Gender Dysphoria

Gender Dysphoria
I.
Terms: (Gender, Gender Assignment, Gender-Atypical, Gender-Nonconforming, Gender
Reassignment, Gender Identity, Transgender and Gender Dysphoria)
Gender is used to denote the public (and usually legally recognized) lived role as boy or
girl, man or woman, but, in contrast to certain social constructionist theories, biological
factors are seen as contributing, in interaction with social and psychological factors, to
gender development.
Gender assignment refers to the initial assignment as male or female.
Gender-atypical refers to somatic features or behaviors that are not typical (in a statistical
sense) of individuals with the same assigned gender in a given society and historical era;
for behavior.
Gender-nonconforming is an alternative descriptive term.
Gender reassignment denotes an official (and usually legal) change of gender.
Gender identity is a category of social identity and refers to an individual's identification
as male, female, or, occasionally, some category other than male or female.
Transgender refers to the broad spectrum of individuals who transiently or persistently
identify with a gender different from their natal gender.
Transsexual denotes an individual who seeks, or has undergone, a social transition from
male to female or female to male, which in many, but not all, cases also involves a
somatic transition by cross-sex hormone treatment and genital surgery (sex reassignment
surgery).
II. What is Gender Dysphoria?
Gender Dysphoria refers to the distress that may accompany the incongruence between
one's experienced or expressed gender and one's assigned gender. Although not all
individuals will experience distress as a result of such incongruence, many are distressed
if the desired physical interventions by means of hormones and/or surgery are not
available.The current term is more descriptive than the previous DSM-IV term gender
identity disorder and focuses on dysphoria as the clinical problem, not identity per se.
Gender Dysphoria as a general descriptive term refers to an individual's affective/
cognitive discontent with the assigned gender but is more specifically defined when used
as a diagnostic category.
A. Gender Dysphoria in Children

Diagnostic Criteria in Children
Criteria A: A marked incongruence between ones experienced/expressed gender and assigned

gender, of at least 6 months duration, as manifested by at least six of the following (one of
which must be Criterion A1):
1. A strong desire to be of the other gender or an insistence that one is the other
gender (or some alternative gender different from ones assigned gender)
2. In boys (assigned gender), a strong preference for cross-dressing or simulating
female attire: or in girls (assigned gender), a strong preference for wearing only
typical masculine clothing and a strong resistance to the wearing of typical
feminine clothing.
3. A strong preference for cross-gender roles in make-believe play or fantasy play.
4. A strong preference for the toys, games, or activities stereotypically used or
engaged in by the other gender
5. A strong preference for playmates of the other gender.
6. In boys (assigned gender), a strong rejection of typically masculine toys, games,
and activities and a strong avoidance of rough-and-tumble play; or in girls
(assigned gender), a strong rejection of typically feminine toys, games, and
activities.
7. A strong dislike of ones sexual anatomy.
8. A strong desire for the primary and/or secondary sex characteristics that match
ones experienced gender.
Criteria B. The condition is associated with clinically significant distress or impairment in
social, school, or other important areas of functioning.
Specify if;
with a disorder of sex development (e.g., a congenital adrenogenital
disorder such as 255.2 [E25.0] congenital adrenal hyperplasia or 259.50 [E34.50] androgen
insensitivity
syndrome).
Coding note: Code the disorder of sex development as well as gender dysphoria.
B. Gender Dysphoria in Adolescence and Adult

Diagnostic Criteria in Adolescence and Adult
Criteria A: A marked incongruence between ones experienced/expressed gender and assigned
gender, of at least 6 months duration, as manifested by at least two of the following:
1. A marked incongruence between ones experienced/expressed gender and
primary and/or secondary sex characteristics (or in young adolescents, the
anticipated secondary sex.
2. A strong desire to be rid of ones primary and/or secondary sex characteristics

