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Gender Dysphoria

An abstract representation of Gender Dysphoria.

Gender dysphoria is the feeling of discomfort or distress that might occur in people whose gender identity differs from the sex assigned at birth or sex-related physical characteristics.

It’s a deep internal conflict where your sense of self clashes with the gender the world sees.

Some very severe complications can occur as a result of this condition. The most severe being suicide. Other complications include eating disorders, depression, anxiety, and social isolation.

Fortunately, we can help alleviate the condition in both children and adults through gender-affirming care and societal support and acceptance.

The following topics will be covered in this post:

  • What is it?
  • Gender Identity and Gender Dysphoria
  • How Common is this condition?
  • Who Suffers From It?
  • What Does it Feel Like?
  • Causes/Triggers
  • Types
  • Signs and Symptoms
  • Co-occurring conditions
  • Diagnosis
  • Treatment
  • Coping Mechanisms
  • Getting Help At Psychology Blossom

1. What is Gender Dysphoria?

It is the feeling of discomfort or distress that might occur in people whose gender identity differs from their sex assigned at birth or sex-related physical characteristics. For example, you may have been assigned a male sex at birth but feel that you are female, or vice versa. Or, you may believe yourself to be neither sex nor something in between or fluid.

Usually, those who are transgender and gender-nonconforming might experience gender dysphoria at some point in their lives. This disconnect between how society views you and how you feel physically and mentally can cause severe distress, anxiety, and depression.

2. Gender Identity and Gender Dysphoria

Gender identity is the deepest, most personal sense of being male, female, both, or neither. This being said some persons don’t feel to be the same sex as their biological one. For example, a person with male sexual characteristics, such as facial hair and male genitals, may not identify as male or feel masculine.

Changing appearance and behaviour is a common urge people with this condition have. Some feel comfortable with only these changes, while others choose medical or surgical procedures for permanent change.

3. Is it common?

The exact number of individuals experiencing it is unknown, as many people with the condition do not seek professional help. Previously, it was rare or uncommon, but the number has increased significantly over the years due to increased public awareness.

4. Statistics

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) reports a prevalence of gender dysphoria at 0.005-0.014% among individuals assigned male at birth and 0.002-0.003% among individuals assigned female at birth.

This condition can affect anyone. Neither gender, social status, background, nor age has anything to do with it.

Some people think that only transgender individuals are affected, but this is not the case. This condition is not exclusive to one gender. Even cisgender individuals (people whose gender matches the sex registered for them at birth) can be affected. In their case, gender roles in society can

While some people mistakenly believe that only transgender individuals are affected by it, the truth is that it is not exclusive to one gender. Even cisgender individuals, whose gender identity matches the sex assigned to them at birth, may experience distress due to societal expectations related to gender roles.

5. What Does Gender Dysphoria Feel Like?

It feels different for everyone. Usually, people with the condition not only feel misalignment with their assigned sex, but they also dislike their sexual characteristics and long for the sexual attributes of another gender.

Some may experience distress, discomfort, anxiety, restlessness, or sadness. However, if they don’t have access to gender-affirming care, these intense emotions can lead to depression, substance abuse, suicidal ideation, attempts, or conflicts with peers.

6. The Causes/Triggers

An Individual suffering from Gender Dysphoria

The exact causes are not completely understood. However, certain factors come into interplay for its development, which include:

1. Biological Factors

* Prenatal Hormones:

The abnormal level of sex hormones (androgens or estrogens) during fetal development can impact brain development, subsequently resulting in gender dysphoria.

* Congenital Conditions:

Congenital conditions like Congenital Adrenal Hyperplasia (CAH) and Partial Androgen Insensitivity Syndrome (PAIS) can cause irregular hormone production. Typical hormone development and production are impacted by this interference. This can lead to physical attributes not aligning with expected characteristics based on assigned sex.

* Brain Structure:

Brain structure can be the cause of this condition. According to the research the brain structures of cisgender and transgender persons have subtle variations. However, it is still uncertain if there is a link between these differences and gender identity.

2. Psychosocial Factors

* Experiences in childhood:

Early exposure to rigid gender norms and expectations can also be a factor.

* Internalised Transphobia:

The dysphoria can be made worse by negative experiences related to gender, such as discrimination, lack of acceptance, and societal stigma.

* Co-occurring mental health conditions:

Anxiety and depression can make this condition worse.

