Gender dysphoria is distress felt when your assigned gender doesn’t match your internal gender identity. It can feel overwhelming, so we’re here to help break it down.
Whether we like it or not, gender impacts nearly every part of our daily lives.
For those who feel aligned with the gender assigned to them at birth, it can be easy to forget how even the most common interactions and occurrences — like dating, shopping, and going to school — are firmly tied to our gender presentation and others’ perceptions of our bodies.
How people perceive your gender may change their attitude and behavior toward you, and gender stereotypes present ongoing challenges to equal opportunities and inclusion in society, especially for cisgender women and transgender and nonbinary folks.
People struggling with gender dysphoria experience a deep feeling of discomfort and misalignment with the gender assigned to them at birth. Someone with gender dysphoria may verbalize this as feeling “trapped in the wrong body” or express sadness and regret over not being born in a different gender.
Grappling with gender dysphoria can feel hopeless, but there are countless allies and peers rooting for you and an abundance of resources to guide and support you every step of the way.
According to the official definition in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), “gender dysphoria refers to the distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender.”
“Gender dysphoria” replaced the outdated “gender identity disorder” diagnosis in 2019, and the preceding even more problematic “transsexualism,” both of which wrongly characterized trans, nonbinary, and gender-questioning people as mentally ill. The gay and bisexual communities fought a similar battle after decades of being categorized as having a mental problem in need of fixing.
Gender dysphoria is directly tied to how we assign sex and gender to people when they’re born. Sex at birth is often determined almost entirely by external genitalia. For example, a baby born with a penis is declared to be of “male” sex and given the gender role “boy.”
However, this child may have other biological factors (chromosomes, hormones, reproductive organs) complicating this sex assignment, which is referred to as being intersex. Or maybe the child feels misaligned with the “boy” gender assigned to them and prefers to live in a different one.
Some, though not all, people with a diagnosis of gender dysphoria come out as transgender, nonbinary, or another identity, and pursue a social transition alongside potential medical treatments to better align their bodies with their internal sense of gender identity.
The most important thing to remember is that the gender assigned to someone at birth does not necessarily predict or match their gender identity.
Gender dysphoria seeks to name any disconnect and discomfort that occurs, so that the person experiencing gender dysphoria can find the resources, support, and care they need.
Gender dysphoria and trans people
Not all people who experience gender dysphoria identify as trans or nonbinary, and not all are interested in medical treatment.
- Recent numbers suggest approximately 1.4 million U.S. adults identify as transgender (0.6% of the overall adult population).
One 2020 studyfound that 78% of trans men and 73% of trans women had experienced gender dysphoria by the age of 7, and others as young as 4. Puberty onsethas been correlated with a spike in feelings of gender dysphoria. A recent European studyfound that receiving both hormone treatment and gender affirming surgery together significantly decreased patients’ gender dysphoria compared to those who received no medical intervention.
- According to the U.S. Transgender Survey, 95% of trans men and women and 49% of nonbinary people reported wanting hormone therapy. Of all respondents, 13% said they weren’t sure if they wanted to transition.
For many people who experience gender dysphoria, it starts early in childhood and can worsen with puberty.
Changes that occur to the body during puberty — including body and facial hair, muscle mass, breast growth, periods, hormones — may be unwanted and deeply traumatizing to those with gender dysphoria. This can manifest as anxiety, depression, and even suicidal thoughts.
Gender dysphoria in childhood can manifest, in part, as children wanting to wear clothes or play with toys associated with a gender different than the one assigned to them, or expressing distress over their genitalia.
For some, gender dysphoria is constant, while for others it may come and go.
Poetically describing how painful it can be for others to not see you as the gender you identify with, Alok V. Menon writes in “Beyond the Gender Binary,” “This is a disconnect I have come to know well: between what people see and who I actually am. I have learned that the most lethal part of the human body is not the fist; it is the eye.”
Common symptoms of gender dysphoria
Gender dysphoria does not feel the same to everyone, and doctors and therapists use different criteria to evaluate children, teens, and adults. Some may have feelings of gender dysphoria but not meet the clinical standards for a diagnosis.
The following three categories summarize the main symptoms of gender dysphoria:
- A marked difference between assigned sex and gender identity
A sense of misalignment rooted in gender may apply to your name, pronouns, appearance, behavior, character traits, and more. You may express this as feeling “trapped in the wrong body” or like there’s another version of you that others can’t see.
- A desire to live as another gender role
This may involve wanting to change your name or pronouns to better match your sense of self, and to provide social validation of your actual gender.
- A desire to change your sex characteristics
This may manifest as negative feelings about your genitalia and other secondary sex characteristics like hair, voice, body shape, and more. Some people may need to seek hormone replacement treatment and/or surgical options to better align their body with their internal sense of gender identity.
For a deeper dive into symptoms, you can check out this article.
