Gender Dysphoria

Gender dysphoria is a sense of unease a person experiences because of a mismatch between his/her biological sex and gender identity.

What Is Gender Dysphoria?

Gender dysphoria (GD) is the psychological distress a person feels when he/she experiences a difference between his/her sex assigned at birth and personal sense of gender. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines GD as a “marked incongruence between [people’s] experienced or expressed gender and the one they were assigned at birth”.

GD was previously termed as “gender identity disorder”. With the destigmatization of homosexuality and the rise of the notions of gender as a social construct and spectrum, gender dysphoria came to be seen as a mental reaction to gender practices of non-conformity and/or gendered prejudice and societal rejection.

However, strictly speaking, gender non-conformity does not equal gender dysphoria—a feeling that is limited to trans and queer people and not homosexuals.

Read More About Homosexuality Here

What Does Gender Dysphoria Feel Like?

People with GD experience mental turmoil because they cannot relate their sex to their lived gender or gender expressions to their biological sex assigned by birth. They sometimes cannot identify themselves within the traditional, rigid, societal binary of male or female roles and expectations.

Because of this, they may conduct themselves in ways that are non-conforming to societal gender expectations. Such behavior, in turn, will make them prey to cultural stigmatization.

Gender fluid people experience social prejudice, rejection, and discrimination. Most often, they are shunned by their own peers, family, and friends and are subject to high levels of interpersonal conflict, humiliation, and trauma.

They develop low self-esteem, body image issues, social withdrawal symptoms, and a negative sense of well-being. Because of this, gender dysphoria manifests itself as a myriad of mental health symptoms, such as:

• Depression
• Anxiety
• Minority stress
• Personality disorders
• Eating disorders
• Substance abuse
• Self-harm
• Suicidal ideation and execution

A 2022 study [mfn] Garg G, Elshimy G, Marwaha R. Gender Dysphoria. [Updated 2022 May 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532313/ [/mfn] shows that 0.5% to 1.3% of the global population experience GD. It is a public health hazard and accounts for most mental health conditions and suicidal deaths in teenagers and young adults. Thankfully, people are being more open and diverse about sexuality and gender orientations and gender dysphoria diagnosis has become more common in recent years.

Read More About Anxiety Here

What Are The Symptoms Of Gender Dysphoria?

Research [mfn] Garg G, Elshimy G, Marwaha R. Gender Dysphoria. [Updated 2022 May 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532313/ [/mfn] shows that the signs of gender dysphoria in children are not well-pronounced. However, in adolescents and young adults, the gender dysphoria symptoms are more apparent. This is because they have a clearer sense of gender identity and how to deal with the unsatisfactory symptoms of this dysphoria. Consequently, gender dysphoria diagnosis takes place mostly in the late teenage years and early adulthood.

The most common symptoms of gender dysphoria include:

1. Identifying with a gender that is incompatible with one’s biological sex
2. Being comfortable with the gender roles and expectations of one’s preferred gender
3. Harboring a strong dislike for one’s sexual anatomy
4. Having a strong desire to hide or rid physical signs of one’s biological sex
5. A strong desire for the primary and/or secondary sex traits of the opposite gender to that of the experienced gender
6. A strong conviction that one has the typical feelings and reactions of the desired gender
7. A strong preference for cross-dressing
8. A strong preference for cross-gender roles in fantasy or make-believe play.
9. A strong preference for toys, games, or activities associated with the other gender.
10. A strong preference for playmates of the other gender
11. Significant clinical distress or impairment in social, academic, and other areas of functioning

What Are The Causes Of Gender Dysphoria?

The common causes of gender dysphoria involve:

1. Genetics

Recent studies [mfn] Garg G, Elshimy G, Marwaha R. Gender Dysphoria. [Updated 2022 May 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532313/ [/mfn] revealed that “many genes contribute to make gender identity an inherited, complex multifactorial polygenetic trait.” For instance, a 2020 study [mfn] Boucher FJO, Chinnah TI. Gender Dysphoria: A Review Investigating the Relationship Between Genetic Influences and Brain Development. Adolesc Health Med Ther. 2020 Aug 5;11:89-99. doi: 10.2147/AHMT.S259168. PMID: 32801984; PMCID: PMC7415463. [/mfn] showed how people suffering from gender dysphoria have genetically inheritable brain structures that verge on gender nonconformity. It suggested that their brain structures appear to be more comparable to the gender with which they identify.