7. Types

1. Body Dysphoria

This type of dysphoria is related to secondary sexual characteristics, such as facial hair, genitals, chest, body shape, or voice.  A person may feel like they don’t align with their gender identity and this can cause a lot of distress and discomfort. It develops after entering puberty or reaching sexual maturity.

2. Social Dysphoria

This refers to discomfort that occurs when being perceived by others. It can be caused by being misgendered by others and being titled incorrectly. It is extremely common in nonbinary people.

3. Mind Dysphoria

Mind dysphoria implies emotional or psychological distress associated with one’s internal sense of gender. Individuals may experience persistent internal conflict that their inner sense of gender identity doesn’t match with physical characteristics.

8. Signs and Symptoms

It might start in childhood and continue into adolescence and adulthood. The symptoms experienced by the different age groups may differ.

1. Symptoms in Children

According to DSM-5, children might be experiencing gender dysphoria if they consistently display two or more of these symptoms for at least six months:

  • Desiring to be another gender
  • Preferring the stereotypical role associated with another gender in imaginary play
  • Experiencing a strong dislike for one’s sexual characteristics
  • Desiring to don clothing aligned with their identified gender
  • Expressing a strong inclination towards friendships with individuals of their identified gender
  • Demonstrating a strong preference for toys, activities, and games typically linked to their identified gender
  • Expressing a strong yearning for sex characteristics, such as breasts or penises, that correspond with their gender identity

2. Symptoms in Adults and Adolescents

Adults and adolescents might be experiencing gender dysphoria if they consistently display two or more of these symptoms for at least six months:

  • Intense urge to get rid of primary and secondary sexual characteristics.
  • Wistful wish to stop the development of secondary sexual characteristics.
  • Strong belief in having feelings and reactions of another gender.
  • Profound belief that their gender does not match their physical body.
  • Frantic urges to have the sex characteristics of the gender with which they identify.
  • Extreme desire to be of a different gender.
  • Wanting to be treated as another gender.

9. Co-occurring conditions

This condition can often co-exist with other conditions. This can make exploring gender identity even harder. Some of the most common are:

  1. Anxiety

Anxiety about expectations from society, discrimination or the process of self-discovery is very common. It involves excessive worry, fear, and nervousness, which can severely impact daily life.

  1. Depression

Social isolation, discrimination, and lack of support can make feelings of sadness, hopelessness, and low self-esteem worse.

  1. Eating Disorders

This comes hand in hand with body dysphoria type and involves irregular eating habits and being worried about weight and shape of the body. Some people develop or experience eating disorders as a result of not being happy in the body they have.

  1. Post-Traumatic Stress Disorder (PTSD)

PTSD usually affects people who, due to their gender identity, face discrimination, violence, and lack of acceptance.

  1. Attention-Deficit/Hyperactivity Disorder (ADHD)

Research studies suggest that there is an underlying link between ADHD and gender dysphoria. Individuals with gender dysphoria are more likely to experience ADHD approximately 75% of the time.

  1. Substance Abuse

Individuals overindulge in substances such as alcohol or drugs as a way to cope with distress related to gender identity.

10. Diagnosis

  1. Clinical Assessment

During clinical assessment gender identity, medical and psychiatric history, substance abuse history, and social and developmental history are evaluated. It also includes a questionnaire about the support system to develop support strategies and tailored interventions.

  1. Physical Examination

It is used to rule out any underlying condition contributing to the symptoms.

  1. Diagnosis Criteria as per DSM-5

Diagnostic criteria are not the same for children, adults, and adolescents. To get a Gender Dysphoria diagnosis, normal functioning in important areas of life, such as work and social situations, has to be severely impaired.

  1. Ruling Out Other Conditions

For an accurate diagnosis, it is important to rule out other conditions that have similar symptoms.

11. Treatment

A symbolic representation of identity and transformation. The image shows a butterfly emerging from a cocoon, symbolizing metamorphosis and change.

Many healthcare professionals are included in the treatment. Endocrinologists, therapists, and surgeons may be needed. The treatment for gender dysphoria can be broadly categorised into:

  1. Medical interventions
  2. Psychotherapy
  3. Non-medical interventions

1. Medical interventions

Many medical interventions are used to align physical appearance with the gender identity of a person. We will talk about them in short in the following text.