An official diagnosis of “gender dysphoria” is made by evaluating the consistency, length, and intensity of a person’s feelings. The DSM-5 requires that symptoms be present for a minimum of 6 months. This arguably constricting criteria for diagnosis is still controversial, contested by professionals and LGBTQIA+ people alike.
Not everyone who experiences gender dysphoria will meet criteria for a diagnosis, and not all people diagnosed with gender dysphoria are transgender.
However, an official diagnosis of gender dysphoria is still often required for trans people in particular to change legal documents and receive the medical care they need.
While the involvement of healthcare professionals can be essential to helping trans and nonbinary folks survive and thrive, it also presents troubling levels of “gatekeeping” and disenfranchises particularly at-risk communities.
People who can officially diagnose someone with gender dysphoria typically are therapists, psychiatrists, or other mental health professionals. Diagnosis and care may also involve general physicians, endocrinologists, urologists, surgeons, and other healthcare professionals.
The mission of any legitimate treatment for gender dysphoria is to provide a safe space for people to express and work through their feelings, and to identify steps they can take to help alleviate their distress. This includes, but is not limited to:
- psychotherapy, also called talk therapy
- exploring different names and pronouns
- exploring different uses of fashion, makeup, chest-binding, padding, and more
- hormone treatment (estrogen, testosterone) or hormone blockers
- surgical options, called “gender affirming surgeries”
The dangers of conversion therapy
Gender identity conversion therapy
- Among LGBTQ youth, 10% report having undergone some kind of conversion therapy, and the majority of these cases occurred under the age of 18.
- Among trans people, 13% report “a psychologist, counselor, or religious advisor, tried to stop them from being transgender.”
- Conversion therapies are still legal in 30 states and often tied to religious organizations.
- Conversion therapies for gender and sexual identity are linked with damaging mental health outcomes and increased suicidality.
Mental health care and potential medical treatments are not the only tools available to manage gender dysphoria. The list below offers some common (and some out-of-the-box) tactics.
- Reach out to local or national LGBTQIA+ organizations and nonprofits for resources (see list at the end of this article), or recommendations for a support group.
- Reach out to others who have experienced or shared feelings of gender dysphoria, remind yourself you are not alone.
- Consider using a support hotline or chatline where you can talk through things anonymously with a peer who understands and is trained in crisis management.
- Seek safe spaces where you can experiment with different names, pronouns, clothes, and accessories.
- Find a creative outlet or hobby where you can express yourself or gain respite from thinking about your dysphoria by focusing on a specific task or project.
- Practice meditation or visualization techniques. Actualize in your mind an empowered image of yourself, and clarify goals for your mental and physical health and what a fulfilling life looks like for you, even if it seems far away.
Additionally, educating yourself about how gender is constructed can provide useful context for your experiences and answers to questions you may have about why society orders bodies this way.
As acclaimed author, theorist, and performance artist Kate Bornstein puts it in their book “Gender Outlaw,” “As soon as I came to some understanding about the constructive nature of gender, and my relationship to that system, I ceased being gender dysphoric. Nowadays I’m positively gender euphoric.”
If you are experiencing symptoms of gender dysphoria, or distress about the misalignment between your assigned gender and your gender identity, it may be reassuring to learn as much as you can about gender dysphoria, so you feel supported on your journey. Here are a few resources to continue reading:
- Human Rights Campaign: Transgender Resources
- The Trevor Project: Trans + Gender Identity
- The Trevor Project: A Guide to Being an Ally to Transgender and Nonbinary Youth
- GLAAD Transgender Resources
For parents and allies, you can find a local support group near you through PFLAG.
Remember, with education and support, gender dysphoria is manageable. Help is available right now. You can find a compassionate, understanding professional through the Association of LGBTQ+ Psychiatrists or reach out to someone you trust.
Most of all, remember: you are not alone.
Are you in a crisis or considering suicide?
If you’re having thoughts of suicide or self-harm, you can access free support right away with these resources:
- The Trans Lifeline. This hotline is run by trans people, for trans people. Call the Trans Lifeline at 877-565-8860.
- The Trevor Project. The Trevor Project is especially intended for LGBTQIA+ folks under 25 years old. Call 866-488-7386, text START to 678678, or chat online 24-7.
- The National Suicide Prevention Lifeline. Call the Lifeline at 800-273-8255, 24 hours a day, 7 days a week.
- The Crisis Text Line. Text HOME to the Crisis Text Line at 741741.
Befrienders Worldwide. This international crisis helpline network can help you find a local helpline.
Donald Collins, MA, is a writer and trans educator based in Los Angeles. His articles and essays have appeared in VICE, Salon, and Bitch magazine, among others. He is the co-author of the award-winning 2017 memoir “At the Broken Places: A Mother and Trans Son Pick Up the Pieces.” He’s particularly interested in the experiences of queer and marginalized people in healthcare systems, trans youth, and America’s chronic illness epidemic. You can find his website here.