender-physical mismatch, desiring to remove physical traits, wanting traits of another gender, longing to be another gender, and believing in another gender’s feelings, according to the American Psychiatry Association article titled, “What are the Symptoms of Gender Dysphoria?”.

These symptoms occur in different ways and vary from person to person, but they usually involve a deep feeling of discomfort or distress with one’s assigned gender at birth. 

The symptoms of gender dysphoria are listed below.

• Experiencing Gender-Physical Mismatch: This is whereby individuals often feel a profound incongruence between their internal sense of gender and their physical body, leading to emotional and psychological distress.
• Desiring to Remove Physical Traits: There is a strong desire to eliminate or alter physical characteristics associated with their assigned sex, such as breasts or facial hair, to align more closely with their identified gender.
• Wanting Traits of Another Gender: Many individuals yearn to possess the physical traits and secondary sexual characteristics of the gender they identify with, such as a deeper voice or a more feminine physique.
• Longing to Be Another Gender: This is a persistent and intense desire to live and be accepted as a member of the gender opposite to their assigned sex, which is a hallmark symptom, often driving significant life changes.
• Believing in Another Gender’s Feelings: This is a state where individuals strongly believe they have the typical feelings and reactions of the gender they identify with, which can further exacerbate feelings of dysphoria when their external appearance does not match their internal experience.

These symptoms interfere with daily life, relationships, and overall well-being. While they can be overwhelming, seeking support and treatment can help individuals manage their symptoms and live happier, more fulfilling lives. 

What are the complications of gender dysphoria?

The complications of Gender Dysphoria are depression, anxiety, low self-esteem, social isolation, substance abuse, and suicidal ideation compared to the general population, as suggested by  Dr. Jack Turban’s article in the American Psychiatry Association “What is Gender Dysphoria?” (August 2022). These complications impair daily functioning at school, work, and in social situations. Relationship difficulties are common, and gender dysphoria is associated with higher rates of mental health disorders.

Moreover, individuals with gender dysphoria also face challenges in accessing healthcare, as many medical professionals lack knowledge and understanding of this condition. This leads to delays in receiving appropriate treatment or even discrimination from healthcare providers.

Additionally, social stigma and discrimination towards those who identify as transgender or non-binary also contribute to the development of mental health issues for individuals with gender dysphoria. They experience rejection from family, friends, and society in general, which can significantly impact their well-being and quality of life.

What are the causes of the gender dysphoria?

Gender dysphoria is caused by a combination of biological, psychological, and environmental factors, as reviewed in “Gender Dysphoria” by Garima Garg (July 11, 2023).

Biological factors contribute to the development of gender dysphoria, with hormonal imbalances playing a crucial role. Gaspari L, Soyer-Gobillard of the University Montpellier in the French National Diethylstilbestrol Journal 2023, suggests that prenatal exposure to certain hormones affects the brain’s development and the formation of reproductive organs, leading to incongruence between an individual’s gender identity and their assigned sex at birth.

Psychological factors also play a significant role in the emergence of gender dysphoria. Feil K, Riedl D of the Medical University of Innsbruck in the Journal of Clinical Medicine suggests that early childhood experiences, especially those involving trauma or rejection, lead to discomfort with one’s assigned gender, fostering a desire for transition. Individuals with gender dysphoria feel different from their peers from a young age, struggling to conform to traditional gender roles and expectations. This sense of nonconformity is distressing and contributes to the development of gender dysphoria. 

Environmental factors, including social stigma and discrimination, significantly impact individuals experiencing gender dysphoria. Transgender individuals often face societal rejection, violence, and prejudice, which can be traumatic and contribute to their dysphoric feelings. 

Also, differences in brain anatomy and function may contribute to the experience of gender identity incongruence. For instance, Feil K, Riedl D of the Medical University of Innsbruck in the Journal of Clinical Medicine suggests that transgender women often exhibit brain structures that align more closely with their identified gender rather than their sex assigned at birth. This includes variations in total brain volume and specific regions, such as the amygdala and hippocampus, where differences in receptor density for sex hormones have been observed.

Are there severe or dangerous effects of gender dysphoria?

Yes, gender dysphoria has severe and dangerous effects on individuals. It is characterized by significant distress and discomfort when a person’s gender identity does not align with their assigned sex at birth, according to Garg G & Elshimy G’s 2024 review “Gender Dysphoria”In StatPearls Journal. This condition can lead to various mental health issues, including anxiety, depression, and suicidal thoughts or behaviors. 

The emotional pain associated with gender dysphoria can severely affect daily functioning, leading to difficulties in school, work, and personal relationships, and may result in school dropout or unemployment.

The distress caused by gender dysphoria can also lead to self-harm and substance misuse, as individuals may struggle to cope with their feelings and societal pressures. The stigma and discrimination faced by transgender and gender-diverse individuals further exacerbate these mental health challenges, contributing to a higher risk of suicide among those who do not receive appropriate support and gender-affirming care.

How to diagnose gender dysphoria based on gender?