*  Hormone Therapy

To get the physical characteristics of the affirmed gender hormone therapy is used with the help of an endocrinologist. Most often, sex hormones testosterone or estrogen are used to develop the desired gender traits.

Feminising Hormonal Therapy (FHT)

Transgender and non-binary persons use this treatment to develop feminine secondary sex characteristics. The action of testosterone is blocked by a combination of medicines, such as estrogen, anti-androgens, or progesterone.

Masculinising Hormonal Therapy (MHT)

Masculinising hormone therapy helps transgender and non-binary individuals assigned to females at birth develop masculine secondary sex characteristics, such as an increase in facial hair, muscle mass, and libido. The primary hormone used in MHT is testosterone. It comes in the form of injections, patches, gels, or implants.

Puberty-blocking Hormones

This is used to get more time for a person to be ready and affirm their gender. Physical changes that happen in puberty are suppressed by blocking testosterone and estrogen.

* Gender-Affirming Surgery

Gender affirmation surgery, also known as sex reassignment surgery, is a medical procedure that permanently changes physical appearance to align with gender identity.

Here are some types of gender affirmation surgeries:

Top Surgery – Can be breast augmentation surgery or chest masculinisation surgery. During breast augmentation surgery breast tissue is added in trans women. On the opposite, chest masculinisation surgery involves procedures to remove breast tissue in men.

Bottom Surgery – Vaginoplasty, a procedure in which a vagina is constructed and the penis and scrotum are removed. Surgical procedures such as metoidioplasty or phalloplasty create a penis for trans men using tissues from various areas of the body.

Facial Procedures – Facial Feminisation Surgery helps achieve a more feminine facial appearance. It normally includes jaw reduction, nose reshaping and cheek augmentation. Facial Masculinisation Surgery involves reshaping bones and soft tissues for a more masculine facial appearance.

2. Psychotherapy

Psychotherapy helps individuals with their gender identity without needing the help of gender-affirming surgery or hormone-based therapy.  It is not used to change gender identity but to help deal with the problems one may face surrounding gender.

Some of the common types of psychotherapy used are:

Dialectical Behavioural Therapy (DBT)

Therapists commonly use Dialectical Behavior Therapy (DBT) to treat gender dysphoria in children. DBT helps children understand that their emotions are normal and equips them with skills to manage and improve their well-being.

Individual Therapy

It employs techniques such as cognitive-behavioural therapy (CBT) to assist individuals in addressing negative thoughts and behaviours related to their gender identity and developing coping mechanisms.

Group Therapy 

According to the research studies, group therapy is very beneficial for those suffering from gender dysphoria. During the sessions, they feel free to explore their sexual identity and at the same time gain community and sense of belonging.

Family Therapy

Family therapy is responsible for creating stronger bonds between family members, therefore creating higher support.

It helps in creating a supportive environment where members can feel seen, heard, and loved.

3. Non-medical Interventions

Non-medical interventions include social and legal affirmations.

Social affirmation means recognising and respecting someone’s gender identity in social interactions.

It includes:

  • Using the individual’s chosen name and pronouns
  • Dressing and presenting in a way that aligns with their gender identity
  • Using gender-neutral language in social interaction
  • Providing emotional support and validation

Legal affirmation involves legally recognising and documenting an individual’s chosen identity. It includes:

  • Changing the legal name and gender markers in official documents (e.g. birth certificates, passports, or driver’s licenses)
  • Gaining legal recognition through court orders or self-declaration processes (varies by jurisdiction).

12. Coping Mechanisms

Coping with feelings of gender dysphoria typically involves treatment that focuses on helping people feel more comfortable with their gender identity.

Some other strategies that can help people manage include:

1. Finding Support
Try joining a support group and talking to peers with similar experiences. As stated previously in the text, group therapy is highly effective in making people with this condition feel better.

2. Reducing Discomfort
Practices like breast binding or genital tucking help minimise physical characteristics. This may help with feeling uncomfortable in your body.

3. Caring for Yourself
Prioritise self-care and emotional wellness by participating in activities that bring you joy and contribute to a positive self-perception of your body.

4. Affirming Your Identity
Try doing small things that will help affirm your gender identity. It might include wearing certain accessories, changing your hairstyle, or asking others to refer to you by your preferred pronouns.

5. Planning for the Future
People may also choose to pursue legal options to transition to their desired gender as well as transitioning in social settings. Research the steps and make a plan that will help you work toward your long-term goals.

