Gender dysphoria

Gender dysphoria is a condition where a person experiences discomfort or distress because there's a mismatch between their biological sex and gender identity. It's sometimes known as gender incongruence.

Biological sex is assigned at birth, depending on the appearance of the genitals. Gender identity is the gender that a person "identifies" with or feels themselves to be.

While biological sex and gender identity are the same for most people, this isn't the case for everyone. For example, some people may have the anatomy of a man, but identify themselves as a woman, while others may not feel they're definitively either male or female.

This mismatch between sex and gender identity can lead to distressing and uncomfortable feelings that are called gender dysphoria. Gender dysphoria is a recognised medical condition, for which treatment is sometimes appropriate. It's not a mental illness.

Some people with gender dysphoria have a strong and persistent desire to live according to their gender identity, rather than their biological sex. These people are sometimes called transsexual or trans people. Some trans people have treatment to make their physical appearance more consistent with their gender identity.

Signs of gender dysphoria

The first signs of gender dysphoria can appear at a very young age. For example, a child may refuse to wear typical boys' or girls' clothes, or dislike taking part in typical boys' or girls' games and activities.

In most cases, this type of behaviour is just part of growing up and will pass in time, but for those with gender dysphoria it continues through childhood and into adulthood.

Adults with gender dysphoria can feel trapped inside a body that doesn't match their gender identity.

They may feel so unhappy about conforming to societal expectations that they live according to their anatomical sex, rather than the gender they feel themselves to be.

They may also have a strong desire to change or get rid of physical signs of their biological sex, such as facial hair or breasts.

Read more about the symptoms of gender dysphoria.

Getting help

See your GP if you think you or your child may have gender dysphoria.

If necessary, they can refer you to a specialist Gender Identity Clinic (GIC). Staff at these clinics can carry out a personalised assessment and provide any support you need.

Assessment

A diagnosis of gender dysphoria can usually be made after an in-depth assessment carried out by two or more specialists.

This may require several sessions, carried out a few months apart, and may involve discussions with people you are close to, such as members of your family or your partner.

The assessment will determine whether you have gender dysphoria and what your needs are, which could include:

• whether there's a clear mismatch between your biological sex and gender identity
• whether you have a strong desire to change your physical characteristics as a result of any mismatch
• how you're coping with any difficulties of a possible mismatch
• how your feelings and behaviours have developed over time
• what support you have, such as friends and family

The assessment may also involve a more general assessment of your physical and psychological health.

Treatment for gender dysphoria

If the results of an assessment suggest that you or your child have gender dysphoria, staff at the GIC will work with you to come up with an individual treatment plan. This will include any psychological support you may need.

Treatment for gender dysphoria aims to help reduce or remove the distressing feelings of a mismatch between biological sex and gender identity.

This can mean different things for different people. For some people, it can mean dressing and living as their preferred gender.

For others, it can mean taking hormones or also having surgery to change their physical appearance.

Many trans people have treatment to change their body permanently, so they're more consistent with their gender identity, and the vast majority are satisfied with the eventual results.

Read more about treating gender dysphoria.

What causes gender dysphoria?

Gender development is complex and there are many possible variations that cause a mismatch between a person’s biological sex and their gender identity, making the exact cause of gender dysphoria unclear.

Occasionally, the hormones that trigger the development of biological sex may not work properly on the brain, reproductive organs and genitals, causing differences between them. This may be caused by:

• additional hormones in the mother’s system – possibly as a result of taking medication
• the foetus’ insensitivity to the hormones, known as androgen insensitivity syndrome (AIS) – when this happens, gender dysphoria may be caused by hormones not working properly in the womb

Gender dysphoria may also be the result of other rare conditions, such as:

• congenital adrenal hyperplasia (CAH) – where a high level of male hormones are produced in a female foetus. This causes the genitals to become more male in appearance and, in some cases, the baby may be thought to be biologically male when she is born.
• intersex conditions – which cause babies to be born with the genitalia of both sexes (or ambiguous genitalia). Parents are recommended to wait until the child can choose their own gender identity before any surgery is carried out.

Read more about disorders of sex development.

How common is gender dysphoria?

It's not known exactly how many people experience gender dysphoria, because many people with the condition never seek help.

A survey of 10,000 people undertaken in 2012 by the Equality and Human Rights Commission found that 1% of the population surveyed was gender variant, to some extent.

While gender dysphoria appears to be rare, the number of people being diagnosed with the condition is increasing, due to growing public awareness.

However, many people with gender dysphoria still face prejudice and misunderstanding.

Gender terminology

Gender dysphoria is a complex condition that can be difficult to understand. Therefore, it helps to distinguish between the meanings of different gender-related terms:

• gender dysphoria – discomfort or distress caused by a mismatch between a person’s gender identity and their biological sex assigned at birth
• transsexualism – the desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to have treatment to make their physical appearance more consistent with their gender identity
• transvestism – where a person occasionally wears clothes typically associated with the opposite gender (cross-dressing) for a variety of reasons
• genderqueer – an umbrella term used to describe gender identities other than man and woman – for example, those who are both man and woman, or neither man nor woman, or moving between genders

Gender dysphoria isn't the same as transvestism or cross-dressing and isn't related to sexual orientation. People with the condition may identify as straight, gay, lesbian, bisexual or asexual, and this may change with treatment.