Gender dysphoria
Gender dysphoria is the marked incongruence between a person's experienced gender and the sex assigned at birth, present for at least 6 months and accompanied by clinically significant distress or impairment; gender nonconformity alone is not a disorder. Diagnosis is clinical, and management is a stepped, individualized plan of psychosocial support and social transition, pubertal suppression or gender-affirming hormone therapy for those who want it, and surgery considered only after at least 1 year of continuous hormone therapy.
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What this article covers
- Overview
Definition: gender dysphoria is the marked, persistent incongruence between a person's experienced gender and the gender assigned at birth, present for at least 6 months and causing clinically…
- Epidemiology
Sex distribution: reported more commonly in individuals assigned male at birth.
- Risk factors
Persistent childhood cross-gender identification: a lifelong sense of being the other gender, beginning in early childhood, characterizes individuals who later seek gender affirmation.
- Pathophysiology
Distress-based mechanism, not an anatomic disease: the disorder is defined by psychological distress from incongruence between an internally experienced gender identity and the sex characteristics…
- Clinical features
Core presentation: persistent incongruence between experienced gender and sex characteristics that has caused clinically significant distress or impairment for at least 6 months.
- Differential diagnosis
Gender nonconformity without dysphoria: a person expresses a gender identity or role different from societal expectations but has no persistent, clinically significant distress or impairment; this is normal variation, not a diagnosis.
- Diagnosis
The diagnosis is clinical: it requires the symptom-count-and-duration threshold above (2 or more characteristic features plus significant distress or impairment, persisting at least 6 months); no…
- Management
First, provide psychosocial support and address comorbid psychiatric conditions: engage the patient (and family, for minors) in multidisciplinary therapy, including safety assessment, before or alongside any medical step.
- Complications
Untreated distress: unaddressed gender dysphoria is associated with depression, anxiety, substance use disorders, and personality disorders; treat these comorbidities alongside gender-affirming care, not after it.
- Prognosis
Relief with affirming care: psychosocial support, social transition, and, when desired, hormone or surgical affirmation relieve the distress that defines the disorder.
- Prevention
Ongoing monitoring on hormone therapy: clinical and laboratory evaluation every 2-3 months during year 1 of gender-affirming hormone therapy, then every 6-12 months thereafter, to catch adverse effects early.
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