Editing Gender dysphoria

{{Short description|Mental distress due to gender incongruence}}
{{pp-semi-indef|small=yes}}

{{Infobox medical condition (new)
| name = Gender dysphoria
| symptoms = Distress related to one's assigned gender, sex or sex characteristics<ref name="DSM-5 fact sheet">{{cite web |title=Gender Dysphoria |date=2013 |url=https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM-5-Gender-Dysphoria.pdf |access-date=December 24, 2016 |publisher=[[American Psychiatric Publishing]] |archive-date=December 29, 2016 |archive-url=https://web.archive.org/web/20161229032303/https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM-5-Gender-Dysphoria.pdf |url-status=live |ref={{sfnref|DSM-5 fact sheet|2013}} }}</ref><ref name="Maddux"/><ref name="Standards of Care" />
| complications = Eating disorders, suicide, depression, anxiety, social isolation<ref name="Davidson-2012">{{Cite book |vauthors=Davidson MR |title=A Nurse's Guide to Women's Mental Health |publisher=Springer Publishing Company |year=2012 |isbn=978-0-8261-7113-9 |page=114}}</ref>
| onset = 
| duration = 
| causes = 
| risks = 
| diagnosis = 
| differential = Variance in gender identity or expression that is not distressing,<ref name="DSM-5 fact sheet" /><ref name="Standards of Care" />
[[psychotic disorder]]s, [[body dysmorphic disorder]], [[autism spectrum disorder]], [[transvestic disorder]]<ref name="dsm5tr">{{cite book |title=Diagnostic and statistical manual of mental disorders: DSM-5-TR™ |date=2022 |publisher=American Psychiatric Association Publishing |location=Washington, DC |isbn=978-0-89042-576-3 |pages=512-521 |edition=Fifth, text revision |access-date=3 March 2025}}</ref>
| prevention = 
| treatment = [[Transitioning (transgender)|Transitioning]], [[psychotherapy]]<ref name="Maddux"/><ref name="Standards of Care" />
| medication = [[Transgender hormone therapy|Hormones]] (e.g., [[anabolic steroid|androgens]], [[antiandrogen]]s, [[estrogen (medication)|estrogens]])
| prognosis = 
| frequency = 
| deaths = 
}}
{{Infobox medical condition (new)
| name = Gender incongruence
| symptoms = a marked and persistent incongruence between an individual´s experienced gender and the assigned sex, which often leads to a desire to ‘transition’<ref name="who">{{Cite web |title=Gender incongruence and transgender health in the ICD |url=https://www.who.int/standards/classifications/frequently-asked-questions/gender-incongruence-and-transgender-health-in-the-icd |access-date=2025-05-10 |website=www.who.int |language=en}}</ref>
 
| differential = Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis<ref name="who"/>
| prevention = 
| treatment = [[gender affirming care]]
| prognosis = 
| frequency = 
| deaths = 
| specialty = [[sexual health]]
}}
{{Transgender sidebar|medicine}}
'''Gender dysphoria''' ('''GD''') is the distress a person experiences due to a mismatch between their [[gender identity]]{{emdash}}their personal sense of their own [[gender]]{{emdash}}and their [[sex assignment|sex assigned at birth]].<ref>{{cite web |author=Human Rights Campaign |author-link=Human Rights Campaign |title=Sexual Orientation and Gender Identity Definitions |url=http://www.hrc.org/resources/sexual-orientation-and-gender-identity-terminology-and-definitions |access-date=June 13, 2021 |archive-date=November 25, 2015 |archive-url=https://web.archive.org/web/20151125033133/http://www.hrc.org/resources/sexual-orientation-and-gender-identity-terminology-and-definitions |url-status=live}}</ref><ref name="MorrowMessinger">{{cite book |veditors=Morrow DF, Messinger L |title=Sexual Orientation and Gender Expression in Social Work Practice: working with gay, lesbian, bisexual, and transgender people |date=2006 |publisher=[[Columbia University Press]] |location=New York |isbn=978-0-231-50186-6 |page=8 |quote=Gender identity refers to an individual's personal sense of identity as masculine or feminine, or some combination thereof.}}</ref> The term replaced the previous diagnostic label of '''gender identity disorder''' ('''GID''')<!--NOTE: Per WP:Alternative title, the term should be bolded somewhere in the lead.--> in 2013 with the release of the diagnostic manual [[DSM-5]]. The condition was renamed to remove the [[Stigmatization|stigma]] associated with the term ''disorder''.<ref>{{harvnb|DSM-5 fact sheet|2013}}: "DSM-5 aims to avoid stigma and ensure clinical care for individuals who see and feel themselves to be a different gender than their assigned gender. It replaces the diagnostic name 'gender identity disorder' with 'gender dysphoria', as well as makes other important clarifications in the criteria."</ref> The [[International Classification of Diseases]] uses the term '''gender incongruence''' ('''GI''') instead of ''gender dysphoria'', defined as a marked and persistent mismatch between gender identity and assigned gender, regardless of distress or impairment. Not all [[transgender]] people have gender dysphoria.<ref>{{Cite web |date=2023-03-09 |title=Understanding transgender people, gender identity and gender expression |url=https://www.apa.org/topics/lgbtq/transgender-people-gender-identity-gender-expression |access-date=2025-01-17 |website=www.apa.org}}</ref><ref name="Russo">{{cite book |vauthors=Russo J, Coker JK, King JH |title=DSM-5® and Family Systems |year=2017 |page=352 |publisher=[[Springer Publishing Company]] |isbn=978-0826183996 |url=https://books.google.com/books?id=0JfvDQAAQBAJ&pg=PA352 |quote=People meeting criteria for Gender Dysphoria most often identify themselves as trans or transgender. ''Trans'' or ''transgender'' can be used as umbrella terms to include the broad spectrum of persons whose gender identity differs from the assigned gender (APA, 2013). |access-date=December 3, 2020 |archive-date=April 19, 2021 |archive-url=https://web.archive.org/web/20210419234216/https://books.google.com/books?id=0JfvDQAAQBAJ&pg=PA352|url-status=live}}</ref> [[Gender nonconformity]] is not the same thing as gender dysphoria<ref name="What Is">{{cite web |first=Ranna |last=Parekh |title=What Is Gender Dysphoria? |url=https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria |access-date=November 20, 2018 |publisher=[[American Psychiatric Publishing]] |archive-date=January 14, 2020 |archive-url=https://web.archive.org/web/20200114173204/https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria |url-status=live}}</ref> and does not always lead to dysphoria or distress.<ref>{{cite web |publisher=[[World Professional Association for Transgender Health]] (WPATH) |url=https://www.wpath.org/publications/soc |title=Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People |date=2011 |archive-url=https://web.archive.org/web/20150814230505/http://www.wpath.org/uploaded_files/140/files/Standards%20of%20Care%2C%20V7%20Full%20Book.pdf |archive-date=August 14, 2015 |edition=ver. 7 |quote=5 ("only ''some'' gender nonconforming people experience gender dysphoria at ''some'' point in their lives.")}}</ref> In pre-pubertal youth, the diagnoses are [[gender dysphoria in children|gender dysphoria in childhood]] and [[gender incongruence of childhood]].
The [[causes of gender incongruence]] are unknown but a gender identity likely reflects genetic, biological, environmental, and cultural factors.<ref name="heylens et al">{{cite journal |vauthors=Heylens G, De Cuypere G, Zucker KJ, Schelfaut C, Elaut E, Vanden Bossche H, De Baere E, T'Sjoen G |display-authors=6 |title=Gender identity disorder in twins: a review of the case report literature |journal=[[Journal of Sexual Medicine]] |volume=9 |issue=3 |pages=751–757 |date=March 2012 |pmid=22146048 |doi=10.1111/j.1743-6109.2011.02567.x |url=https://biblio.ugent.be/publication/1974611/file/6763837 |quote=Of 23 [[Twin#Monozygotic (identical) twins|monozygotic]] female and male twins, nine (39.1%) were concordant for GID; in contrast, none of the 21 same‐sex dizygotic female and male twins were concordant for GID, a statistically significant difference (P = 0.005)... These findings suggest a role for genetic factors in the development of GID. |author3-link=Kenneth Zucker}}</ref><ref name="diamond-2013">{{cite journal |last=Diamond |first=Milton |author-link=Milton Diamond |year=2013 |title=Transsexuality Among Twins: Identity Concordance, Transition, Rearing, and Orientation |journal=[[International Journal of Transgenderism]] |volume=14 |issue=1 |pages=24–38 |doi=10.1080/15532739.2013.750222 |quote=Combining data from the present survey with those from past-published reports, 20% of all male and female monozygotic twin pairs were found concordant for transsexual identity... The responses of our twins relative to their rearing, along with our findings regarding some of their experiences during childhood and adolescence show their identity was much more influenced by their genetics than their rearing.|s2cid=144330783}}</ref><ref name="Rosenthal-2014">{{cite journal |vauthors=Rosenthal SM |title=Approach to the patient: transgender youth: endocrine considerations |journal=[[Journal of Clinical Endocrinology and Metabolism]] |volume=99 |issue=12 |pages=4379–4389 |date=December 2014 |pmid=25140398 |doi=10.1210/jc.2014-1919 |doi-access=free}}</ref> 

Diagnosis can be given at any age, although gender dysphoria in children and adolescents may manifest differently than in adults.<ref name="APA-Position" /> Complications may include [[anxiety]], [[Depression (mood)|depression]], and [[eating disorder]]s.<ref name="Russo" /> Treatment for gender dysphoria includes [[Gender transition|social transitioning]] and often includes [[Transgender hormone therapy|hormone replacement therapy]] (HRT) or [[Gender-affirming surgery|gender-affirming surgeries]], and [[psychotherapy]].<ref name="Maddux">{{cite book |url=https://books.google.com/books?id=eOlzCgAAQBAJ&pg=PA464 |title=Psychopathology: Foundations for a Contemporary Understanding |vauthors=Maddux JE, Winstead BA |publisher=[[Routledge]] |year=2015 |isbn=978-1317697992 |pages=464–465 |access-date=December 26, 2019 |archive-date=June 5, 2020 |archive-url=https://web.archive.org/web/20200605125851/https://books.google.com/books?id=eOlzCgAAQBAJ&pg=PA464 |url-status=live}}</ref><ref name="Standards of Care">{{cite journal |vauthors=Coleman E |year=2011 |title=Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7 |journal=International Journal of Transgenderism |volume=13 |issue=4 |pages=165–232 |doi=10.1080/15532739.2011.700873 |publisher=[[Routledge]] Taylor & Francis Group |url=http://www.wpath.org/uploaded_files/140/files/IJT%20SOC,%20V7.pdf |url-status=dead |archive-url=https://web.archive.org/web/20140802135807/http://www.wpath.org/uploaded_files/140/files/IJT%20SOC%2C%20V7.pdf |archive-date=August 2, 2014 |access-date=August 30, 2014 |s2cid=39664779}}</ref>

Some researchers and transgender people argue for the declassification of the condition because they say the diagnosis [[pathologizes]] gender variance and reinforces the [[Gender binary|binary model of gender]].<ref name="Karl Bryant">{{cite encyclopedia |vauthors=Bryant K |title=Gender Dysphoria |encyclopedia=[[Encyclopædia Britannica Online]] |date=2018 |access-date=August 16, 2018 |url=https://www.britannica.com/science/gender-dysphoria |archive-date=April 18, 2020 |archive-url=https://web.archive.org/web/20200418213857/https://www.britannica.com/science/gender-dysphoria |url-status=live}}</ref> However, this declassification could carry implications for healthcare accessibility, as HRT and gender-affirming surgery could be deemed cosmetic by insurance providers, as opposed to medically necessary treatment, thereby affecting coverage.<ref name="Zack Ford" />

== Diagnoses ==
=== DSM-5 ===
The [[American Psychiatric Association]] permits a diagnosis of ''gender dysphoria'' in adolescents or adults if two or more of the following criteria are experienced for at least six months' duration:<ref name="DSM5" />
<!--Note that these are paraphrased from the original to avoid copyright violation.-->
* A significant incongruence between one's experienced or expressed gender and one's [[sexual characteristics]]
* A strong desire to be rid of one's sexual characteristics due to incongruence with one's experienced or expressed gender
* A strong desire for the sexual characteristics of a gender other than one's assigned gender
* A strong desire to be of a gender other than one's assigned gender
* A strong desire to be treated as a gender other than one's assigned gender
* A strong conviction that one has the typical reactions and feelings of a gender other than one's assigned gender
In addition, the condition must be associated with clinically significant distress or impairment.<ref name="DSM5" />

The diagnosis also contains two specifiers:<ref name="DSM5" />
* "With a [[intersex|disorder/difference of sex development]]" should be used for those with [[intersex conditions]], in which case the condition should be coded. 
* "Posttransition" may be used if the patient "has transitioned to full-time living in the experienced gender (with or without legalization of gender change)" and has or will undergo "at least one gender-affirming medical procedure or treatment regimen—namely, regular gender-affirming hormone treatment or gender reassignment surgery".

