Table of ContentsView AllTable of ContentsBackgroundClassificationDefinitionsDiagnosis in AdultsDiagnosis in ChildrenFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Background
Classification
Definitions
Diagnosis in Adults
Diagnosis in Children
Frequently Asked Questions
Gender dysphoriais the term used to describe the distress caused when a person’s biological sex andgender identitydo not match cultural expectations.
For example, a person with a penis may exist as a woman, while a person with a vagina may exist as a man.
Additionally, someone may exist as a gender outside of the binary categories of man and woman altogether, regardless of their sex characteristics.
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In the past, mental health professionals referred to the condition using terms like “cross-gender identification,” suggesting people simply identified with the opposite sex.
In its latest edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5) the American Psychiatric Association (APA) reclassified it as “gender dysphoria.”
Instead of suggesting that a person “wants to be the other sex,” the DSM-5 asserts that there is a tangible conflict or incongruence between one’s sexual physiology and one’s identity (the qualities, beliefs, personality, looks, and expressions that make you unique).
As the public continues to gain greater awareness about gender dysphoria (and abouttransgenderand gender diverse people in general), efforts have been made to clarify how the condition is diagnosed.
To this end, the APA has issued a set of criteria for a diagnosis, which some people refer to as a gender dysphoria test.
There’s longstanding controversy surrounding “gender dysphoria” diagnoses. Many trans people oppose the presence of “gender dysphoria” as a diagnosis in the DSM, often asserting that it stigmatizes being trans and brands it as an illness.
In the previous DSM-4 issued in 1994, gender dysphoria was classified as gender identity disorder (GID).
This placed the condition under a broader classification of sexual disorders, suggesting that treatment was afforded to correct a “psychological abnormality.” It was a stigmatizing label that kept many people from seeking treatment and support.
It further reframes the condition as distress that can potentially be rectified with gender affirming procedures, rather than as a lifelong disorder of the identity.
In providing a framework for diagnosis, the APA has issued a list of criteria a person must meet in order in order to be diagnosed with gender dysphoria.
There are two sets of criteria, one for adults and adolescents and the other for children.
Gender dysphoria is in no way associated with sexual orientation, nor does it refer to homosexuality in any way. Rather, gender dysphoria places the focus on distress with one’s body due to social enforcement of sex and gender binaries.
People whose assigned sex and gender identity do not match are referred to as transgender and are considered so irrespective of attire, hormonal therapy, or surgery.
As such, you do not need to undergogender-affirming surgerynor experience gender dysphoria to be transgender; you simply are considered transgender based on self-identification.
Gender Nonconformity
Gender dysphoria should not be confused withgender nonconformity(GNC).
By definition, GNC does not adhere to a binary model of gender, or the idea that you are either a man or woman. Rather, it describes people who exist outside of the constraints society places ongender categoriesand performance. It describes individuals whose gender expression, gender identity, or gender role differs from gender norms associated with their assigned birth sex.
Sometimes, people who identify with both or neither genders will refer to themselves as “non-binary” or “genderqueer.” Whilesomenon-binary or genderqueer people are transgender, not all members of this community are trans. It is best to not assume.
By contrast, terms like “transsexual” or “cross-dressers” are considered offensive, implying sexual deviation rather than a healthy exploration of one’s gender identity.
The term “cisgender” is used to describe people whose sex assigned at birth aligns with social expectations of gender identification.
A 2017 study in theAmerican Journal of Public Healthsuggested 390 out of every 100,000 people in the United States—approximately one million—are transgender. Due to definition confusion and the stigmatization of transgender people, researchers believe the numbers are actually far greater.
In addition, these conditions must cause significant distress or impaired functioning at school, work, home, or in social settings.
Diagnosing gender dysphoria in children is far more difficult. That’s because children may have less insight into what they’re experiencing or lack the ability to express those insights. To this end, the test is focused as much on behaviors as it is likes, dislikes, and preferences.
According to the DSM-5, children must experience at least six of the following criteria (one of which must be the first criterion) for at least six months:
The condition must also be associated with significant distress or impaired functioning at school, home, or in social settings.
Because terms like “strong preference” and “strong desire” are highly subjective, clinical judgment from a qualified mental health professional is needed to establish a diagnosis. Even then, it may be hard to assess how long these feelings may or may not persist in children.
With adults, for example, feelings of incongruity may be carried for a lifetime. With children, the intense emotional responses may, in fact, change over time.
The data are often conflicting as to how many children will “desist” and eventually achieve congruence between their sex and gender identity. Depending on which study you refer to, the rate may be as low as 25% or as high as 80%.
However, children are typically under intense pressure to maintain societal norms and are tacitly discouraged from transitioning.
Many children surrender to pressure and claim to be cisgender even if dysphoria persists. For this reason, psychologists assess their overall emotional state to better characterize the nature of their responses. It’s often better to do this away from parents and other influences, however well-intentioned.
A Word From Verywell
While you can “self-test” yourself or your child for gender dysphoria, this should only be considered the first step toward a diagnosis. Even as adults, people can have difficulty articulating their true feelings or identifying the sources of those feelings.
