When discussing gender and sex, especially for those who are transgender or gender-diverse, it is important to know about gender incongruence and gender dysphoria:
- Gender incongruence is when a person’s gender is different from their sex assigned at birth.
- Sometimes gender incongruence can cause psychological distress. This is called gender dysphoria.
The treatment for gender incongruence and gender dysphoria is gender-affirming care. Understanding what gender dysphoria is and what causes it can help people find the care they need.
What Is Gender Dysphoria?
To better understand the definition of gender dysphoria, it’s important to know the difference between sex, gender identity, and gender expression.
Sex (commonly referred to as sex assigned at birth) refers to a person’s physical traits when they are born. These characteristics are generally used to classify someone as either male or female. Those born with both male and female physical characteristics are called intersex.
Gender identity is a person’s internal sense of self-regarding gender. A person’s gender identity may or may not match their sex and gender assigned at birth. Someone might also see themselves as having a non-binary gender — neither male nor female.
Gender expression is the way a person expresses their gender identity. This can include clothing, body language, and pronouns. Gender expression may follow binary gender roles or be androgynous/gender neutral. An androgynous/gender neutral gender expression may have characteristics of multiple genders.
Gender dysphoria is distress because your sex assigned at birth is different from your gender identity and/or expression. For example, someone whose gender is female and was assigned male at birth may experience discomfort with the masculine characteristics they have, such as facial hair. They may also experience gender dysphoria when treated or referred to as a man.
Gender dysphoria may affect those who are transgender and gender-diverse, though not all transgender and gender-diverse people experience gender dysphoria. In addition, gender dysphoria may be experienced by someone who is cisgender (who’s sex assigned at birth matches their gender identity and/or expression).
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What Are Common Gender Dysphoria Symptoms?
Gender dysphoria symptoms can appear at any time, most commonly from early childhood to early adulthood. Common symptoms of gender dysphoria include distress caused by:
- A strong feeling that your sex assigned at birth doesn’t match the gender you feel like inside (i.e., your gender identity).
- A desire to get rid of or change primary sex characteristics — such as a penis or vagina.
- A desire to get rid of or change secondary sex characteristics or other physical traits associated with sex, gender identity, or gender expression. These may include breasts, menstruation, a prominent Adam’s apple, or voice pitch.
- A desire to be a different gender than what was assigned at birth or have different gender-associated body parts than those you have. This may include wanting a penis, vagina, or breasts.
- Wanting other people to treat you as a gender other than your current gender expression.
- Having your internal sense of self match a gender identity that is different from how others currently see or treat you as.
What Causes Gender Dysphoria?
Someone who is transgender or gender-diverse may or may not experience gender dysphoria. The intensity of a person’s distress can also vary. Being unable to access gender-affirming care and support can cause gender dysphoria.
Gender dysphoria, gender expression, and gender identity are not related to a person’s sexual orientation (i.e., to whom a person is sexually attracted).
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Gender Dysphoria Treatment
Gender dysphoria treatment helps a person affirm and align their gender identity with their gender expression. This process is known as gender affirmation.
Gender affirmation is a very personal process that may include multiple areas of someone’s life, including:
- Psychological: Internal acceptance of their own gender identity.
- Social: The expression of gender through pronouns and appearance.
- Legal: The changing of a name and gender on official documents.
- Medical: The use of hormones to alter secondary sex characteristics.
- Surgical: Medical procedures to align someone’s external, physical characteristics with their gender identity.
For gender dysphoria treatment that includes medical or surgical care, you can start by talking to your primary care doctor or a specialist in gender-affirming care.
Treatment with a medical professional can include hormone therapy and/or surgery.
Hormone therapy involves taking both supplemental hormones (estrogen or testosterone) and hormone-blocking medicines. These hormones can change your appearance and align your gender expression with your gender identity. Forms of medicine include topical gels and creams, external patches, and pills and injections.
The physical changes of puberty can cause distress and gender dysphoria for children who are trans, gender-diverse, or otherwise questioning or exploring their gender identity and gender expression. Prepubescent adolescents in need of gender affirming care may have the option to delay, pause, or prevent going through puberty with puberty-blocking hormones.
Some people choose to have gender-affirming surgery. This can include:
- Facial surgery to reshape the nose, jaw, chin, and cheekbones.
- Top surgery to either augment or flatten the chest.
- Bottom surgery to remove reproductive organs and/or reshape the genitals.
Depression and Gender Identity and Expression
Being unable to access gender-affirming care can lead to depression, as well as:
- Experiencing unequal treatment.
- Societal stigma.
- Discrimination due to gender identity or gender expression.
Symptoms of depression include:
- Changes in appetite, such as wanting to eat more or eat less than usual.
- Changes in sleeping, such as having trouble sleeping or sleeping more than usual.
- Losing interest in activities that were usually fun.
- Not wanting to spend time with friends.
- Feeling agitated or having a short temper.
- Feeling sad, anxious, guilty, or worthless much of the time.
- Not having a lot of energy or having trouble sitting still.
- Having unexplained aches, pains, headaches, cramps, or stomach problems.
People experiencing depression or anxiety should seek mental health care. Treatment options may include counseling or medicine.
How to Support a Loved One With Gender Dysphoria
If someone you know has gender dysphoria, supporting them starts with listening to them. When they tell you how they feel, listen without judgment.
If they want you to use a different name and different pronouns, use what they choose. Pronouns they may choose include she/her, he/him, they/them, and ze/hir. If you make a mistake and use an incorrect name or pronoun, apologize, and try to make the right choice next time.
Learn about the difference between sex and gender and the different types of gender identity and gender expression that exist. It’s okay to feel confused or frustrated about gender-affirming care. Talk to a counselor to help you understand your loved one’s experience and to talk through your own feelings.
The Gender and Sexual Development Program at UPMC Children’s Hospital of Pittsburgh provides gender-affirming resources for both children and parents. The Parent Outreach Program connects participants with other parents who have a trans or gender-diverse child.
resolve Crisis Services at UPMC Western Behavioral Health provides 24/7 counseling and support to all Allegheny County residents. Call 1-888-796-8226 or visit our walk-in center at 333 North Braddock Ave., Pittsburgh, PA 15208.
UPMC Western Psychiatric Hospital provides behavioral health care services, including mental health treatment, in an LGBTQIA+ affirming setting. To learn more about programs and services at UPMC Western Psychiatric, call 412-235-5444.
Headquartered in Pittsburgh, UPMC is a world-renowned health care provider and insurer. We operate 40 hospitals and 700 doctors’ offices and outpatient centers, with locations in central and western Pennsylvania, Maryland, New York, and internationally. We employ 4,900 physicians, and we are leaders in clinical care, groundbreaking research, and treatment breakthroughs. U.S. News & World Report consistently ranks UPMC Presbyterian Shadyside as one of the nation’s best hospitals in many specialties and ranks UPMC Children’s Hospital of Pittsburgh on its Honor Roll of America’s Best Children’s Hospitals.