The DSM-5 stated that "Gender dysphoria as a general descriptive term refers to the distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender. However, it is more specifically defined when used as a diagnostic category. It does not refer to distress related to stigma, a distinct although possibly co-occurring source of distress."<ref name="DSM5"/>

Neither the [[DSM-I]] (1952) nor the [[DSM-II]] (1968) contained a diagnosis analogous to gender dysphoria. Gender identity disorder first appeared as a diagnosis in the [[DSM-III]] (1980), where it appeared under "psychosexual disorders" but was used only for the childhood diagnosis. Adolescents and adults received a diagnosis of transsexualism (homosexual, heterosexual, or asexual type). The DSM-III-R (1987) added "Gender Identity Disorder of Adolescence and Adulthood, Non-Transsexual Type" (GIDAANT).<ref>{{cite journal |vauthors=Koh J |title=[The history of the concept of gender identity disorder] |journal=Seishin Shinkeigaku Zasshi = Psychiatria et Neurologia Japonica |volume=114 |issue=6 |pages=673–680 |year=2012 | pmid = 22844818 }}</ref><ref>{{cite journal |vauthors = Pauly IB |year=1993 |title=Terminology and Classification of Gender Identity Disorders |journal=[[Journal of Psychology & Human Sexuality]] |volume=5 |issue=4 |pages=1–14 |doi=10.1300/J056v05n04_01 |s2cid=142954603}}</ref><ref>Drescher, Jack, [[doi:10.1080/19359701003589637|Transsexualism, Gender Identity Disorder and the DSM]], ''[[Journal of Gay & Lesbian Mental Health]]'' 14, no. 2 (2010): 112.</ref>  The DSM-5 moved this diagnosis out of the sexual disorders category and into a category of its own.<ref name="DSM5" /> The diagnosis was renamed from gender identity disorder to gender dysphoria, after criticisms that the former term was stigmatizing.<ref name="DSMVChild">{{cite web |date=May 4, 2011 |title=Gender Dysphoria in Children |url=http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=192 |access-date=July 3, 2011 |publisher=[[American Psychiatric Association]] |archive-date=March 14, 2012 |archive-url=https://web.archive.org/web/20120314204820/http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=192 |url-status=live}}</ref> Subtyping by sexual orientation was deleted. The diagnosis for children was separated from that for adults, as "[[gender dysphoria in children]]". The creation of a specific diagnosis for children reflects the lesser ability of children to have insight into what they are experiencing, or ability to express it if they have insight.<ref>{{cite web |title=P 00 Gender Dysphoria in Children |url=http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=192 |access-date=April 2, 2012 |publisher=[[American Psychiatric Association]] |archive-date=March 14, 2012 |archive-url=https://web.archive.org/web/20120314204820/http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=192 |url-status=live}}</ref> ''Other specified gender dysphoria'' or ''unspecified gender dysphoria'' can be diagnosed if a person does not meet the criteria for gender dysphoria but still has clinically significant distress or impairment.<ref name="DSM5" /> [[Intersex]] people are no longer excluded from the diagnosis of GD.<ref name="Davy">{{cite journal |vauthors=Davy Z, Toze M |title=What Is Gender Dysphoria? A Critical Systematic Narrative Review |journal=[[Transgender Health (journal)|Transgender Health]] |volume=3 |issue=1 |pages=159–169 |year=2018 |pmid=30426079 |pmc=6225591 |doi=10.1089/trgh.2018.0014 |publisher=Mary Ann Liebert, Inc. Publishers}}</ref>

=== ICD-11 ===
The [[International Classification of Diseases]] ([[ICD-11]]) lists three conditions<!--They are defined as "conditions" by the ICD, not "diseases" or "disorders".--> related to gender identity:<ref name="icd11-gc">{{cite web |title=Gender incongruence (ICD-11) |url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/411470068 |access-date=August 28, 2018 |website=icd.who.int |publisher=[[World Health Organization]] |archive-date=August 1, 2018 |archive-url=https://archive.today/20180801205234/https://icd.who.int/browse11/l-m/en%23/http://id.who.int/icd/entity/294762853#/http://id.who.int/icd/entity/411470068 |url-status=live}}</ref>
* Gender incongruence of adolescence or adulthood ({{ICD11|HA60|90875286}})
* [[Gender incongruence of childhood]] ({{ICD11|HA61|344733949}})
* Gender incongruence, unspecified ({{ICD11|HA6Z}})

ICD-11 defines gender incongruence as "a marked and persistent incongruence between an individual's experienced gender and the assigned sex", with no requirement for significant distress or impairment, and a note that "gender variant behaviour and preferences alone are not a basis for assigning the diagnosis..<ref name="icd11-gc"/><ref name="who"/>

The ICD-10 contained the diagnoses "transsexualism" and "gender identity disorder of children" under the chapter "Mental and behavioral disorders" chapter. The ICD-11 renamed the conditions "gender incongruence of adolescence" or adulthood and "gender incongruence of childhood" and moved them into the chapter "Conditions related to sexual health" to reflect "current knowledge that trans-related and gender diverse identities are not conditions of mental ill-health, and that classifying them as such can cause enormous stigma". The [[World Health Organization]] said its inclusion in the ICD-11 "should ensure transgender people’s access to gender-affirming health care" and health insurance.<ref name="who"/>

== Causes ==
{{See also|Causes of gender incongruence}}

In a 2020 position statement, the [[Endocrine Society]] stated that in the late 20th century, transgender and gender incongruent people were thought to suffer a mental health disorder and gender identity was considered malleable and subject to external influences. But that this was no longer considered valid as "Considerable scientific evidence has emerged demonstrating a durable biological element underlying gender identity. Individuals may make choices due to other factors in their lives, but there do not seem to be external forces that genuinely cause individuals to change gender identity".<ref name="endocrine-society-2020"/>

The cited evidence includes that attempts to change the gender identity of intersex patients to match their genitalia or chromosomes are generally unsuccessful, that there is evidence that higher levels of exposure to androgens in utero causes higher rates of male gender identity among those with female chromosomes, that those with [[complete androgen insensitivity syndrome]] among those with male chromosomes typically have a female gender identity, that identical twins are more likely to both be transgender than non-identical twins, and that brain scans have shown associations with gender identity rather than genitalia or chromosomes.<ref name="endocrine-society-2020"/>

Their 2017 clinical practice guidelines stated "Results of studies from a variety of biomedical disciplines—genetic, endocrine, and neuroanatomic—support the concept that gender identity and/or gender expression likely reflect a complex interplay of biological, environmental, and cultural factors" and noted research pointing to unique brain phenotype associated with gender dysphoria and gender incongruence, heritability of the conditions, the role of pre- and post-natal androgens in gender development, and gender identities among intersex people.<ref name="Hembree"/>

== Signs and symptoms ==

In the [[DSM-5]], a marked incongruence between a person's felt gender and assigned sex or gender (usually at birth) is the core component of the diagnosis, which requires distress about the incongruence.<ref name="DSM5">{{cite book |author1=American Psychiatry Association |author-link=American Psychiatry Association |url=https://archive.org/details/diagnosticstatis0005unse/page/451 |title=Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Text Revision (DSM-5-TR) |date=2022 |publisher=[[American Psychiatric Publishing]] |isbn=978-0-89042-576-3 |edition=5th TR |location=Washington, DC |pages=511–520}}</ref> In pre-pubertal youth it may manifest as an insistence that they are, or will grow up to be, another gender than the one assigned at birth, an aversion to their assigned gender, or an insistence they have or desire to have different genitalia. They may express aversions to stereotypically gendered activities and desire opposite sex-typical toys, games, activities, or playmates though this may be less prominent in surroundings with fewer stereotypes.<ref name="DSM5"/>

Autistic people are more likely to be gender diverse and in those with gender dysphoria there is an overrepresentation of autistic traits.<ref name="DSM5"/> In prepubertal youth, increasing age is associated with more behavioral and emotional problems due to increasing nonacceptance of gender nonconforming behaviors than others, while children and adolescents in affirming environments show less or no psychological problems. Younger children are also less likely to express extreme and persistent dysphoria about their anatomy.<ref name="DSM5"/>

The [[DSM-5]] states that gender dysphoria tends to be [[Gender dysphoria in children|early-onset]] (starting prior to puberty) or late-onset (starting during or after puberty) in non-intersex individuals. Those with early-onset GD which continues into adolescence mostly identify as heterosexual, being attracted to their assigned gender at birth. In some cases, the GD desists or is denied, during which the youth may identify as lesbian or gay, though some may experience a later resurgence in GD. Some of those with late-onset GD report desire to transition during childhood that was not verbalized and others have no recollections of childhood gender dysphoria.<ref name="DSM5"/> According to the ''American Psychiatric Association'',<ref>{{cite web |last=Turban |first=Jack |author-link=Jack Turban |date=August 2022 |title=What is Gender Dysphoria? |url=https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria |website=[[American Psychiatric Association]] |access-date=October 23, 2023}}</ref> those who experience gender dysphoria later in life "often report having secretly hidden their gender dysphoric feelings from others when they were younger".<ref>{{Cite web|url=https://www.psychiatry.org/patients-families/gender-dysphoria/expert-q-and-a|title=Expert Q&A: Gender Dysphoria|website=www.psychiatry.org}}</ref> No particular sexual orientation indicates gender dysphoria.<ref>{{cite journal |last1=Thompson |first1=Lucy |last2=Sarovic |first2=Darko |journal=[[PLOS Global Public Health]] |title=A PRISMA systematic review of adolescent gender dysphoria literature: 1) Epidemiology |year=2022 |volume=2 |issue=3 |pages=e0000245 |doi=10.1371/journal.pgph.0000245 |pmid=36962334 |pmc=10021877 |s2cid=247379163 |doi-access=free}}</ref><ref name="Kaltiala-Heino" /> A 2021 review in Dialogues in Clinical Neuroscience found no relation to sexual orientation, but acknowledged that historically the two were often erroneously conflated.<ref>{{cite journal |vauthors=Crocq MA |title=How gender dysphoria and incongruence became medical diagnoses - a historical review |journal=[[Dialogues in Clinical Neuroscience]] |volume=23 |issue=1 |pages=44–51 |year=2021 |pmid=35860172 |pmc=9286744 |doi=10.1080/19585969.2022.2042166}}</ref> The British [[National Health Service]] also stated "gender dysphoria is not related to sexual orientation".<ref>{{Cite web |url=https://www.nhs.uk/conditions/gender-dysphoria/ |title=Gender Dysphoria |date=23 October 2017 |archive-url=https://web.archive.org/web/20221022102600/https://www.nhs.uk/conditions/gender-dysphoria/ |archive-date=October 22, 2022 |access-date=October 23, 2022}}</ref>

== Treatment ==
Treatment for a person diagnosed with GD may include psychological counseling, supporting the individual's [[gender expression]], or may involve physical transition resulting from medical interventions such as hormonal treatment, genital surgery, electrolysis, laser hair removal, chest surgery, breast surgery or other reconstructive surgeries.<ref name="NHS">{{cite web |year=2016 |title=NHS - Treatment - Gender dysphoria |url=https://www.nhs.uk/conditions/gender-dysphoria/treatment/ |access-date=January 10, 2019 |publisher=[[NHS]] |archive-date=November 2, 2013 |archive-url=https://web.archive.org/web/20131102135038/http://www.nhs.uk/Conditions/Gender-dysphoria/Pages/Treatment.aspx |url-status=live}}</ref> The goal of treatment may simply be to reduce problems resulting from the person's transgender status, for example, counseling the patient in order to reduce guilt associated with cross-dressing.<ref name="Leiblum-2006">{{Cite book |vauthors=Leiblum S |title=Principles and Practice of Sex Therapy, Fourth Edition |publisher=[[Guilford Press]] |year=2006 |isbn=978-1-59385-349-5 |pages=488–9}}</ref>

Guidelines have been established to aid clinicians. The [[World Professional Association for Transgender Health]] (WPATH) [[Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People|Standards of Care]] are used by some clinicians as treatment guidelines. Others use guidelines outlined in Gianna Israel and Donald Tarver's ''Transgender Care''.<ref>{{cite journal |vauthors=Heyes CJ, Latham JR |date=2018 |title=Trans surgeries and cosmetic surgeries: The politics of analogy |journal=[[Transgender Studies Quarterly]] |volume=5 |number=2 |pages=174–189|doi=10.1215/23289252-4348617 }}</ref> Guidelines for treatment generally follow a "[[harm reduction]]" model.<ref name="AAP">{{cite journal |vauthors=((Committee On Adolescence)) |title=Office-based care for lesbian, gay, bisexual, transgender, and questioning youth |journal=[[Pediatrics (journal)|Pediatrics]] |volume=132 |issue=1 |pages=198–203 |date=July 2013 |pmid=23796746 |doi=10.1542/peds.2013-1282 |quote=However, adolescents with multiple or anonymous partners, having unprotected intercourse, or having substance abuse issues should be tested at shorter intervals. |doi-access=free}}</ref><ref name="GLMA">{{cite web |year=2013 |title=www.glma.org Compendium of Health Profession Association LGBT Policy & Position Statements |publisher=GLMA |url=http://www.glma.org/_data/n_0001/resources/live/GLMA%20Compendium%20of%20Health%20Profession%20Association%20LGBT%20Policy%20and%20Position%20Statements.pdf |access-date=August 27, 2013 |archive-date=November 9, 2020 |archive-url=https://web.archive.org/web/20201109071446/http://www.glma.org/_data/n_0001/resources/live/GLMA%20Compendium%20of%20Health%20Profession%20Association%20LGBT%20Policy%20and%20Position%20Statements.pdf |url-status=live}}</ref><ref name="APA">{{cite web |year=2011 |title=APA Policy Statements on Lesbian, Gay, Bisexual, & Transgender Concerns |url=http://www.apa.org/about/policy/booklet.pdf |access-date=August 27, 2013 |publisher=[[American Psychological Association]] |quote=Be it further resolved that APA recognizes the efficacy, benefit, and necessity of gender transition treatments for appropriately evaluated individuals and calls upon public and private insurers to cover these medically necessary treatments |url-status=live |archive-date=January 21, 2022 |archive-url=https://web.archive.org/web/20220121154251/https://www.apa.org/about/policy/booklet.pdf}}</ref>

=== Children ===
{{Main|Gender dysphoria in children}}

Medical, scientific, and governmental organizations have opposed [[conversion therapy]], defined as treatment viewing gender nonconformity as pathological and something to be changed, instead supporting approaches that affirm children's diverse gender identities.<ref name="Lambda">{{cite web |title=Health and Medical Organization Statements on Sexual Orientation, Gender Identity/Expression and 'Reparative Therapy' |url=https://www.lambdalegal.org/publications/health-and-med-orgs-stmts-on-sex-orientation-and-gender-identity |website=lambdalegal.org |publisher=[[Lambda Legal]] |access-date=January 14, 2022 |archive-date=June 15, 2017 |archive-url=https://web.archive.org/web/20170615154255/https://www.lambdalegal.org/publications/health-and-med-orgs-stmts-on-sex-orientation-and-gender-identity |url-status=live}}</ref><ref name="HRC">{{cite web |title=Policy and Position Statements on Conversion Therapy |url=http://www.hrc.org/resources/policy-and-position-statements-on-conversion-therapy |website=[[Human Rights Campaign]] |access-date=April 12, 2017 |archive-date=April 27, 2017 |archive-url=https://web.archive.org/web/20170427021742/http://www.hrc.org/resources/policy-and-position-statements-on-conversion-therapy |url-status=live}}</ref><ref name="APA_Position_2018">{{cite web |title=Position Statement on Therapies Focused on Attempts to Change Sexual Orientation (Reparative or Conversion Therapies) |url=https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-Conversion-Therapy.pdf |archive-url=https://web.archive.org/web/20211210052014/https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-Conversion-Therapy.pdf |archive-date=10 December 2021 |date=December 2018 |author=American Psychiatric Association |publisher=[[American Psychiatric Association]] |quote=While many might identify as questioning, queer, or a variety of other identities, 'reparative' or conversion therapy is based on the a priori assumption that diverse sexual orientations and gender identities are mentally ill and should change ... APA encourages legislation which would prohibit the practice of 'reparative' or conversion therapies that are based on the a priori assumption that diverse sexual orientations and gender identities are mentally ill(references omitted)|author-link=American Psychiatric Association}}</ref> People are more likely to keep having gender dysphoria the more intense their gender dysphoria, cross-gendered behavior, and verbal identification with the desired/experienced gender are (i.e. stating that they ''are'' a different gender rather than ''wish to be'' a different gender).<ref name="Ristori">{{cite journal |vauthors=Ristori J, Steensma TD |title=Gender dysphoria in childhood |journal=[[International Review of Psychiatry]] |volume=28 |issue=1 |pages=13–20 |date=January 2, 2016 |pmid=26754056 |doi=10.3109/09540261.2015.1115754 |s2cid=5461482}}</ref>