To diagnose gender dysphoria, healthcare providers follow specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), according to Nokoff NJ, 2022 review “Medical Interventions for Transgender Youth” in Endotext Journal. The diagnosis is based on the presence of significant distress or impairment related to a marked incongruence between an individual’s experienced or expressed gender and their assigned gender at birth.

• Initial Evaluation: A trained mental health professional conducts an initial assessment, which includes discussing the individual’s gender identity, feelings, and experiences related to their gender.
• Duration of Symptoms: The DSM-5 specifies that individuals must experience a marked incongruence between their experienced/expressed gender and assigned gender for at least six months.
• Criteria Assessment: The clinician evaluates the presence of specific criteria. For adolescents and adults, there must be incongruence between experienced gender and primary/secondary sex characteristics.
• Consideration of Other Factors: The clinician must rule out other psychiatric conditions that may explain the distress or incongruence, ensuring that the diagnosis of gender dysphoria is appropriate.
• Support and Treatment Options: Following diagnosis, the clinician discusses potential treatment options, including social affirmation, medical interventions, or therapeutic support to address any co-occurring mental health issues.

The diagnostic process for gender dysphoria is an essential step in understanding and addressing the needs of individuals who experience incongruence between their experienced gender and assigned gender at birth.

Does a gender dysphoria test exist?

Yes, a gender dysphoria test exists, but these tests are not diagnostic tools. They are self-assessments designed to help individuals reflect on their experiences and feelings related to gender identity, according to The Very Well Health article titled “How Gender Dysphoria Is Diagnosed”  by James Myhre & Dennis Sifris, MD (October 2023). 

For instance, various online quizzes provide insights into whether someone is experiencing symptoms of gender dysphoria, but they should not replace a professional evaluation by a licensed mental health provider.

The assessment for gender dysphoria in children involves a comprehensive evaluation by a qualified mental health professional. The process includes initial assessment, history taking, and diagnostic criteria where the feelings of gender incongruence must persist for at least six months and cause significant distress or impairment in functioning.

These procedures emphasize the importance of professional evaluation in diagnosing gender dysphoria, ensuring that individuals receive appropriate support and treatment.

What is the treatment of gender dysphoria?

The treatment of gender dysphoria includes psychosocial support, hormone therapy, and, in some cases, gender-affirming surgeries, according to the NHS article “Gender dysphoria”  (May 2020).

1. Psychosocial support: This involves counseling, therapy, and support groups to help individuals explore their gender identity, cope with distress, and address any co-existing mental health concerns. Therapy aims to improve psychological well-being, quality of life, and self-fulfillment without altering one’s gender identity.
2. Hormone therapy: For adolescents and adults, hormone treatment helps align physical characteristics with gender identity. This involves feminine hormones (e.g., estrogen) and masculinizing hormones (e.g., testosterone).
3. Gender-affirming surgeries: Some individuals opt for surgical procedures to further align their physical appearance with their gender identity. These include breast augmentation or chest masculinization, genital reconstruction procedures, and facial feminization or masculinization procedures.
4. Social transition: This non-medical approach involves adopting gender expression that aligns with one’s identity, such as changing names, pronouns, clothing, and hairstyles.
5. Legal affirmation: Changing name and gender markers on official documents.
6. Voice and communication therapy: To help develop vocal characteristics matching the experienced or expressed gender.

The treatment of gender dysphoria is individualized and involves a combination of these approaches. The goal is to help individuals feel comfortable with their gender identity and expression, reducing distress and improving overall well-being. 

What is the difference between dysphoria and dysmorphia?

The difference between dysphoria and dysmorphia is that dysphoria involves significant distress due to a mismatch between one’s gender identity and the sex assigned at birth. Dysmorphia involves an obsessive focus on perceived flaws in one’s physical appearance, which may be minor or nonexistent to others, according to the Medical News Today Article “What to know about body dysmorphia vs. body dysphoria” by  Sarah Vevers (Feb 2024).

Gender dysphoria is the psychological distress experienced when an individual’s gender identity does not align with the sex assigned at birth. This condition is characterized by a strong desire to get rid of one’s primary or secondary sex characteristics. One also experiences a strong desire to have the physical sex characteristics of another gender.

Symptoms of gender dysphoria include discomfort with one’s body, a strong desire to change physical sex characteristics, and significant distress in social, occupational, or other important areas of functioning. It is important to note that gender dysphoria itself is not classified as a mental illness but rather a condition that can cause significant mental health challenges, such as anxiety and depression.

Body dysmorphic disorder is a mental health condition where an individual is excessively concerned with perceived defects or flaws in their physical appearance. These perceived flaws are often not noticeable to others. Key characteristics include preoccupation with one or more perceived defects or deficiencies in physical appearance. There are also repetitive behaviors such as mirror checking, excessive grooming, or skin picking.

People with BDD avoid social situations, seek frequent reassurance about their appearance, and may even pursue multiple cosmetic procedures without satisfaction. Unlike gender dysphoria, BDD is specifically related to body image and does not involve issues of gender identity.

While both conditions involve dissatisfaction with one’s body, they differ fundamentally in their focus. Gender dysphoria is centered on the incongruence between gender identity and assigned sex. Body dysmorphic disorder is focused on perceived physical defects and body image issues.

