What is gender dysphoria? Symptoms and mental health impact

What Is Gender Dysphoria, and What Is the Difference Between Sex and Gender?

Gender dysphoria is characterized by experiencing distress and extreme discomfort as a result of feeling like the sex you’re assigned at birth does not match, or is incongruent with, your experience of gender. 

Understanding the difference between sex and gender is key to understanding gender dysphoria. 

• Sex is a biological trait based on characteristics like anatomy, physiology, and hormones. 
• Gender is a social construct, meaning it exists because humans have developed it as an idea over time. 

Cultural expectations and typical gender roles influence how society thinks people of a particular gender should think, act, and express themselves. In many Western cultures, gender is considered binary, with specific traits and ideas associated with each. This might include stereotypes like “men should be strong” or “women should be caregivers.” 

Because society tends to assume there are only two ways to express gender and that a person’s gender expression is always tied to their birth-assigned sex, most people have an assumed gender assigned to them from birth. This can make it hard for people who experience gender differently from their biological sex to embrace being themselves. 

This experience is often where gender dysphoria originates: the idea that one’s physical traits or gender expression do not match who they truly are. Those experiencing gender dysphoria often feel distressed about their current gender expression.

Gender identity is a spectrum, with people landing in many places along it—from cis-gender (feeling that gender is aligned with assigned sex at birth) to non-binary (not solely identifying with either masculine or feminine gender expressions) to transgender (identifying as a different gender than what was assigned at birth).

Though physical traits and body image can contribute to feelings of gender dysphoria, it is not always a factor. Gender dysphoria is specifically about gender expression, which involves both physical traits and expressing oneself through clothes, hair, makeup, and more—how someone presents themself to the world, and in-turn, how they are perceived by others.

What Is an Example of Gender Dysphoria?

Imagine you were born as a girl, but as you grew up, you realized you felt more masculine at heart. While girls you knew loved their long hair and dresses, you felt drawn to shorter hair, boyish clothes (think: basketball shorts or collared shirts), and even envied boys for their flat chests.

All the while, you continued to dress femininely, either because of parental or societal expectations of who you were or because you didn’t feel ready for that kind of change. However, when you looked in the mirror, the person you saw didn’t feel like you at all. In fact, the image staring back at you was so incongruent with what you felt like on the inside that looking at it made you extremely uncomfortable.

That discomfort is gender dysphoria: feeling that the way you present yourself to the world, or rather the way your gender is being presented, is not who you are.

Who Experiences Gender Dysphoria?

Anyone can experience gender dysphoria. However, just because the way you experience gender is different from what you were assigned at birth doesn’t mean you feel dysphoric about your gender. “Dysphoria” is an intense feeling of distress, unhappiness, or uneasiness. This means that gender dysphoria only occurs when one’s assigned gender feels different from the way they experience gender internally and they are extremely unhappy with or distressed about that. 

This happens when someone doesn’t express their gender in a way that feels true to them, either because they don’t feel safe enough, they’ve been taught that it’s wrong, or a number of other reasons.

Gender dysphoria is also tied to the desire to express the physical characteristics of a different gender than what you were assigned at birth or currently present yourself as. 

Dressing outside of gender norms or expectations does not specifically indicate gender dysphoria. For example, someone who was born a boy may express themselves more femininely without identifying as a girl or woman.

Since this issue revolves around gender, people who struggle with it tend to be part of the trans community—trans women, trans men, and non-binary people. People can also be gender-fluid, meaning that their gender identity can fluctuate often, shifting from feminine to masculine and in-between as they wish.

What Is the Difference Between Body Dysmorphia and Gender Dysphoria?

Though they can often be confused, the main difference between gender dysphoria and body dysmorphia is that body dysmorphia is not centered around gender. Rather, it’s a discomfort with one’s current body and physical traits. Those with body dysmorphia see flaws with their body that may seem slight to other people but cause them to experience undue amounts of self-criticism and distress.

Body dysmorphia is more about disliking how you look, often focusing on certain body parts and what is societally “good-looking” rather than gender-specific traits. It can be centered around issues with: 

• Weight
• Acne
• The look of certain body parts
• A body’s alignment with what someone thinks they should look like 

Gender dysphoria, on the other hand, is centered solely around one’s gender incongruence. Someone can experience both gender dysphoria and body dysmorphia at the same time, but just because someone has gender dysphoria does not mean that they will meet the criteria for body dysmorphia.