6. Meditation
Meditation helps individuals focus their minds on the present moment, which helps reduce stress, promote relaxation, and enhance mental well-being.

7. Self-soothing Activities
Self-soothing activities are behaviours and actions, such as journaling, drawing, listening to calm music, and painting, that provide comfort during distress.

Get Help At Psychology Blossom

Psychology Blossom's Counselling Room

Exploring the complexities of gender identity can be overwhelming. At Psychology Blossom, a Therapy and Counselling Centre in Singapore, we recognise the significance of every step you take.

If you identify with signs of gender dysphoria, our professional counselling services are here to provide a supportive and understanding environment.

Remember, you’re not alone in this journey. Your well-being is our priority, and we’re here to support and guide you every step of the way.

Feeling Alone in Your Journey? We’re Here to Listen.

Watch the video attached to learn more!

Contact Us

Message: +65 8800 0554

Phone: +65 8686 8592

[email protected]

Gender Dysphoria FAQs:

Is Gender Dysphoria a Disorder?

It is still a matter of debate. Previously, it received the label of ‘Gender Identity Disorder’. However, due to concerns about stigmatisation and the recognition that gender identity isn’t an illness, it is now classified in DSM-5 as a ‘condition for further study’. This shift indicates that the focus has moved from viewing gender dysphoria as a disorder to recognising it as a natural variation in human experience.

Nevertheless, it’s important to note that it’s still included in DSM-5 to ensure that individuals who require gender-affirming care, such as hormone therapy or gender-affirming surgeries, can receive the appropriate medical support.

What Happens If You Don’t Treat Gender Dysphoria?

Untreated gender dysphoria can have a negative impact on individual well-being, such as:

Reduced quality of life.

Increased anxiety and depression.

Increased risk of suicidal thoughts or attempts.

Decreased self-esteem and self-worth.

Increased isolation and loneliness due to lack of social acceptance.

Increased risk of substance abuse.

Can Gender Dysphoria Go Away After Puberty?

Gender dysphoria doesn’t always disappear after puberty. In some cases, it can further exacerbate due to the development of secondary sex characteristics, which further highlights the mismatch between a person’s internal sense of gender and their assigned sex. However, for some people, gender dysphoria becomes more manageable over time due to societal acceptance, access to gender-affirming care, and supportive environments.

When Does Gender Dysphoria Start?

It might start in early childhood, recognising a disconnection between their assigned sex and their internal sense of gender. Others may not experience it until later in adolescence or adulthood due to societal expectations, lack of awareness, or fear of rejection. In addition, research studies suggest that individuals experience gender dysphoria around the age of 3 and 7.

Can Hormone Imbalance Cause Gender Dysphoria?

Hormonal imbalance can mimic the symptoms of gender dysphoria, including changes in mood, energy levels, and physical appearance, but it is not the direct cause of it. While hormonal imbalance can affect the development of secondary sex characteristics during puberty, gender dysphoria is rooted in a person’s internal sense of gender.

How Do We Deal With Gender Dysphoria Without Transitioning?

Feeling unprepared for social, legal, or medical transition is okay. Transitioning is not the only option to alleviate gender dysphoria; there are still some ways to manage and cope with gender dysphoria effectively. They are:

Engaging in self-care activities

Talking to your friends and family about what you’re experiencing

Seeking assistance from a mental health care provider

Exploring who you are

Finding ways to express your gender

Joining a support group

Can Gender Dysphoria Get Worse With Age?

The relationship between age and gender dysphoria is complex and varies from person to person. Children often freely express themselves outside their assigned gender roles without fearing repercussions, but it can become more challenging as they grow older due to an increase in societal expectations.

Regardless of age, individuals lacking access to care, support or social acceptance may experience negative impacts on their mental health, potentially exacerbating symptoms of gender dysphoria. Nevertheless, even those who transition later in life can still find welcoming communities and experience the relief of living as their true selves.

Is There a Gender Dysphoria Test?

If you find yourself questioning your gender identity and want to determine whether you are experiencing gender dysphoria, you can take online self-evaluation tests. These tests offer you deep insights into your gender identity, helping you to figure out whether you need to seek help in exploring your gender identity and reducing symptoms of gender dysphoria. However, it’s important to note that they are not proper diagnostic tools; reach out to your healthcare providers for an appropriate diagnosis.

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