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Gender dysphoria
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Gender dysphoria

Contributors: Shea A. Nagle MPH, Michael W. Winter MD
Other Resources UpToDate PubMed

Synopsis

Gender dysphoria refers to emotional and social distress experienced by an individual identifying with a gender that is incongruent with their biologic sex characteristics. Biological sex refers to anatomic sex, determined by anatomic sex characteristics. Gender assigned at birth refers to the gender marked on a birth certificate, which is based on a newborn's external genitalia. Transgender or nonbinary gender is characterized by an individual identifying with a gender that is incongruent with their assigned gender at birth. These individuals are at increased risk for gender dysphoria, although gender dysphoria can occur in individuals who identify with their birth-assigned gender.

The abbreviation FTM (female-to-male) is often used in the literature to describe a transgender man's transition. Conversely, MTF (male-to-female) is often used to describe a transgender woman's transition. Gender nonbinary is a broad term that describes many other gender identities that do not conform to the binary male / female construct. Examples include gender nonbinary, gender nonconforming, agender, gender expansive, and genderqueer.

It is difficult to assess the prevalence of gender diversity and gender dysphoria in the population for numerous reasons. The US census and other surveys often have gender options that conform to a binary gender system, limited to only male or female. Many gender-diverse individuals do not seek out medical treatment, so they may not be included in medical records. In some circumstances, it may not be safe for some people to identify themselves publicly as not conforming to their birth-assigned gender. All of these variables make total population estimates of transgender or gender nonbinary individuals inaccurate (likely underestimated), and therefore underestimate the prevalence of gender dysphoria.

Gender dysphoria can also refer to the formal diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5); however, not all transgender and gender nonbinary individuals experiencing gender dysphoria meet those criteria. Furthermore, not all gender-diverse individuals experience gender dysphoria.

Codes

ICD10CM:
F64.9 – Gender identity disorder, unspecified

SNOMEDCT:
93461009 – Gender dysphoria

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Gender nonconformity – For example, a girl who identifies as a "tomboy." Distinct from gender dysphoria in the range and degree of gender-variant behavior and expression as well as the extent of distress the individual feels related to their gender.
  • Body dysmorphic disorder – Individuals are focused on alteration of specific parts of their body. Some patients may meet criteria for both gender dysphoria and body dysmorphic disorder, but clinicians should be careful not to conflate the two.
  • Disorders of sex development – Klinefelter syndrome, Turner syndrome, Swyer syndrome, 5-α-reductase deficiency, partial or complete androgen insensitivity, congenital adrenal hyperplasia, ovotesticular disorder, mixed gonadal dysgenesis, and mosaicism. Intersex individuals may have coexisting gender dysphoria; this is particularly common for patients who underwent surgical interventions as infants and grew up not identifying as the gender assigned to them.
  • Schizophrenia and psychotic disorders – Delusions of belonging to another gender are a rare presentation of psychosis, but other psychotic symptoms must be present. It is also important to note that patients with gender dysphoria can have separate, unrelated psychiatric conditions such as psychotic disorders.
  • Anxiety, depression, suicidal ideation – Often comorbid in patients with gender dysphoria; may also be secondary to minority stress.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:10/09/2019
Last Updated:12/26/2019
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Gender dysphoria
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Gender dysphoria : Anxiety, Depressed mood
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