Gender dysphoria in adults

Gender dysphoria, also known as gender incongruence, is present when there is a distressing dissonance between a person's biological sex and associated social gender role, as assigned at birth, and that person's sense of their own gender.

Many adults with gender dysphoria will not seek specialist medical intervention, and prevalence is likely underestimated.

In children and adolescents, gender dysphoria is particularly complicated, may have higher comorbidity, and may change form as patients mature, making specialist assessment particularly important. This topic covers the management of gender dysphoria in adults only.

Subspecialty consultation is required for any patient with suspected or confirmed gender dysphoria (gender incongruence). Treatment is complex and should only be undertaken as part of a package of care provided by a multidisciplinary team with extensive experience in this area.

Gender non-conformity is when a person’s gender identity, role, or expression differs from the cultural norms prescribed for people of a particular sex.[1]Coleman E, Bockting W, Botzer M, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, v7. Int J Transgend. 2012;13(4):165-232. https://www.wpath.org/publications/soc

Gender dysphoria, also known as gender incongruence, is present when there is a distressing dissonance between a person's biological sex and associated social gender role, as assigned at birth, and that person's sense of their own gender.[1]Coleman E, Bockting W, Botzer M, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, v7. Int J Transgend. 2012;13(4):165-232. https://www.wpath.org/publications/soc [2]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition (DSM-5). Washington, DC: American Psychiatric Publishing; 2022. https://ebooks.appi.org/product/diagnostic-statistical-manual-mental-disorders-fifth-edition-text-revision-dsm5tr [3]World Health Organization. International statistical classification of diseases and health related problems (ICD). 11th revision. Jan 2022 [Internet publication]. https://icd.who.int/en 'Gender identity disorder' and related terms should be avoided due to their connotations with mental ill health and the associated stigma. APA: gender dysphoria Opens in new window WHO: FAQs Gender incongruence and transgender health in the ICD Opens in new window

People with gender dysphoria express the desire to live and be accepted in a social gender role other than that assigned at birth. Gender dysphoria is usually accompanied by a sense of discomfort with one's own body, particularly those primary and secondary sexual characteristics others use to assign social gender role, such as genitals, breasts, or facial hair.[2]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition (DSM-5). Washington, DC: American Psychiatric Publishing; 2022. https://ebooks.appi.org/product/diagnostic-statistical-manual-mental-disorders-fifth-edition-text-revision-dsm5tr

Only some gender non-conforming people experience gender dysphoria at some point in their lives.[1]Coleman E, Bockting W, Botzer M, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, v7. Int J Transgend. 2012;13(4):165-232. https://www.wpath.org/publications/soc

The historical terms ‘transvestite’ and ‘transsexual’ are considered pejorative, and their use should be avoided.