Gender Dysphoria

An abstract representation of Gender Dysphoria.

Gender dysphoria goes beyond personal preferences; it's a deep internal conflict where your sense of self clashes with the gender the world sees. For those living with this discord, it's like wearing an ill-fitting suit every day, leading to frustration, sadness, and confusion, which can negatively impact self-image and behaviour, leading to anxiety and depression.

Fortunately, we can help alleviate gender dysphoria in both children and adults through gender-affirming care and societal support and acceptance. Stay in the loop with us to learn more.

 

What is Gender Dysphoria?

Gender dysphoria 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.

 

Gender Identity and Gender Dysphoria

Gender identity is the innermost, personal sense of whether one is male, female, both, or neither. However, some individuals experience an incongruence between their gender identity and biological sex. For example, a person with male sexual characteristics, such as facial hair and male genitals, may not identify as male or feel masculine.

Individuals with gender dysphoria feel a strong urge to live a life that aligns with their gender identity by changing their appearance or behaviour. Some find satisfaction through gender expression alone, while others opt for gender-affirming medical or surgical procedures for a permanent change.

 

How Common is Gender Dysphoria?

The exact number of individuals experiencing gender dysphoria 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.

 

Gender Dysphoria 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.

 

Who Suffers From Gender Dysphoria?

Gender dysphoria can affect anyone, regardless of age, gender, background, or social status. While some people mistakenly believe that only transgender individuals are affected by gender dysphoria, 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.

 

What Does Gender Dysphoria Feel Like?

Gender dysphoria feels different for everyone. Usually, people with gender dysphoria 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.

 

What Causes/Triggers Gender Dysphoria?

An Individual suffering from Gender Dysphoria

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

1. Biological Factors

i. Prenatal Hormones:

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

ii. Congenital Conditions:

Congenital conditions like Congenital Adrenal Hyperplasia (CAH) and Partial Androgen Insensitivity Syndrome (PAIS) can cause irregular hormone production. This interference affects typical hormone production and development. Disruption can lead to physical attributes not aligning with expected characteristics based on assigned sex.  This misalignment may contribute to the experience of gender dysphoria.

iii. Brain Structure:

Research studies indicate subtle variations in the brain structures of cisgender and transgender individuals. However, the exact cause-and-effect relationship between these differences and gender identity remains uncertain.

2. Psychosocial Factors

i. Childhood experience:

Early exposure to rigid gender norms and expectations can contribute to gender dysphoria.

ii. Internalised Transphobia:

Negative experiences related to gender, such as discrimination, lack of acceptance, and societal stigma, can lead to distress or self-denial, which can exacerbate the dysphoria.

iii. Mental health conditions:

Co-occurring mental conditions like anxiety and depression can intensify gender dysphoria.

 

Types of Gender Dysphoria

1. Body Dysphoria

Body dysphoria refers to discomfort or distress an individual may experience with their physical characteristics. Typically, it includes secondary sexual characteristics (develops after entering puberty or reaching sexual maturity), such as facial hair, genitals, chest, body shape, or voice.

2. Social Dysphoria

Social dysphoria refers to distress or discomfort that occurs due to how society perceives or treats an individual based on their gender identity. It includes issues like facing discrimination, struggling with societal expectations, or feeling misgendered by others.

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.

 

Signs and Symptoms of Gender Dysphoria

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

Gender Dysphoria 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

Gender Dysphoria 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.
  • Keen desire to be of a different gender.
  • Genuine desire for others to treat them as another gender.

 

Co-occurring conditions with Gender Dysphoria

Gender dysphoria can often co-exist with other conditions, creating additional challenges in exploring gender identity. Some of the common co-occurring conditions are:

1. Anxiety

Individuals with gender dysphoria may experience anxiety related to societal expectations, discrimination, or the process of self-discovery. It involves excessive worry, fear, and nervousness, which can severely impact their daily life.

2. Depression

Feelings of sadness, hopelessness, and low self-esteem can characterise depression. When individuals with gender dysphoria face social isolation, discrimination, and lack of access to support, these feelings may further exacerbate.

3. Eating Disorder

Eating disorders involve irregular eating habits and concern about body weight or shape. Some individuals with gender dysphoria may develop or experience eating disorders as a way to cope with distress related to body image.

4. Post-traumatic Stress Disorder (PTSD)

Transgender individuals who experience trauma related to their gender identity, such as discrimination, violence, or lack of acceptance, are at higher risk of developing Post-Traumatic Stress Disorder (PTSD). It can result in a wide range of symptoms, including intrusive thoughts, flashbacks, nightmares, and avoidance behaviours.

5. 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.