Read More About Genetics Here

2. Hormonal influences during prenatal development

Hormonal dysfunction [mfn] Foreman, M., Hare, L., York, K., Balakrishnan, K., Sánchez, F. J., Harte, F., Erasmus, J., Vilain, E., & Harley, V. R. (2019). Genetic Link Between Gender Dysphoria and Sex Hormone Signaling. The Journal of clinical endocrinology and metabolism, 104(2), 390–396. https://doi.org/10.1210/jc.2018-01105 [/mfn] in the womb may also enhance the risk factors for gender dysphoria. Excessive female hormones from the mother’s system or the fetal insensitivity to sex hormones can create gender-nonconforming physical attributes and identity concerns.

3. Exposure to progesterone or other estrogenic drugs

Research [mfn] Keuroghlian AS, Reisner SL, White JM, Weiss RD. Substance use and treatment of substance use disorders in a community sample of transgender adults. Drug Alcohol Depend. 2015 Jul 1;152:139-46. doi: 10.1016/j.drugalcdep.2015.04.008. Epub 2015 Apr 22. PMID: 25953644; PMCID: PMC4458188. [/mfn] shows that males or females exposed to progesterone or estrogenic drugs in the womb are at an increased risk of gender dysphoria.

4. Environmental factors

According to one 2022 study [mfn] Garg G, Elshimy G, Marwaha R. Gender Dysphoria. [Updated 2022 May 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532313/ [/mfn], “The development of gender to its assigned sex in childhood may be influenced by interactions with children’s temperament and parental qualities, as well as their dynamic relationship”. It elaborates that certain environmental conditions also contribute to gender dysphoria, such as:

• Childhood trauma
• Experiences of homophobia, transphobia, etc.
• Dysfunctional child rearing
• Deficits in normal human bonding

5. Rare conditions that may lead to gender dysphoria

Rare medical conditions in which babies are born with intersex conditions (hermaphroditism [mfn] Yordam, N., Alikasifoglu, A., Kandemir, N., Caglar, M., & Balci, S. (2001). True hermaphroditism: clinical features, genetic variants and gonadal histology. Journal of pediatric endocrinology & metabolism : JPEM, 14(4), 421–427. https://doi.org/10.1515/jpem.2001.14.4.421 [/mfn] ) or chromosomal abnormalities or appear to suffer from congenital adrenal hyperplasia (CAH [mfn] Momodu II, Lee B, Singh G. Congenital Adrenal Hyperplasia. [Updated 2022 May 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448098/ [/mfn] ) can also experience gender dysphoria.

How To Get Diagnosed With Gender Dysphoria?

The criteria for gender dysphoria diagnosis have been laid out in the DSM-5 for both children and adults. A thorough physical examination of the person’s body is carried out to eliminate the possibility of physical conditions like congenital adrenal hyperplasia or androgen insensitivity syndrome that present symptoms similar to gender dysphoria.

Further meticulous assessment and genetic testing should be performed to take into consideration:

• A personal and family medical history
• Age- and sex-appropriate screenings
• History of hormonal or surgical treatments
• Instances of substance abuse
• Sexual health concerns
• Comorbid mental health symptoms
• Risk-taking behavior, self-harm, and suicide
• A desire for fertility preservation
• A history of potentially harmful treatment approaches (like unprescribed hormone use, self-surgeries, etc.)
• Goals, risks, and expectations of treatment and trajectory of care
• Types of social support from family, friends, and peers

In the absence of a medical condition, the individual will be referred to a mental health professional (MHP) for mental health treatment.

Read More About Self-Harm Here

How To Treat Gender Dysphoria?

The treatment for gender dysphoria involves a wide range of therapy, medication, and surgery:

1. Therapy

People suffering from gender dysphoria can avail behavioral and conduct therapies that help them come to terms with their gender identities, deal with minority stress and social prejudice, and address issues related to their ‘coming out’ or gender transition.

