What You Should Know About Gender Dysphoria

When we’re born, a doctor usually decides whether we are male or female based on our physical appearance. This information is recorded on your birth certificate as your “sex.” 

But your sex doesn’t fully describe who you are. That’s where gender comes in. According to the American Psychological Association (APA), gender is a concept defined by different cultures that relate characteristics like emotions, behaviors, and attitudes to a person’s biological sex. In general, it consists of two main aspects:

1) Gender identity: This is how you think about yourself, in your own head. You might identify as a man, a woman, neither, or both.

2) Gender expression: This is how you show your gender through your behavior — like how you act, dress, and interact with others. These behaviors might be interpreted as masculine, feminine, or neither. 

Many people go through life feeling like their assigned sex is a good match for their gender identity. These people are usually called cisgender (or cis). Cisgender people can have a wide range of gender expression and sexual orientation.

But for many other people, their assigned sex doesn’t represent their true gender identity. These people are called transgender (or trans). Many people who are trans are a man or a woman. Other transgender people may identify as “non-binary,” “genderqueer,” or a different gender altogether. And just like cis people, trans people can have all different gender expressions and sexual orientations. 

It can be hard to have a gender that’s different from your assigned sex. In some cases, it can even lead to serious emotional distress — to the point where it starts to interfere with your everyday life. When this happens, it’s called gender dysphoria. 

Keep in mind: Not everyone who is trans will have gender dysphoria. Many people even experience gender euphoria when they embrace their authentic gender identity. But if you’re struggling with gender dysphoria, help is available. Read on to learn more about gender dysphoria, and how gender-affirming care can help.  

What is gender dysphoria?

Gender dysphoria is a medical diagnosis. Healthcare providers use it to describe the unhappiness and anxiety some people feel when their assigned sex doesn’t match their gender identity. People with gender dysphoria are so distressed by this mismatch that they have trouble with normal activities like going to work or school. 

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It affects both children and adults. In fact, children as young as 2 or 3 years old can have gender dysphoria. We don’t know how many people have gender dysphoria because some people aren’t comfortable talking about it. Some studies estimate that 1% of all people have gender dysphoria. 

It’s important to recognize that being transgender isn’t a medical diagnosis. But the concept of gender dysphoria lets healthcare providers and researchers communicate using a shared language. This is important for developing and delivering gender-affirming therapies and ensuring appropriate access to care. 

And remember: Not all transgender people experience gender dysphoria. You do not need to have gender dysphoria to get gender-affirming care. 

What are the symptoms of gender dysphoria?

All people with gender dysphoria have the following in common:

• The sex you were assigned at birth doesn’t match your gender identity.

• This mismatch causes emotional distress, like depression or anxiety.

• Gender-related distress makes it hard for you to function at home, work, or school.

Symptoms are usually different for children than adults. Symptoms in children may include a strong:

• Desire or expression to be a specific gender

• Preference for clothing of a preferred gender

• Preference for playmates of a preferred gender

• Preference for toys traditionally associated with their preferred gender

• Dislike of their sexual anatomy

• Desire to have physical anatomy that matches their preferred gender 

Symptoms in teens and adults may include a strong:

• Desire to have the physical characteristics of your preferred gender

• Desire to get rid of the physical characteristics that don’t feel authentic to your gender

• Desire to be a different gender from your assigned sex

• Desire to be treated as your preferred gender 

• Belief that you have the typical feelings and reactions of your preferred gender

At what age can a child know their gender?

Children develop gender identity very early. Most children express their gender identity by the time they are 3 years old. One study showed nearly all transgender people who experierenced gender dysphoria showed signs of it by the time they were 7 years old. 

How do healthcare providers diagnose gender dysphoria?

There’s no “test” for gender dysphoria. A healthcare provider can talk with you about your gender identity and how it affects your life. They will use this information to help you understand whether you have gender dysphoria, and to make a diagnosis. 

Some people choose to take an online self-assessment before talking to a healthcare provider. While online tools can’t confirm whether you have gender dysphoria, they can be a helpful starting point.  

What can healthcare offer someone with gender dysphoria?

Being trans is normal. It isn’t an illness or a medical condition. 

But for people with gender dysphoria, healthcare can support you in living your authentic gender — and help reduce distress. There’s even research to prove that gender-affirming healthcare can improve the well-being of people with gender dysphoria. 

Here are some treatment options for gender dysphoria.

Mental health services

Mental health support is important for anyone experiencing gender dysphoria. Working with a gender-affirming therapist or psychiatrist can help reduce gender distress. A mental health provider can also help you manage anxiety, depression, and any other mental health concerns that you may be dealing with. Support groups can also be helpful. 

Gender-affirming hormone therapy

For some people, gender-affirming hormone therapy (GHT) can also help. GHT causes physical changes in the body by using hormones like testosterone and estrogen. It can change things like fat distribution, hair distribution, and the texture and size of your genitals. 

Children and teens who haven’t gone through puberty often start with puberty blockers (instead of GHT). Puberty blockers are injections that put a “pause” on puberty — but they’re reversible. Puberty blockers give young people more time to decide how they want to proceed with their gender-affirming care. 

Gender-affirming surgery

Some people decide to have gender-affirming surgery to permanently change their bodies. Body areas that can be changed with surgery include:

• Neck

• Face

• Chest

• Genitals 

Gender-affirming surgery can be expensive, even with insurance coverage. Many people work with a healthcare facility that has a lot of experience with these procedures. These facilities will have a dedicated team that can help navigate all aspects of treatment. In addition to surgeons, many people work with physical therapists and speech therapists after surgery. 

Expression of authentic identity

Not all people with gender dysphoria choose to pursue gender-affirming medical or surgical therapy. And that’s OK. For many people, being able to claim their gender identity is enough to relieve gender dysphoria. 

Many people start feeling better once they’re able to live as their authentic selves. Finding a supportive community that accepts you is also important — this includes finding gender-affirming healthcare providers.

What do I do if my child has gender dysphoria?

Gender exists on a spectrum. It's totally normal for children to explore gender expression and identity. 

But if your child seems anxious or depressed about their gender, or they aren’t participating in school, social, or family activities — they could have gender dysphoria. Here are some things you can do to support your:

• Use their preferred name and pronouns.

• Encourage close friends and relatives to respect your child’s gender expression.

• Listen to your child and let them tell you about their gender expression experiences.

• Find a gender-affirming provider who has experience working with kids and teens.

Why trust our experts?

Written by:

Sameer Hassamal, MD

Sameer Hassamal is an assistant professor of psychiatry at California University of Sciences and Medicine and Arrowhead Regional Medical Center. He is board certified in adult psychiatry, addiction psychiatry, and brain injury medicine by the American Board of Psychiatry and Neurology.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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