What is gender dysphoria?
Gender dysphoria occurs when there is a conflict between the sex you were assigned at birth and the gender with which you identify. This can create significant distress and can make you feel uncomfortable in your body.
People with gender dysphoria may want to change the way that they express their gender. This may mean changing the way they dress, transitioning socially (using the pronouns and public bathroom associated with their affirmed gender), transitioning medically or surgically, or some combination of these.
Gender dysphoria symptoms
People with gender dysphoria feel that the sex they were assigned at birth does not match the gender with which they identify. For example, someone who was born with the reproductive organs and other physical traits of a male may identify as female. The word "dysphoria" means significant uneasiness and dissatisfaction, and gender dysphoria can start to present as early as childhood in some people. Other symptoms include:
- negative self-image
- strong dislike of your sexual anatomy
- strong preference for the toys and activities associated with the other gender (in children)
The distress related to this condition has been associated with an increased risk of substance abuse, self-harming behaviors, and suicide attempts. This is mostly because of the increased risk of discrimination for individuals who are transgender or gender non-conforming.
Gender dysphoria was sometimes previously called "gender identity disorder" and "transsexualism," but these terms are outdated and may be considered offensive. Gender dysphoria is not the same as homosexuality, which refers to sexual orientation rather than gender identification. It is also different from gender non-conformity, which refers to engaging in behaviors that don't conform to gender norms or stereotypes, such as cross-dressing.
Gender dysphoria causes
We still don't know exactly what causes gender dysphoria, although some experts believe that hormonal influences in the womb may be involved.
How we care for gender dysphoria
Our skilled team includes specialists in plastic surgery, urology, endocrinology, nursing, gender management, and social work, who collaborate to provide a full suite of treatment options for transgender teens and young adults. By partnering with the hospital's nationally recognized GeMS Program, we help youths with gender identity concerns transfer seamlessly to surgical care, if and when they are ready. We also work with transgender teens and young adults who are medically managed outside of Boston Children’s.
Gender Dysphoria | Diagnosis & Treatment
How is gender dysphoria diagnosed?
You must meet certain criteria to be diagnosed with gender dysphoria, and these criteria differ based on your age.
To be diagnosed with gender dysphoria as a teenager or adult, you must have experienced significant distress for at least six months due to at least two of the following:
- marked incongruence between your experienced and expressed gender and your primary or secondary sex characteristics
- strong desire to be rid of your primary or secondary sex characteristics
- strong desire for the primary or secondary sex characteristics of the other gender
- strong desire to be of the other gender
- strong desire to be treated as the other gender
- strong conviction that you have the typical feelings and reactions of the other gender
Children are typically diagnosed with gender dysphoria if they have experienced significant distress for at least six months and at least six of the following:
- strong desire to be of the other gender or an insistence that they are the other gender
- strong preference for wearing clothes typical of the opposite gender
- strong preference for cross-gender roles in make-believe play or fantasy play
- strong preference for the toys, games or activities stereotypically used or engaged in by the other gender
- strong preference for playmates of the other gender
- strong rejection of toys, games and activities typical of their assigned gender
- strong dislike of their sexual anatomy
- strong desire for the physical sex characteristics that match their experienced gender
Gender dysphoria of childhood is not a surgical diagnosis. It is a medical diagnosis that does not require treatment, other than possibly individual or family therapy, until a child reaches puberty. Gender dysphoria is typically diagnosed by a therapist or other mental health professional.
Gender dysphoria treatment
The goal of gender dysphoria treatment is to address the distress and other negative emotions associated with having a gender that doesn't align with your assigned sex at birth. It's important to remember that the problem isn't your gender identity, it's the discomfort associated with it. That's why treating gender dysphoria is best accomplished through a team approach with clinicians from different specialties, including psychology, social work, endocrinology, urology and surgery. Treatment options include:
Counseling. Some people who experience gender dysphoria don't wish to pursue medical or surgical transition. For example, you may want to live and be recognized as your affirmed gender without using hormones or having gender affirmation surgery. An experienced therapist can help support you during all parts of your gender identity journey.
Hormone therapy. For people who wish to develop more physical characteristics of their affirmed gender, supplemental hormones can help. In children, puberty-blocking hormones can suppress the physical changes associated with puberty until they and their parents are ready to affirm their gender. In adults and adolescents who have passed puberty, hormones can help encourage the development of gender affirming physical traits.
Surgery. Procedures such as chest reconstruction or breast augmentation ("top" surgery) and metoidioplasty, phalloplasty or vaginoplasty ("bottom" surgery) can be part of the gender affirmation process. People who choose to undergo surgery usually do so after taking other steps in their gender affirmation journey first, such as taking supplemental hormones.