An individual can experience both conditions simultaneously. For example, a person with gender dysphoria might also develop body dysmorphia related to specific physical features that they associate with their assigned sex.

Understanding these distinctions is crucial for appropriate diagnosis and treatment, which include therapies such as cognitive-behavioral therapy (CBT) and, in some cases, medical interventions for gender dysphoria.

What signs indicate dysphoria in males versus females?

The signs of dysphoria in males assigned at birth include a strong desire to get rid of male physical characteristics like facial hair or genitals and a wish to have the physical characteristics of females instead, according to the American Psychiatry Association post “What is Gender Dysphoria?” by Jack Turban by August 2022. 

They feel uncomfortable with typical male gender roles and expressions, preferring to dress and behave in ways traditionally associated with women.

The signs of dysphoria in males assigned at birth are listed below.

• Desire for Physical Change: A strong desire to eliminate male physical characteristics, such as facial hair or genitals, and to possess female physical traits.
• Discomfort with Male Identity: A marked incongruence between their experienced gender and their assigned male gender, often leading to significant distress.
• Rejection of Masculine Norms: A tendency to reject typically masculine toys, games, and activities, often favoring those associated with femininity.
• Social Isolation: Feelings of loneliness or isolation from peers, often exacerbated by societal pressures or bullying related to their gender identity.
• Emotional Distress: This can include anxiety, depression, and suicidal thoughts, particularly if they feel unable to express their gender identity or if they lack support

The signs of dysphoria in females assigned at birth are listed below.

• Desire for Physical Change: Similar to males, females may express a strong desire to rid themselves of female physical characteristics and to have male physical traits.
• Discomfort with Female Identity: A marked incongruence between their experienced gender and their assigned female gender, leading to significant distress.
• Rejection of Feminine Norms: A strong preference for activities, clothing, and behaviors typically associated with males, and a rejection of those associated with femininity.
• Social Isolation: Feelings of loneliness or pressure to conform to societal expectations of femininity, which can lead to bullying or harassment.
• Emotional Distress: This may include feelings of anxiety, depression, and thoughts of self-harm, particularly if they feel unsupported in their gender identity

Both males and females experience dysphoria through a combination of physical, emotional, and social signs. The key indicators include a strong desire to change physical characteristics, discomfort with their assigned gender, and significant emotional distress.

What signs indicate dysmorphia in males versus females?

The signs indicating dysmorphia in males versus females include distinct areas of preoccupation related to body image. Specifically, men were more likely than women to be preoccupied with their genitals, thinning hair, and body build, while women were more likely to be concerned with their skin, stomach, weight, breasts, buttocks, and legs.

Both genders experience similar symptoms of BDD, which are listed below.

• Intense preoccupation with perceived flaws in appearance that are often unnoticeable to others.
• Repetitive behaviors include mirror checking, excessive grooming, or seeking reassurance about their looks.
• Avoidance of social situations due to embarrassment about their appearance.
• Comparing appearance with others frequently.

The common concerns in males are listed below.

• Genital size and appearance: Many men experience anxiety regarding their penis size and appearance, often influenced by societal standards and personal perceptions, leading to feelings of inadequacy despite most sizes being within the normal range.
• Thinning hair or baldness: Hair loss is a prevalent concern for men, often associated with aging or genetic factors. It can impact self-esteem and body image, as men may feel less attractive or youthful.
• Muscle size and body build: Muscle dysmorphia is a psychological condition where individuals, particularly men, obsess over their perceived lack of muscularity, leading to excessive exercise and dietary restrictions despite often having a well-built physique

The common concerns in females are listed below.

• Skin imperfections: These include conditions like acne, blemishes, and scars that can affect the appearance and texture of the skin, often leading to emotional distress and a desire for corrective treatments.
• Body weight and shape: This refers to concerns regarding body fat and the overall silhouette, particularly in areas like the stomach and legs, which can impact self-esteem and body image.
• Breast size and overall body proportions: This encompasses worries about breast size relative to the rest of the body, which influences perceptions of femininity and attractiveness and can lead to considerations for cosmetic procedures.

Understanding these differences helps in recognizing the unique ways dysmorphia manifests in different genders, which is crucial for effective treatment and support.

Do transgender women have periods?

No, transgender women do not have periods in the biological sense, as seen in  Lowik AJ’s  2021 review  “Just because I don’t bleed, doesn’t mean I don’t go through it”: Expanding knowledge on trans and non-binary menstruators. in Transgender Health Journal.  Menstruation involves the shedding of the uterine lining, a process that requires the presence of a uterus and ovaries, which transgender women do not have. 

However, transgender women who undergo hormone replacement therapy (HRT) experience symptoms similar to those of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) due to the hormonal fluctuations induced by the therapy.

How can you prevent gender dysphoria?

To prevent or mitigate gender dysphoria, creating a supportive environment and engaging in affirmative practices are essential, according to Francis Kuehnle, a registered nurse, in his review on Healthline 2023.  Strategies include expressing feelings through art or journaling, seeking support from understanding friends or communities, and using items that help affirm one’s gender identity, such as clothing or accessories.