Gender Identity What Is Gender Dysphoria? By Kendra Cherry, MSEd Kendra Cherry, MSEd Facebook Twitter Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book." Learn about our editorial process Updated on September 21, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print Vladimir Vladimirov/Getty Images Table of Contents View All Table of Contents Symptoms Diagnosis Causes Treatment Challenges How to Cope Important Terms to Know Gender dysphoria refers to feelings of distress and discomfort that a person experiences when their assigned gender does not match their gender identity. People who experience gender dysphoria may feel uncomfortable with and distressed over the conflict between the sexual characteristics of their physical body and how they feel and think about themselves. They may also experience feelings of distress or discomfort over the traditional gender roles expected of their assigned gender. The effects of gender dysphoria can differ from one person to the next. For some people, these feelings of conflict may affect their self-image and behavior. A person with gender dysphoria may cope with discomfort by altering their gender expression, gender representation, or gender assignment from their gender assigned at birth. They may also make adjustments to their physical appearance. Children who experience gender dysphoria may express their wish to be the opposite gender and insist on toys, hairstyles, and clothing typically associated with the opposite gender. Not everyone who has gender dysphoria identifies as transgender, but many people diagnosed with gender dysphoria do identify as transgender, gender fluid, or gender non-conforming. Symptoms of Gender Dysphoria Symptoms of gender dysphoria can include feeling a strong sense of distress or discomfort with one's assigned gender. Some signs that someone is experiencing gender dysphoria include: A desire to no longer have the primary sex characteristics of their birth-assigned genderA desire to be treated as the opposite genderA desire to have the primary and secondary sex characteristics of their preferred gender identityThe insistence that they are a gender different from their birth-assigned sexPreferences for roles that are different from those expected of their gender assigned at birthStrong rejection of toys, games, and other things that are typically associated with their birth-assigned genderWearing clothing typically associated with the opposite gender People who experience gender dysphoria may frequently express that they want to be the opposite gender. They often feel uncomfortable with the gender roles and gender expressions of their birth-assigned sex. This might manifest in behaviors such as dressing as their preferred gender, playing with toys typically associated with the opposite gender and rejecting many gender-stereotypical behaviors. Gender dysphoria is not related to an individual's sexual orientation. People who experience gender dysphoria may be straight, gay, lesbian, or bisexual. People who feel gender dysphoria may also be gender-nonconforming or transgender. However, it is important to recognize that not everyone who is transgender or gender nonconforming experiences gender dysphoria. Gender Identity vs. Sexual Orientation It is also important to note the distinction between gender identity and sexual identity. Gender identity refers to a person's internal sense of gender, whether male, female, or outside of the gender binary. Sexual orientation refers to a person's physical, emotional, or romantic attraction to other people. Where gender involves who you are, sexuality is about who you are attracted to. Some people with gender dysphoria are part of the LGBTQ+ community, but experiencing gender dysphoria does not mean that a person is gay, lesbian, or bisexual. Diagnosis of Gender Dysphoria Gender dysphoria is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In the previous edition of the DSM, it was known as gender identity disorder. This was changed in 2013 to remove the stigma associated with calling it a disorder. Where it was previously presented as a disorder related to identity, the DSM-5 takes a more descriptive approach that is focused on the discomfort and distress that dysphoria causes. The 2022 publication of the DSM-5-TR (text revision), gender dysphoria terminology was updated to help ensure the use of less stigmatizing and more culturally-sensitive language. The DSM now uses the terms "experienced gender," "gender-affirming hormone treatment," "individual assigned male at birth," and "individual assigned female at birth." Prevalence The DSM-5 estimates that around 0.005% and 0.014% of people assigned male at birth and 0.002% and 0.003% of people assigned female at birth have gender dysphoria. While not all transgender people experience gender dysphoria, research suggests it is more common among people are transgender. In Adolescents and Adults To be diagnosed with gender dysphoria as an adolescent or adult, an individual must experience clinically significant distress or impairments in social, work, and other important life areas. These feelings must last for at least six months and be accompanied by at least two of the following: A significant incongruence between primary and secondary sex characteristics and the individual's experienced genderA marked desire to be rid of primary or secondary sex characteristicsA desire to have the primary or secondary sex characteristics of their experienced genderA desire to be their experienced genderA wish to be