6. Substance Abuse

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

 

Gender Dysphoria Diagnosis

1. Clinical Assessment

Healthcare providers evaluate an individual's gender identity, medical and psychiatric history, substance abuse history, and social and developmental history during clinical assessments. Additionally, it includes questions about the level of support from family and peers to develop tailored interventions and support strategies.

2. Physical Examination

It helps determine whether there is an underlying co-occurring condition contributing to symptoms of gender dysphoria.

3. Diagnosis Criteria as per DSM-5

The therapist may use the criteria outlined in DSM-5 for the diagnosis of gender dysphoria for an accurate diagnosis. There are specific diagnostic criteria for children, adults, and adolescents. However, to receive a Gender Dysphoria diagnosis, an individual must experience significant distress or impairment in important areas of their life, such as social or occupational functioning.

4. Exclusion of Other Conditions

It's important to differentiate gender dysphoria from other conditions that share similar symptoms, such as depression, anxiety, or eating disorders, to get an accurate diagnosis.

 

Gender Dysphoria Treatment

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

Multiple healthcare professionals like endocrinologists, therapists, and surgeons may be required to address gender dysphoria, as individuals may need a combination of various gender affirmation treatments. We can categorise these treatments broadly into:

1. Medical Affirmation

Healthcare providers can use various medical interventions to align the individual's physical appearance and how they feel. It includes:

i. Hormone Therapy

Individuals seeking physical characteristics of their affirmed gender can undergo hormone therapy with the help of an endocrinologist. Usually, Individuals take sex hormones like testosterone or estrogen to develop the traits of the gender with which they identify.

a. Feminising Hormonal Therapy (FHT)

It involves taking a combination of medicines, such as estrogen, anti-androgens, or progesterone, to block the action of testosterone. This process helps transgender or non-binary individuals assigned male at birth develop feminine secondary sex characteristics, such as breast enlargement, facial hair elimination, and a female body contour.

b. 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, which comes in the form of injections, patches, gels, or implants.

c. Puberty-blocking Hormones

It helps to suppress the physical changes associated with puberty until they are ready to affirm their gender. They work by blocking testosterone and estrogen, which leads to puberty-related changes in the body, such as voice deepening, facial hair growth, breast enlargement, etc.

ii. 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:

a. Top Surgery

  • Breast augmentation surgery

It involves procedures to add breast tissue in trans women.

  • Chest masculinisation surgery

It involves procedures to remove breast tissue in trans men.

b. Bottom Surgery

Trans women undergo vaginoplasty, a procedure that constructs a vagina following the removal of the penis and scrotum. Surgical procedures such as metoidioplasty or phalloplasty create a penis for trans men using tissues from various areas of the body.

c. Facial Procedures

  • Facial Feminisation Surgery 

It helps achieve a more feminine facial appearance through jaw reduction, nose reshaping and cheek augmentation.

  • Facial Masculinisation Surgery 

This process involves reshaping bones and soft tissues to create 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. The goal of psychotherapy is not to change one's gender identity but, instead, to tackle the issues surrounding gender and explore methods to alleviate gender dysphoria.

Some of the common types of psychotherapy used for treating gender dysphoria are:

i. 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.

ii. 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.

iii. Group Therapy

Research studies suggest that group therapy reduces and manages psychological distress related to gender dysphoria and explores gender identity. Group therapy offers a safe and supportive space to connect with individuals who share similar experiences. It helps individuals feel they are not alone and gain a sense of belonging.

iv. Family Therapy 

Family therapy helps improve communication between family members, facilitating the development of stronger and more supportive relationships.

By working together, families can create a safe and supportive environment where their loved ones feel seen, heard, and loved.

3. Non-medical Interventions

i. Social Affirmation

Social affirmation involves acknowledging and respecting an individual's gender identity in social interaction. 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

ii. Legal Affirmation

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)
  • Obtaining legal recognition through court orders or self-declaration processes (varies by jurisdiction).

 

Coping Mechanisms for Gender Dysphoria

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 feelings of gender dysphoria include:

i. Finding Support

Try joining a support group and talking to peers with similar experiences.

ii. Reducing Discomfort

Use practices like breast binding or genital tucking to minimise physical characteristics contributing to dysphoria.

iii. Caring for Yourself

Prioritise self-care and emotional wellness by participating in activities that genuinely bring joy and contribute to a positive self-perception of your body.

iv. 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 you by your preferred pronouns.

v. Planning for the Future

People may also opt 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.

vi. Meditation

Meditation helps individuals focus their minds on the present moment, which helps reduce stress, promote relaxation, and enhance mental well-being. Many individuals lean on spirituality and faith communities for comfort and support, helping to manage difficult emotions related to gender dysphoria.

vii. Try 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. Contact Us Now!

 

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