Professionals who treat gender dysphoria in children sometimes prescribe [[puberty blocker]]s to delay the onset of puberty until a child is believed to be old enough to make an informed decision on whether hormonal or surgical gender reassignment is in their best interest.<ref>''The Transgendered Child: A Handbook for Families and Professionals'' (Brill and Pepper, 2008){{full citation needed|date=May 2016}}{{page needed|date=May 2016}}</ref><ref name="Alleyne">{{cite news |vauthors=Alleyne R |date=April 15, 2011 |title=Puberty blocker for children considering sex change |work=[[The Daily Telegraph]] |url=https://www.telegraph.co.uk/news/health/news/8454002/Puberty-blocker-for-children-considering-sex-change.html |url-access=subscription |url-status=live |access-date=December 1, 2020 |archive-url=https://ghostarchive.org/archive/20220111/https://www.telegraph.co.uk/news/health/news/8454002/Puberty-blocker-for-children-considering-sex-change.html |archive-date=January 11, 2022}}{{cbignore}}</ref> Short-term side effects of puberty blockers include headaches, fatigue, insomnia, muscle aches and changes in breast tissue, mood, and weight.<ref>{{Cite web |title=Puberty Blockers |url=https://www.stlouischildrens.org/conditions-treatments/transgender-center/puberty-blockers |access-date=August 18, 2022 |website=www.stlouischildrens.org |language=en |archive-url=https://web.archive.org/web/20220701000713/https://www.stlouischildrens.org/conditions-treatments/transgender-center/puberty-blockers |archive-date=July 1, 2022}}</ref> Research on the long-term effects on brain development, cognitive function, fertility, and sexual function is limited.<ref name="Reuters-2022">{{Cite news |date=October 6, 2022 |title=As children line up at gender clinics, families confront many unknowns |language=en |work=[[Reuters]] |url=https://www.reuters.com/investigates/special-report/usa-transyouth-care/ |access-date=October 10, 2022 |archive-url=https://web.archive.org/web/20221006130806/https://www.reuters.com/investigates/special-report/usa-transyouth-care/ |archive-date=October 6, 2022}}</ref><ref name="autogenerated1">{{cite journal |vauthors=Rosenthal SM |title=Transgender youth: current concepts |journal=[[Annals of Pediatric Endocrinology & Metabolism]] |volume=21 |issue=4 |pages=185–192 |date=December 2016 |pmid=28164070 |pmc=5290172 |doi=10.6065/apem.2016.21.4.185 |quote=The primary risks of pubertal suppression in gender dysphoric youth treated with GnRH agonists include adverse effects on bone mineralization, compromised fertility, and unknown effects on brain development.}}</ref><ref name="deVries2012">{{cite journal |vauthors=de Vries AL, Cohen-Kettenis PT |title=Clinical management of gender dysphoria in children and adolescents: the Dutch approach |journal=[[Journal of Homosexuality]] |volume=59 |issue=3 |pages=301–320 |date=2012 |pmid=22455322 |doi=10.1080/00918369.2012.653300 |s2cid=11731779}}</ref>

A review published in ''Child and Adolescent Mental Health'' found that puberty blockers are reversible, and that they are associated with such positive outcomes as decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life.<ref name="pubmed.ncbi.nlm.nih.gov">{{cite journal |vauthors=Rew L, Young CC, Monge M, Bogucka R |title=Review: Puberty blockers for transgender and gender diverse youth-a critical review of the literature |journal=[[Child and Adolescent Mental Health]] |volume=26 |issue=1 |pages=3–14 |date=February 2021 |pmid=33320999 |doi=10.1111/camh.12437 |url=https://pubmed.ncbi.nlm.nih.gov/33320999/ |access-date=June 5, 2022 |url-status=live |quote=Positive outcomes were decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life. |s2cid=229282305 |archive-url=https://web.archive.org/web/20220520212910/https://pubmed.ncbi.nlm.nih.gov/33320999/ |archive-date=May 20, 2022}}</ref>

According to the [[American Psychiatric Association]], "Due to the dynamic nature of puberty development, lack of gender-affirming interventions (i.e. social, psychological, and medical) is not a neutral decision; youth often experience worsening dysphoria and negative impact on mental health as the incongruent and unwanted puberty progresses. Trans-affirming treatment, such as the use of puberty suppression, is associated with the relief of emotional distress, and notable gains in psychosocial and emotional development, in trans and gender diverse youth".<ref name="APA-Position">{{Cite web |url=https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-Transgender-Gender-Diverse-Youth.pdf |archive-url=https://web.archive.org/web/20201207160233/https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-Transgender-Gender-Diverse-Youth.pdf |archive-date=December 7, 2020 |url-status=live |title=Position Statement on Treatment of Transgender (Trans) and Gender Diverse Youth}}</ref>

In its position statement published December 2020, the [[Endocrine Society]] stated that there is durable evidence for a biological underpinning to gender identity and that pubertal suppression, hormone therapy, and medically indicated surgery are effective and relatively safe when monitored appropriately and have been established as the standard of care. They noted a decrease in suicidal ideation among youth who have access to gender-affirming care and comparable levels of depression to cisgender peers among socially transitioned pre-pubertal youth.<ref name="endocrine-society-2020">{{Cite web |date=December 15, 2020 |title=Transgender Health: An Endocrine Society Position Statement |url=https://www.endocrine.org/advocacy/position-statements/transgender-health |access-date=June 15, 2022 |website=www.endocrine.org |publisher=The Endocrine Society |language=en |archive-url=https://web.archive.org/web/20201225153455/https://www.endocrine.org/advocacy/position-statements/transgender-health |archive-date=December 25, 2020}}</ref> In its 2017 guideline on treating those with gender dysphoria, it recommends puberty blockers be started when the child has started puberty ([[Tanner scale|Tanner Stage 2]] for breast or genital development) and cross-sex hormones be started at 16, though they note "there may be compelling reasons to initiate sex hormone treatment prior to the age of 16 years in some adolescents with GD/gender incongruence". They recommend a multidisciplinary team of medical and mental health professionals manage the treatment for those under 18 and recommend "monitoring clinical pubertal development every 3 to 6 months and laboratory parameters every 6 to 12 months during sex hormone treatment".<ref name="Hembree">{{cite journal |vauthors=Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, T'Sjoen GG |display-authors=6 |title=Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline |journal=[[The Journal of Clinical Endocrinology and Metabolism]] |volume=102 |issue=11 |pages=3869–3903 |date=November 2017 |pmid=28945902 |doi=10.1210/jc.2017-01658 |doi-access=free}}</ref>

The [[World Professional Association for Transgender Health]]'s Standards of Care 8, published in 2022, declare puberty blocking medication as "medically necessary", and recommends them for usage in transgender adolescents once the patient has reached Tanner stage 2 of development, and state that longitudinal data shows improved outcomes for transgender patients who receive them.<ref>{{cite journal |vauthors=Coleman E, Radix AE, Bouman WP, Brown GR, de Vries AL, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, Hancock AB, Johnson TW, Karasic DH, Knudson GA, Leibowitz SF, Meyer-Bahlburg HF, Monstrey SJ, Motmans J, Nahata L, Nieder TO, Reisner SL, Richards C, Schechter LS, Tangpricha V, Tishelman AC, Van Trotsenburg MA, Winter S, Ducheny K, Adams NJ, Adrián TM, Allen LR, Azul D, Bagga H, Başar K, Bathory DS, Belinky JJ, Berg DR, Berli JU, Bluebond-Langner RO, Bouman MB, Bowers ML, Brassard PJ, Byrne J, Capitán L, Cargill CJ, Carswell JM, Chang SC, Chelvakumar G, Corneil T, Dalke KB, De Cuypere G, de Vries E, Den Heijer M, Devor AH, Dhejne C, D'Marco A, Edmiston EK, Edwards-Leeper L, Ehrbar R, Ehrensaft D, Eisfeld J, Elaut E, Erickson-Schroth L, Feldman JL, Fisher AD, Garcia MM, Gijs L, Green SE, Hall BP, Hardy TL, Irwig MS, Jacobs LA, Janssen AC, Johnson K, Klink DT, Kreukels BP, Kuper LE, Kvach EJ, Malouf MA, Massey R, Mazur T, McLachlan C, Morrison SD, Mosser SW, Neira PM, Nygren U, Oates JM, Obedin-Maliver J, Pagkalos G, Patton J, Phanuphak N, Rachlin K, Reed T, Rider GN, Ristori J, Robbins-Cherry S, Roberts SA, Rodriguez-Wallberg KA, Rosenthal SM, Sabir K, Safer JD, Scheim AI, Seal LJ, Sehoole TJ, Spencer K, St Amand C, Steensma TD, Strang JF, Taylor GB, Tilleman K, T'Sjoen GG, Vala LN, Van Mello NM, Veale JF, Vencill JA, Vincent B, Wesp LM, West MA, Arcelus J |display-authors=6 |title=Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 |journal=[[International Journal of Transgender Health]] |volume=23 |issue=Suppl 1 |pages=S1–S259 |year=2022 |pmid=36238954 |pmc=9553112 |doi=10.1080/26895269.2022.2100644}}</ref> Some medical professionals disagree that adolescents are cognitively mature enough to make a decision with regard to hormone therapy or surgery, and advise that irreversible genital procedures should not be performed on individuals under the age of legal consent in their respective country.<ref name="Maddux2">{{cite book |url=https://books.google.com/books?id=eOlzCgAAQBAJ&pg=PA464 |title=Psychopathology: Foundations for a Contemporary Understanding |vauthors=Maddux JE, Winstead BA |publisher=[[Routledge]] |year=2015 |isbn=978-1317697992 |pages=464–465}}</ref>

A review commissioned by the UK Department of Health found that there was very low certainty of quality of evidence about puberty blocker outcomes in terms of mental health, quality of life and impact on gender dysphoria.<ref>{{Cite web|title=Evidence review: Gonadotrophin releasing hormone analogues for children and adolescents with gender dysphoria |url=https://arms.nice.org.uk/resources/hub/1070905/attachment|url-status=live|access-date=2 April 2021 |quote=The critical outcomes for decision making are the impact on gender dysphoria, mental health and quality of life. The quality of evidence for these outcomes was assessed as very low certainty using modified GRADE.|archive-date=2 April 2021|archive-url= https://web.archive.org/web/20210402083804/https://arms.nice.org.uk/resources/hub/1070905/attachment}}</ref> The Finnish government commissioned a review of the research evidence for treatment of minors and the [[Ministry of Social Affairs and Health|Finnish Ministry of Health]] concluded that there are no research-based health care methods for minors with gender dysphoria.<ref>{{Cite web |title=Finnish guidelines for treatment of child and adolescent gender dysphoria |date=March 2021 |url=https://palveluvalikoima.fi/documents/1237350/22895008/Alaik%C3%A4iset_suositus.pdf/c987a74c-dfac-d82f-2142-684f8ddead64/Alaik%C3%A4iset_suositus.pdf|url-status=live|access-date=22 April 2021 |website=Council for Choices in Health Care (COHERE)|quote=Terveydenhuoltolain mukaan (8§) terveydenhuollon toiminnan on perustuttava näyttöön ja hyviin hoito- ja toimintakäytäntöihin. Alaikäisten osalta tutkimusnäyttöön perustuvia terveydenhuollon menetelmiä ei ole.|quote-page=6|trans-quote=According to the Health Care Act (Section 8), health care activities must be based on evidence and good care and operating practices. There are no research-based health care methods for minors. [translation provided by Wikipedia]|archive-date=3 December 2020|archive-url=https://web.archive.org/web/20201203061437/https://palveluvalikoima.fi/documents/1237350/22895008/Alaik%C3%A4iset_suositus.pdf/c987a74c-dfac-d82f-2142-684f8ddead64/Alaik%C3%A4iset_suositus.pdf}}</ref> Nevertheless, they recommend the use of puberty blockers for minors on a case-by-case basis, and the [[American Academy of Pediatrics]] state that "pubertal suppression in children who identify as TGD [transgender and gender diverse] generally leads to improved psychological functioning in adolescence and young adulthood."<ref>{{cite journal | vauthors = Rafferty J | title = Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents | journal = [[Pediatrics (journal)|Pediatrics]] | volume = 142 | issue = 4 | pages = e20182162 | date = October 2018 | pmid = 30224363 | doi = 10.1542/peds.2018-2162 | doi-access = free }}</ref>

