How to know if you're experiencing gender dysphoria — and why it's important to address your feelings in 3 ways
- Gender dysphoria is when the gender you identify as is different than the one you were assigned at birth.
- Common signs of gender dysphoria include a strong desire to be treated as another gender, or wanting to get rid of your primary or secondary sex characteristics.
- You can treat gender dysphoria and feel more comfortable with lifestyle changes like chest binding or dressing differently, as well as medical treatments like hormone therapies or reconstructive surgery.
Globally, it's estimated that gender incongruence — or gender dysphoria — occurs with one in every 30,000 male-assigned births and one in every 100,000 female-assigned births.
Gender dysphoria can have harmful mental and physical
What is gender dysphoria?
When a baby is born, their gender is often based on their primary sex characteristics. If you have a penis, your gender assigned at birth is male, and if you have a vagina, your gender assigned at birth is female.
Gender dysphoria is when the gender you identify as conflicts with the gender you were assigned at birth. If you have gender dysphoria, you might feel uncomfortable with your body, especially after puberty, when secondary sex characteristics like fat distribution, muscle mass, and body hair create more pronounced physical differences between males and females. Or, you might feel uncomfortable with the social expectations or gender roles assigned to you.
Though it is a condition defined in the DSM-5 — the manual used by mental health professionals to help define mental disorders — some health experts say that gender dysphoria shouldn't be solely viewed through the lens of mental health.
"I actually like to think of gender dysphoria sort of outside of the mental health world," says Robert Goldstein, MD, medical director of the Transgender Health Program at Massachusetts General Hospital. "I think about it as basically a disconnect between someone's internalized gender, how someone identifies themselves, and the way that someone is able to present that gender to the world."
Signs and symptoms
There are a wide variety of potential signs or symptoms for gender dysphoria. At a base level, the DSM-5 provides a helpful overview of the major feelings one might experience:
- An incongruence between one's experienced gender and their primary sex characteristics like genitalia and reproductive organs, and/or secondary sex characteristics like fat distribution, hip size, facial hair, muscle mass, vocal tone
- Wanting to get rid of one's primary and/or secondary sex characteristics, and desiring the primary and/or secondary sex characteristics of the other gender
- A strong desire to be treated as another gender
- A strong conviction that one has the typical feelings and reactions of another gender
According to the Boston Children's Hospital, to be diagnosed with gender dysphoria, teens or adults must have experienced two of the above symptoms for at least six months. Children can be diagnosed with gender dysphoria if they experience significant distress for at least six of the following signs for at least six months:
- 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
For example, young children who experience gender dysphoria might insist that they're a different gender, such as saying, 'I'm a boy, not a girl,' according to Australia's Raising Children Network, supported by the Australian Government's Department of Social Services. Young children might also ask to use a different name or pronouns, or ask questions about their gender such as, 'can I be a mommy instead of a daddy when I grow up?'
Teenagers with gender dysphoria may ask to use a different name or pronouns, as well as dressing in clothes that hide their body. Gender dysphoria can also manifest as anxiety and depression in teenagers, who may cope with self-harming tactics as a result. Eating disorders are also particularly common in teens with gender dysphoria, Goldstein says.
Is a diagnosis necessary?
If you think you have gender dysphoria, it may be helpful to see a medical professional that focuses on LGBTQ+ health. Specifically, the World Professional Association of Transgender Health (WPATH) has a provider directory list that can point you to professionals in LGBTQ+ therapy, psychiatry, and psychology.
For many people, it is useful to talk with a professional who may be able to help them feel more comfortable or seek treatment. In some cases, a diagnosis can be made, though it isn't always necessary, and it may not be what you are looking for.
"I sort of bristle at the idea of there having to be a diagnosis [of gender dysphoria]," Goldstein says. "I don't think that we should be diagnosing people as transgender or not, I think people are transgender, or they're not transgender. I don't think that we need to give them a pathologic diagnosis or a medicalized diagnosis."
In most places, you won't necessarily need a diagnosis to get prescription medication for gender-affirming hormone therapy — whether feminizing or masculinizing. To learn more, you should check with the clinics and medical professionals in your area regarding whether a diagnosis is necessary for the treatment you're seeking.
