Charlotte, NC
Gauri Adhikari, MD
Ritu Pokharel Dahal, MD
Gender dysphoria is a profound sense of discomfort or distress that occurs when a person’s gender identity doesn’t align with the sex they were assigned at birth. It’s not just a matter of preference or choice but rather a deeply felt incongruence between one’s internal sense of gender and one’s physical body.
This can manifest in various ways, such as feeling uncomfortable with one’s body, voice, or how others perceive them. However, it is important to note that not all transgender or gender non-conforming individuals experience gender dysphoria.
While people have interchangeably used sex and gender, they are different. Sex refers to the sex assigned at birth based on external genitals and chromosomes, while gender identity is based on a deeper internal sense of who you are. For example, you might be labeled female at birth but feel deep down that you’re male.
Describes individuals who identify with the sex assigned to them at birth; “cis” means “on the same side”.
Individuals are assigned male at birth but identify as women; some may identify as female-to-male (FTM or F2M).
Individuals are assigned females at birth but identify as men; some may identify as male-to-female (MTF or M2F).
Individuals who don’t conform to the gender binary, neither identifying strictly as male or female.
Gender dysphoria can start showing up when they are still kids. That being said, it’s quite common for kids to act this way as they grow up. Just because a child shows these behaviors doesn’t always mean they have gender dysphoria or other gender identity concerns.
Three important things to watch out for in kids include :
The child strongly wants to be the other gender and insists on identifying as that gender.
This could make them unhappy or disconnected from their own body. For example, a child born as a female but identifies as a boy might feel very upset about growing breasts or starting periods. Similarly, a child born as a male but identifies as a girl might feel bothered about growing facial hair or their voice getting deeper during puberty.
When kids experience the mismatch between their internal sense of gender and societal expectations, they may feel distress, anxiety, and even depression. This can lead to social isolation, taking unnecessary risks, and neglecting themselves.
In adolescents and adults, the effects of gender dysphoria vary from those in children, presenting unique challenges and experiences. Individuals in this age group may strongly desire to be treated according to their identified gender, seeking respectful acknowledgment and recognition. Additionally, many may express a wish for gender-affirming treatments, such as altering physical characteristics to align with their gender identity. This longing often intensifies during puberty, heightening feelings of discomfort and distress. Such emotions can significantly impact various aspects of daily life, including work and relationships, leading to feelings of loneliness and isolation. Furthermore, individuals may encounter external pressures from peers, colleagues, or family members to conform to societal expectations, facing potential bullying and harassment for expressing their true selves.
The diagnosis of gender dysphoria involves a thorough assessment by mental health professionals trained in working with gender-diverse individuals.
The process typically begins with an in-depth evaluation of the individual’s experiences, feelings, and thoughts about gender identity. This may include discussions about their childhood, family dynamics, social interactions, and previous gender-related experiences.
Doctors may use various assessment tools and techniques to gather information and diagnose accurately. These may include interviews, questionnaires, psychological testing, and observations of the individual’s behavior and interactions.
Diagnostic criteria for gender dysphoria are outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. According to the DSM-5, the diagnosis of gender dysphoria requires the presence of significant distress or impairment related to one’s assigned gender at birth and a strong desire to be of another gender. The criteria are different for different age groups.
Individuals with gender dysphoria often face significant challenges in expressing their true gender identity. However, some steps can be taken to help align their outward expression with their internal sense of self. These include changing one’s name and pronouns to match one’s preferred gender identity, updating official identifying documents like passports or driver’s licenses to reflect one true gender, selecting clothing styles that align with one’s gender identity, whether masculine, feminine, or gender-neutral, and making aesthetic changes such as growing or removing facial hair to reflect their desired appearance better. Each of these actions can play a crucial role in helping individuals with gender dysphoria feel more comfortable and authentic in their skin.
Treatment options for gender dysphoria may involve expressing their gender identity or receiving medical and surgical therapies depending on their needs and preferences.
1. Puberty blockers: Puberty blockers are drugs that can temporarily pause physical changes associated with puberty, such as the growth of breasts or facial hair. These medications are frequently prescribed for children with gender dysphoria. (1)
2. Gender-affirming hormones: Teenagers over the age of 16 who have been using hormone blockers for at least 12 months may be given these hormones. These hormones produce irreversible changes, such as breast development and reduced masculine features (induced by taking estrogens and testosterone blockers or feminizing hormones) or breaking or deepening of the voice (induced by testosterone use or masculinizing hormones)
-> Side Effects of Hormone Therapy: Although hormone therapy helps in psychological and social distress related to gender, it comes with various side effects.
-> Feminizing Hormone Therapy (4)
-> Masculinizing Hormone (5)
While gender affirmation surgeries are not mandatory, a considerable number of individuals choose to undergo one or more of the following surgical procedures.
1. Top Surgery: Top surgery refers to the surgical procedures to alter the chest. For transmasculine individuals, this may involve mastectomy (removal of breast tissue) with or without chest masculinization procedures to create a more masculine chest contour. For transfeminine individuals, breast augmentation may be performed to enhance breast size and shape.
2. Bottom or Genital Surgery: Bottom surgery encompasses surgical procedures to alter the genitalia.
3. Facial Reconstructive Surgery: Facial gender surgery can help achieve more feminine or masculine features. Feminine facial features may include reshaping the nose, brow lift, chin, cheek, and jaw, Adam’s apple reduction, lip augmentation, hairline restoration, and earlobe reduction. Masculine features may include forehead lengthening and augmentation, cheek augmentation, nose and chin reshaping, jaw augmentation, and thyroid cartilage enhancement to create an Adam’s apple.
Transgender individuals may have unique healthcare needs that require tailored screening protocols along with the usual screening that is done for all other people.
Self-medication in gender dysphoria involves individuals seeking and using hormones or other medications without medical supervision to induce physical changes aligning with their gender identity. While it may offer a sense of empowerment and relief, self-medication poses significant risks due to the lack of medical oversight. Incorrect dosages, adverse reactions, and long-term health complications can arise without proper monitoring of hormone levels, liver function, and overall health. Moreover, self-medication may hinder access to comprehensive healthcare services, including mental health support and gender-affirming care, potentially leading to suboptimal outcomes and increased vulnerability to health challenges.