In the [[United States]], several states have introduced or are considering legislation that would prohibit the use of puberty blockers in the treatment of transgender children.<ref name="Safer">{{cite news |vauthors=Safer JD |title=Controversial pubertal blocker legislation may bring unintended consequences for children |work=Healio |date=February 17, 2020 |url=https://www.healio.com/news/endocrinology/20200217/controversial-pubertal-blocker-legislation-may-bring-unintended-consequences-for-children |access-date=15 December 2020 |url-status=live |archive-date=December 30, 2020 |archive-url=https://web.archive.org/web/20201230155709/https://www.healio.com/news/endocrinology/20200217/controversial-pubertal-blocker-legislation-may-bring-unintended-consequences-for-children}}</ref> The [[American Medical Association]],<ref>{{Cite web |url=https://www.ama-assn.org/print/pdf/node/66096 |title=AMA fights to protect health care for transgender patients |date=March 26, 2021 |publisher=American Medical Association |series=State Advocacy Update |access-date=June 29, 2021 |archive-date=June 29, 2021 |archive-url=https://web.archive.org/web/20210629100649/https://www.ama-assn.org/print/pdf/node/66096 |url-status=live}}</ref> the [[Endocrine Society]],<ref>{{Cite web |url=https://www.endocrine.org/news-and-advocacy/news-room/2019/transgender-custody-statement |title=Endocrine Society urges policymakers to follow science on transgender health: Texas custody case prompts unfounded claims |date=October 28, 2019 |location=Washington, DC |website=Endocrine Society |type=Press release |access-date=June 11, 2021 |url-status=live |archive-date=June 11, 2021 |archive-url=https://web.archive.org/web/20210611144435/https://www.endocrine.org/news-and-advocacy/news-room/2019/transgender-custody-statement}}</ref> the [[American Psychological Association]],<ref>{{Cite web |url=https://www.apa.org/pi/lgbt/resources/policy/issues/gender-affirmative-care |title=Criminalizing Gender Affirmative Care with Minors: Suggested Discussion Points With Resources to Oppose Transgender Exclusion Bills |website=American Psychological Association |access-date=2021-06-29 |url-status=live |archive-date=2021-06-29 |archive-url=https://web.archive.org/web/20210629100650/https://www.apa.org/pi/lgbt/resources/policy/issues/gender-affirmative-care}}</ref> the [[American Academy of Child and Adolescent Psychiatry]]<ref>{{Cite web |title=AACAP Statement Responding to Efforts to ban Evidence-Based Care for Transgender and Gender Diverse Youth |website=[[American Academy of Child and Adolescent Psychiatry]] |date=November 8, 2019 |url=https://www.aacap.org/AACAP/Latest_News/AACAP_Statement_Responding_to_Efforts-to_ban_Evidence-Based_Care_for_Transgender_and_Gender_Diverse.aspx |access-date=June 29, 2021 |archive-date=June 7, 2021 |archive-url=https://web.archive.org/web/20210607005936/https://www.aacap.org/AACAP/Latest_News/AACAP_Statement_Responding_to_Efforts-to_ban_Evidence-Based_Care_for_Transgender_and_Gender_Diverse.aspx |url-status=live}}</ref> and the [[American Academy of Pediatrics]]<ref>{{Cite news |title=FAQ: What you need to know about transgender children |vauthors=Schmidt S |newspaper=[[The Washington Post]] |date=April 22, 2021 |url=https://www.washingtonpost.com/dc-md-va/2021/04/22/transgender-child-sports-treatments/ |url-status=live |access-date=June 29, 2021 |archive-date=16 June 2021 |archive-url=https://web.archive.org/web/20210616184819/https://www.washingtonpost.com/dc-md-va/2021/04/22/transgender-child-sports-treatments/}}</ref> oppose bans on puberty blockers for transgender children. In the UK, in the case of ''[[Bell v Tavistock]]'', an appeal court, overturning the original decision, ruled that children under 16 could give consent to receiving puberty blockers.<ref>{{cite news |vauthors=Siddique H |title=Appeal court overturns UK puberty blockers ruling for under-16s |work=[[The Guardian]] |date=17 September 2021 |url=https://www.theguardian.com/society/2021/sep/17/appeal-court-overturns-uk-puberty-blockers-ruling-for-under-16s-tavistock-keira-bell |access-date=September 17, 2021 |archive-date=September 17, 2021 |archive-url= https://web.archive.org/web/20210917131838/https://www.theguardian.com/society/2021/sep/17/appeal-court-overturns-uk-puberty-blockers-ruling-for-under-16s-tavistock-keira-bell |url-status=live}}</ref> In 2022, the [[National Board of Health and Welfare]] in [[Sweden]] issued new guidelines recommending that puberty blockers only be given in "exceptional cases" and said that their use was grounded in "uncertain science." Instead, they recommended child psychiatric treatment, psychosocial interventions, and suicide prevention measures to be offered by clinicians.<ref>{{cite news |vauthors=Milton J |date=February 23, 2022 |title=Swedish health board wants doctors to stop prescribing life-saving puberty blockers |work=[[PinkNews]] |url=https://www.pinknews.co.uk/2022/02/23/sweden-trans-healthcare-puberty-blockers/ |access-date=October 12, 2022}}</ref><ref>{{cite news |vauthors=Ghorayshi A |date=July 28, 2022 |title=England Overhauls Medical Care for Transgender Youth |work=[[The New York Times]] |url=https://www.nytimes.com/2022/07/28/health/transgender-youth-uk-tavistock.html |access-date=October 12, 2022}}</ref>

=== Psychological treatments ===
{{Main|Psychotherapy}}
Until the 1970s, psychotherapy was the primary treatment for gender dysphoria and generally was directed to helping the person adjust to their assigned sex. Psychotherapy is any therapeutic interaction that aims to treat a psychological problem. Psychotherapy may be used in addition to biological interventions, although some clinicians use only psychotherapy to treat gender dysphoria.<ref name="treatment review">{{cite journal |vauthors=Gijs L, Brawaeys A |year=2007 |title=Surgical Treatment of Gender Dysphoria in Adults and Adolescents: Recent Developments, Effectiveness, and Challenges |journal=[[Annual Review of Sex Research]] |volume=18 |issue=178–224|pages=178–224 |doi=10.1080/10532528.2007.10559851 }}</ref> Psychotherapeutic treatment of GD involves helping the patient to adapt to their gender incongruence or to explorative investigation of confounding co-occurring<ref name=":3">{{cite journal | vauthors = Kaltiala-Heino R, Sumia M, Työläjärvi M, Lindberg N | title = Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development | journal = [[Child and Adolescent Psychiatry and Mental Health]] | volume = 9 | pages = 9 | date = 2015 | pmid = 25873995 | pmc = 4396787 | doi = 10.1186/s13034-015-0042-y | doi-access = free }}</ref><ref>{{Cite web |website=Swedish National Board of Health and Welfare |date=Feb 2020 |title=Development of the diagnosis gender dysphoria |language=sv |url=https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/ovrigt/2020-2-6600.pdf |url-status=live |access-date=March 13, 2021 |archive-date=March 8, 2021 |archive-url=https://web.archive.org/web/20210308184807/https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/ovrigt/2020-2-6600.pdf}}</ref><ref>{{cite journal | vauthors = Kozlowska K, Chudleigh C, McClure G, Maguire AM, Ambler GR | title = Attachment Patterns in Children and Adolescents With Gender Dysphoria | journal = Frontiers in Psychology | volume = 11 | pages = 582688 | date = 2021-01-12 | pmid = 33510668 | pmc = 7835132 | doi = 10.3389/fpsyg.2020.582688 | doi-access = free }}</ref><ref>{{cite journal | vauthors = D'Angelo R, Syrulnik E, Ayad S, Marchiano L, Kenny DT, Clarke P | title = One Size Does Not Fit All: In Support of Psychotherapy for Gender Dysphoria | journal = Archives of Sexual Behavior | volume = 50 | issue = 1 | pages = 7–16 | date = January 2021 | pmid = 33089441 | pmc = 7878242 | doi = 10.1007/s10508-020-01844-2 }}</ref> mental health issues. Attempts to alleviate GD by changing the patient's gender identity to reflect assigned sex have been ineffective and are regarded as [[conversion therapy]] by most health organizations.<ref name="Lambda" /><ref name="merck manual">{{cite book|author=George R. Brown, MD|title=The Merck Manual of Diagnosis and Therapy|title-link=Merck Manual of Diagnosis and Therapy|date=July 20, 2011|publisher=[[Merck & Co.]], Inc.|isbn=978-0-911910-19-3|editor1=Robert S. Porter, MD|edition=19th|location=[[Whitehouse Station, NJ]], USA|pages=1740–1747|chapter=Chapter 165 Sexuality and Sexual Disorders|display-editors=etal}}</ref>{{rp|1741}}

=== Biological treatments ===
{{Main|Gender-affirming care}}
Biological treatments physically alter [[Primary sex characteristic|primary]] and [[Secondary sex characteristic|secondary]] sex characteristics to reduce the discrepancy between an individual's physical body and gender identity.<ref name="care guidelines">{{cite journal | vauthors = Bockting W, Knudson G, Goldberg J |date=January 2006|title=Counselling and Mental Health Care of Transgender Adults and Loved Ones|journal=International Journal of Transgenderism |volume=9|issue=3–4 |pages=35–82 |doi=10.1300/J485v09n03_03 |s2cid=71503744|quote=As per Figure 1, delusions about sex or gender, dissociative disorders, thought disorders, or obsessive or compulsive features should be evaluated and treated prior to proceeding with hormone therapy or surgery. Thought disorders, dissociative disorders, and obsessive-compulsive disorders can, rarely, cause a transient wish for sex reassignment which disappears or significantly lessens when the underlying mental health condition is treated. It is important to treat these disorders before proceeding with hormones or surgery to ensure that the desire for alteration of primary or secondary sex characteristics is not a temporary desire.}} See also [https://www.wpath.org/publications/soc WPATH Standards of Care, version 7] {{Webarchive|url=https://web.archive.org/web/20150814230505/http://www.wpath.org/uploaded_files/140/files/Standards%20of%20Care%2C%20V7%20Full%20Book.pdf |date=2015-08-14 }}, page 23: "The role of mental health professionals includes making reasonably sure that the gender dysphoria is not secondary to or better accounted for by other diagnoses." And the paradigmatic [http://dx.doi.org/10.1080/00918369.2012.653300 Dutch model] {{Webarchive|url=https://web.archive.org/web/20220609011001/https://www.tandfonline.com/doi/abs/10.1080/00918369.2012.653300 |date=2022-06-09 }} for consideration of comorbid conditions before proceeding with treatment for childhood onset.</ref> Biological treatments for GD are typically undertaken in conjunction with psychotherapy; however, the [[HBIGDA-SOC|WPATH Standards of Care]] state that psychotherapy should not be an absolute requirement for biological treatments.<ref name="SOC28">{{cite web |title=Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People |url=https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_English.pdf |publisher=World Professional Association for Transgender Health |access-date=15 March 2021 |pages=28–29 |archive-date=18 March 2021 |archive-url=https://web.archive.org/web/20210318100049/https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_English.pdf |url-status=live }}</ref>

Hormonal treatments have been shown to reduce a number of symptoms of psychiatric distress associated with gender dysphoria.<ref name = Neuroimaging>{{cite journal | vauthors = Altinay M, Anand A | title = Neuroimaging gender dysphoria: a novel psychobiological model | journal = Brain Imaging and Behavior | volume = 14 | issue = 4 | pages = 1281–1297 | date = August 2020 | pmid = 31134582 | doi = 10.1007/s11682-019-00121-8 | url = https://link.springer.com/article/10.1007/s11682-019-00121-8 | url-status = live | quote = A recently published study (Colizzi et al. 2014), where 118 patients were followed before and 12 months after HRT revealed that 14% of the patients had comorbid Axis-I psychiatric diagnosis. Psychiatric distress and impairment were found to be higher in the beginning phase of the study but after HRT, there was a significant improvement in major depressive disorder, anxiety and functional impairment. Similarly, Fisher and colleagues' (Fisher et al. 2013) 2013 paper suggests that the dysfunction and impairment in the transgender population is highly associated with lack of HRT, which may suggest that at least a fraction of the impairment that was documented as comorbid Axis-I psychiatric disorders could in fact be impairment from GD. Finally, a metanalysis done by Dhejne and colleagues (Dhejne et al. 2016) reviewed 38 longitudinal studies that investigated psychiatric comorbidities pre and post gender affirmation treatments in transgender people with GD. The results of this analysis indicate that depression and GAD do have higher prevalence in transgender population but this finding was isolated to baseline (pre-gender affirmation treatments) where after gender affirmation therapies, rate of psychiatric comorbidities decreased to cisgender population levels | s2cid = 167207854 | archive-url = https://web.archive.org/web/20211021113310/https://link.springer.com/article/10.1007/s11682-019-00121-8 | archive-date = 2021-10-21 }}</ref> A WPATH commissioned systematic review of the outcomes of hormone therapy "found evidence that gender-affirming hormone therapy may be associated with improvements in [quality of life] scores and decreases in depression and anxiety symptoms among transgender people." The strength of the evidence was low due to methodological limitations of the studies undertaken.<ref>{{cite journal | vauthors = Baker KE, Wilson LM, Sharma R, Dukhanin V, McArthur K, Robinson KA | title = Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review | journal = Journal of the Endocrine Society | volume = 5 | issue = 4 | pages = bvab011 | date = April 2021 | pmid = 33644622 | pmc = 7894249 | doi = 10.1210/jendso/bvab011 | quote = This systematic review of 20 studies found evidence that gender-affirming hormone therapy may be associated with improvements in QOL scores and decreases in depression and anxiety symptoms among transgender people. Associations were similar across gender identity and age. The strength of evidence for these conclusions is low due to methodological limitations. | doi-access = free }}</ref> Some literature suggests that gender-affirming surgery is associated with improvements in quality of life and decreased incidence of depression.<ref>{{cite journal | vauthors = Wernick JA, Busa S, Matouk K, Nicholson J, Janssen A | title = A Systematic Review of the Psychological Benefits of Gender-Affirming Surgery | journal = The Urologic Clinics of North America | volume = 46 | issue = 4 | pages = 475–486 | date = November 2019 | pmid = 31582022 | doi = 10.1016/j.ucl.2019.07.002 | url = https://www.sciencedirect.com/science/article/pii/S0094014319300497 | access-date = 2021-12-27 | series = Gender Affirming Surgery | s2cid = 201997501 }}</ref> Those who choose to undergo gender-affirming surgery report high satisfaction rates with the outcome, though these studies have limitations including risk of bias (lack of randomization, lack of controlled studies, self-reported outcomes) and high loss to follow up.<ref name=":5" /><ref>{{cite journal | vauthors = Murad MH, Elamin MB, Garcia MZ, Mullan RJ, Murad A, Erwin PJ, Montori VM | title = Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes | journal = Clinical Endocrinology | volume = 72 | issue = 2 | pages = 214–231 | date = February 2010 | pmid = 19473181 | doi = 10.1111/j.1365-2265.2009.03625.x | url = https://pubmed.ncbi.nlm.nih.gov/19473181/ | access-date = 2021-07-17 | url-status = live | quote = The evidence in this review is of very low quality9, 10 due to the serious methodological limitations of included studies. Studies lacked bias protection measures such as randomization and control groups, and generally depended on self-report to ascertain the exposure (i.e. hormonal therapy was self-reported as opposed to being extracted from medical records). Our reliance on reported outcome measures may also indicate a higher risk of reporting bias within the studies. Statistical heterogeneity of the results was also significant. | s2cid = 19590739 | archive-url = https://web.archive.org/web/20210717025223/https://pubmed.ncbi.nlm.nih.gov/19473181/ | archive-date = 2021-07-17 }}</ref><ref>{{cite journal | vauthors = Sutcliffe PA, Dixon S, Akehurst RL, Wilkinson A, Shippam A, White S, Richards R, Caddy CM | display-authors = 6 | title = Evaluation of surgical procedures for sex reassignment: a systematic review | journal = Journal of Plastic, Reconstructive & Aesthetic Surgery | volume = 62 | issue = 3 | pages = 294–306; discussion 306–308 | date = March 2009 | pmid = 18222742 | doi = 10.1016/j.bjps.2007.12.009 | url = https://pubmed.ncbi.nlm.nih.gov/18222742/ | access-date = 2021-07-17 | url-status = live | quote = The evidence concerning gender reassignment surgery in both MTF and FTM transsexism has several limitations in terms of: (a) lack of controlled studies, (b) evidence has not collected data prospectively, (c) high loss to follow up and (d) lack of validated assessment measures. Some satisfactory outcomes were reported, but the magnitude of benefit and harm for individual surgical procedures cannot be estimated accurately using the current available evidence. | archive-url = https://web.archive.org/web/20210717025221/https://pubmed.ncbi.nlm.nih.gov/18222742/ | archive-date = 2021-07-17 }}</ref>

