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Gender dysphoria in adults

Last reviewed: 4 Sep 2023
Last updated: 07 Jun 2022



History and exam

Key diagnostic factors

  • incongruence between birth-assigned gender and experienced gender
  • altered appearance or affect
More key diagnostic factors

Risk factors

  • congenital adrenal hyperplasia
  • partial androgen insensitivity syndromes
  • Klinefelter syndrome
More risk factors

Diagnostic investigations

1st investigations to order

  • serum testosterone
  • serum dihydrotestosterone
  • serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
  • serum prolactin
  • serum liver function tests
  • serum lipid screen
  • CBC
More 1st investigations to order

Treatment algorithm


born males

born females



James Barrett, FRCPsych, BSc, MSc

Consultant Psychiatrist and Lead Clinician

Charing Cross Gender Identity Clinic




JB has produced educational material for the Royal College of Physicians Gender Healthcare course and is a tutor on the course. He has occasionally received payment for speaking engagements on the subject and usually gets paid expenses. JB is an author of a number of references cited in this topic.

Peer reviewers

Roy Goldberg, MD

Medical Director

Kings Harbor Multicare Center




RG declares that he has no competing interests.

Craig N. Sawchuk, PhD

Affiliate Assistant Professor

Department of Psychiatry and Behavioral Sciences

University of Washington Medical Center




CNS declares that he has no competing interests.

  • Differentials

    • Autogynephilia
    • Body dysmorphic disorder
    • Ego-dystonic sexual orientation
    More Differentials
  • Guidelines

    • Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR)
    • International Classification of Diseases 11th revision (ICD-11)
    More Guidelines
  • Patient leaflets

    Gender dysphoria in adults: what is it?

    Gender dysphoria in adults: hormone treatment

    More Patient leaflets
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