Last updated date: 13-Feb-2023

Originally Written in English

What you need to understand about Gender Dysphoria?

    Gender dysphoria


    What is Gender Dysphoria? 

    The term "transgender" describes a person whose gender identity (one's psychological perception of their gender) differs from their sex assigned at birth (the sex given by a physician at birth, typically based on outward genitalia). Gender dysphoria, which is the psychological anguish brought on by incongruence between one's assigned sex at birth and one's gender identity, can occur in certain transgender people. Even though gender dysphoria frequently manifests in childhood, some people may not experience it until well after puberty.

    People who identify as transgender may opt to affirm their gender in a variety of ways, such as social affirmation (changing their name and pronouns), legal affirmation (such as changing the gender markers on official documents), medical affirmation (such as pubertal suppression or hormones that promote gender equality), and/or surgical affirmation (vaginoplasty, facial feminization surgery, breast augmentation, masculine chest reconstruction, etc.). It should be taken into consideration that not all transgender people would desire gender affirmation in all areas because these are very personal and individual choices.

    It's crucial to understand that gender expression and gender identity are two distinct things. Gender expression represents the way a person shows themselves to the outside world in a gendered fashion, as opposed to gender identification, which relates to one's internal understanding of their gender. For instance, wearing a dress is typically regarded as a "feminine" gender expression, while donning a tuxedo is typically regarded as a "masculine" gender expression in most countries, including the United States of America. These standards have a cultural definition and change over time and across cultures. Gender expression does not correspond to gender identity in all cases. Similar to varied gender identities, a wide range of gender expressions do not necessarily indicate a mental illness.

    Additionally, gender identity is distinct from sexual orientation. The categories of persons one is sexually attracted to are referred to as one's sexual orientation. The sexual preferences of transgender people are as varied as those of cisgender people (people whose sex assigned at birth matches their gender identity).

    The gender dysphoria DSM 5 definition (Diagnostic and Statistical Manual of Mental Disorders) describes a sense of difficulty that an individual has because of mismatches between biological sex and gender identity, which may be very intense, having a significant impact on one’s everyday life.


    What is gender identity defined as?

    Gender identity

    It is essential to acknowledge that our sense of who we are, how we see and identify ourselves, and our gender identity are all related to one another. Most people categorize themselves as "man" or "female”, identities that are sometimes referred to as "binary". However, some people believe that their gender identity and their biological sex are distinct. For instance, some individuals may possess male genitalia and facial hair yet not feel or identify as a man. Despite having female genitalia and breasts, some people do not view themselves as women or feel feminine, meaning that some individuals do not identify as having a binary identity and they don’t consider gender to be important to who they really are. In order to express their identity, they mostly use phrases like “agender” or “gender non-conforming” and they are frequently referred to as “non-binary” as a group.

    Not all people with gender dysphoria may seek to express their gender identity through hormones, but some may. Although gender dysphoria is not a mental disorder, some persons may experience mental health issues as a result of it.


    What causes Gender dysphoria?

    It is uncertain what specifically causes gender dysphoria. Due to the complexity of gender development, there are still many unanswered questions. Sexual orientation has nothing to do with gender dysphoria. All straight, gay, lesbian, or bisexual identities are possible for those who experience gender dysphoria. Nobody is truly sure how many people suffer from gender dysphoria since not everyone who is uncomfortable with their gender identity or already identifies as gender-varied needs or requests support. However, there has been a significant increase in referrals and diagnoses of gender dysphoria.


    What does gender dysphoria look like? Gender dysphoria symptoms, gender dysphoria signs 

    Gender dysphoria symptoms

    People who have gender dysphoria can modify their interests, behavior, or outward appearance. Additionally, they could exhibit indicators of discomfort or distress such as low self-esteem, socially isolating themselves, experiencing symptoms of anxiety or depression, taking unnecessary risks more often than usual or simply neglecting themselves.

    If an individual first experienced gender dysphoria as a youngster, they may now feel much more certain about their gender identity and the way they wish to approach it. However, they can also discover that as time passes, the emotions they experienced when they were younger slowly vanish and they become more comfortable with their biological sex. They might also discover that they identify as gay, lesbian, bisexual or any other sexual orientation.

    Teenagers and adults are affected differently by gender dysphoria than children. They could feel:

    • Very sure that their gender identity conflicts with their biological sex
    • Comfort only while in the gender role of their preferred gender identity, including non-binary as well
    • Intense desire to get rid of physical aspects of their biological sex or hiding them (for example breasts or facial hair)
    • Intense hate of their biological sex's genitalia

    One can experience loneliness or social isolation. Additionally, they might come under peer pressure to act a specific way from friends, coworkers, classmates, or family members. Or they might experience harassment and bullying for being unique. The emotional and psychological well-being is impacted by having or repressing these feelings.


    Can gender dysphoria go away? Gender dysphoria treatment

    Gender dysphoria treatment

    The goal of treatment for gender dysphoria is to enable patients to live their preferred gender identity or non-binary lifestyle. This has diverse meanings for children, adolescents, and adults, and depends on the individual. Currently, there are substantial wait times for both referrals and treatment.