Disagreement among practitioners regarding treatment of adolescents is in part due to the lack of long-term data.<ref name ="Kaltiala-Heino" >{{cite journal |vauthors=Kaltiala-Heino R, Bergman H, Työläjärvi M, Frisén L |title=Gender dysphoria in adolescence: current perspectives |journal=[[Adolescent Health, Medicine and Therapeutics]] |volume=9 |pages=31–41 |date=March 2, 2018 |pmid=29535563 |pmc=5841333 |doi=10.2147/AHMT.S135432 |quote="for the majority of adolescent-onset cases, GD presented in the context of severe mental disorders and general identity confusion. In such situations, appropriate treatment for psychiatric comorbidities may be warranted before conclusions regarding gender identity can be drawn."; "There is still no clear consensus regarding hormonal treatment for adolescents because long-term data are unavailable"; "In a nationwide long-term follow-up study of adult cases, psychiatric morbidity, suicide attempts and suicide mortality persisted as elevated after juridical and medical SR." |doi-access=free}}</ref> Young people qualifying for biomedical treatment according to the Dutch model<ref>{{cite journal |vauthors=Cohen-Kettenis PT, Delemarre-van de Waal HA, Gooren LJ |title=The treatment of adolescent transsexuals: changing insights |journal=The Journal of Sexual Medicine |volume=5 |issue=8 |pages=1892–1897 |date=August 2008 |pmid=18564158 |doi=10.1111/j.1743-6109.2008.00870.x |url=https://pubmed.ncbi.nlm.nih.gov/18564158/ |access-date=April 14, 2021 |url-status=live |archive-url=https://web.archive.org/web/20210413032947/https://pubmed.ncbi.nlm.nih.gov/18564158/ |archive-date=April 13, 2021}}</ref><ref>{{cite journal |vauthors=de Vries AL, McGuire JK, Steensma TD, Wagenaar EC, Doreleijers TA, Cohen-Kettenis PT |title=Young adult psychological outcome after puberty suppression and gender reassignment |journal=Pediatrics |volume=134 |issue=4 |pages=696–704 |date=October 2014 |pmid=25201798 |doi=10.1542/peds.2013-2958 |url=https://pubmed.ncbi.nlm.nih.gov/25201798/ |access-date=April 14, 2021 |url-status=live |s2cid=18155489 |archive-url=https://web.archive.org/web/20210413032943/https://pubmed.ncbi.nlm.nih.gov/25201798/ |archive-date=April 13, 2021}}</ref> (including having GD from early childhood which intensifies at puberty and absence of co-occurring psychiatric conditions that could challenge diagnosis or treatment) found reduction in gender dysphoria, although limitations to these outcome studies have been noted, such as lack of controls or considering alternatives like psychotherapy.<ref>{{cite journal |vauthors=Zucker KJ |title=Adolescents with Gender Dysphoria: Reflections on Some Contemporary Clinical and Research Issues |journal=[[Archives of Sexual Behavior]] |volume=48 |issue=7 |pages=1983–1992 |date=October 2019 |pmid=31321594 |doi=10.1007/s10508-019-01518-8 |url=https://doi.org/10.1007/s10508-019-01518-8 |access-date=April 14, 2021 |url-status=live |quote=In the Dutch model, several factors were identified in deeming adolescent eligibility for early biomedical treatment. According to Cohen-Kettenis, Delemarre-van de Waal, and Gooren (2008), these included the following: (1) the presence of gender dysphoria from early childhood on; (2) an exacerbation of the gender dysphoria after the first signs of puberty; (3) the absence of psychiatric comorbidity that would interfere with a diagnostic evaluation or treatment; (4) adequate psychological and social support during treatment; and (5) a demonstration of knowledge of the sex/gender reassignment process. Several studies have reported on the benefits of this therapeutic protocol in reducing gender dysphoria (e.g., de Vries et al., 2014, which is the best study to date). Of course, one should bear in mind some of the limitation to these outcome studies, including the fact that not all assessed adolescents were deemed eligible for the treatment protocol (and thus we know relatively little about the longer-term outcomes of these youth) and that study designs have not included alternative treatment options (such as psychosocial therapy) or even being assigned to a wait-list control condition |s2cid=197663705 |archive-url=https://web.archive.org/web/20220609011010/https://link.springer.com/article/10.1007/s10508-019-01518-8 |archive-date=June 9, 2022}}</ref>{{unreliable medical source|reason=Author is, and was at the time of publication, editor-in-chief of this journal. This may count as self-published.|date=September 2024}}

In its position statement published December 2020, the [[Endocrine Society]] stated that there is durable evidence for a biological underpinning to gender identity and that pubertal suppression, hormone therapy, and medically indicated surgery are effective and relatively safe when monitored appropriately and have been established as the standard of care. They noted a decrease in suicidal ideation among youth who have access to gender-affirming care and comparable levels of depression to cisgender peers among socially transitioned pre-pubertal youth.<ref name="endocrine-society-2020"/>

A review published in ''Child and Adolescent Mental Health'' found that puberty blockers are fully reversible, and that they are associated with such positive outcomes as decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life.<ref name="pubmed.ncbi.nlm.nih.gov"/>

More rigorous studies are needed to assess the effectiveness, safety, and long-term benefits and risks of hormonal and surgical treatments.<ref name=":5">{{cite journal |vauthors=Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, T'Sjoen GG |display-authors=6 |title=Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline |journal=[[Journal of Clinical Endocrinology and Metabolism]] |volume=102 |issue=11 |pages=3869–3903 |date=November 2017 |pmid=28945902 |doi=10.1210/jc.2017-01658 |quote="In the future, we need more rigorous evaluations of the effectiveness and safety of endocrine and surgical protocols.Specifically, endocrine treatment protocols for GD/gender incongruence should include the careful assessment of the following: (1) the effects of prolonged delay of puberty in adolescents on bone health, gonadal function, and the brain (including effects on cognitive, emotional, social, and sexual development); [...] and (4) the risks and benefits of gender-affirming hormone treatment in older transgender people." "Future research is needed to ascertain the potential harm of hormonal therapies (176)." "The satisfaction rate with surgical reassignment of sex is now very high (187)." "Owing to the lack of controlled studies, incomplete follow-up, and lack of valid assessment measures, evaluating various surgical approaches and techniques is difficult." "Several postoperative studies report significant long-term psychological and psychiatric pathology (259–261)." "We need more studies with appropriate controls that examine long-term quality of life, psychosocial outcomes, and psychiatric outcomes to determine the long-term benefits of surgical treatment." | doi-access = free }}</ref> For instance, a 2020 Cochrane review found insufficient evidence to determine whether feminizing hormones were safe or effective, due to the lack of "completed studies that met [their] inclusion criteria."<ref>{{cite journal |vauthors=Haupt C, Henke M, Kutschmar A, Hauser B, Baldinger S, Saenz SR, Schreiber G |title=Antiandrogen or estradiol treatment or both during hormone therapy in transitioning transgender women |journal=[[The Cochrane Database of Systematic Reviews]] |volume=2020 |issue=11 |pages=CD013138 |date=November 2020 |pmid=33251587 |pmc=8078580 |doi=10.1002/14651858.cd013138.pub2 |quote=We found insufficient evidence to determine the efficacy or safety of hormonal treatment approaches for transgender women in transition.}}</ref> Several studies have found significant long-term psychological and psychiatric pathology after surgical treatments.<ref name=":5" />

In 2021, a review published in ''Plastic and Reconstructive Surgery'' found that about 1% (95% [[confidence interval|CI]] <1%–2%) of people who undergo gender-affirming surgery regret the decision. It concluded that "There is an extremely low prevalence of regret in transgender patients after GAS. We believe this study corroborates the improvements made in regard to selection criteria for GAS. However, there is high subjectivity in the assessment of regret and lack of standardized questionnaires, which highlight the importance of developing validated questionnaires in this population."<ref>{{cite journal |vauthors=Bustos VP, Bustos SS, Mascaro A, Del Corral G, Forte AJ, Ciudad P, Kim EA, Langstein HN, Manrique OJ |display-authors=6 |title=Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence |journal=Plastic and Reconstructive Surgery. Global Open |volume=9 |issue=3 |pages=e3477 |date=March 2021 |pmid=33968550 |pmc=8099405 |doi=10.1097/GOX.0000000000003477 }}</ref>

== Co-occurring conditions ==
Among youth, around 20% to 30% of individuals attending gender clinics meet the DSM criteria for an [[anxiety disorder]].<ref>{{Cite book |vauthors=Janssen A, Leibowitz S |url=https://books.google.com/books?id=DLZcDwAAQBAJ&q=ADHD+gender+dysphoria |title=Affirmative Mental Health Care for Transgender and Gender Diverse Youth: A Clinical Guide |date=May 22, 2018 |publisher=Springer |isbn=978-3-319-78307-9 |pages=8 |language=en |access-date=August 6, 2021 |archive-date=October 15, 2021 |archive-url=https://web.archive.org/web/20211015105910/https://books.google.com/books?id=DLZcDwAAQBAJ&q=ADHD+gender+dysphoria |url-status=live}}</ref> Gender dysphoria is also associated with an increased risk of [[eating disorders]] in transgender youth.<ref>{{cite journal | vauthors = Coelho JS, Suen J, Clark BA, Marshall SK, Geller J, Lam PY | title = Eating Disorder Diagnoses and Symptom Presentation in Transgender Youth: a Scoping Review | journal = Current Psychiatry Reports | volume = 21 | issue = 11 | pages = 107 | date = October 2019 | pmid = 31617014 | doi = 10.1007/s11920-019-1097-x | quote = Significantly higher rates of eating disorder symptoms were documented in transgender youth compared to cisgender youth. | s2cid = 204542613 }}</ref>

A widely held view among clinicians is that there is an over-representation of [[Neurodevelopmental disorder|neurodevelopmental conditions]] amongst individuals with GD, although this view has been questioned due to the low quality of evidence.<ref name=":1">{{cite journal |vauthors=Thrower E, Bretherton I, Pang KC, Zajac JD, Cheung AS |title=Prevalence of Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder Amongst Individuals with Gender Dysphoria: A Systematic Review |journal=[[Journal of Autism and Developmental Disorders]] |volume=50 |issue=3 |pages=695–706 |date=March 2020 |pmid=31732891 |doi=10.1007/s10803-019-04298-1 |url=https://doi.org/10.1007/s10803-019-04298-1 |access-date=August 6, 2021 |url-status=live |s2cid=208061795 |archive-url=https://web.archive.org/web/20220609011012/https://link.springer.com/article/10.1007/s10803-019-04298-1 |archive-date=June 9, 2022}}</ref> Studies on children and adolescents with gender dysphoria have found a high prevalence of autistic traits or a confirmed diagnosis of [[autism]].<ref name="york"/><ref name="kyriakou"/> Adults with gender dysphoria attending specialist gender clinics have also been shown to have high rates of autistic traits or an autism diagnosis as well.<ref name="kyriakou">{{cite journal |vauthors=Kyriakou A, Nicolaides NC, Skordis N |title=Current approach to the clinical care of adolescents with gender dysphoria |journal=Acta Bio-Medica |volume=91 |issue=1 |pages=165–175 |date=March 2020 |pmid=32191677 |pmc=7569586 |doi=10.23750/abm.v91i1.9244}}</ref> It has been estimated that autistic children were over four times as likely to be diagnosed with GD,<ref name=":1" /> with autism being reported from 6% to over 20% of teens referring to gender identity services.<ref name ="Kaltiala-Heino" />

Children and adolescents with gender dysphoria are also <!--in addition to anxiety, eating disorders, autistic spectrum--> more likely to have [[ADHD]], [[Depression (mood)|depression]] and histories of [[Suicide|suicidality]], [[self-harm]] and [[adverse childhood experience]]s.<ref name="york">{{Cite journal |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326681 |title=Characteristics of children and adolescents referred to specialist gender services: a systematic review |last1=Taylor |first1=Jo |last2=Hall |first2=Ruth |last3=Langton  |first3=Trilby |last4=Fraser |first4=Lorna |last5=Hewitt |first5=Catherine Elizabeth |display-authors=etal |journal=Archives of Disease in Childhood |year=2024 |volume=109 |issue=Suppl 2 |pages=s3–s11 |doi=10.1136/archdischild-2023-326681 |doi-access=free |pmid=38594046 }}</ref>
== Epidemiology ==
{{See also|Transgender#Population figures and prevalence|Transsexual#Prevalence}}

Different studies have arrived at different conclusions about the prevalence of gender dysphoria. The DSM-5 gives a gender dysphoria prevalence of 0.005% to 0.014% of people assigned male at birth (5-14 per 100k) and 0.002% to 0.003% of people assigned female at birth (2-3 per 100k).<ref name="dsm5_454">{{cite book |url=https://archive.org/details/diagnosticstatis0005unse/page/454 |title=Diagnostic and Statistical Manual of Mental Disorders 5 |publisher=[[American Psychiatric Association]] |year=2013 |isbn=978-0-89042-555-8 |page=[https://archive.org/details/diagnosticstatis0005unse/page/454 454]}}</ref> The DSM-5 states that these numbers are likely underestimates, being based on the number of referrals to specialty clinics.<ref name="dsm5_454"/> Not all adults seeking medical transition are referred to specialty clinics.<ref name="dsm5_454"/>

According to ''[[Black's Medical Dictionary]]'', gender dysphoria "occurs in one in 30,000 male births and one in 100,000 female births."<ref>{{cite encyclopedia |title=Gender Identity Disorders |url=https://books.google.com/books?id=6asrDwAAQBAJ |editor=Harvey Marcovitch |encyclopedia=[[Black's Medical Dictionary]] |edition=43rd |location=New York |publisher=Bloomsbury |year=2018 |isbn=9781472943064 |access-date=2021-01-14 |archive-date=2022-06-09 |archive-url=https://web.archive.org/web/20220609011002/https://www.google.com/books/edition/Black_s_Medical_Dictionary/6asrDwAAQBAJ |url-status=live }}</ref> Studies in European countries in the early 2000s found that about 1 in 12,000 natal male adults (8 per 100k) and 1 in 30,000 (3 per 100k) natal female adults seek out [[gender-affirming surgery]].<ref name=":0">{{cite journal | vauthors = Zucker KJ | title = Epidemiology of gender dysphoria and transgender identity | journal = Sexual Health | volume = 14 | issue = 5 | pages = 404–411 | date = October 2017 | pmid = 28838353 | doi = 10.1071/SH17067 | s2cid = 205237976 | url = http://www.publish.csiro.au/?paper=SH17067 | access-date = 2020-12-22 | url-status = live | archive-url = https://web.archive.org/web/20220609011008/https://www.publish.csiro.au/sh/SH17067 | archive-date = 2022-06-09 }}</ref> Studies of hormonal treatment or legal [[name change]] find higher prevalence than sex reassignment, with, for example a 2010 Swedish study finding that 1 in 7,750 (13 per 100k) adult natal males and 1 in 13,120 (8 per 100k) adult natal females requested a legal name change to a name of the opposite gender.<ref name=":0" />