Moreover, as parents, we may not recognize how our own biases and words unintentionally sway our children’s responses. Often, parents focus solely on the confirmation of a child’s gender identity rather than affirmatively supporting the development of the child’s identity, whatever it may be.
It’s important to work with a clinician experienced in gender dysphoria to help you reach an affirmative diagnosis and find appropriate care. You can start your search with the APA’sonline psychologist locator. The organization “Health Professionals Advancing LGBTQ Equality” also has asearch engineto help find providers (counsellors as well as gender affirming therapy providers).
You can then embark on which steps to take if diagnosed with gender dysphoria, including emotional and family support, gender expression counseling, hormone therapy, or surgery.
While there is not a specific medical or psychiatric test for gender dysphoria, the DSM-5 has criteria for diagnosing gender dysphoria.
Children can experience gender dysphoria but it can be harder to diagnose, as they may find it difficult to express how they feel and may not fully understand gender. Feelings of gender dysphoria are also more likely to be transient in kids than in adults.Given these differences, there are slightly different DSM-5 diagnostic criteria for children than adults.
Children can experience gender dysphoria but it can be harder to diagnose, as they may find it difficult to express how they feel and may not fully understand gender. Feelings of gender dysphoria are also more likely to be transient in kids than in adults.
Given these differences, there are slightly different DSM-5 diagnostic criteria for children than adults.
Signs of gender dysphoria include strong desires to be the gender other than the one a person was assigned when they were born. A person experiencing gender dysphoria may want to have the sexual anatomy and characteristics of the other sex, as well as want to be treated like the other sex.
Estrogen Treatment for Transgender Women
5 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Davy Z, Toze M.What is gender dysphoria? A critical systematic narrative review.Transgend Health. 2018;3(1):159-169. doi:10.1089/trgh.2018.0014American Psychological Association.Key Terms and Concepts in Understanding Gender Diversity and Sexual Orientation Among Students.Meerwijk EL, Sevelius JM.Transgender population size in the United States: a meta-regression of population-based probability samples.Am J Public Health. 2017;107(2):e1-e8. doi:10.2105/AJPH.2016.303578Temple Newhook J, Pyne J, Winters K, et al.A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children.Int J Transgenderism.2018;19:2;212-24. doi:10.1080/15532739.2018.1456390American Psychiatric Association.What Is Gender Dysphoria?.Additional ReadingAmerican Psychiatry Association (2013).Diagnostic and Statistical Manual of Mental Disorders (DSM-5)(5th ed.). Washington, D.C.: American Psychiatric Publishing; pp. 451-60. doi:10.1176/appi.books.9780890425596
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Davy Z, Toze M.What is gender dysphoria? A critical systematic narrative review.Transgend Health. 2018;3(1):159-169. doi:10.1089/trgh.2018.0014American Psychological Association.Key Terms and Concepts in Understanding Gender Diversity and Sexual Orientation Among Students.Meerwijk EL, Sevelius JM.Transgender population size in the United States: a meta-regression of population-based probability samples.Am J Public Health. 2017;107(2):e1-e8. doi:10.2105/AJPH.2016.303578Temple Newhook J, Pyne J, Winters K, et al.A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children.Int J Transgenderism.2018;19:2;212-24. doi:10.1080/15532739.2018.1456390American Psychiatric Association.What Is Gender Dysphoria?.Additional ReadingAmerican Psychiatry Association (2013).Diagnostic and Statistical Manual of Mental Disorders (DSM-5)(5th ed.). Washington, D.C.: American Psychiatric Publishing; pp. 451-60. doi:10.1176/appi.books.9780890425596
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Davy Z, Toze M.What is gender dysphoria? A critical systematic narrative review.Transgend Health. 2018;3(1):159-169. doi:10.1089/trgh.2018.0014American Psychological Association.Key Terms and Concepts in Understanding Gender Diversity and Sexual Orientation Among Students.Meerwijk EL, Sevelius JM.Transgender population size in the United States: a meta-regression of population-based probability samples.Am J Public Health. 2017;107(2):e1-e8. doi:10.2105/AJPH.2016.303578Temple Newhook J, Pyne J, Winters K, et al.A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children.Int J Transgenderism.2018;19:2;212-24. doi:10.1080/15532739.2018.1456390American Psychiatric Association.What Is Gender Dysphoria?.
Davy Z, Toze M.What is gender dysphoria? A critical systematic narrative review.Transgend Health. 2018;3(1):159-169. doi:10.1089/trgh.2018.0014
American Psychological Association.Key Terms and Concepts in Understanding Gender Diversity and Sexual Orientation Among Students.
Meerwijk EL, Sevelius JM.Transgender population size in the United States: a meta-regression of population-based probability samples.Am J Public Health. 2017;107(2):e1-e8. doi:10.2105/AJPH.2016.303578
Temple Newhook J, Pyne J, Winters K, et al.A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children.Int J Transgenderism.2018;19:2;212-24. doi:10.1080/15532739.2018.1456390
American Psychiatric Association.What Is Gender Dysphoria?.
American Psychiatry Association (2013).Diagnostic and Statistical Manual of Mental Disorders (DSM-5)(5th ed.). Washington, D.C.: American Psychiatric Publishing; pp. 451-60. doi:10.1176/appi.books.9780890425596
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