Gender dysphoria !

Distress caused by a mismatch between a person's gender identity and the sex assigned at birth. Being transgender is not a disorder.

Updated 2026-11-01

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What it is

A diagnosis that describes clinically significant distress or impairment caused by a marked incongruence between a person's experienced gender and the sex assigned at birth, lasting at least 6 months. Being transgender or gender diverse is not a mental disorder; the diagnosis focuses on the distress. ICD-11 moved the concept («gender incongruence») out of mental disorders into conditions related to sexual health.

Who gets it

Estimates vary widely by definition; the number of people seeking gender-affirming care has increased worldwide, especially adolescents. Transgender people in Colombia and Latin America face high rates of discrimination, violence and barriers to health care. Colombia allows correction of the sex marker in identity documents through a notarial procedure.

Causes

Gender identity develops from an interaction of biological, psychological and social factors
Prenatal hormone exposure and genetic factors are thought to contribute
Distress is increased by rejection, stigma and discrimination (minority stress)

Risk factors

Lack of family and social support
Bullying, discrimination and violence
Barriers to respectful health care
Coexisting autism spectrum disorder (higher rates of gender diversity are reported)
Puberty, when body changes can intensify distress

Pathophysiology

No single biological mechanism is established. The distress arises from the incongruence between gender identity and the body or the gender role assigned by others, and is greatly amplified by stigma, rejection and violence. Puberty, driven by the hypothalamic–pituitary–gonadal axis, often intensifies distress, which is why puberty suppression with GnRH analogues acts at this level.

Classification

Gender dysphoria in children (at least 6 of 8 criteria, including the desire to be of another gender)
Gender dysphoria in adolescents and adults (at least 2 of 6 criteria)
Specifier: with a difference of sex development
Specifier: post-transition

Symptoms and signs

Strong, persistent desire to be, or insistence that one is, another gender
Strong dislike of one's sexual anatomy or wish to prevent expected puberty changes
Wish to be treated as another gender
Preference for clothes, roles or play typical of another gender (children)
Anxiety, low mood, social withdrawal or self-harm linked to distress

Diagnosis

Clinical: Clinical diagnosis after a respectful, comprehensive assessment by an experienced team: incongruence lasting at least 6 months with significant distress or impairment. Assess mental health, suicide risk, family and social support, and coexisting conditions. Use the person's chosen name and pronouns. Conversion («reparative») practices are harmful and are rejected by professional bodies.
Tests: Not needed for diagnosis. Before hormone treatment: baseline blood tests such as blood count, lipids, liver function and hormone levels, and screening for sexually transmitted infections when indicated. Karyotype only if a difference of sex development is suspected.
Imaging: Not needed for diagnosis. Bone density may be assessed during long-term puberty suppression or hormone treatment.

Differential diagnosis

Gender non-conformity without distress (not a disorder)
Transvestic disorder (cross-dressing linked to sexual arousal, without identity incongruence)
Body dysmorphic disorder
Psychotic disorder with gender-related delusions (rare)
Differences of sex development (assessed and specified, not excluded)

Goal of treatment

Reduce distress and improve well-being and functioning through individualised, affirming, multidisciplinary care; treat coexisting mental health problems and prevent suicide.

Treatment

Conservative: Psychological support and exploration of gender identity without a predetermined outcome; family therapy and peer support
Conservative: Social transition (name, pronouns, presentation) and legal change of documents, chosen by the person
Medical: Medical care by specialised teams: puberty suppression with GnRH analogues in selected adolescents, and gender-affirming hormones (oestrogens with antiandrogens, or testosterone) in older adolescents and adults; never in prepubertal children
Surgical: Gender-affirming surgery for some adults, after careful assessment
Follow-up: Monitoring of mental health, suicide risk, and hormone effects such as thrombosis, liver tests, lipids and bone health

Complications

Depression, anxiety and suicide attempts, largely linked to stigma and rejection
Harm from unsupervised hormones or injected industrial silicone
Violence and social exclusion
Venous thromboembolism and reduced bone density as hormone-related risks

Prognosis

Distress usually improves with acceptance, family and social support and access to affirming care. Childhood gender diversity does not always persist into adolescence; persistence after puberty is more stable.

Prevention

Family and school acceptance and anti-bullying policies
Non-discriminatory health services and staff training
Avoiding conversion practices

Test yourself

Think of the answer, then tap the question to see it.

Is being transgender in itself a mental disorder?

No; gender dysphoria refers to the clinically significant distress or impairment, not to the identity itself.

What minimum duration of incongruence is required for a diagnosis of gender dysphoria?

At least 6 months.

Which medicine class is used to suppress puberty in selected adolescents with gender dysphoria?

GnRH analogues.

Which serious adverse effect is monitored during oestrogen-based hormone therapy?

Venous thromboembolism.

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Educational information, not medical advice. For any symptom, see a health professional.

Sources: What is Gender Dysphoria? (American Psychiatric Association, 2024).

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Representative model, for educational purposes only.

Hypothalamus highlighted on the Durgical 3D model