Studies that measure transgender status by self-identification find even greater prevalence of gender identity different from sex assigned at birth (although some of those who identify as transgender or gender nonconforming may not experience clinically significant distress and so do not have gender dysphoria). A study in [[New Zealand]] found that 1 in 3,630 natal males (13 per 100k) and 1 in 22,714 (4 per 100k) natal females have changed their legal gender markers.<ref name=":0" /> A survey of [[Massachusetts]] adults found that 0.5% (500 per 100k) identify as transgender.<ref name=":0" /><ref name="AJPH">{{cite journal |vauthors=Conron KJ, Scott G, Stowell GS, Landers SJ |title=Transgender health in Massachusetts: results from a household probability sample of adults |journal=[[American Journal of Public Health]] |volume=102 |issue=1 |pages=118–122 |date=January 2012 |pmid=22095354 |pmc=3490554 |doi=10.2105/AJPH.2011.300315 |publisher=[[American Public Health Association]] |quote=Between 2007 and 2009, survey participants aged 18 to 64 years in the Massachusetts Behavioral Risk Factor Surveillance System (MA-BRFSS; N = 28 662) were asked: "Some people describe themselves as transgender when they experience a different gender identity from their sex at birth. For example, a person born into a male body, but who feels female or lives as a woman. Do you consider yourself to be transgender?" ... We restricted the analytic sample to 28176 participants who answered yes or no to the transgender question (excluding n=364, 1.0% weighted who declined to respond. ... Transgender respondents (n=131; 0.5%; 95% confidence interval [CI]=0.3%, 0.6%) were somewhat younger and more likely to be Hispanic than were nontransgender respondents. |oclc=01642844}}</ref> A national survey in [[New Zealand]] of 8,500 randomly selected secondary school students from 91 randomly selected high schools found 1.2% (1,200 per 100k) of students responded "yes" to the question "Do you think you are transgender?".<ref>{{cite journal |vauthors=Clark TC, Lucassen MF, Bullen P, Denny SJ, Fleming TM, Robinson EM, Rossen FV |title=The health and well-being of transgender high school students: results from the New Zealand adolescent health survey (Youth'12) |journal=[[Journal of Adolescent Health]] |volume=55 |issue=1 |pages=93–99 |date=July 2014 |pmid=24438852 |doi=10.1016/j.jadohealth.2013.11.008 |quote=Whether a student was transgender was measured by the question, "Do you think you are transgender? This is a girl who feels like she should have been a boy, or a boy who feels like he should have been a girl (e.g., Trans, Queen, [[Fa'afafine|Fa'faffine]], Whakawahine, Tangata ira Tane, [[Genderqueer]])?" ... Over 8,000 students (n = 8,166) answered the question about whether they were transgender. Approximately 95% of students did not report being transgender (n=7,731; 94.7%), 96 students reported being transgender (1.2%), 202 reported not being sure (2.5%), and 137 did not understand the question (1.7%). |doi-access=free|hdl=2292/22335 |hdl-access=free }}</ref> Outside of a clinical setting, the stability of transgender or non-binary identities is unknown.<ref name=:0/>

Research indicates that among people who transition in adulthood, individuals are up to three times more likely to be male assigned at birth. However, among people transitioning in childhood, the sex ratio is closer to 1:1.<ref name="prevalence">{{cite journal |vauthors=Landén M, Wålinder J, Lundström B |date=April 1996 |title=Prevalence, incidence and sex ratio of transsexualism |journal=[[Acta Psychiatrica Scandinavica]] |volume=93 |issue=4 |pages=221–223 |doi=10.1111/j.1600-0447.1996.tb10638.x |pmid=8712018 |s2cid=26661088 |quote=On average, the male [to female]:female [to male] ratio in prevalence studies is estimated to be 3:1. However ... the incidence studies have shown a considerably lower male [to female] predominance. In Sweden and England and Wales, a sex ratio of 1:1 has been reported. In the most recent incidence data from Sweden, there is a slight male [to female] predominance among the group consisting of all applicants for sex reassignment, while in the group of primary [early onset] transsexuals there is no difference in incidence between men and women.}}</ref> The prevalence of [[gender dysphoria in children]] remains uncertain due to the lack of formal prevalence studies.<ref name="Ristori" /> A 2022 literature review reported that approximately 36% of adolescents assessed in specialized gender clinics were natal males, and 63% were natal females. One study highlighted in the review found no significant change in these proportions from 2014 to 2016.<ref>{{Cite journal |last1=Chiniara |first1=Lyne N. |last2=Bonifacio |first2=Herbert J. |last3=Palmert |first3=Mark R. |date=June 19, 2018|title=Characteristics of Adolescents Referred to a Gender Clinic: Are Youth Seen Now Different from Those in Initial Reports? |url=https://doi.org/10.1159/000489608 |journal=[[Hormone Research in Paediatrics]] |volume=89 |issue=6 |pages=434–441 |doi=10.1159/000489608 |pmid=29920505 |s2cid=49314194 |issn=1663-2818}}</ref> However, when comparing more recent data with earlier studies, there has been a shift favoring natal females (ratio of 1:3) as opposed to nearly equal proportions in earlier studies (ratios of 0.8–0.9:1).<ref>{{Cite journal |last1=Thompson |first1=Lucy |last2=Sarovic |first2=Darko |last3=Wilson |first3=Philip |last4=Sämfjord |first4=Angela |last5=Gillberg |first5=Christopher |date=March 9, 2022 |title=A PRISMA systematic review of adolescent gender dysphoria literature: 1) Epidemiology |journal=[[PLOS Global Public Health]] |language=en |volume=2 |issue=3 |pages=e0000245 |doi=10.1371/journal.pgph.0000245 |issn=2767-3375 |pmc=10021877 |pmid=36962334 |doi-access=free}}</ref>

== Society and culture ==
[[File:2013 Rally for Transgender Equality 21175.jpg|right|thumb|A sign at a trans rights rally: "Gender is like that old jumper from my cousin: It was given to me and it doesn't fit."]]
Researchers disagree about the nature of distress and impairment in people with GD. Some authors have suggested that people with GD suffer because they are [[social stigma|stigmatized]] and [[victimisation|victimized]];<ref name="Karl Bryant"/><ref name=":2">{{Cite book |vauthors=Bryant KE |title=The Politics of Pathology and the Making of Gender Identity Disorder |year=2007 |isbn=978-0-549-26816-1 |location=Ann Arbor, Michigan |page=222}}</ref> and that, if society had less strict gender divisions, transgender people would suffer less.<ref name="Giordano-2012">{{Cite book |vauthors=Giordano S |title=Children with Gender Identity Disorder: A Clinical, Ethical, and Legal Analysis |publisher=[[Routledge]] |year=2012 |isbn=978-0-415-50271-9 |location=New Jersey |page=147}}</ref>

Some controversy surrounds the creation of the GD diagnosis, with Davy et al. stating that although the creators of the diagnosis state that it has rigorous scientific support, "it is impossible to scrutinize such claims, since the discussions, methodological processes, and promised field trials of the diagnosis have not been published."<ref name="Davy"/>

Some cultures have [[Third gender|three or more defined genders]]. The existence of accepted social categories other than man or woman may alleviate the distress associated with cross-gender identity. For example, in [[Samoa]], the ''[[fa'afafine]]'', a group of [[feminine males]], are mostly socially accepted. The fa'afafine appear similar to transgender women in terms of their lifelong identities and gendered behavior, but experience far less distress than do transgender women in Western cultures. This suggests that the distress of gender dysphoria is significantly increased by difficulties encountered from social disapproval by one's culture.<ref name="fa'afafine">{{cite journal |vauthors=Vasey PL, Bartlett NH |title=What can the Samoan "Fa'afafine" teach us about the Western concept of gender identity disorder in childhood? |journal=[[Perspectives in Biology and Medicine]] |volume=50 |issue=4 |pages=481–490 |year=2007 |pmid=17951883 |doi=10.1353/pbm.2007.0056 |s2cid=37437172}}</ref> Overall, it is unclear whether or not gender dysphoria persists in cultures with third gender categories.<ref>{{cite book |url=https://archive.org/details/diagnosticstatis0005unse/page/459 |title=Diagnostic and Statistical Manual of Mental Disorders 5 |publisher=[[American Psychiatric Association]] |year=2013 |isbn=978-0-89042-555-8 |page=[https://archive.org/details/diagnosticstatis0005unse/page/457 457]}}</ref>

=== Classification as a disorder ===
The [[mental disorder|psychiatric diagnosis]] of gender identity disorder (now gender dysphoria) was introduced in DSM-III in 1980. [[Arlene Istar Lev]] and [[Deborah Rudacille]] have characterized the addition as a political maneuver to re-stigmatize homosexuality.<ref>{{cite book |vauthors=Lev AI |url=https://books.google.com/books?id=LwxvazLRmiEC&q=homosexuality+dsm-iii+transsexuality&pg=PA172 |title=Transgender Emergence: Therapeutic Guidelines for Working with Gender-Variant People and Their Families |publisher=Haworth Press |year=2004 |isbn=978-0-7890-2117-5 |page=172 |author-link=Arlene Istar Lev |access-date=November 11, 2020 |archive-date=January 23, 2021 |archive-url=https://web.archive.org/web/20210123073430/https://books.google.com/books?id=LwxvazLRmiEC&q=homosexuality+dsm-iii+transsexuality&pg=PA172|url-status=live}}</ref><ref>{{cite book |vauthors=Rudacille D |title=The Riddle of Gender: Science, Activism, and Transgender Rights |date=February 2005 |publisher=Pantheon |isbn=978-0-375-42162-4 |author-link=Deborah Rudacille}}{{page needed|date=May 2016}}</ref> (Homosexuality was [[Homosexuality in the DSM|declassified as a mental disorder]] in the DSM-II in 1974.) By contrast, [[Kenneth Zucker]] and [[Robert Spitzer (psychiatrist)|Robert Spitzer]] argue that gender identity disorder was included in DSM-III because it "met the generally accepted criteria used by the framers of DSM-III for inclusion."<ref name="Historical Note">{{cite journal | vauthors = Zucker KJ, Spitzer RL | title = Was the gender identity disorder of childhood diagnosis introduced into DSM-III as a backdoor maneuver to replace homosexuality? A historical note | journal = Journal of Sex & Marital Therapy | volume = 31 | issue = 1 | pages = 31–42 | date = Jan–Feb 2005 | pmid = 15841704 | doi = 10.1080/00926230590475251 | author2-link = Robert Spitzer (psychiatrist) | s2cid = 22589255 | author-link = Kenneth Zucker }}</ref> Some researchers, including Spitzer and Paul J. Fink, contend that the behaviors and experiences seen in transsexualism are abnormal and constitute a dysfunction.<ref name="PsychNews">{{cite news | vauthors = Hausman K | date = 18 July 2003 |title=Controversy Continues to Grow Over DSM's GID Diagnosis|publisher=Psychiatric News|url=http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=106462|access-date=2014-05-22|archive-date=2014-05-22|archive-url=https://web.archive.org/web/20140522142507/http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=106462|url-status=live}}</ref> The American Psychiatric Association stated that [[gender nonconformity]] is not the same thing as gender dysphoria,<ref name="What Is"/> and that "gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition."<ref name="DSM-5 fact sheet"/>

Individuals with gender dysphoria may or may not regard their own cross-gender feelings and behaviors as a disorder. Advantages and disadvantages exist to classifying gender dysphoria as a disorder.<ref name="Standards of Care" /> Because gender dysphoria had been classified as a disorder in medical texts (such as the previous DSM manual, the DSM-IV-TR, under the name "gender identity disorder"), many insurance companies are willing to cover some of the expenses of sex reassignment therapy. Without the classification of gender dysphoria as a medical disorder, sex reassignment therapy may be viewed as a cosmetic treatment, rather than medically necessary treatment, and may not be covered.<ref name="Zack Ford">{{cite web| vauthors = Ford Z |title=APA Revises Manual: Being Transgender is No Longer a Mental Disorder|website=[[ThinkProgress]]|url=http://thinkprogress.org/lgbt/2012/12/03/1271431/apa-revises-manual-being-transgender-is-no-longer-a-mental-disorder/?mobile=nc|url-status=dead|archive-url=https://web.archive.org/web/20130202082602/http://thinkprogress.org/lgbt/2012/12/03/1271431/apa-revises-manual-being-transgender-is-no-longer-a-mental-disorder/?mobile=nc|archive-date=February 2, 2013|access-date=April 7, 2013}}</ref> In the United States, transgender people are less likely than others to have health insurance, and often face hostility and insensitivity from healthcare providers.<ref>{{Cite book| vauthors = Mallon GP |title=Social Work Practice with Transgender and Gender Variant Youth|publisher=Routledge|year=2009|isbn=978-0-415-99482-8|location=New Jersey}}</ref> The [[Americans with Disabilities Act]] covers individuals with gender dysphoria,<ref>{{cite news |author=Devan Cole |title=Federal appeals court says Americans with Disabilities Act protections cover 'gender dysphoria,' handing a win to trans people |url= https://www.cnn.com/2022/08/16/politics/americans-with-disabilities-act-transgender-gender-dysphoria/index.html |access-date=5 September 2022 |work=CNN |agency=CNN}}</ref> provides some legal protections against discrimination which may aid transgender people in accessing legal protections they otherwise may be unable to.{{Original research inline|date=October 2024}} Some researchers and transgender people support declassification of the condition because they say the diagnosis [[pathologizes]] gender variance and reinforces the [[Gender binary|binary model of gender]].<ref name="Karl Bryant" />

An analysis of the Samoan third gender ''fa'afafine'' suggests that the DSM-IV-TR diagnostic component of distress is not inherent in the cross-gender identity; rather, it is related to social rejection and discrimination suffered by the individual.<ref name="fa'afafine" /> Psychology professor Darryl Hill insists that gender dysphoria is not a mental disorder, but rather that the diagnostic criteria reflect psychological distress in children that occurs when parents and others have trouble relating to their child's gender variance.<ref name="PsychNews" /> Transgender people have often been harassed, socially excluded, and subjected to discrimination, abuse and violence, including murder.<ref name="Davidson-2012" /><ref name="Giordano-2012" />

