Gender dysphoria, also known as gender incongruence, may be experienced by transgender individuals and others whose gender does not align with the gender they were assigned at birth. Some people may develop mental health concerns as a result of distress experienced with gender dysphoria, but this incongruence itself is not a mental health condition, just as being transgender is not a mental health condition.
Many, though not all, trans people experience dysphoria. Non-binary, agender, and other gender nonconforming individuals might also experience dysphoria, as may some intersex people. Anxiety, depression, stress, and feelings of isolation may develop in those who experience dysphoria, and Dr. Kerryn Armstrong can offer support to individuals coping with these and other concerns.
Once thought to be a psychiatric condition, gender incongruence is now widely recognized as a medical condition that is potentially rooted in biological factors such as prenatal development of gender identity. However, the cause of dysphoric feelings, as well as the reasons some experience it and some do not, has not yet been determined. The experience of dysphoria differs by individual, and distress is not necessarily part of the experience of all trans individuals. For many, feelings of dysphoria can be distressing or uncomfortable, but not all individuals who experience dysphoria will be negatively impacted. Gender dysphoria itself does not indicate or cause mental health concerns, just as being transgender does not. However, people who have dysphoria may develop depression, anxiety, or face other challenges to mental and emotional well-being, often as a result of societal judgment, stigma, transphobia, and/or harmful stereotypes. People may experience dysphoria regardless of their gender identity; that is, non-binary or gender-nonconforming individuals are equally likely to experience body or social dysphoria.
Gender dysphoria is sometimes incorrectly associated with body dysmorphia, a condition associated with body image and anxiety, but the two are not related. People diagnosed with body dysmorphia usually experience persistent negative thoughts about what they feel are imperfections in their appearance, but these thoughts typically cause significant distress, often to the point where they interfere with daily life. Individuals diagnosed with body dysmorphia may seek to correct what they perceive to be flaws with surgery, but surgery is not considered a treatment for body dysmorphia, as it does not usually resolve the feelings of distress. Body dysmorphia is not related to gender identity.
Gender dysphoria may be experienced as body dysphoria, social dysphoria, or both. Body dysphoria may lead an individual to feel uncomfortable with the entire body or only with certain parts of the body. Some may feel as if they were born into the “wrong” body, but others may use different language to describe their personal experience. Because each person’s experience differs, no broad statement can describe how an individual may be affected by dysphoria.
Social dysphoria can describe distress and discomfort that occurs as a result of how one is viewed by society. Assuming a person’s gender, using incorrect pronouns, or making assumptions about social roles in relation to gender can all be factors contributing to a person’s experience of social dysphoria.
Individuals who are non-binary (people who do not identify as male or female) might experience both body and social dysphoria. Non-binary identities are often marginalized, ignored, or written off as "gender confusion." Some people may not even be aware of any gender identity other than male or female, and people who do not conform to societal expectations of gender may be stigmatized, misgendered (sometimes intentionally), and may face harassment. All of these can have a harmful impact and contribute to negative feelings, including dysphoria.
The term intersex describes the condition of having genitalia that does not align with genitalia typically described as female or male. An intersex condition may be noticed late in life, in adulthood, at birth, or may never be realized. In years past, when babies were born with intersex anatomy, doctors often performed surgery immediately to give the infant either male or female genitalia. Some doctors informed the parents and allowed them to make the choice, but some doctors performed these procedures without the parents' knowledge or consent. In either scenario, many children who were assigned a gender and then received surgery to physically align their bodies with that gender expressed a different gender identity later in life, and many of them experienced gender dysphoria.
Today, awareness of the harm this practice can cause is shifting the way intersex conditions are treated. Many doctors encourage parents to wait until children born with intersex are old enough to make an informed decision about surgery for themselves. Individuals who seek surgery on their own to align physical characteristics with their internal sense of gender may be less likely to experience dysphoria.
Many individuals first experience gender incongruence in childhood, but some may not have feelings of dysphoria until later in life. Children who express a gender identity different from the gender assigned at birth early in life may also have feelings of dysphoria at an early age. Some research has shown when these children are encouraged to live as their actual gender and are otherwise supported and accepted, they may be less likely to experience anxiety and depression and may experience greater emotional and mental well-being overall than those who are not supported.
People might develop feelings of dysphoria when they first realize their physical characteristics do not align with their gender, but they may also not experience feelings of dysphoria until later in life, if at all. Many individuals seek the help of a therapist when they first experience these feelings, but many more are not able to seek professional care, for any number of reasons. The lack of access to care may contribute to worsened feelings of dysphoria and may have an impact on mental and emotional well-being.
A person may continue to experience dysphoric feelings for months or even years. Some may be significantly impacted by dysphoria, but for others, the distressing feelings may only rarely surface. For many, outwardly expressing their actual gender helps address the sense of gender incongruence and may reduce dysphoric feelings. There is no specific treatment for gender dysphoria, but those experiencing distressing feelings typically can take a number of steps to address them.
Many work through feelings of dysphoria with the help of a trained therapist or counselor. Individuals who wish to take hormones and/or pursue surgery to better align physical characteristics with their gender may find feelings of dysphoria begin to ease as they take these steps. Some may simply live as their true gender without hormones or surgery. Many individuals legally change their name and gender marker to reflect their true gender, and for many individuals, it may be the case that being socially recognized as a member of their actual gender and being addressed by the correct pronouns helps to ease feelings of dysphoria.
People might develop feelings of dysphoria when they first realize their physical characteristics do not align with their gender, but they may also not experience feelings of dysphoria until later in life, if at all.Regardless of the stage a person is at in transition or whether or not a person transitions at all, gender dysphoria may still persist, and talking through any negative or distressing feelings with a therapist or counselor may be beneficial to many. Family acceptance and peer support can also have a positive impact. In general, greater awareness and social acceptance of trans and nonbinary identities may help make the experience of social dysphoria less likely for many.
It is important to note gender dysphoria is not linked to low self-esteem. People with gender dysphoria may experience low self-esteem, like anyone else, but encouraging individuals to love their body or have more self-confidence or otherwise attempting to treat low self-esteem will not resolve feelings of distress related to gender dysphoria and may have a negative impact. Individuals who seek therapeutic treatment may wish to find a therapist who specializes in the treatment of gender dysphoria.
When individuals with gender dysphoria also experience depression, anxiety, or other concerns, a therapist will treat these also. Some individuals may be referred to a psychiatrist for medication to treat these conditions, or they may continue in therapy for treatment of other concerns even if they do not continue to experience gender dysphoria.
Many individuals who experience gender dysphoria do not have access to any sort of counseling or medical care. Every person should have access to care and all treatment options, whether they choose to pursue any manner of treatment or not. Increased awareness of transgender and nonbinary identities, people who are intersex, and the challenges they may face is likely to be a helpful step in greater recognition of gender dysphoria and an increase in access to compassionate medical and mental health care.