Gender dysphoria - what is it?

Gender dysphoria occurs when someone feels trapped in a body that does not coincide with their own sense of gender. This is a complex condition but finding out more about what causes it, how it can be treated and where people with the condition stand within the law is useful to understanding how to help those affected live the lives they want.

This article on gender dysphoria is by Kathryn Senior, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites. 

What is gender dysphoria?

Gender is a much more complex issue than simply being either male or female. There are three different facets to gender:

• Your biological sex - as determined by your genitalia and chromosomes
• Your gender identity – that is your own personal sense of who you are
• Your gender role – such as the clothes you wear and the way you behave

Gender dysphoria occurs when there is conflict between a person’s biological sex and either their gender identity or the gender role they choose. Many people with gender dysphoria describe themselves as someone who is trapped in a body that is the ‘wrong’ sex for the way they feel.

It is important to stress that gender dysphoria has no bearing on sexuality and should not be confused with homosexuality or being a transvestite, a man who dresses as a woman for pleasure. Equally, gender dysphoria is not the same as intersex conditions, such as those seen in hermaphrodites. A hermaphrodite is a person who is born with either both sets of genitalia or whose genitalia have an ambiguous appearance; they seem neither one thing nor the other.

Symptoms of gender dysphoria

The symptoms of gender dysphoria often show up from a very early age. Children as young as two may feel uncomfortable in the clothes and gender roles assigned to them. For example, boys may prefer to play with dolls and wear dresses and girls may display tom-boy tendencies. Children may also feel uncomfortable passing urine in the way that is traditional for their sex (i.e. standing or sitting). Both of these behaviours at this age are within the normal spectrum, however, and the condition is usually diagnosed much later.

In the vast majority of cases, the early signs and symptoms will pass and are put down to a phase, or part of growing up. In a few cases, these symptoms will strengthen as puberty arrives, with the child feeling very uncomfortable with the way their sexuality is developing. Someone with gender dysphoria can become upset and distressed at the physical changes that puberty brings. By the mid-teens, it is usually clear whether someone has genuine gender dysphoria, and treatment and counselling can then be sought.

Causes of gender dysphoria

For many years, gender dysphoria was thought of as a purely psychological condition. However, recent research has shown that there may also be physical causes. One theory is that the hormones produced in the mother’s body during early pregnancy may not have the normal effect on the growing foetus. For example, male hormones released around week eight in response to the activation of the male chromosome may fail to influence the developing brain to exactly the same extent as the genitalia, leading to a difference in gender between the two.

Treatment for gender dysphoria

In some countries, such as the USA, it is seen as acceptable to treat children with hormone suppressants if psychological tests show that their gender dysphoria is likely to continue after puberty. The aim of this treatment is to prevent any further physical development that will confuse the child’s preferred gender. However this treatment is controversial and is not permitted in the UK.

Once a person has finished puberty, they have a range of options open to them, depending on how strongly they feel about their gender dysphoria. Specialist Gender Dysphoria Clinics can offer a wide range of practical advice to help someone live in the gender role they have chosen, and for many people, this is sufficient. Others choose to take hormones to enhance the physical characteristics of their chosen gender, such as growing breasts and reducing body hair, or bulking up muscles and deepening their voice.

For many people with gender dysphoria, however, the preferred solution is to have their biological gender reassigned through surgery. These people are called transsexuals and they will change both physically and legally to the opposite gender.

Gender dysphoria and the law

In December 2002, the UK government published a statement stating that transexualism is not a mental illness. Furthermore, international human rights legislation states that a person’s gender identity is not a medical condition and should not be suppressed.

In UK law, the Gender Recognition Act of 2004 allows people with gender dysphoria and transsexuals to marry as their preferred gender, and also obtain passports and birth certificates stating the gender of their choice.

Gender dysphoria and sexuality

Contrary to popular prejudice, gender dysphoria has no bearing on sexuality, and people with the condition may be heterosexual, homosexual or bisexual, just as the rest of the population. However, it is possible that hormone treatments and transgender surgery may cause changes to the sexual orientation of the person affected, making this an extremely complex condition to both live with and to help manage.

Profile of the author

Dr Kathryn Senior is an acclaimed medical journalist who has written over 500 feature articles for leading international journals within The Lancet group. As Senior Writer at Freelance Copy she produces high quality scientific and medical content for websites and printed publications for companies and organisations in the health, medical and pharmaceutical sectors.

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