    Treatment for children and young people

    Children and teenagers can be seen and treated by a multidisciplinary team, including children psychologists, psychotherapists, psychiatrists and family therapists. The team will conduct a thorough evaluation, typically over the course of 3 to 6 appointments spread out over many months. Based on the results, good options for this age group include family therapy, individual psychotherapy for children, parental support and counseling. There are many support groups that work with young people and their parents regarding this issue. Regular reviews monitoring gender identity and its development may also help. 

    The majority of available treatments at this point are psychological rather than medicinal. This is due to the fact that as kids hit puberty, gender-variant behavior or feelings frequently go away. When they approach puberty, some young individuals who fulfill strict requirements and exhibit persistent symptoms of gender dysphoria may be referred to a consultant endocrinologist who specializes in hormones to evaluate if they can take hormone blockers. Puberty blockers stop the development of the physical characteristics of puberty, such as the growth of facial hair or breasts. The long-term implications of hormone or puberty blockers in children with gender dysphoria are little understood. It is unknown what the potential psychological repercussions may be. Furthermore, it is unknown if hormone blockers have an impact on how young children's bones and the teenage brain develop. Additionally, possible side effects include hot flushes, tiredness, and mood swings. Teenagers who have been taking hormone blockers for at least 12 months and are 16 years old may be prescribed cross-sex hormones, also referred to as gender-affirming hormones. These cause some changes that are irreversible, for example:

    • Breast development may be caused by taking estrogen. 
    • An individual’s voice may break or deepen due to taking testosterone. 
    • When one uses transgender hormones long-term, it can lead to temporary or even permanent infertility.

    Cross-sex hormones shouldn’t be regarded as a dependable method of contraception, as they may affect different people in various ways.

    For teenagers that are 17 or older, it is alright to visit adult gender identity clinics. Teenagers and the clinic staff may be more comfortable verifying a gender dysphoria diagnosis at this point. It is possible to take steps toward more permanent treatments that correspond with the preferred gender identity or as non-binary, if desired.


    Treatment for adults

    Adults who think they may suffer from gender dysphoria should be referred to a gender dysphoria clinic, abbreviated as GDC. Many healthcare professionals are included in a multidisciplinary team offering ongoing assessments, treatments and support, including many types of psychological support (for example, counseling), cross-sex hormone therapy and last but not least, speech and language therapy that helps one sound more typical of their gender identity. 

    Some people only require the clinic’s assistance and guidance to be at ease with their gender identification, while others will require long-term care. The goal of hormone therapy is to improve one’s self-confidence regarding how one looks and feels physically. Even after having gender surgery, the hormones may need to be taken for the rest of their life. It's crucial to keep in mind that hormone therapy is just one option for treating gender dysphoria. Psychological assistance and vocal therapy are some others. Following consultation with the clinic staff, a decision regarding hormone therapy will be made.

    In general, those seeking to become more masculine frequently use testosterone, while those seeking feminization frequently use estrogen. Both often also suppress the production of "unwanted" hormones from the testes or ovaries. Whatever method is utilized, hormone therapy might take several months to take effect, which can be frustrating. Additionally, it's important to keep in mind the things it cannot alter, such as one’s height or how broad or narrow their shoulders are. Factors that are specific to each person (such as hereditary characteristics) that cannot be changed by changing the dose limit the efficacy of hormone therapy.

    There are some existent concerns regarding the potential dangers of long-term use of transgender hormones, and people should be well informed by the clinic they decide to go to. The most typical negative effects are the formation of blood clots, gallstones, gaining weight, skin issues such as acne, dyslipidemia (characterized by unusual levels of fat inside the blood), and polycythemia (described as a high concentration of red blood cells).

    In case an individual uses hormones that are obtained from unreliable sources or over the internet, there may be additional concerns regarding the quality of the drug and therefore so he/she should stay away from these. Infertility may still develop over time even if the use of cross-sex hormones is discontinued.

    For adults, doctors can offer suggestions for gamete storage, the process of collecting and preserving eggs or sperm for later use. 

    Some people may opt for surgery to change bodily features related to their biological sex permanently. They will be referred to a surgeon outside the clinic who specializes in this kind of surgery based on the advice of the experts at the gender dysphoria clinic. In addition to the social transition to their preferred gender identity before a referral is made for gender surgery there are a few things one should keep in mind, including not smoking, losing weight in case they are overweight and taking cross-sex hormones for specific surgical procedures. It’s also very important to have any chronic diseases under good control (for example diabetes, high blood pressure and others).


    Gender dysphoria in children

    Gender dysphoria in children

    Children may express curiosity in items of clothing or playthings that, according to society, are more frequently associated with the opposite gender. They might not like their sex-related physical traits. However, this kind of behavior is normal for children and comes with maturing. It does not imply that all kids displaying these behaviors experience gender dysphoria or other problems with gender identity.