treated as their experienced genderA belief that they have the behaviors, feelings, and reactions that are characteristics of their experienced gender In Children Children can also experience gender dysphoria. It is not uncommon for kids to exhibit gender non-conforming behaviors. Therefore, it's important to distinguish between typical childhood behaviors and true gender dysphoria. Like adults, children must experience impairments in functioning or significant distress lasting a minimum of six months. They must also experience at least six of the following symptoms: The insistence that they are the opposite gender or a desire to be the opposite genderA preference for engaging in fantasy play or make-believe as the opposite gender roleA preference for clothing typically associated with the opposite genderA preference for toys stereotypically preferred by the opposite genderRejecting toys or activities typically associated with their assigned genderExpressing dislike for their physical sex characteristicsA desire to have the sex characteristics that match their gender identityPreferring to play with other children of the opposite gender Signs of gender dysphoria in children can be present as early as age 4. These symptoms often grow more severe as children get older, particularly once they experience the physical changes associated with puberty. Gender Dysphoria vs. Gender Nonconformity It is important to note that gender dysphoria and gender nonconformity are not the same. Gender nonconformity involves behaviors and gender expressions that do not correspond to the stereotypical norms associated with a person's birth-assigned gender. Gender nonconformity is not considered a mental disorder. Causes of Gender Dysphoria The exact causes of gender dysphoria are not entirely understood, but several factors may play a role. Genetics, hormonal influences during prenatal development, and environmental factors may be involved. For example, prenatal exposure to certain chemicals has been associated with disruptions in the normal development of sex determination before birth. Research also points to a genetic link since there is a higher shared prevalence between identical twins than fraternal twins. The onset of gender dysphoria is often during early childhood. While the exact mechanisms are unclear, we know that when children are born, they are assigned a sex based upon their physical anatomy. The sex that a child is assigned at birth often determines how they are raised and how others interact with them. As they grow older, they may begin to feel a mismatch between their gender identity and their assigned sex. In some cases, this mismatch can lead to feelings of gender dysphoria. Treatment of Gender Dysphoria Treatment for gender dysphoria is highly individual and based on each person’s unique needs. It usually focuses on helping the individual explore their gender identity, often by allowing them to express their gender in a way that corresponds to their internal sense of gender. This can include dressing in a way that aligns with their gender identity, using different names and pronouns, or taking medical steps to change the body physically. In addition to counseling, treatment for gender dysphoria may involve hormones and gender reassignment surgery. Medical Options Some people with gender dysphoria may prefer more extensive treatment involving gender-affirming hormone treatment and gender-affirming medical procedures. Treatment may also involve body modifications that help align a person’s outward presentation with their internal gender identity. Hormone therapy and surgery are two ways to accomplish this. But again, treatment needs to be adapted to the needs and goals of the individual. Some people may want to achieve a full transition to the gender with which they identify. Others may wish only to minimize the secondary sex characteristics, such as facial hair or breasts, that do not align with their gender identity. It is important to remember that while surgical gender affirmation surgery is an option, not everyone with gender dysphoria makes that choice. Surgery is expensive and usually not covered by insurance, and not everyone wants to have complete gender reassignment. Hormone therapy may help some people, while others may choose to change their outward gender expression and dress to correspond with their internal sense of gender identity. Masculinizing and feminizing hormones can sometimes help lessen or resolve feelings of gender dysphoria. Such hormones can have side effects, including changes in libido and the potential for manic, hypomanic, or psychotic symptoms in people with an underlying psychiatric condition. However, people who cannot take any of these steps may begin to experience increased psychological distress, including feelings of anxiety and depression. In such cases, psychotherapy may help people feel more comfortable expressing their internal sense of gender and improve mental well-being. Psychotherapy Some individuals may wish to have counseling to help them feel more comfortable with their feelings, affirm their identity, and help them cope or reduce any feelings of distress. Relationship or family counseling can help partners, parents, and other family members better understand what their loved one is experiencing. This can help the individual gain social and peer support, providing a more affirming environment. Psychotherapeutic treatments for gender dysphoria do not try to change an individual’s gender identification. Instead, psychotherapy