In December 2002, the British Lord Chancellor's office published a ''Government Policy Concerning Transsexual People'' document that categorically states, "What transsexualism is not ... It is not a mental illness."<ref>{{cite web|year=2003|title=Government Policy concerning Transsexual People|url=http://www.dca.gov.uk/constitution/transsex/policy.htm|url-status=dead|archive-url=https://web.archive.org/web/20080511211217/http://www.dca.gov.uk/constitution/transsex/policy.htm|archive-date=May 11, 2008|work=People's rights/Transsexual people|publisher=U.K. Department for Constitutional Affairs}}</ref> In May 2009, the government of France declared that a transsexual gender identity will no longer be classified as a psychiatric condition,<ref>{{cite news|date=May 16, 2009|title=La transsexualité ne sera plus classée comme affectation psychiatrique|work=Le Monde|url=http://www.lemonde.fr/societe/article/2009/05/16/la-transsexualite-ne-sera-plus-classee-comme-affectation-psychiatrique_1193860_3224.html|access-date=May 31, 2009|archive-date=February 26, 2018|archive-url=https://web.archive.org/web/20180226213224/http://www.lemonde.fr/societe/article/2009/05/16/la-transsexualite-ne-sera-plus-classee-comme-affectation-psychiatrique_1193860_3224.html|url-status=live}}</ref> but according to French trans rights organizations, beyond the impact of the announcement itself, nothing changed.<ref>{{Cite news |date=May 17, 2011 |title=La France est très en retard dans la prise en charge des transsexuels |trans-title=France is far behind in caring for transsexuals |language=fr |work=Libération |url=http://www.liberation.fr/societe/2011/05/17/la-france-est-tres-en-retard-dans-la-prise-en-charge-des-transsexuels_736344 |quote=En réalité, ce décret n'a été rien d'autre qu'un coup médiatique, un très bel effet d'annonce. Sur le terrain, rien n'a changé. |trans-quote=In reality, this decree was nothing other than a media stunt, a very good publicity effect. On the ground, nothing has changed. |access-date=March 11, 2018 |archive-date=November 30, 2014 |archive-url=https://web.archive.org/web/20141130231929/http://www.liberation.fr/societe/2011/05/17/la-france-est-tres-en-retard-dans-la-prise-en-charge-des-transsexuels_736344 |url-status=live}}</ref> Denmark made a similar statement in 2016.<ref>{{Cite news |vauthors=Worley W |date=May 14, 2016 |title=Denmark will become first country to no longer define being transgender as a mental illness |work=[[The Independent]] |url=https://www.independent.co.uk/news/world/europe/denmark-will-be-the-first-country-to-no-longer-define-being-transgender-as-a-mental-illness-a7029151.html |access-date=March 22, 2018 |archive-date=March 11, 2018 |archive-url=https://web.archive.org/web/20180311201855/http://www.independent.co.uk/news/world/europe/denmark-will-be-the-first-country-to-no-longer-define-being-transgender-as-a-mental-illness-a7029151.html |url-status=live}}</ref>

In the ICD-11, GID is reclassified as "gender incongruence", a condition related to sexual health.<ref name="icd11-gc" /> The working group responsible for this recategorization recommended keeping such a diagnosis in ICD-11 to preserve access to health services.<ref name="pmid27717275">{{cite journal |vauthors=Reed GM, Drescher J, Krueger RB, Atalla E, Cochran SD, First MB, Cohen-Kettenis PT, Arango-de Montis I, Parish SJ, Cottler S, Briken P, Saxena S |display-authors=6 |title=Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations |journal=[[World Psychiatry]] |volume=15 |issue=3 |pages=205–221 |date=October 2016 |pmid=27717275 |pmc=5032510 |doi=10.1002/wps.20354}}</ref>

== Gender euphoria ==
{{primary sources section|find=gender euphoria|find2=history of the term|date=June 2022}}
[[File:Portrait of Virginia Prince.jpg|thumb|258x258px|In 1990, [[Virginia Prince]] ended an article wishing her readers "gender euphoria."]]

''Gender euphoria'' (GE) is a term for the satisfaction, enjoyment, or relief felt by people when they feel their gender expression matches their personal [[gender identity]].<ref>{{Cite journal |last1=Tebbe |first1=Elliot A. |last2=Budge |first2=Stephanie L. |date=2022-09-26 |title=Factors that drive mental health disparities and promote well-being in transgender and nonbinary people |journal=Nature Reviews Psychology |language=en |volume=1 |issue=12 |pages=694–707 |doi=10.1038/s44159-022-00109-0 |issn=2731-0574 |pmc=9513020 |pmid=36187743}}</ref><ref name=":0" /><ref name=":9">{{cite journal |last=Benestad |first=E. E. P. |date=October 2010 |title=From gender dysphoria to gender euphoria: An assisted journey |url=http://dx.doi.org/10.1016/j.sexol.2010.09.003 |journal=[[Sexologies]] |volume=19 |issue=4 |pages=225–231 |doi=10.1016/j.sexol.2010.09.003 |issn=1158-1360 |access-date=May 15, 2021}}</ref><ref>{{cite journal |last1=Austin |first1=Ashley |last2=Papciak |first2=Ryan |last3=Lovins |first3=Lindsay |date=December 5, 2022 |title=Gender euphoria: a grounded theory exploration of experiencing gender affirmation |url=https://www.tandfonline.com/doi/full/10.1080/19419899.2022.2049632 |journal=[[Psychology & Sexuality]] |language=en |volume=13 |issue=5 |pages=1406–1426 |doi=10.1080/19419899.2022.2049632 |s2cid=247281003 |issn=1941-9899}}</ref> ''[[Psych Central]]''{{'s}} definition is "deep joy when your internal gender identity matches your gender expression."<ref name=":4">{{Cite web | vauthors = Collins D |date=2022-05-12 |title=Sex vs. Gender: What's the Difference and Why Does it Matter? |url=https://psychcentral.com/health/sex-vs-gender |access-date=2022-06-01 |language=en |archive-date=2022-06-02 |archive-url= https://web.archive.org/web/20220602003724/https://psychcentral.com/health/sex-vs-gender |url-status=live | work = PsychCentral }}</ref> It is proposed that feelings of gender euphoria require societal acceptance of gender expression.<ref name=":9" /> In academics and the medical field, a consensus has not yet been reached on a precise definition of the term, as it has been mainly used within a social context.<ref>{{cite journal | vauthors = Bradford NJ, Rider GN, Spencer KG | title = Hair removal and psychological well-being in transfeminine adults: associations with gender dysphoria and gender euphoria | journal = The Journal of Dermatological Treatment | volume = 32 | issue = 6 | pages = 635–642 | date = September 2021 | pmid = 31668100 | doi = 10.1080/09546634.2019.1687823 | s2cid = 204975343 }}</ref><ref name=":10">{{cite journal | vauthors = Beischel WJ, Gauvin SE, van Anders SM | title = "A little shiny gender breakthrough": Community understandings of gender euphoria | journal = International Journal of Transgender Health | volume = 23 | issue = 3 | pages = 274–294 | date = 2021-05-03 | pmid = 35799953 | pmc = 9255216 | doi = 10.1080/26895269.2021.1915223 }}</ref> The first attempt to rigorously define gender euphoria through an online survey took place in 2021, conducted by Will Beischel, Stéphanie Gauvin, and Sari van Anders.<ref name=":10" /><ref name=":11">{{cite journal |last1=Kai |first1=Jacobsen |last2=Devor |first2=Aaron |date=2022 |title=Moving From Gender Dysphoria to Gender Euphoria: Trans Experiences of Positive Gender-Related Emotions |journal=Bulletin of Applied Transgender Studies |volume=1 |issue=1–2 |pages=119–143 |url=https://bulletin.appliedtransstudies.org/article/1/1-2/6/ |doi=10.57814/GGFG-4J14 |issn=2769-2124}}</ref> ''Transgender congruence'' is also used to ascribe transgender individuals feeling genuine, authentic, and comfortable with their gender identity and external appearance.<ref>{{cite journal |last1=Huit |first1=T. Zachary |last2=Ralston |first2=Allura L. |last3=Haws |first3=J. Kyle |last4=Holt |first4=Natalie R. |last5=Hope |first5=Debra A. |last6=Puckett |first6=Jae A. |last7=Mocarski |first7=Richard A. |last8=Woodruff |first8=Nathan |date=2021-11-04 |title=Psychometric Evaluation of the Transgender Congruence Scale |url=https://doi.org/10.1007/s13178-021-00659-7 |url-status=live |journal=[[Sexuality Research and Social Policy]] |volume=20 |issue=2 |pages=491–504 |language=en |doi=10.1007/s13178-021-00659-7 |issn=1553-6610 |archive-url=https://web.archive.org/web/20220609011111/https://link.springer.com/article/10.1007/s13178-021-00659-7 |archive-date=2022-06-09 |access-date=2022-05-06 |s2cid=243792173}}</ref><ref>{{Cite journal |last1=Kozee |first1=Holly B. |last2=Tylka |first2=Tracy L. |last3=Bauerband |first3=L. Andrew |date=June 2012 |title=Measuring Transgender Individuals' Comfort With Gender Identity and Appearance: Development and Validation of the Transgender Congruence Scale |url=http://journals.sagepub.com/doi/10.1177/0361684312442161 |url-status=live |journal=[[Psychology of Women Quarterly]] |language=en |volume=36 |issue=2 |pages=179–196 |doi=10.1177/0361684312442161 |issn=0361-6843 |archive-url=https://web.archive.org/web/20211223000255/https://journals.sagepub.com/doi/10.1177/0361684312442161 |archive-date=2021-12-23 |access-date=2022-05-06 |s2cid=10564167}}</ref>

The term ''gender euphoria'' has been used by the transgender community since at least the mid-1970s.<ref name=":11" /> Originally, it referred to the feeling of joy arising from fulfilling a mix of [[gender role]]s, which was different from the concept of gender dysphoria, which is used to describe individuals who wished to medically transition to a different sex.<ref name=":11" /> In the 1980s, the term was published in trans contexts, coming up in interviews with trans people.<ref>{{Cite book | vauthors = Aman R |url=https://books.google.com/books?id=iwrqAAAAMAAJ&q=%22gender+euphoria%22 |title=Maledicta |date=1986 |publisher=Maledicta Press |isbn=978-0-916500-29-0 |language=en |access-date=2022-06-02 |archive-url=https://web.archive.org/web/20220602003726/https://books.google.com/books?id=iwrqAAAAMAAJ&newbks=0&printsec=frontcover&dq=%22gender+euphoria%22&q=%22gender+euphoria%22&hl=en |archive-date=2022-06-02 |url-status=live}}</ref><ref>{{Cite book | vauthors = Aman R |url= https://books.google.com/books?id=J2n5iLgdClkC&q=%22gender+euphoria%22 |title=Lillian Mermin Feinsilver Festschrift |date=1988 |publisher=Maledicta Press |isbn=978-0-916500-29-0 |language=en |access-date=2022-06-02 |archive-url=https://web.archive.org/web/20220602003729/https://books.google.com/books?id=J2n5iLgdClkC&newbks=0&printsec=frontcover&dq=%22gender+euphoria%22&q=%22gender+euphoria%22&hl=en |archive-date=2022-06-02 |url-status=live}}</ref><ref>{{Cite book |url=https://books.google.com/books?id=nhLaAAAAMAAJ&q=%22gender+euphoria%22 |title=Transsexualism: A Collection of Articles, Editorials, and Letters on the Subject of Male-to-female and Female-to-male Transsexualism Edited from the TV-TS Tapestry Journal, Issues 39-52 |date=1988 |publisher=International Foundation for Gender Education |language=en |access-date=2022-06-02 |archive-url=https://web.archive.org/web/20220602003725/https://books.google.com/books?id=nhLaAAAAMAAJ&newbks=0&printsec=frontcover&dq=%22gender+euphoria%22&q=%22gender+euphoria%22&hl=en |archive-date=2022-06-02 |url-status=live}}</ref> For example, in a 1988 interview with a [[trans man]], the subject states, "I think that day [Dr. Charles Ilhenfeld] administered my first shot of the 'wonder-drug' must have been one of the 'peak-experiences' of my life -- talk about 'gender euphoria'!"<ref name=":7">{{Cite book |url=https://books.google.com/books?id=nhLaAAAAMAAJ&q=%22gender+euphoria%22 |title=Transsexualism: A Collection of Articles, Editorials, and Letters on the Subject of Male-to-female and Female-to-male Transsexualism Edited from the TV-TS Tapestry Journal, Issues 39-52 |date=1988 |publisher=International Foundation for Gender Education |location=University of Michigan |language=en |access-date=2022-06-02 |archive-url=https://web.archive.org/web/20220602003725/https://books.google.com/books?id=nhLaAAAAMAAJ&newbks=0&printsec=frontcover&dq=%22gender+euphoria%22&q=%22gender+euphoria%22&hl=en |archive-date=2022-06-02 |url-status=live}}</ref> The interview indicates he is referring to [[testosterone]].<ref name=":7" />

Other figures, including [[Mariette Pathy Allen]] and [[Virginia Prince]], have used the term in their work. In 1990, [[Virginia Prince]] used the phrase in the trans magazine ''Femme Mirror,'' ending an article with, "...from here on you can enjoy GENDER EUPHORIA - HAVE A GOOD LIFE!"<ref>{{Cite book |url=https://books.google.com/books?id=0HVdAAAAMAAJ&q=%22gender+euphoria%22 |title=Femme Mirror |date=1990 |language=en |access-date=2022-06-02 |archive-url=https://web.archive.org/web/20220602003734/https://books.google.com/books?id=0HVdAAAAMAAJ&newbks=0&printsec=frontcover&dq=%22gender+euphoria%22&q=%22gender+euphoria%22&hl=en |archive-date=2022-06-02 |url-status=live |last1=Prince |first1=Virginia }}</ref> Starting in 1991, a monthly newsletter named ''Gender Euphoria'' was released,<ref>{{Cite book | vauthors = MacKenzie GO |url=https://books.google.com/books?id=p60N-QvxvD8C&pg=PA180 |title=Transgender Nation |date=1994 |publisher=Popular Press |isbn=978-0-87972-596-9 |language=en |access-date=2022-06-02 |archive-url=https://web.archive.org/web/20220602003732/https://books.google.com/books?id=p60N-QvxvD8C&newbks=0&printsec=frontcover&pg=PA180&dq=%22gender+euphoria%22&hl=en |archive-date=2022-06-02 |url-status=live}}</ref> featuring articles about transgender topics; [[Leslie Feinberg]] read the newsletter to better understand the transgender community.<ref>{{Cite book |vauthors=Feinberg L |url=https://books.google.com/books?id=j1HtppmYfBEC&pg=PA22 |title=Trans Liberation: Beyond Pink or Blue |date=October 10, 1999 |publisher=[[Beacon Press]] |isbn=978-0-8070-7951-5 |language=en |access-date=2022-06-02 |archive-url=https://web.archive.org/web/20220602003728/https://books.google.com/books?id=j1HtppmYfBEC&newbks=0&printsec=frontcover&pg=PA22&dq=%22gender+euphoria%22&hl=en |archive-date=2022-06-02 |url-status=live}}</ref> However, there are instances in which gender euphoria has been used with a different meaning, such as in 1979, when the Black feminist [[Michele Wallace]] used it to describe the [[male privilege]] present in Black men.<ref>{{Cite book |vauthors=Gittelson N |url=https://books.google.com/books?id=E_lsoCPr94sC |title=Dominus: A Woman Looks at Men's Lives |date=1979 |publisher=Harcourt Brace Jovanovich |isbn=978-0-15-626118-0 |language=en |access-date=June 2, 2022 |archive-url=https://web.archive.org/web/20220602003732/https://books.google.com/books?id=E_lsoCPr94sC&newbks=0&hl=en |archive-date=June 2, 2022 |url-status=live}}</ref><ref>{{Cite book |vauthors=Kriegel L |url=https://books.google.com/books?id=D6ixAAAAIAAJ&q=%22gender+euphoria%22 |title=On Men and Manhood |date=1979 |publisher=Hawthorn Books |isbn=978-0-8015-0248-4 |language=en |access-date=June 2, 2022 |archive-url=https://web.archive.org/web/20220602003724/https://books.google.com/books?id=D6ixAAAAIAAJ&newbks=0&printsec=frontcover&dq=%22gender+euphoria%22&q=%22gender+euphoria%22&hl=en |archive-date=June 2, 2022 |url-status=live}}</ref>

