Gender dysphoria

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Also known as gender identity disorder

Gender dysphoria is a formal diagnosis used when a person is very uncomfortable with the sex or gender they were assigned at birth.

A person may feel as though their gender identity (their personal sense of identification as male, female, neither, both, or somewhere in between) does not match their body, or the gender that others see them as. The discomfort a person feels because of this is called gender dysphoria.

Many people who experience gender dysphoria are transgender, trans*, or gender diverse. These are used as umbrella terms to describe people whose gender identity is different from the sex they were given at birth.

  • Gender identity is not the same as sexual orientation. People who are transgender may identify as straight, gay, lesbian, bisexual, asexual or any other sexual orientation.
  • Transgender identities are varied and diverse. Some of these include: Takatāpui, whakawahine, tangata ira tane, FtM, MtF, transsexual, fa’afafine, transmen, transwomen, akava’ine, leiti, genderqueer and gender-neutral.

Transgender identities, and gender diversity, are not mental illnesses. 

However, people who are transgender often face discrimination, harassment and social rejection. Because of this, they may be more likely to experience depression, anxiety, suicidal thoughts or other mental health problems.

Gender dysphoria is a mental health problem that many transgender people experience. It can include anxiety or distress related to not being recognised as the gender they identify with, social isolation, and a strong desire to change their physical body to feel more consistent with their gender identity (for example, through hormone treatment or surgery).

Causes

Gender diversity is a natural part of human life. A person's transgender identity may be related to their biology (for example, genetic influences or prenatal hormone levels), or their life experiences. Research suggests that a person's gender identity is fixed in most people around the time of puberty. 

Gender dysphoria develops when a person suffers distress related to their gender identity. In part, this distress may be related to whether they are accepted and valued by family, friends and their community.

Signs of gender dysphoria

It is common for young children to play around with how they express gender – for example, not wanting to wear typical boys’ or girls’ clothes, or dressing up and taking part in traditionally male or female games or activities. In most children, these behaviours do not mean they are transgender or experiencing gender dysphoria.

Children and young people who are experiencing gender dysphoria may:

  • consistently say they are a boy or a girl, even though they have physical traits associated with the opposite sex
  • be disgusted by their own genitals or want to get rid of them
  • believe they will grow up to be the gender they identify as
  • strongly prefer friends of the gender they identify with
  • reject clothes, toys and games that are designed for the "wrong" gender
  • refuse to urinate in the way that is typical for their body type (i.e. standing or sitting)
  • be extremely distressed or anxious about the changes that happen to their body during puberty.

Adolescents and adults with gender dysphoria may:

  • be certain that their true gender does not match their body
  • feel disgust with their genitals or body
  • have a strong desire to get rid of their genitals or undergo gender reassignment surgery.

Diagnosis

While gender identity is not a problem, diagnosis and treatment of gender dysphoria are important. People who experience gender dysphoria have higher rates of other mental health conditions. These may include depression, anxiety, suicidal thoughts, alcohol or other drug addiction, or eating disorders.

It is worth talking to a doctor about your experience of gender dysphoria, and any treatment or physical transition you are interested in undergoing.

Your doctor will take a note of your history (what you have felt and for how long) and will talk to you about how you are feeling, to understand whether you are experiencing any other mental health problems like depression or anxiety. The doctor can then refer you to a mental health professional who is qualified to accurately diagnose gender dysphoria. In New Zealand, this is usually required if you are interested in undergoing a physical transition, such as taking hormones or getting gender reassignment surgery.

Transition and treatment options

The goal of any treatment is to support you to reduce the distressing feeling of having a mismatch between your body and gender identity. Treatment is not about changing your gender identity or who you are.

"Transitioning" is a process that many transgender people go through to change their appearance or their presentation to match their gender identity. For most transgender people, being able to go through the transition process they choose helps to reduce gender dysphoria.

Treatment or transition means different things for different people. It could include:

  • "coming out" to friends, family and others as transgender, or another identity
  • dressing and living as your preferred gender
  • changing your name
  • asking people to use different pronouns to describe you (for example he, she, or they)
  • having your gender changed on legal identification documents like your birth certificate, passport, or driver's license
  • taking puberty blockers – medication that a young person can take to suppress physical changes associated with puberty. This means they can delay making a decision about whether they want to take hormones or have surgery until they are older
  • taking hormones (estrogen or testosterone), or having surgery, to change your body's appearance
  • having counselling to reduce distress, anxiety or other distressing feelings
  • getting counselling for your family or friends to help them understand and adjust to your situation.

Talking therapies and counselling

It can be really helpful to get counselling from someone who knows a lot about gender identity issues and can offer support through any changes associated with transitioning. Therapy is intended to help you adapt to and feel okay about your situation.

All types of therapy/counselling should be provided to you and your family and whānau in a manner that is respectful of you, and with which you feel comfortable and free to ask questions. It should be consistent with and incorporate your cultural beliefs and practices.

Medicines

Biological treatments, like taking hormones and physically altering sex characteristics, can reduce the feeling of mismatch between your physical body and gender identity. Initial assessment prior to hormone therapy requires the assessment of a mental health professional, so you will be guided through this by them.

If you're prescribed hormone therapy, you will be taken through the names of the medicines; what symptoms they are supposed to treat; how long it will be before they take effect; how long you will have to take them for; and understand the side effects.

Surgery

Many transgender people have treatment to change their body permanently so that it is more consistent with their gender identity. This might include genital surgery, hair removal and chest/breast or other reconstructive surgeries. In New Zealand, letters of support are generally required from two mental health specialists for genital surgery, but this is usually reduced to one opinion for non-genital surgery, such as facial surgery and breast (chest reconstruction) surgery. 

Treatment for children

Some young children who are uncomfortable about their gender identity go on to identify as transgender teens and adults, yet some do not. Individual and family therapy is recommended for children to create a supportive environment at home and in school. 

Supporting someone else

People who are gender diverse can and do live happy, fulfilling lives. This is made a lot easier when the people around them are encouraging, supportive, and loving. Gender dysphoria can be much worse when a person is not supported or accepted by whānau and family, or when they are judged, bullied, or discriminated against. If someone has told you they are transgender, try to be respectful of this. It may take you some to get used to the change, but they are still the same person you know and love, and your aroha and acceptance is what they need most. It’s okay if you feel confused, upset, angry, or even a sense of loss at first. All they need to know is that you still care about and love them. If this change feels too overwhelming, let them know you need time to process it, and get support for yourself, such as counselling.

Thanks to Janet Peters, registered psychologist for reviewing this content. Date last reviewed: February 2015