Gender dysphoria in adults

Last reviewed: 1 Sep 2022
Last updated: 07 Jun 2022
07 Jun 2022

ICD-11 represents major shift in the classification of gender identity-related health

The World Health Organization’s International classification of diseases 11th revision (ICD-11) came into effect in February 2022 and includes significant updates to the classification of gender identity-related health compared with ICD 10th revision (ICD-10).

These include:

  • Gender identity disorder" and "transsexualism" have been replaced with "gender incongruence".

  • New diagnostic categories have been moved out of the "Mental and behavioral disorders" chapter and into the new "Conditions related to sexual health" chapter.

Minor changes have also been made to terminology used in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR), published in March 2022.

These include:

  • Use of "experienced gender" rather than "desired gender".

  • Use of "gender-affirming" rather than "cross-sex" in relation to treatment and medical procedures.

It is hoped that the updates to language used in ICD-11 and DSM-5-TR will help remove stigma associated with gender diversity.

See Diagnosis: criteria

Original source of update



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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