because of a marked incongruence with ones experienced/expressed gender
(or in young adolescents, a desire to prevent the development of the
anticipated secondary sex characteristics).
3. A strong desire for the primary and/or secondary sex characteristics of the
other gender.
4. A strong desire to be of the other gender (or some alternative gender different
from ones assigned gender).
5. A strong desire to be treated as the other gender (or some alternative gender
different from ones assigned gender).
6. A strong conviction that one has the typical feelings and reactions of the other
gender (or some alternative gender different from ones assigned gender).
Criteria B: The condition is associated with clinically significant distress or impairment in
social, Occupational or other important areas of functioning.
Specify if:
With a disorder of sex development (e.g., a congenital adrenogenital disorder
such as 255.2 [E25.0] congenital adrenal hyperplasia or 259.50 [E34.50] androgen insensitivity
syndrome).
Coding note: Code the disorder of sex development as well as gender
Specify if:
-
Post transttion: The individual has transitioned to full-time living in the desired
gender (with or without legalization of gender change) and has undergone (or is
preparing to have) at least one cross-sex medical procedure or treatment regimen
namely, regular cross-sex hormone treatment or gender reassignment surgery
confirming the desired gender (e.g., penectomy, vaginoplasty in a natal male;
mastectomy or phalloplasty in a natal female).
III. Prevalance
For natal adult males, prevalence ranges from 0.005% to 0.014%, and for natal females,
from 0.002% to 0.003%.
In children, sex ratios of natal boys to girls range from 2:1 to 4.5:1.
In adolescents, the sex ratio is close to parity; in adults, the sex ratio favors natal males,
with ratio ranging from 1:1 to 6.1:1.
In two countries, the sex ratio appears to favor natal females (Japan: 2.2:1; Poland:
3.4:1).
IV. Development and course
Criteria for children are defined in a more concrete, behavioral manner than those for
adolescents and adults.
Young children are less likely than older children, adolescents, and adults to express
extreme and persistent anatomic dysphoria.
A very young child may show signs of distress (e.g., intense crying) only when parents
tell the child that he or she is "really" not a member of the other gender but only "desires"
to be.
In adolescents and adults, incongruence between experienced gender and somatic sex is a
central feature of the diagnosis.
In adolescents and adults, distress may manifest because of strong incongruence between
experienced gender and somatic sex.
Such distress may, however, be mitigated by supportive environments and knowledge
that biomedical treatments exist to reduce incongruence. Impairment (e.g., school refusal,
development of depression, anxiety, and substance abuse) may be a consequence of
gender dysphoria.
Early-onset gender dysphoria starts in childhood and continues into adolescence and
adulthood; or, there is an intermittent period in which the gender dysphoria desists and
these individuals self-identify as gay or homosexual, followed by recurrence of gender
dysphoria.
Late-onset gender dysphoria occurs around puberty or much later in life. Some of
these individuals report having had a desire to be of the other gender in childhood that
was not expressed verbally to others.
V. Risk and Prognostic Factors
A. Temperamental
Individuals with gender dysphoria without a disorder of sex development, atypical

gender behavior among individuals with early-onset gender dysphoria develops in
early preschool age.
it is possible that a high degree of atypicality makes the development of gender
dysphoria and its persistence into adolescence and adulthood more likely.
B. Environmental
Among individuals with gender dysphoria without a disorder of sex development,
males with gender dysphoria (in both childhood and adolescence) more
commonly have older brothers than do males without the condition.
Additional predisposing Factors under consideration, especially in individuals
with late-onset gender dysphoria (adolescence, adulthood), include habitual
fetishistic transvestism developing into autogynephilia(i.e., sexual arousal
associated with the thought or image of oneself as a woman) another forms of
more general social, psychological, or developmental problems
C. Genetic and physiological
For individuals with gender dysphoria without a disorder of sex development,

some genetic contribution is suggested by evidence for (weak) familiality of
transsexualism among nontwin siblings, increased concordance for transsexualism
in monozygotic compared with dizygotic same-sex twins, and some degree of
heritability of gender dysphoria.

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Gender Dysphoria

II. What is Gender Dysphoria?

A. Gender Dysphoria in Children

Criteria A: A marked incongruence between ones experienced/expressed gender and assigned

B. Gender Dysphoria in Adolescence and Adult

2. A strong desire to be rid of ones primary and/or secondary sex characteristics

IV. Development and course

Individuals with gender dysphoria without a disorder of sex development, atypical

For individuals with gender dysphoria without a disorder of sex development,

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