Such therapies [mfn] Garg G, Elshimy G, Marwaha R. Gender Dysphoria. [Updated 2022 May 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532313/ [/mfn] include:

• Gender therapy
• Hormone therapy
• Sex reassignment therapy
• Psychotherapy
• Family therapy
• Group therapy

Read More About Group Therapy Here

2. Medication

According to research [mfn] James, H. A., Chang, A. Y., Imhof, R. L., Sahoo, A., Montenegro, M. M., Imhof, N. R., Gonzalez, C. A., Lteif, A. N., Nippoldt, T. B., & Davidge-Pitts, C. J. (2020). A community-based study of demographics, medical and psychiatric conditions, and gender dysphoria/incongruence treatment in transgender/gender diverse individuals. Biology of sex differences, 11(1), 55. https://doi.org/10.1186/s13293-020-00332-5 [/mfn] and medical practice, the following drugs are used to treat conditions and symptoms related to gender dysphoria:

• Spironolactone
• Estradiol
• Testosterone
• Progesterone
• Medroxyprogesterone
• Conjugated estrogens

3. Surgery

People suffering from gender dysphoria opt for surgical treatment as a last resort. According to a 2022 study [mfn] Garg G, Elshimy G, Marwaha R. Gender Dysphoria. [Updated 2022 May 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532313/ [/mfn], to avail sex reassessment surgery treatment, “the individual should be on one year of continuous hormone therapy and living in the desired gender role.”

There are 2 types of surgeries, namely, “top surgery” and “bottom surgery”, which include processes like:

• Breast augmentation
• Gonadectomy
• Metoidioplasty
• Scrotoplasty

However, resorting to surgery therapy for gender dysphoria treatment carries a lot of health risks and medical complications tend to grow severe over time. Sex surgeries are also accompanied by scathing social prejudice and rejection; but, continued support from family, community, and peers predict favorable treatment outcomes for people undergoing sex surgeries to escape their gender dysphoria.

How To Deal With Gender Dysphoria?

If you are someone suffering from gender dysphoria, consider the following measures:

• Explore and integrate your gender identity
• Accept yourself and be comfortable with your gender identity
• Decide on how you want to express your gender identity—either by ‘coming out’ or ‘transitioning’
• Try addressing the mental and emotional impacts of your gender dysphoria and experiences of gendered prejudice and discrimination
• Build a support network
• Explore healthy sexuality in the context of ‘coming out’ and gender transition
• Make decisions about your physical and mental health treatment options
• Develop a plan to address social and legal issues related to your ‘coming out’ and gender transition
• Devise healthy coping mechanisms and self-help strategies to aid you throughout your process of gender nonconformity
• Consider therapy to help you through the stages of your life
• Increase your well-being and quality of life
• Fight discrimination for homophobia, transphobia, etc. with campaigns, mass education, etc.
• Consider availing services related to hair removal or transplantation, genital tucking, breast binding, breast padding, packing, etc.
• Try aesthetic services (such as makeup application or wardrobe consultation) to express your gender identity
• Avail legal services (such as advanced directives, living wills, or legal documentation) to secure your resources after you have transitioned or ‘come out’
• Avail social and community services to deal with workplace issues, minority stress, or parenting issues

How To Help Someone With Gender Dysphoria?

If you know someone suffering from gender dysphoria, consider the following measures:

• Educate yourself about prevailing gender norms
• Do away with the stigma surrounding gender nonconformity
• Engage compassionately with gender non-conforming people
• Support and validate their experience and struggles
• Correct yourself quickly if you misgender them
• Keep their gender identities or dysphoria private
• Ask how you can help them with their dysphoria
• Suggest fun activities that will distract them
• Check on them regularly and make house-visits
• Encourage them to socialize
• Use gender-inclusive language
• Bring self-care gifts that include delicious snacks, lotions or soaps, a favorite movie or book, a journal, etc.
• If needed, encourage them to seek help like therapy, peer-support groups, etc.
• Stand up for them when they experience tough situations involving homophobia, etc.
• Advocate for all-gender accommodations in your community

Takeaway

Gender dysphoria is a public health hazard and accounts for most mental health conditions and suicidal deaths in teenagers and young adults. We should address it with sincere attempts at gender equality and destigmatizing gender nonconformity.

Gender Dysphoria At A Glance

1. Gender dysphoria is a sense of unease a person experiences because of a mismatch between his/her biological sex and gender identity.
2. Trans and queer people mostly experience gender dysphoria.
3. The causes of gender dysphoria include genetic, biological, and environmental factors.
4. Its symptoms include being uncomfortable with one’s gender, preference for cross-dressing, a dislike for one’s own anatomy, etc.
5. It can manifest as poor mental health conditions, self-harm, and suicide.
6. It can be addressed with therapies and surgery.

Frequently Asked Questions (FAQs)