What is gender dysphoria?

Gender dysphoria is a feeling of discomfort caused by a mismatch between assigned sex and gender identity. Many but not all transgender people experience this before they start living as themselves (transition and gender expression). And it can be at any time in life, from childhood to adulthood. Individuals with gender dysphoria will suffer extremely with emotional and psychological aspects when they are unable to be or express their experienced gender, or when they are not provided with the understanding or acceptance that they might require.

What does Gender Dysphoria feel?

Most people with gender dysphoria experience severe, persistent feelings that result from having the physical characteristics of one gender and feeling or ascribing to either an opposite gender or a gender that does not fit the definition of binary genders (male and female).

You may feel:

• Anxious.
• Depressed.
• Isolated.
• Misunderstood.
• A part of you is missing.
• Shameful.
• Suicidal.
• An urge to self-harm.
• Uncomfortable with your appearance.

What are the symptoms for gender dysphoria?

Gender dysphoria may lead to a significant difference between the inner gender identity and assigned gender that persists for at least six months. The difference is manifested by at least two of the following:

A discrepancy between gender identity and sexual anatomy or secondary sex characteristics, including breast size, voice, and facial hair. In early adolescence, a person may feel a difference between their gender identity and the expected physical changes of their gender. They might strongly wish to get rid of their genitals or physical traits related to their gender, or want to stop those traits from developing. They could also have a strong desire to have the genitals and physical traits of a different gender. Additionally, they may want to be seen or treated as another gender, and they strongly believe they have the typical feelings and reactions of that gender.

It can also result in significant distress that impacts your ability to function in social or other contexts, at work or in school, or otherwise.

Gender dysphoria could begin at some point in childhood and extend into later adolescence and adult life. Or you could have times when you are not experiencing gender dysphoria. Your gender dysphoria might begin at the onset of puberty or many years later.

What causing gender dysphoria?

The cause is not yet known. The disorder may be based on biological factors that occur before birth.

The distress, anxiety and overall unease of gender dysphoria has been associated with societal stigma. Gender non-conforming children, adolescents, and adults face significant levels of discrimination and verbal harassment. One in 4 is physically assaulted, and more than 1 in 10 is sexually assaulted.

What are the criteria for diagnosis?

Your healthcare provider may consider making a diagnosis of gender dysphoria based on: Behavioral health evaluation. The provider evaluates you to establish whether gender dysphoria is present or not and also to record how minority stress factors about your gender identity affect mental health. They will, however, question the support that you get from the family, chosen family, and peers.

• Your mental health professional may utilize the DSM-5 criteria for gender dysphoria published by the American Psychiatric Association.
• Gender dysphoria is not simply about failing to act like what would stereotypically be the gender. It presents with feelings of discomfort because a person has a strong, pervasive desire to be another gender.
• Some young people may articulate their feelings of gender dysphoria to a parent or a health care provider. Others may manifest symptoms of a mood disorder, anxiety or depression. Or they may experience social or academic problems.

What does treatment look like?

The goal of gender-affirming treatment is to help you achieve peace of mind, which means different things to different people. And it often takes time to achieve results. Visiting a healthcare provider who specializes in transgender health can help you explore your options.

There are many ways to achieve gender affirmation. Surgery can help, but it's not always necessary.

What treatments are available for gender dysphoria?

Treatment can be expressed as gender identity or medical or surgical treatment.

Gender expression

This refers to behaviors and actions that help you achieve your preferred gender identity. You may want to:

• Change your name and the pronouns people address you by (him, her or them).
• Update your gender on government-issued identification. This can include your passport or driver's license.
• Dress in a way that is more masculine, feminine or gender-neutral.
• Cosmetic modifications can include removing hair or adding something to the face.

Medical interventions

Medical treatments may include gender-affirming hormones;

• Masculinizing hormones: testosterone for trans men
• Testosterone blockers and feminizing hormones: estrogen and progesterone for trans women

Gender affirmation surgery

Surgery helps bring about permanent changes that are more aligned with your desired gender. You may want to undergo:

Top surgery

Surgeries to enhance breast tissue in trans women and remove it in trans men.

Bottom surgery

• For Trans men, bottom surgery constructs a penis from tissue from other parts of your body. This may include metoidioplasty or phalloplasty.
• For Trans women, vaginoplasty forms a vagina following the removal of your penis and scrotum.

Facial surgeries     

• Facial feminization surgery renders your face more feminine. Surgical procedures may involve making a smaller forehead or petite jawline.
• Facial masculinization surgery can make your face more masculine. Your forehead may be lengthened or your brow line more angular as a result of surgery.

Why is mental health therapy used to treat gender dysphoria?

You can better regulate your feelings by talking to a qualified mental health therapist. You can learn new ways to think and cope. Therapy can also involve:

• Medication that helps reduces anxiety or depression.
• Emergency counseling if you are in crisis or have suicidal thoughts.

If you are thinking about gender affirmation surgery, your insurance might require you to have therapy. You will need to show that you:

• Recognize the long-term consequences of the procedure.
• Be mentally capable of consenting to the procedure.

What support is available for people with gender dysphoria?

Support goes a long way in helping you overcome specific issues in your life. You might want to attend a transgender support group. Attending enables you to learn from other people's experiences just like yours. Support to enable you to overcome bullying or even persecution may also be found in your community.

What treatments are appropriate for children and adolescents?

Some treatments can be initiated immediately by adolescents. However, others are recommended after a while because the body is still developing.

• Initiate therapy immediately: Therapy looks into why the feelings are negative. It also gives ways of overcoming them.
• Puberty suppression can be considered in adolescence: Treatment may halt the changes such as breast development or facial hair growth.
• Wait to start other treatments: Hormone treatment may begin at 16 years of age. Surgery is most appropriate for those aged 18 and above.

What is the prognosis for someone with gender dysphoria?

Treatment can allow you to free yourself from the negative emotions you are facing. Once you feel more positive about yourself, you'll find it easier to make decisions about your future, such as your preferred gender identity.

How do I help a loved one who suffers from gender dysphoria?

Here are some things you can do:

• Listen to them.
• Validate and acknowledge their feelings.
• Don't try to convince them otherwise.
• Join in on family therapy to work through challenges.
• Use their name and pronouns.
• Get them into counseling if they have thoughts of suicide or are self-harming.

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