Gender dysphoria

What exactly is gender dysphoria?

The term Gender dysphoria refers to the clinically significant psychological distress or the unease a person feels when a clear Gender incongruence is available. Gender incongruence In turn, this describes the situation in which the gender assigned at birth Gender (often based on external genitalia) does not correspond to one’s own, deeply felt Gender identity – the inner knowledge of which Gender one belongs to – corresponds to.

Whilst Gender incongruence is a descriptive term for this condition, focusing on Gender dysphoria the aspect of suffering associated with it. It is important to understand that not all Transgender people or people with Gender incongruence inevitably suffer from a clinically significant suffer from gender dysphoria.

Distinction: Gender identity, gender incongruence and psychological distress

• Gender identity: That deep-seated, personal sense of belonging to a particular Gender (e.g. male, female, non-binary). It is a core aspect of one’s personality.
• Gender incongruence: The discrepancy between the Gender identity and the one assigned at birth Gender and/or the primary/secondary Sexual characteristics.
• Gender dysphoria: The proven psychological distress, which, as a result of this Gender incongruence may arise. This psychological distress is the reason why a Diagnosis and, where applicable, a Treatment should be aimed for.

Many trans people identify with their Gender identity, without necessarily suffering from severe Gender dysphoria to suffer, particularly if they live in a supportive environment and are able to express their identity.

Symptoms of gender dysphoria in adolescents and adults

The Symptoms of gender dysphoria can take many forms and vary depending on the stage of life:

• A strong and ongoing an expressed wish to the other person Gender to belong to it or to be treated as such.
• A marked sense of unease about one’s own primary and/or the expected secondary sexual characteristics.
• The desire to have the other person’s sexual characteristics Gender to have.
• The conviction that typical feelings and reactions of the opposite sex to possess.
• At Gender dysphoria in adolescents and adults this can lead to considerable emotional stress, anxiety, depression and social isolation if the Gender identity is not the same as sex (assigned) matches.

Diagnosis and classification of gender incongruence according to ICD-10, ICD-11 and DSM-5

The Diagnostics by Gender incongruence and gender dysphoria is a meticulous process carried out by experienced specialists.

• ICD-10: In the earlier International Statistical Classification of Diseases (ICD-10) of the World Health Organisation (WHO) this was listed under „Transsexualism“classified as a „gender identity disorder“, which was often perceived as pathologising.”.
• ICD-11: The current ICD-11 has made a significant change here. „Gender incongruence“ is now covered in the chapter „States with Relation to sexual health“ and is no longer classified as a mental disorder (Disorder) classified. This underlines that identity itself is not the problem, but rather the potential psychological distress (dysphoria) or the medical necessity for gender-affirming treatment. The Diagnosis of gender incongruence is a prerequisite for many medical procedures.
• DSM-5: The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association uses the term „Gender dysphoria“. It highlights the clinically significant psychological distress or impairment in important areas of life as a diagnostic criterion.

A German Guideline (S3 guideline) on diagnosis, counselling and Treatment in the context of Gender incongruence and gender dysphoria provides guidance for professionals.

Treatment approaches and transition for gender dysphoria

The aim of the Treatment is the one that Gender dysphoria to alleviate and restore harmony between body and Gender identity to increase. The Transition is an individual process:

• Social transition: Adapting one’s social behaviour to the Gender identity (Name, pronouns, clothing).
• Medical treatment (somatic treatment): Comprises two main approaches: Hormone therapy to prevent the secondary sexual characteristics (puberty blockers in adolescents) or to promote the characteristics of the experienced Gender (Oestrogens for Trans women, testosterone for Trans men) and Operational measures such as gender reassignment surgery, which for many Trans people could be an important step towards improving physical Gender incongruence and the associated psychological distress to reduce.

The Treatment is based on international recommendations such as the „Standards of Care“the World Professional Association for Transgender Health (WPATH).

Psychotherapy and psychological support in the context of gender incongruence

Psychological support is often a key component in:

• The psychological distress the Gender dysphoria to cope with.
• To support decision-making during the transition process.
• To develop strategies to combat discrimination.
• Any accompanying mental health issues to address issues that may arise or be exacerbated by stigmatisation or by the dysphoria itself. It is not a question of Gender identity not to change, but to provide support on one’s own individual path.

The importance of support and acceptance for transgender people

A supportive environment (family, friends, society) is crucial to the well-being of Transgender people and can help to reduce the Gender dysphoria caused psychological distress to reduce. The acceptance of the Gender identity is fundamental.

Support and information for those affected: support services and standards of care

People affected by Gender dysphoria and their families can find help at:

• Specialist doctors (endocrinology, psychiatry, etc.) with experience in Trans Health.
• Psychotherapists with the relevant specialisation.
• Counselling centres and self-help groups. The „Standards of Care from the World Professional Association for Transgender Health“ (SOC) are an important resource for those affected and their carers in providing high-quality Treatment to ensure. The German S3-Guideline provides comprehensive information.