The term has been embraced as part of a movement to stop pathologizing being transgender.<ref name=":13">{{Cite book |vauthors=Califia P |url=https://books.google.com/books?id=m_aHAAAAIAAJ&q=%22gender+euphoria%22 |title=Sex Changes: The Politics of Transgenderism |date=1997 |publisher=Cleis Press |isbn=978-1-57344-072-1 |language=en |access-date=June 2, 2022 |archive-url=https://web.archive.org/web/20220602003731/https://books.google.com/books?id=m_aHAAAAIAAJ&newbks=0&printsec=frontcover&dq=%22gender+euphoria%22&q=%22gender+euphoria%22&hl=en |archive-date=June 2, 2022 |url-status=live}}</ref> In 1989, [[Mariette Pathy Allen]] published an unnamed transgender person's quote in her photography book ''Transformations'': "The shrinks may call it 'gender dysphoria,' but for some of us, it's gender 'euphoria,' and we're not going to apologize anymore!"<ref>{{Cite book |vauthors=Allen MP |url=https://books.google.com/books?id=No1pAAAAMAAJ&q=%22gender+euphoria%22 |title=Transformations: Crossdressers and Those who Love Them |date=1989 |publisher=Dutton |isbn=978-0-525-24820-0 |language=en |access-date=June 2, 2022 |archive-url=https://web.archive.org/web/20220602003728/https://books.google.com/books?id=No1pAAAAMAAJ&newbks=0&printsec=frontcover&dq=%22gender+euphoria%22&q=%22gender+euphoria%22&hl=en |archive-date=June 2, 2022 |url-status=live}}</ref> The movement to focus on the positive side of gender expression was also advocated for in 1994, when the Scottish "[[Transvestism|TV]]/[[Transsexual|TS]]" periodical ''The Tartan Skirt'' wrote, "Let's accentuate the positive, discard the negative, and promote the new condition of 'Gender Euphoria.'"<ref>{{Cite book |url=https://books.google.com/books?id=F9laAAAAMAAJ |title=The Tartan Skirt: Magazine of the Scottish TV/TS Group |date=1994 |publisher=ADF Editorial Services |language=en |access-date=2022-06-02 |archive-date=2022-06-02 |archive-url=https://web.archive.org/web/20220602003730/https://books.google.com/books?id=F9laAAAAMAAJ&newbks=0&hl=en |url-status=live }}</ref> In 1997, [[Patrick Califia]] described [[Transgender rights movement|transgender activists]] picketing using signs that read "Gender Euphoria NOT Gender Dysphoria" and handing out "thousands of leaflets" at protests.<ref name=":13" /> The following year, in 1998, ''Second Skins: The Body Narratives of Transsexuality'' reported:

{{blockquote|The transactivist group [[The Transexual Menace|Transexual Menace]] is campaigning to have the diagnosis "Gender Identity Disorder" removed entirely from the ''[[Diagnostic and Statistical Manual of Mental Disorders]]''. "Gender Euphoria NOT Gender Dysphoria"; its slogans invert the pathologizing of transgender, offering pride in queer difference as an alternative to the psychiatric story.<ref>{{Cite book | vauthors = Prosser J |url=https://books.google.com/books?id=0O-HAAAAIAAJ&q=%22gender+euphoria%22 |title=Second Skins: The Body Narratives of Transsexuality |date=1998 |publisher=Columbia University Press |isbn=978-0-231-10934-5 |language=en |access-date=2022-06-02 |archive-date=2022-06-02 |archive-url=https://web.archive.org/web/20220602003727/https://books.google.com/books?id=0O-HAAAAIAAJ&newbks=0&printsec=frontcover&dq=%22gender+euphoria%22&q=%22gender+euphoria%22&hl=en |url-status=live }}</ref>}}

Similarly, [[Florence Ashley]] has advocated for the medical field to focus on helping patients achieve gender euphoria instead of treating patients on the basis of gender dysphoria.<ref>{{cite journal | vauthors = Ashley F | title = The Misuse of Gender Dysphoria: Toward Greater Conceptual Clarity in Transgender Health | journal = Perspectives on Psychological Science | volume = 16 | issue = 6 | pages = 1159–1164 | date = November 2021 | pmid = 31747342 | doi = 10.1177/1745691619872987 | s2cid = 208214158 }}</ref><ref>{{cite journal | vauthors = Ashley F, Ells C | title = In Favor of Covering Ethically Important Cosmetic Surgeries: Facial Feminization Surgery for Transgender People | journal = The American Journal of Bioethics | volume = 18 | issue = 12 | pages = 23–25 | date = December 2018 | pmid = 31159694 | doi = 10.1080/15265161.2018.1531162 | s2cid = 81006262 }}</ref> They argue that currently, in order for individuals to receive [[gender-affirming care]], they must be diagnosed with gender dysphoria, which is not always accessible and entails people must be experiencing significant distress before they can fully express their own [[gender identity]].<ref>{{cite journal | vauthors = Ashley F | title = Gatekeeping hormone replacement therapy for transgender patients is dehumanising | journal = Journal of Medical Ethics | volume = 45 | issue = 7 | pages = 480–482 | date = July 2019 | pmid = 30988174 | doi = 10.1136/medethics-2018-105293 | s2cid = 117715087 | doi-access = free }}</ref> Ashley's stance that gender euphoria does not need to be preceded by a clinical diagnosis of gender dysphoria, and that gender euphoria is complex, is echoed by Elliot Tebbe and Stephanie Budge in their 2022 ''Nature Reviews Psychology''<ref>Tebbe, Elliot A; Budge, Stephanie L (September 26, 2022). "Factors that drive mental health disparities and promote well-being in transgender and nonbinary people". ''National Library of Medicine''.</ref> article, in which they write, "Gender euphoria is not merely the absence of gender dysphoria, but rather a conglomeration of positive emotions and subjective well-being in response to being affirmed in one’s gender."<ref>{{cite journal | vauthors = Tebbe EA, Budge SL | title = Factors that drive mental health disparities and promote well-being in transgender and nonbinary people | journal = Nature Reviews Psychology | pages = 694–707 | date = September 2022 | volume = 1 | issue = 12 | pmid = 36187743 | pmc = 9513020 | doi = 10.1038/s44159-022-00109-0 }}</ref>

Gender euphoria has also been expressed through art. Photography in the East Village in Manhattan has served as means to express gender euphoria, contrasting fashion photography, which is said to reinforce the [[gender binary]].<ref>{{Cite thesis |vauthors=Ridout A |title=Gender Euphoria: Photography, Fashion, and Gender Nonconformity in The East Village |url=https://digitalcommons.lsu.edu/gradschool_theses/3825 |publisher=[[Louisiana State University and Agricultural and Mechanical College]] |date=October 28, 2015 |degree=Master of Arts |doi=10.31390/gradschool_theses.3825 |language=en |doi-access=free}}</ref>

In 2019, the [[Midsumma Festival|Midsumma]] festival in Australia hosted "Gender Euphoria," a [[cabaret]] focusing on "bliss" in transgender experiences, including musical, ballet, and [[American burlesque|burlesque]] performances.<ref>{{Cite web |date=2019-01-25 |title=The joy that comes from embracing trans identity shouldn't be so rare | vauthors = Connor A |url=http://www.theguardian.com/world/2019/jan/26/the-joy-that-comes-from-embracing-trans-identity-shouldnt-be-so-rare |access-date=2022-06-02 |website=The Guardian |language=en |archive-date=2022-06-02 |archive-url=https://web.archive.org/web/20220602003726/https://www.theguardian.com/world/2019/jan/26/the-joy-that-comes-from-embracing-trans-identity-shouldnt-be-so-rare |url-status=live }}</ref><ref name=":8">{{Cite web | vauthors = Dezfouli L | date = 19 January 2019 |title=Review: Gender Euphoria, Midsumma Festival |url=https://www.artshub.com.au/news/reviews/review-gender-euphoria-midsumma-festival-257176-2362042/ |access-date=2022-06-02 |website=ArtsHub Australia |language=en-AU |archive-date=2022-06-02 |archive-url=https://web.archive.org/web/20220602003724/https://www.artshub.com.au/news/reviews/review-gender-euphoria-midsumma-festival-257176-2362042/ |url-status=live }}</ref><ref>{{Cite web |date=2019-10-17 |title=Gender Euphoria review (Melbourne International Arts Festival) |url=https://dailyreview.com.au/gender-euphoria-review-melbourne-international-arts-festival/ |access-date=2022-06-02 |website=Daily Review: Film, stage and music reviews, interviews and more. |language=en-US |archive-date=2022-03-28 |archive-url=https://web.archive.org/web/20220328183642/https://dailyreview.com.au/gender-euphoria-review-melbourne-international-arts-festival/ |url-status=live }}</ref><ref>{{Cite web |vauthors=Woodhead C |date=October 16, 2019 |title=A joyful and poignant celebration of difference |url=https://www.theage.com.au/culture/theatre/a-joyful-and-poignant-celebration-of-difference-20191016-p5316n.html |access-date=June 2, 2022 |website=The Age |language=en |archive-date=June 2, 2022 |archive-url=https://web.archive.org/web/20220602003724/https://www.theage.com.au/culture/theatre/a-joyful-and-poignant-celebration-of-difference-20191016-p5316n.html |url-status=live}}</ref> A reviewer described it as "triumphant – honest, unpretentious, touching, and a vital celebration."<ref name=":8" />

The 2020 [[young adult novel|young adult]] [[fantasy (genre)|fantasy]] novel ''[[Euphoria Kids]]'' by [[Alison Evans (author)|Alison Evans]] was also inspired by the concept of gender euphoria.<ref>{{cite news |last1=Kerr |first1=Jodie |title=State of euphoria: Alison Evans on 'Euphoria Kids' |url=https://www.booksandpublishing.com.au/articles/2019/11/08/141016/state-of-euphoria-alison-evans-on-euphoria-kids/ |access-date=30 November 2024 |work=Books + Publishing |date=8 November 2019}}</ref> In the book's foreword, Evans wrote: "I want people to learn about gender euphoria (before) gender dysphoria... I want the young trans kids that will read this book to be proud of who they are, and to imagine wonderful, magic lives for themselves."<ref>{{cite book |last1=Evans |first1=Alison |title=Euphoria Kids |date=2020 |publisher=Echo Publishing}}</ref>

== See also ==
* [[List of transgender-related topics]]
* [[Gender transitioning]]
* [[Detransition]]
* {{slink|ICD-11|Gender incongruence}}
* [[Transmedicalism]]
* [[Wrong-body narrative]]

== References ==
{{Reflist}}

== Further reading ==
{{refbegin}}
* {{cite web |vauthors=Conway L |url=https://ai.eecs.umich.edu/people/conway/TSsuccesses/TransMen.html |title=Successful TransMen: Links and Photos |author-link=Lynn Conway |work=ai.eecs.umich.edu |date=June 26, 2014 |access-date=December 2, 2014}}
* {{cite web |vauthors=Conway L |url=https://ai.eecs.umich.edu/people/conway/TSsuccesses/TSsuccesses.html |title=Transsexual Women's Successes: Links and Photos |work=ai.eecs.umich.edu |date=February 5, 2011 |access-date=December 2, 2014}}
* {{cite news |vauthors=Jacques J |url=https://www.theguardian.com/lifeandstyle/series/transgender-journey |title=A Transgender Journey |work=[[The Guardian]] |access-date=December 2, 2014}}
* {{cite journal |vauthors=Sharp VM, Lewis CB, Lieven NM |title=Bell v Tavistock |journal=In the High Court of Justice Administrative Court Divisional Court |issue=[2020] EWHC 3274 (Admin) |page=CO/60/2020 |url=https://www.judiciary.uk/wp-content/uploads/2020/12/Bell-v-Tavistock-Judgment.pdf |archive-url=https://ghostarchive.org/archive/20221009/https://www.judiciary.uk/wp-content/uploads/2020/12/Bell-v-Tavistock-Judgment.pdf |archive-date=2022-10-09 |url-status=live}}
* {{cite book |url=http://admin.associationsonline.com/uploaded_files/140/files/Standards%20of%20Care,%20V7%20Full%20Book.pdf |title=Standards of Care for Gender Identity Disorders |author=World Professional Association for Transgender Health |publisher=Harry Benjamin International Gender Dysphoria Association |year=2012 |url-status=dead |archive-url=https://web.archive.org/web/20140924061804/http://admin.associationsonline.com/uploaded_files/140/files/Standards%20of%20Care%2C%20V7%20Full%20Book.pdf |archive-date=September 24, 2014}} Includes a description of ICD-10 criteria.
{{refend}}

== External links ==
* [https://web.archive.org/web/20060604060835/http://www.transgendercare.com/guidance/resources/ictlep_soc.htm Health Law Standards of Care for Transsexualism] – An alternative to the Benjamin Standards of Care proposed by the International Conference on Transgender Law and Employment Policy.
* [https://web.archive.org/web/20030812130936/http://www.lcd.gov.uk/constitution/transsex/policy.htm The Lord Chancellor's Department Government Policy concerning Transsexual People]
{{Medical resources
| ICD11           = {{ICD11|HA60}}, {{ICD11|HA61}}, {{ICD11|HA6Z}}
|  ICD10          = {{ICD10|F64.8}}, {{ICD10|F64.9}}
|  ICD9           = {{ICD9|302.85}}
|  ICDO           =
|  OMIM           =
|  MedlinePlus    = 001527
|  eMedicineSubj  =
|  eMedicineTopic =
|  MeshID         = D000068116
}}

{{Transgender topics}}
{{Sexual identities}}
{{Authority control}}

[[Category:Gender identity]]
[[Category:Transgender health care]]
[[Category:LGBTQ studies]]