    A tiny percentage of kids may have persistent, severe distress that worsens with age. This frequently occurs around puberty, when young people may believe their physical characteristics do not correspond to their gender identification.The urge to alter some aspects of one's physical appearance, such as breast size or facial hair, might persist into adulthood for some people.

    It is uncommon for a child to have a gender dysphoria diagnosis. Most young children who appear unsure of their gender identity will no longer feel this way after reaching puberty. Children as young as three often act out different roles. If a parent is concerned that their child may be depressed, anxious or withdrawn the best option is to consult a medical professional regarding this issue. Before consulting a doctor, they might wish to find out if these behaviors have also been observed at school or any other places the child spends a lot of time at.


    Complications and risks of gender dysphoria

    As previously mentioned, gender dysphoria is not considered to be a medical condition. However, the distress it causes may be connected to mental health issues like eating disorders, suicidal thoughts, schizophrenia, depression and anxiety disorders. According to some studies, 7 out of 10 people who experience gender dysphoria will go on to develop another mental health condition.

    High levels of stigmatization, discrimination, and victimization experienced by transgender people contribute to poor self-esteem and higher incidence of other mental health conditions. Transgender people have a far higher suicide rate than the overall population due to an increased public risk of victimization and hate. For example, children and teenagers who identify as transgender frequently experience bullying and harassment at school. Interventions are frequently required to establish secure and supportive school settings.


    Gender dysphoria quiz / How is gender dysphoria diagnosed? 

    Gender dysphoria diagnosis

    A behavioral health assessment may be used to diagnose gender dysphoria by a healthcare provider that will conduct an evaluation to determine whether gender dysphoria exists in the patient and to note the negative effects on their mental health of prejudice and discrimination based on your gender identity (minority stress factors).

    There are many online gender dysphoria quizzes and tests that are available for everyone that has access to an internet connection and the majority of them are completely free. However, they should not be viewed as diagnostic tools, as they are not designed to replace professional diagnosing methods. The more honest an individual is when completing the quiz, the more accurate the results will be. If the final results are concerning, a simple search on the internet saying “gender dysphoria therapist near me” may be enough to find a good medical professional that can help make a significant difference. Since it is a psychological issues, it may be difficult to find a suitable gender dysphoria therapist and the process may require going to several therapists before finding the right one for each individual. 


    Legal considerations- being legally recognized as the opposite gender

    Some people wish to be legally recognized as their preferred gender and they may desire to change their name, which is accepted in some countries and prohibited in others. While petitioning for legal name changes in court, some judges require medical evidence of successful gender surgeries before granting the change. People that have prior criminal convictions may find more difficulties during the process of getting the change granted.

    One should be allowed to change their name on official documents such a birth certificate, passport, and driver's license once it has been properly done. It could take more effort to change the gender. Before allowing someone to alter their gender officially, some states or offices require them to submit an affidavit or medical paperwork from a doctor. However, not all governments or jurisdictions will permit a gender transition.

    Having a legal counsel can be helpful to an individual during the procedure. Resources are frequently accessible from groups like the Human Rights Campaign and the American Civil Liberties Union (ACLU).


    Conclusion- What is important to remember?

    Gender dysphoria

    A baby's sex is determined at birth based on their anatomy. The actions and behaviors parents engage in with their kids are frequently influenced by their sex. These actions frequently have a gendered component. Parents might purchase dolls for a child designated as "female" and tech- or science-related toys for a child designated as "masculine," for instance. When a person has a strong sense that the gender that corresponds to the sex they were assigned at birth does not match the gender with which they identify, it is said that they have gender dysphoria.

    Children may eventually feel that their physical features don't match the gender they identify with. For instance, a person with feminine body parts could feel like a man and want a man's body despite their anatomy. They might adopt stereotypically masculine habits and dress in male-oriented attire. They may go by a different name and prefer that people refer to them by using male pronouns. Some people will take various measures to alter their life so that they more closely resemble the sex they identify with. For instance, some people may eventually go through a medical transition involving hormone therapy and a sex-change procedure. Each person experiences change at a different level.

    People who experience gender dysphoria worry or are unhappy with their gender. Some individuals might never publicly acknowledge this discomfort. As a result, it's uncertain how widespread it is. Some people are afraid to express their emotions for fear of being mocked, shamed, or abandoned. "Gender identity disorder" was the previous name for gender dysphoria. Due to the fact that gender dysphoria is not a mental illness, the term is no longer in use. The term "transgender" may be used to refer to someone whose ascribed gender and personal identification are different.

    The causes of gender dysphoria are not completely known, yet its symptoms may have a strong impact on one’s daily life, affecting it in multiple ways. Gender dysphoria typically implies intense effects on one’s mental health, causing various psychological issues such as symptoms of anxiety and depression. Both adults and children can experience gender dysphoria, even though they might experience the symptoms and show signs in different ways. Gender dysphoria therapists are trained to find suitable treatment and support options based on how old the patients are, the experienced symptoms, and their intensity as well.