What Are the Signs of Gender Dysphoria? Diagnostic Criteria in the DSM-5

The DSM-5’s diagnostic criteria for gender dysphoria is split by age. People older than 13 must experience two or more of the following symptoms for at least six months:

• A marked difference between one’s experienced/expressed gender and primary and/or secondary sex characteristics 
• A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked difference with one’s experienced/expressed gender
• A strong desire for the primary and/or secondary sex characteristics of the other gender (or some alternative gender different from one’s designated gender)
• A strong desire to be of the other gender (or some alternative gender different from one’s designated gender)
• A strong desire to be treated as the other gender (or some alternative gender different from one’s designated gender)
• A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s designated gender)

Children under 13 have similar criteria, but they must exhibit six of the following symptoms over the course of six months, specifically including the first symptom listed: 

• A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gender different from one’s designated gender)
• A strong preference for wearing clothes typical of the opposite gender (or some alternative gender different from one’s designated gender)
• A strong preference for cross-gender roles in make-believe play or fantasy play
• A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender
• A strong preference for playmates of the other gender
• A strong rejection of toys, games, and activities typical of one’s assigned gender
• A strong dislike of one’s sexual anatomy
• A strong desire for the physical sex characteristics that match one’s experienced gender

Another important note is that these symptoms must also be coupled with clinically significant levels of distress and impairment.

How Gender Dysphoria Affects Mental Health

The impact of gender dysphoria can depend on the society or culture in which you live, but at its worst, the effects can be devastating to a person’s mental health. Possible outcomes include: 

• Suicidality 
• Anxiety
• Depression
• PTSD (due to bullying, threats, hate crimes)

One of the communities most negatively impacted by gender dysphoria and society’s insistence on a gender binary is the transgender community. In areas like physical healthcare, mental healthcare, education, and more, transgender individuals are disproportionately underserved. 

Anxiety, Depression, and Gender Dysphoria

According to a study done at Cambridge University, people experiencing gender dysphoria had high rates of individuals with mental disorders: 64.5% reported depressive symptoms, 42.9% struggled with suicidality, 25.9% experienced anxiety, and 40.2% had substance use disorders.

Can Gender Dysphoria Go Away Without Transitioning?

Yes, sometimes gender dysphoria can be resolved without fully transitioning, though not always. Each person’s experience with gender dysphoria is entirely unique, and what helps one person may not work for another. 

For some, things like wearing gender-affirming clothing or getting a gender-affirming haircut may be enough to feel less dysphoric and more like themselves. Others may not feel fully comfortable in their bodies until they start taking hormones or undergo gender-affirming surgeries (e.g., sexual reassignment or facial feminizing/masculinization). 

People can fall anywhere on this spectrum, and research shows that gender-affirming care, such as surgery, leads to improved mental health.

To know where you or your child fall on this spectrum, it may help to seek care from a mental health professional. They can assist you in organizing your thoughts, ask questions to help you better understand your needs, and help you find the words to articulate how you’re feeling.

How to Support People Experiencing Gender Dysphoria

There are many ways to find support for those experiencing gender dysphoria. Commonly used resources include:

• Therapy: Talking to a mental health professional about your symptoms and how you’re feeling can be a great source of support for people with gender dysphoria. They can assess your symptoms, discern whether you might have any co-occurring conditions, validate your lived experiences, create an individualized treatment plan for you, and more.
• Support groups: Support groups can be an excellent place to find community, belonging, and support, as it’s important to see that you are not alone in your struggles and experiences. They can also be a great way to connect with your local LGBTQIA+ community, including others who have or are experiencing gender dysphoria. By forming connections with people you have common experiences with, you can start to feel more understood and validated in your experience. 
• Consuming supportive media: Make sure your social media feeds have more inclusive content and less content that feeds your dysphoria. This can also help affirm and validate your experience.
• Finding supportive places: Many communities have LGBTQIA+-friendly spaces, such as libraries, bookstores, coffee shops, bars, etc. these can be great places to meet accepting individuals and those with similar experiences to you.
• Being gender-affirming: Gender affirmation starts with you; consider dressing in a way that makes you feel euphoric, even if it’s just at home or when you’re by yourself. You can also read affirming books, talk to supportive loved ones, find other ways to feel accepted that suit you, and explore what feels good or congruent to your gender experience.

Though being out and proud helps many people feel more comfortable in their gender experience, you don’t have to be out all the time if you aren’t ready. The best way to support yourself as you experience gender dysphoria is to do things that make you comfortable and happy with people you feel safe around. 

If you still struggle to manage your symptoms and the distress of dysphoria is impacting your well-being, reach out to an LGBTQIA+-specialized mental health professional for personalized support.