Why it's important to treat gender dysphoria
Regardless of whether you get an official diagnosis, it's important to treat gender dysphoria, as it can have detrimental health effects. For example, those with gender dysphoria have a higher suicide risk than the general population, with a 2018 study finding that 48.3% of the 151 people sampled experienced suicidal ideation and 23.8% attempted suicide.
Another 2018 study found that those with gender dysphoria have an increased risk for mood symptomatology like anxiety and depression, substance use disorders, and risky sexual behaviors.
Experts recommend that doctors have honest conversations with their patients about the risks and benefits of gender-affirming treatments, allowing people to choose the best course of action for their desired goals.
"Treatment for each person with gender dysphoria needs to be individualized because what helps one person reduce their dysphoria will not be the same as what helps others," says Neeral Sheth, DO, a psychiatrist specializing in LGBTQ health at Rush University.
1. Start with lifestyle changes
One way to alleviate dysphoria is to alter your physical appearance, as it's one you can immediately start and don't need a medical professional to do so. Changing your outward appearance allows you to experiment with your gender before finding which gender suits you best.
For example, those with breasts can bind their chest with chest binding garments. Altering hairstyles and body hair can also help you align your physical appearance to your gender.
Clothes can be another way to lessen gender dysphoria. Baggy pants and hoodies help hide the appearance of breasts and hips, while tighter clothes with padding in certain areas can create the appearance of fullness in the chest and hips.
"In addition to changing outward physical appearance, supporting individuals in using names and pronouns that match their experienced gender can also help reduce gender dysphoria," Sheth says.
2. Then consider medical treatments
Those who are particularly dysphoric with parts of their bodies may elect to undergo medical changes. "Oftentimes, gender dysphoria can melt away as someone goes through gender-affirming surgery procedures," Goldstein says.
Some examples of medical changes you can undergo to alleviate gender dysphoria include:
- Feminizing hormone therapy. Lowering levels of testosterone and raising levels of estrogen to that of a typical cisgender woman's range.
- Masculinizing hormone therapy. Raising testosterone levels to that of a typical cisgender man's range.
- Top surgery. Removing breast tissue in transmasculine individuals to create the appearance of a more traditionally masculine chest.
- Breast augmentation. Creates the appearance of a more feminine chest in transfeminine individuals.
- Feminizing vaginoplasty. Inverts a penis to create a vagina.
- Masculinizing phalloplasty or scrotoplasty. Creating a penis using a patch of skin from the transmasculine individual's arm or leg.
- Metoidioplasty. Creating a penis from the enlarged clitoris caused by testosterone hormone therapy.
- Facial feminization surgery. Altering the bones in the face to create a more feminine facial bone structure.
- Reduction thyrochondroplasty. Shaving the trachea to create a more traditionally feminine neck.
3. Make sure to address your mental health
In addition to physical treatment, Sheth says that behavioral and mental health treatments can also help dysphoric individuals:
- Cope with their distress
- Process feelings of gender dysphoria in healthy, productive ways
- Build resiliency against stigma and discrimination
- Help navigate the physical and social changes that occur during gender-affirming treatment
Mental health professionals, especially therapists and counselors who specialize in LGBTQ+ issues, can help treat any mental health issues such as anxiety, depression, and other psychological effects people with gender dysphoria are likely to suffer from, Sheth says.
It's also important to lean on those around you. A small 2017 study found that transgender individuals with high social support were more likely to have better mental health outcomes during periods of discrimination and harassment, reducing suicide risk.
"I think the most important thing that I can say to parents, or family members of my patients, is that feelings of depression or anxiety from gender dysphoria are something that this person has internalized and felt for their entire life," Goldstein says.
Like with depression or anxiety, gender dysphoria can drastically reduce your quality of life. Treatments for it exist, and Goldstein urges those with gender dysphoria not to let stigma obstruct getting help.
"Having that disconnect between [gender] identity and expression is not a bad thing," Goldstein says. "It's not something that we demonize or stigmatize. It should be something that we acknowledge and work to address."
Related articles from Health Reference:
- How to bind your chest safely, according to experts
- Why transfeminine vocal training can be an important part of gender-affirming therapy — and how to do it effectively
- Hormone microdosing is an option for trans people who want slower, gradual change to their bodies — here's how it works and the risks involved
- 10 changes to expect from masculinizing hormone therapy and how to know if taking testosterone is right for you
- What is top surgery? A guide to the reconstructive chest procedure for transmasculine individuals
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