Gender dysphoria is a term used to describe the distress a person feels when their gender does not match the sex they were assigned at birth. Here we look more closely at what gender dysphoria is and how counselling can be a support.
There are lots of people who feel this way. While gender dysphoria is not a mental health problem, it can cause the person a great deal of stress. Not feeling able to express your true identity, along with living in a society filled with misunderstanding and stigma may affect your wellness.
In this video, Dr Dane Duncan Mills discusses gender identity, what to look for in a therapist and where to find support.
What is gender dysphoria?
Gender dysphoria is the distress someone feels when they are assigned a gender at birth, but identifies as another. For example, a person assigned male at birth may identify as female or vice versa. Some people may not identify with a gender at all or may identify as gender fluid.
People who feel this way are most commonly known as ‘transgender’ or ‘trans’ however, we understand that trans people self-identify in many ways. Throughout this page, we will use ‘trans’ as an inclusive term, which embraces trans, trans*, transgender, gender nonconforming and gender variant, among others.
Non-binary gender identity
People can also describe themselves as ‘non-binary’, which is when they do not feel they are male nor female. Non-binary also embraces those who identify as androgyne, thirdgender and polygender, who are not comfortable thinking of themselves as simply male or female. They may identify as a combination of the two, or neither.
Is gender dysphoria a disorder?
Although gender dysphoria is listed in the DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), it is not considered a disorder or mental illness. Originally referred to as gender identity disorder, this was replaced by gender dysphoria with the release of the DSM-5 in 2013.
Since 2019, the World Health Organization (WHO) has stated that gender incongruence is no longer classified under mental and behavioural disorders. WHO officials say that is it ‘not actually a mental health condition’ since the introduction of the International Classification of Diseases 11 (ICD-11). These changes were made to help reduce stigma, as well as due to new, better understandings of gender incongruence.
Since this update, many health professionals and organisations worldwide have changed how they talk about gender dysphoria to reflect this, including the NHS, which states: "Gender dysphoria is not a mental illness, but some people may develop mental health problems because of gender dysphoria.”
Signs of gender dysphoria
It’s common for the signs of gender dysphoria to show at a very early age. Children may refuse to wear certain clothes or dislike taking part in typical boys or girls’ activities. Other early behaviours may include:
- insisting that they are of the opposite sex
- wanting to wear clothes typically worn by the other sex, and disliking or refusing to wear clothes typically worn by their sex
- insisting or hoping that their genitals will change
- feeling extreme distress at puberty and the physical changes that will occur
- feelings of anxiety and depression
In some cases, these behaviours are just a part of the child growing up. Yet if the feelings of gender dysphoria are still present as they go through their teenage years and into adulthood, it is likely that it is not a stage of development, and further support may be needed.
While many people with gender dysphoria will feel this way during early childhood, this isn’t always the case. Some people may not recognise their feelings for what they are until adulthood, or have simply learned to suppress and hide the feelings to avoid peer and family rejection while growing up.
Puberty forces changes on a body that can feel particularly uncomfortable. Unwanted changes are happening, so while a child may have enjoyed being androgynous growing up, the secondary sex characteristics of puberty can be very distressing.
I sat down on the arm of the sofa, head feeling like it was about to explode, when it hit me. A strong, resonate thought that shook me to the core: I don’t want to be a girl anymore.
- Read Zach's story.
If you are a teenager or adult, whose feelings of gender dysphoria started in childhood, you may now feel like you have a much clearer sense of your identity and how you want to deal with it. You may be certain that your gender identity is at odds with your assigned sex, a strong desire to hide or be rid of the physical signs of your sex, such as breasts and body hair.
Only you can ever say how you feel. Some people will know from a very young age, while others will feel like they don’t ‘fit’ with members of their sex, but do not know what to do, or how to tell people how they feel. Many people will keep their thoughts and feelings to themselves, living a life and body they aren’t happy in.
Everyone deserves to live the life they want. This is why we are passionate about raising awareness of issues and providing people with the information and support they need.
Living with gender dysphoria
It can be very distressing to keep how you feel to yourself. Whether through lack of support, information or from fear of judgement or discrimination, living a life where you are unhappy, really, is no life at all.
Gender dysphoria is not a mental illness, however, people who experience gender dysphoria often suffer great stress as a result of not living their true identity. This is why it is so important that we speak about these issues - society needs to understand and be more aware of the feelings many people experience. Talking about it and supporting each other is the first step to breaking down the stigma and helping trans people feel more comfortable in reaching out and asking for help. Nobody should feel they have to keep quiet about who they are.
According to charity Stonewall, two in five trans people (41%) said that when accessing general health care services in 2017, healthcare staff lacked understanding of trans health needs.
If a person has made the decision to change their gender identity, this is known as ‘transition’. This enables them to express themselves in line with their gender identity, perhaps by choosing a new name and changing their appearance, like changing their hair or wearing different clothes. The way in which individuals express themselves will vary from person to person, everyone is different and these changes take time.
