How Gender Dysphoria Is Diagnosed

Teenage Boy Looking In Mirror At Home

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Gender dysphoria occurs when a person feels that their biological sex inaccurately represents their true being.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes people that live with this dysphoria as having a “marked incongruence between their experienced or expressed gender and the one they were assigned at birth." 

Previously known as "gender identity disorder," it’s hard to say just how many people live with this condition. What is widely accepted, however, is that a growing number of people—children, adolescents, and adults alike, are finding that they are unable to live within, and perform the traditional roles expected of their assigned sex at birth.

If you find yourself constantly in disagreement with your assigned sex and believe it to be wrongly representative of your true identity, you may be experiencing gender dysphoria.

This article looks at the signs of gender dysphoria and its diagnosis in both adolescents and adults.

Signs of Gender Dysphoria in Children

Children begin to express gender between the ages of three and five, during which time they are socially, and culturally exposed to the roles and responsibilities of their assigned genders. 

From that time period, however, children and adolescents with gender dysphoria may begin to feel that their assigned gender does not represent who they really are.

In Boys

Children assigned as male at birth may appear more feminine when they live with gender dysphoria. Such children may shun rough play, manual labor, or the usual games boys find engaging. These children may describe their genitals as repulsive and may express the repeated desire to not have a penis. 

In Girls

Girls with gender dysphoria are more likely to be labeled "tomboy." They will reject typical girls' clothing such as dresses and skirts, favoring boys' attire. In addition, a girl experiencing gender dysphoria may refuse to urinate in the typical position and may reveal a determination to grow male sex organs and characteristics.

Signs of Gender Dysphoria in Adolescents and Adults

Adolescents experiencing gender dysphoria tend to exhibit some of the same signs that children do. For instance, they might wish to alter the characteristics that do not "match" the gender they feel more aligned with.

In adults, the same unease is usually experienced with outward physical characteristics and gender expectations. Adults will display more conviction towards a gender identity, and they are usually more certain that their outward gender identity does not conform with their true nature. Adults are usually at peace when they take on the roles and characteristics of their desired gender. 

Adults that experience gender dysphoria may also feel a pressing need to get rid of the physical characteristics of their assigned gender such as:

  • Facial hair
  • Breasts
  • A deep/light voice
  • Genitalia

Diagnosing Gender Dysphoria in Children

According to the DSM-5, when a child shows disdain for their outward appearance or activities associated with their assigned gender for a period of six months, this could indicate gender dysphoria.

If said child displays at least six of the following traits that could qualify for a gender dysphoria diagnosis:

  • A strong insistence that they are of another gender or that they prefer to be another gender
  • For assigned male or female children, a desire to cross-dress or wear clothing suited for their preferred gender
  • Acting out in fantasies, or make-believe roles in their preferred gender
  • A preference for the tools or toys commonly ascribed to their favored gender
  • Selecting playmates of the gender they feel more connected to
  • Strongly wishing for the physical and sexual features of the gender they gravitate towards
  • Their feelings about another gender are enough to affect their social, school, or other relationships

Diagnosing Gender Dysphoria in Adolescents and Adults

Like children dealing with gender dysphoria, an adolescent or adult is expected to harbor feelings of dissatisfaction with their assigned gender for a period of about six months. Within that time, any two of the following traits should be observed before a diagnosis of gender dysphoria can be made:

  • Adolescents and adults may desire to lose their sexual characteristics for failing to match with those of their experienced gender
  • A strong longing for the physical and sexual characteristics of their preferred gender
  • Wishing to be a part of their expressed gender
  • Wanting to be treated or addressed in ways reserved for their expressed gender
  • These desires are standing in the way of their normal daily functioning
  • For early adolescents—a disparity between the characteristics puberty will bring, and the developments they hope for, usually of their preferred gender

Differential Diagnosis

In some cases, despite expressing symptoms observable in gender dysphoria, a person may be living through a different circumstance.

Conditions that share certain similarities with gender dysphoria include:

  • Autogynephilia: A situation where a man becomes sexually interested in himself as a woman
  • Body dysmorphic disorder: A condition where a person fixates on perceived flaws in their appearance
  • Gynandromorphophilia: A sexual attraction to transgender people
  • Intersexuality: A person may express another gender as a result of being intersex. However, not all intersex people live with gender dysphoria.
  • Schizophrenia: In some instances, a person may be suffering from delusions that cause them to lean towards another gender.
  • Transvestism: Where a person only chooses to cross-dress. They do not hold strong convictions of being another gender.
  • Paraphilia: A person may hold sexual desires or behaviors that are distressing to their everyday life. This is not interchangeable with gender dysphoria.

Managing Emotional Distress

A lot of emotional distress often accompanies someone who is experiencing gender dysphoria. So measures should be taken to help manage that distress. The following courses of action may be adopted to care for a person living with gender dysphoria.

Psychotherapy

Speaking to a professional to explore your gender identity is especially important for children. This is also the case with adolescents who will have to navigate the many emotions puberty and longing for their expressed gender will bring.

Adults will also benefit from therapy to help them feel more comfortable in their identity and gender expression.

Psychotherapy will also help to address any other mental health challenges like depression that may accompany gender dysphoria.

Hormonal Therapy

Depending on the goals and wishes of the person involved, hormones may be taken to further the expression of someone's preferred gender. These hormones may be taken to suppress internal hormones and alter hormone levels to match one’s gender identity.

Children may take puberty blockers to prevent the formation of sex characteristics that do not align with their identity. 

Not all people that experience gender dysphoria will opt for hormonal therapy. It is advisable that this measure is adopted in combination with therapy.

Surgical Therapy

Managing gender dysphoria can also be achieved by making external bodily changes that match with their expressed gender identity.

This measure is usually taken after a year of hormone treatment and of living as the desired gender.

A Word From Verywell

As more people of all ages recognize their authentic identities, getting proper diagnoses can be an important part of living as one’s true self. 

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4 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.
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