Gender Dysphoria - Mental Health Disorders - MSD Manuals

Gender dysphoria involves a strong, persistent feeling that a person's anatomic sex does not match their inner sense of self as masculine, feminine, mixed, ... MSDManual PleaseconfirmthatyouarenotlocatedinsidetheRussianFederation Yes No LeavethisSite? Thelinkyouhaveselectedwilltakeyoutoathird-partywebsite.Wedonotcontrolorhaveresponsibilityforthecontentofanythird-partysite. 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TheOne-PageManualofHealth Pronunciations Quizzes Self-AssessmentTools Tables Videos Weights&Measures NEWS It'sTimetoReplaceYourSmokeAlarmBatteries AfterClocks'FallBack'ThisWeekend,WatchOutforSeasonalMoodChanges AHANews:BostonNonprofitHelpsYoungAdultsExperiencingHomelessnessLaunchCareers AHANews:WhatParentsShouldKnowAbouttheCOVID-19VaccineFor5-to11-Year-Olds ViewAllNews> ViewAllNews> ABOUT Overview History EditorsandtheEditorialProcess PublishingandProductionStaff EditorialBoard Contributors Reviewers ContentProviders GlobalMedicalKnowledge FAQ ContactUs HealthTopics&Chapters A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Home / MentalHealthDisorders / GenderDysphoria / ... / GenderDysphoria / INTHISTOPIC Symptoms Genderdysphoriasymptomsinchildren Genderdysphoriasymptomsinadults Diagnosis Treatment Hormonetherapy Sex-reassignmentsurgery OTHERTOPICSINTHISCHAPTER GenderDysphoria GenderIdentity GenderDysphoria ADDITIONALCONTENT Testyourknowledge Obsessive-CompulsiveDisorder Obsessive-CompulsiveDisorder(OCD)ischaracterizedbyobsessionsorcompulsions.Obsessionsareproblematicthoughts,urges,orimagesthatoccupythemindexcessively.Compulsions(rituals)arerealormentalactspeoplefeelcompelledtoperformrepeatedlytolessentheiranxiety.WhichofthefollowingistheagerangeduringwhichOCDtypicallyfirstappears?  Age14yearsoryounger  Ages19to20years  Ages25to34years  Ages65yearsandover MoreContent Videos News SOCIALMEDIA GenderDysphoria (GenderDysphoriaDisorder) By GeorgeR.Brown ,MD,EastTennesseeStateUniversity Lastfullreview/revisionApr2021|ContentlastmodifiedApr2021 ClickherefortheProfessionalVersion Genderdysphoriainvolvesastrong,persistentfeelingthataperson'sanatomicsexdoesnotmatchtheirinnersenseofselfasmasculine,feminine,mixed,neutral,orsomethingelse(genderidentity).Thisfeelingofmismatchcausessignificantdistressorgreatlyimpairstheperson'sabilitytofunction.Themostextremeformofgenderdysphoria,onceknownastranssexualism,oftenincludesthedesirefortreatmentsandprocedurestochangetheirphysicalappearancetomatchtheirgenderidentity.Childrenfocusonactivitiestypicallyassociatedwiththeothersexandhavenegativefeelingsabouttheirgenitals.Doctorsbasethediagnosisonsymptomsindicatingastrongpreferencetobetheothersex.Mostpeoplewhofeelastrongneedtoliveastheothersexseektreatment—hormonetherapyandsometimesirreversiblegenitalsurgery—thatwillmaketheirphysicalappearancelikethatofthegendertheyfeeltheyare.Somepeoplewhofeelthattheiranatomicsexdoesnotmatchtheirgenderidentityaresatisfiedbyworking,living,anddressinginsocietyasamemberoftheoppositegender,butmanyofthesepeopledonothavesymptomsthatmeetthecriteriaforgenderdysphoria.Peoplewithgenderdysphoriabelievethattheyarevictimsofabiologicaccidentandthattheyarecruellyimprisonedinabodyincompatiblewiththeirinnersenseofselfasmasculine,feminine,orsomethingelse(genderidentityGenderIdentityVarioustermsareusedtotalkaboutsexandgender:Sexreferstoaperson'sanatomy:male,female,ornotclearlymaleorfemale(ambiguousgenitals,orintersex).Sexualidentityrefersto...readmore).Forexample,somepeoplewhoarelabeledmaleatbirthfeellikewomentrappedinaman'sbody,andviceversa.Thisfeelingofmismatch(calledgenderincongruityorgendernonconformity)isnotconsideredadisorderunlessitcausessignificantdistressorinterfereswiththeperson'sabilitytofunction.Thedistressistypicallyacombinationofanxiety,depression,andirritability.Somebrainimagingstudieshaveshownthatgender-dysphoricpeoplehavefunctionalandanatomicfindingsthatareconsistentwiththeirfeltgender(genderidentity)ratherthantheirbirthsex.Somepeoplefeelthattheyareneithermasculinenorfeminine,thattheyaresomewherein-between,thattheyareacombinationofthetwo,orthattheiridentitychanges.Genderqueerisacatchalltermthatreferstosomeofthesevariationsofgenderidentity.Othertermsthatmaybeusedincludenonbinaryandagender.Howmanypeoplehavegenderdysphoriaisnotknown,butitisestimatedtooccurin5to14of1,000babieswhosebirthsexismaleand2to3of1,000babieswhosebirthsexisfemale.Manymorepeopleidentifythemselvesastransgenderthanmeetthecriteriaforgenderdysphoria.IntransvestismTransvestismTransvestisminvolvesrecurrent,intensesexualarousalfromcross-dressing.Transvesticdisorderistransvestismthatcausessignificantdistressorsubstantiallyinterfereswithdailyfunctioning...readmore(cross-dressing),people(almostalwaysmen)becomesexuallyarousedbywearingclothingoftheoppositesex,buttheydonothaveaninnersenseofactuallybelongingtothatsex.Forsomepeoplewithgenderdysphoria,theincompatibilityfeltbetweenanatomicsexandgenderidentityiscomplete,severe,disturbing,andlong-standing,andtheyarelikelytoseekdrugtreatmentandprocedurestoresolvetheincompatibility.Thetermtranssexualismhasbeenusedtodescribethisconditionbuthasfallenoutoffavoramongprofessionals;however,manypeoplewithagenderidentitydifferentfromthatusuallyassociatedwiththeirbiologicsexrefertothemselvesas"trans."Mostofthesepeoplearebiologicmaleswhoidentifythemselvesasfemales,sometimesearlyinchildhood,andregardtheirgenitalsandmasculinefeatureswithrepugnance.However,mostchildrenwithgenderidentityproblemsdonotbecometransadults.Peoplewhowerebornwithgenitalsthatarenotclearlymaleorfemale(ambiguousgenitalsSymptomsDefectsofthegenitalscaninvolvethepenis,scrotum,ortestes(testicles)inboysandthevaginaandlabiaingirls.Sometimesthegenitalsareambiguous,thatis,notclearlyfemaleor...readmore)orwhohaveageneticabnormality,suchasTurnersyndromeTurnerSyndromeTurnersyndromeisasexchromosomeabnormalityinwhichgirlsarebornwithoneoftheirtwoXchromosomespartiallyorcompletelymissing.Turnersyndromeiscausedbythedeletionofpart...readmoreorKlinefeltersyndromeKlinefelterSyndromeKlinefeltersyndromeisasexchromosomeabnormalityinwhichboysarebornwithtwoXchromosomesplusoneY(XXY).KlinefeltersyndromeoccurswhenaboyhasoneextraXchromosome.Boysmay...readmore,maysufferfromvaryingdegreesofgenderdysphoria.However,whenchildrenareclearlyandconsistentlyconsideredandrearedaseitherboysorgirls,evenwhengenitalsareambiguous,mostofthemhaveaclearsenseoftheirgenderidentity.SymptomsGenderdysphoriainchildrenusuallydevelopsbyage2to3yearsold.GenderdysphoriasymptomsinchildrenChildrenwhohavegenderdysphoriamaydothefollowing:Prefercross-dressingInsistthattheyareoftheothersexWishthattheywouldwakeupastheothersexPreferparticipatingingamesandactivitiesassociatedwiththeothersexHavenegativefeelingstowardtheirgenitalsForexample,ayounggirlmayinsistshewillgrowapenisandbecomeaboy;shemaystandtourinate.Aboymayfantasizeaboutbeingfemaleandavoidrough-and-tumbleplayandcompetitivegames.Hemaysittourinateandwishtoberidofhispenisandtestes.Forboyswithgenderdysphoria,distressatthephysicalchangesofpubertyisoftenfollowedbyarequestfortreatmentthatwillmaketheirbodymorelikeawoman’s.However,mostchildrenwhopreferactivitiesconsideredtobemoreappropriatefortheothersex(calledgender-nonconformingbehavior)donothavegenderdysphoria.Andveryfewofthechildrenactuallydiagnosedwithgenderdysphoriaremaingenderdysphoricasadults.Asaresult,thereiscontroversyaroundwhetherorwhentosupportachild'ssocialand/ormedicaltransitiontotheothergender.GenderdysphoriasymptomsinadultsAlthoughmostpeoplewithgenderdysphoriabeganhavingsymptomsorbeganfeelingdifferentinearlychildhood,somedonotacknowledgethesefeelingsuntiladulthood.People,usuallymen,maybecross-dressersfirstandnotacknowledgetheiridentificationwiththeothersexuntillaterinlife.Someofthesemenmarrywomenortakestereotypicallymasculinejobsasawaytoescapeordenytheirfeelingsofwantingtobetheothersex.Oncetheyacceptthesefeelings,manypubliclyadoptasatisfyingandconvincingfemininegenderrole,withorwithouthormonetherapyorsex-reassignmentsurgery.Othersexperienceproblems,suchasanxietyOverviewofAnxietyDisordersAnxietyisafeelingofnervousness,worry,oruneasethatisanormalhumanexperience.Itisalsopresentinawiderangeofpsychiatricdisorders,includinggeneralizedanxietydisorder,...readmore,depressionDepressionAshortdiscussionofprolongedgriefdisorder.Depressionisafeelingofsadnessand/oradecreasedinterestorpleasureinactivitiesthatbecomesadisorderwhenitisintenseenoughto...readmore,andsuicidalbehaviorDepressionAshortdiscussionofprolongedgriefdisorder.Depressionisafeelingofsadnessand/oradecreasedinterestorpleasureinactivitiesthatbecomesadisorderwhenitisintenseenoughto...readmore.Thestressofnotbeingacceptedbysocietyand/orbyfamilymaycauseorcontributetotheseproblems.DidYouKnow...Childrenwithgenderdysphoriamayinsistthattheyaretheoppositesex.DiagnosisAdoctor'sevaluation,basedonspecificcriteriaMostchildrenwithgenderdysphoriaarenotevaluateduntiltheyare6to9yearsold.Doctorsdiagnosegenderdysphoriawhenpeople(childrenoradults)dothefollowing:Feelthattheiranatomicsexdoesnotmatchtheirgenderidentityandhavefeltthatwayfor6monthsorlongerFeelgreatlydistressedorcannotfunctionnormallybecauseofthisfeelingHavecertainothersymptoms,whichvarybyagegroupTheothersymptomsrequiredforadoctortodiagnosegenderdysphoriaareslightlydifferentinchildrenthaninadolescentsandadults.Childrenmustalsohaveatleastsixofthefollowingsymptoms:Astrong,persistentdesiretobeorinsistencethattheyaretheothergender(orsomeothergender)Astrongpreferencefordressinginclothingoftheoppositegenderand,ingirls,resistancetowearingtypicallyfeminineclothingAstrongpreferenceforpretendingtobetheoppositegenderwhenplayingAstrongpreferencefortoys,games,andactivitiestypicaloftheothergenderAstrongpreferenceforplaymatesoftheothergenderAstrongrejectionoftoys,games,andactivitiestypicalofthegenderthatmatchestheiranatomicsex(forexample,boysrefusetoplaywithtrucksorfootballs)AstrongdislikeoftheiranatomyAstrongdesireforthesexcharacteristicsthatmatchtheirgenderidentityAdolescentsandadultsmustalsohaveoneormoreofthefollowingsymptoms:Astrongdesiretoberidoftheirsexcharacteristicsand,foryoungadolescents,topreventthedevelopmentofsecondarysexcharacteristics(thosethatoccurduringpuberty)AstrongdesireforthesexcharacteristicsthatmatchtheirgenderidentityAstrongdesiretobetheothergender(orsomeothergender)AstrongdesiretoliveorbetreatedasanothergenderAstrongbeliefthattheyfeelandreactlikeanothergenderTreatmentPsychotherapySometimeshormonetherapySometimessex-reassignmentsurgeryandothergender-relatedsurgeriesAdultswhofeelthattheiranatomicsexdoesnotmatchtheirgenderidentitymaynotrequiretreatmentiftheydonothavepsychologicdistressortroublefunctioninginsociety.Somepeoplearesatisfiedwithchangingtheirgenderrolebyworking,living,anddressinginsocietyasamemberoftheoppositegender.Thisapproachmayincludeobtainingidentification(suchasadriver'slicense)thathelpsthemworkandliveinsocietyastheoppositegender.Theymayneverseektoaltertheiranatomyinanyway.Manyofthesepeopledonothavesymptomsthatmeetthecriteriaforamentalhealthdisorder.InmostWesterncultures,mostindividualswithseveregenderdysphoriawhorequesttreatmentarepeoplewhoseanatomicsexismale,whoidentifyasfemale,andwhoregardtheirgenitalsandmasculinefeatureswithdisgust.Whenmostofthesepeopleseektreatment,theydonotwantpsychologictreatment.Theywanthormonetherapyand/orsurgerythatwillmaketheirphysicalappearanceresembletheirfeltgenderidentity.Manyappeartobehelpedmostbyacombinationofthefollowing:HormonetherapyElectrolysisIfdesired,genital(sex-reassignment,orgender-confirming)surgery,whichisirreversiblePsychotherapyisnolongerrequiredbeforepeoplecanbegivenhormonetherapyand/orhavesex-reassignmentsurgery.However,mentalhealthcarepractitionerscanhelpbydoingthefollowing:Determiningwhetheranymentalhealthdisorders(suchasdepressionDepressionAshortdiscussionofprolongedgriefdisorder.Depressionisafeelingofsadnessand/oradecreasedinterestorpleasureinactivitiesthatbecomesadisorderwhenitisintenseenoughto...readmoreorasubstanceusedisorderSubstanceUseDisordersSubstanceusedisordersgenerallyinvolvebehaviorpatternsinwhichpeoplecontinuetouseasubstancedespitehavingproblemscausedbyitsuse.Thesubstancesinvolvedtendtobemembers...readmore)arepresentHelpingpeopledealwithproblems(suchasdisapprovalordiscrimination)thattheirconditionmayhaveprovokedHelpingpeoplefindawaytoexpresstheirfeltgenderinawaythatiscomfortableIfapplicable,helpingthemchangegenderroles,comeout,andtransitiontoanothergenderHormonetherapySomepeoplewithgenderdysphoria,inadditiontoadoptingthebehavior,dress,andmannerismsoftheoppositesex,receivehormonetreatmentstochangetheirsecondarysexcharacteristics:Inbiologicmales,useofthefemalehormoneestrogencausesbreastgrowthandotherbodychanges,suchasdecreasedfacialandbodyhair,wastingofthegenitals(genitalatrophy),andtheinabilitytomaintainanerection.Inbiologicfemales,useofthemalehormonetestosteronecausessuchchangesasgrowthoffacialhair,deepeningofthevoice,andchangesinbodyodoranddistributionofbodyfatandmuscle.Inadditiontophysicaleffects,hormonetherapyhassignificantbeneficialpsychologiceffects,includingfeelingmoreatease,lessanxious,andmoreabletointeractasthepreferredgender.Sex-reassignmentsurgeryOtherpeoplerequestsex-reassignment(orgender-confirmation)surgery.Thissurgeryisirreversible.Forbothsexes,surgeryisprecededbyUseoftheappropriatesexhormone(estrogeninmale-to-femaletransformationandtestosteroneinfemale-to-maletransformation)Livingfull-timeintheoppositegenderroleforatleast1yearForbiologicmales,surgeryinvolvesremovalofpartofthepenisandthetestesandcreationofanartificialvagina.Thepartofthepenisthatisleftactsasaclitoris.Theremainingpartisusuallysexuallysensitiveandmakesorgasmpossible.Male-to-femaletransformationmayalsoincludenongenitalcosmeticsurgeriestocreateorenhancefeminineattributes(forexample,breastaugmentation,rhinoplasty,browlift,trachealshave[paringdowntheAdam'sapple],and/orjawreconfiguration).Somepeopleundergovocalcordsurgeriestochangethequalityofthevoice.Forbiologicfemales,surgeryinvolvesremovalofthebreasts(mastectomy)andsometimestheinternalreproductiveorgans(uterusandovaries),closureofthevagina,andcreationofanartificialpenisandusuallyascrotum.Resultsoffemale-to-malesurgeryarelesssatisfactorythanmale-to-femalesurgeryintermsofappearanceandfunction,possiblyexplainingwhyfewerfemalesrequestsex-reassignmentsurgery.Also,complications,mainlyurinaryproblems,arecommon.Buttechniquesforfemale-to-malesurgerycontinuetoimprove,andmorebiologicfemalesarerequestingsurgery.Althoughpeoplewithseveregenderdysphoriawhohavesexreassignmentsurgerycannotprocreate,manyareabletohavesatisfactorysexualrelations.Theabilitytoachieveorgasmisoftenretainedaftersurgery,andsomepeoplereportfeelingcomfortablesexuallyforthefirsttime.However,fewpeopleendurethesex-reassignmentprocessforthesolepurposeofbeingabletofunctionsexuallyastheoppositesex.Confirmationoftheirinnersenseofgenderidentityistheusualmotivation. NOTE: ThisistheConsumerVersion. DOCTORS: ClickherefortheProfessionalVersion ClickherefortheProfessionalVersion ©2021MerckSharp&DohmeCorp.,asubsidiaryofMerck&Co.,Inc.,Kenilworth,NJ,USA GenderIdentity WasThisPageHelpful? Yes No OverviewofSomaticSymptomandRelatedDisorders OTHERTOPICSINTHISCHAPTER GenderDysphoria GenderIdentity GenderDysphoria Othersalsoread GenderIdentity OverviewofSexuality Transvestism Testyourknowledge Obsessive-CompulsiveDisorder Obsessive-CompulsiveDisorder(OCD)ischaracterizedbyobsessionsorcompulsions.Obsessionsareproblematicthoughts,urges,orimagesthatoccupythemindexcessively.Compulsions(rituals)arerealormentalactspeoplefeelcompelledtoperformrepeatedlytolessentheiranxiety.WhichofthefollowingistheagerangeduringwhichOCDtypicallyfirstappears?  Age14yearsoryounger  Ages19to20years  Ages25to34years  Ages65yearsandover MSDandtheMSDManuals MerckandCo.,Inc.,Kenilworth,NJ,USA(knownasMSDoutsideoftheUSandCanada)isaglobalhealthcareleaderworkingtohelptheworldbewell.Fromdevelopingnewtherapiesthattreatandpreventdiseasetohelpingpeopleinneed,wearecommittedtoimprovinghealthandwell-beingaroundtheworld. TheManualwasfirstpublishedastheMerckManualin1899asaservicetothecommunity.ThelegacyofthisgreatresourcecontinuesastheMSDManualoutsideofNorthAmerica.LearnmoreaboutourcommitmenttoGlobalMedicalKnowledge. 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