focuses on helping people feel more comfortable in their identity and expression of their gender. The goal is to help people feel more fulfilled and improve their quality of life by lessening feelings of dysphoria. This is sometimes accomplished by: Exploring gender identity and expressionLearning ways to manage stressPracticing self-acceptanceBuilding a support networkMaking decisions about transition optionsImproving relationships Therapy can help people reduce feelings of dysphoria, but it can also help people at any phase of the process improve their quality of life and well-being. Challenges People who are gender nonconforming and their families are often at an increased risk of exposure to stigma and discrimination because of their gender identity. People with gender dysphoria who are transgender or gender nonconforming also have a higher risk of being the victims of violence or bullying. Those who do pursue medical treatments such as hormones or surgical procedures may also face difficulties in accessing appropriate healthcare and insurance coverage for their treatment. Feelings of dysphoria combined with a lack of social support can often contribute to mental distress and other issues. Some disorders associated with gender dysphoria include depression, anxiety, substance misuse, self-harm, and other mental health problems. Research has also shown that people with gender dysphoria have a higher risk of dying by suicide than the general population. One study found that 48.3% of participants with gender dysphoria had experienced suicidal ideation, and 23.8% had attempted suicide at least once. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, see our National Helpline Database. Coping With Gender Dysphoria Coping with feelings of gender dysphoria typically involves treatment that focuses on helping people feel more comfortable with their gender identity. Some other strategies that can help people manage with feelings of gender dysphoria include: Find support: Try joining a support group and talking to peers who have had similar experiences. Reduce discomfort: Utilize practices such as breast binding or genital tucking to minimize physical characteristics that contribute to feelings of dysphoria. Care for yourself: Prioritizing self-care and emotional wellness, including doing things that make you feel good about yourself and your body. Affirm your identity: Try doing small things that will help affirm your gender identity. This might include wearing certain accessories, changing your hairstyle, or asking others to refer to you by your preferred pronouns. Plan for the future: People may also opt to pursue legal options to transition to their desired gender and transition in social settings. Research the steps and make a plan that will help you work toward your long-term goals, whether those goals involve making a medical, social, or legal transition. Pronouns Some people with gender dysphoria may prefer to use pronouns corresponding to their gender identity. Or they may prefer the use of the gender-neutral, singular "they," "them," "their" pronouns. As you work toward your long-term goals, look for solutions that will also help you cope with your feelings of dysphoria in the short term. This might involve covering or minimizing your contact with the primary or secondary sex characteristics that cause feelings of distress. Spend time exploring your identity and the ways of expressing it that feel right for you. Important Terms to Know Some key terms that are related to gender dysphoria include: Cisgender: Describes a person whose gender identity is aligned with the sex assigned to them at birth Gender expression: The ways that people outwardly express their gender identity, often through their dress, physical appearance, mannerisms, and other characteristics Gender identity: A person's inner sense and experience of their gender Nonbinary: An umbrella term to describe people who are outside of the traditional male/female gender binary Transgender: An umbrella term to describe someone who identified as a gender different from the one they were assigned at birth Glossary of Must-Know Gender Identity Terms 10 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American Psychiatric Association. What is gender dysphoria? Byne W, Karasic DH, Coleman E, et al. Gender dysphoria in adults: an overview and primer for psychiatrists. Transgend Health. 2018;3(1):57-70. doi:10.1089/trgh.2017.0053 GLAAD. How sexual orientation is different than gender identity. Davy Z, Toze M. What is gender dysphoria? a critical systematic narrative review. Transgend Health. 2018;3(1):159-169. doi:10.1089/trgh.2018.0014 American Psychiatric Association. Gender dysphoria. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Fifth edition. 2013. Zaliznyak M, Bresee C, Garcia MM. Age at first experience of gender dysphoria among transgender adults seeking gender-affirming surgery. JAMA Netw Open. 2020;3(3):e201236. doi:10.1001/jamanetworkopen.2020.1236 Garg G, Elshimy G, Marwaha R. Gender dysphoria. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. American Psychiatric Association. Expert Q & A: gender dysphoria. García-Vega E, Camero A, Fernández M, Villaverde A. Suicidal ideation and suicide attempts in persons with gender dysphoria. Psicothema. 2018;30(3):283-288. doi: 10.7334/psicothema2017.438 By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book." See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist Online Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.