The Equality Act 2010
Gender reassignment is a protected characteristic under the Equality Act 2010. This means you are protected by law if you are a victim of harassment or discrimination in the workplace, and wider society. For more information on the Equality Act 2010 and the laws against hate crime, visit our discrimination page.
Coming out as transgender
Telling people about your sexuality or gender identity is typically called ‘coming out’. Coming out is an incredibly individual process and not necessarily a one-off event. Lesbian, gay, bisexual and trans people may have to come out many times during their lives and sadly, many people will face challenges when doing so.
How you come out will depend what you feel comfortable with. For example, you may feel comfortable speaking about your gender identity with your close friends, but not with your family.
If you have decided that you are ready to tell people, it can help to sit and really think about how and where you want to tell them. Depending on who you talk to, they may have questions, so be prepared to answer them, or tell them if you’re not ready.
If they react badly, remember that they may just need some time to absorb what you’ve told them. While you can’t predict how people will respond, if you have told a close friend you trust, the chances are they’ll be pleased you’ve shared something so personal and support you.
Don’t feel under pressure to come out - take your time. Only you will know when you’re ready to talk and asking for help isn’t easy. If you feel ready to come out but are unsure of how to broach the subject with loved ones, visit Stonewall for more information.
Some people need time to think and consider to go from one step to the other (for example between coming out to one person and the next), whilst some like to act fast and get results once the decision has been made (coming out at school, changing names, writing to the clinic – all almost in one day). Whatever is your way – it’s the right way.
- Read more tips for transitioning teens by counsellor Anna Jezuita (MBACP)
Treatment for gender dysphoria - the next steps
Treatment for gender dysphoria aims to help people live the way they want to, as the gender they identify with. What this means will vary for each person, and is different for children, young people and adults.
The first step is to speak to a professional. Whether this is your GP, a psychotherapist or a counsellor, if you have come to the decision that you want further treatment, professional support is essential.
Children and young people
Under 18s will typically be referred to a specialist child and adolescent Gender Identity Clinic (GIC), where staff will carry out a detailed assessment, to help determine what support they need. Treatment will vary depending on the results of the assessment and the age of the child, though options include:
- family therapy
- individual child psychotherapy
- parental support or counselling
- regular reviews
- hormone therapy
Also, know that schools have a legal duty to support trans students (even single-sex schools) and many are doing so very well. If you or your child is at school and would like support outside of a professional environment, consider speaking to the student support services if available, or your teacher. They will be able to explain the support available and together you can decide on the next steps.
Adults with gender dysphoria should be referred to a specialist adult GIC. As with children and young people, these clinics can offer ongoing support and advice, assessments and treatment. This may include:
- mental health support, such as counselling
- cross-sex hormone treatment
- speech and language therapy
- peer support groups
Some people find that the support and advice from a specialist clinic is all they need to feel comfortable in their transition. Others will need more extensive treatment, such as a full transition to the opposite sex. The level of treatment you receive is completely down to you - only you know what you need and how you feel.
Hormone therapy is prescribed to help make individuals more comfortable with themselves - in terms of both physical appearance, and how they feel. If undergoing hormone therapy, individuals will take the hormone of their preferred gender. Whether testosterone or oestrogen, the hormones will start the process of changing the body into one that is more male or female.
Typically, this will be a lifelong treatment, even if you have had genital reconstructive surgery.
Social gender role transition
If you are considering a transition that requires surgery, you are typically required to live in your preferred gender identity full-time for at least one year before surgery. This is known as ‘social gender role transition’ (previously known as ‘real life experience’) and will help in confirming whether surgery is the right option for you.
Once you have completed your social gender role transition, and you and your care team are confident you are ready, you may decide to go ahead with the surgery.
Counselling for gender dysphoria
As we said, gender dysphoria is not a mental illness. Yet, living a life that you feel isn’t yours can be detrimental to your mental health and well-being. The confusion, the fear of judgement, the isolation, the stress. All of these things can affect a person’s mental health and if untreated, can lead to further problems.
Talking is an incredibly helpful tool, wherever you are in your journey. Of course, this can be easier said than done, and sadly, stigma and misunderstanding is still present in today’s society. If you’re not ready to talk to friends and family, seeking professional support can be an option.
A counsellor experienced in gender dysphoria and trans people will have an understanding of what you are going through, and the options available to you. They can offer you a safe place to talk, free of stigma and judgement, and without shame. In the counselling room, you can be you.
On Counselling Directory, we have a Proof Policy in place in which professionals must provide proof of qualifications and insurance or membership with a professional body. We encourage all members to provide information on their experience and specialisms on their profiles, so to help you understand their way of working, and if they are the right person for you.
Know that all counselling professional bodies have outlawed 'conversion' or 'reparative' therapies. While counsellors can offer you a safe space to explore gender dysphoria, they are not permitted to attempt to 'convert' someone's gender or sexuality.
For anyone struggling with their gender identity, I’d say identity is complex, and there is no one-size-fits-all solution. I’m still finding myself, where my masculinity/femininity sits, and how much surgery I want to undergo. My best advice is this: if it’s making you happy, keep going, and anything else, push away.
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