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Gender dysphoria

Gender dysphoria, also known as gender identity disorder (GID) is when a person is born one gender, but is unhappy living that way.

There are lots of children and young people who feel that their gender identity is not a complete match with the sex they were assigned at birth. Imagine your sense of self not matching your physical being - feeling this way can be very distressing. While gender dysphoria is not a mental health problem, it can cause the person a great deal of stress.

Hiding your true identity, along with growing up in a society filled with misunderstanding and stigma, will undoubtedly affect you.

What is gender dysphoria?

Gender dysphoria, or gender identity disorder, is when someone is born one gender, but identifies as another. This may mean that a person born a male identifies as female, or vice versa.

Some people may not identify with a gender at all.

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 fact-sheet, 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.

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 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
  • wanting to take part in and play with members of the opposite sex, while refusing to take part in
  • activities typically with and for 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 many 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 they 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.

A strong, resonate thought that shook me to the core: I don’t want to be a girl anymore.

- Read Zach's story.

There are no physical signs of gender dysphoria, but there are specific behaviours that people may display.

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.

How will I know if I have it?

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 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, keeping 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 hiding their identity. This is why it is so important that we speak about these issues - society needs to understand and be more aware of the issues and 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 role, 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 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 called ‘coming out’. Coming out is an incredibly individual process and it’s not necessarily a one-off event. Lesbian, gay, bi and trans people may have to come out many times during their lives and sadly, many people will face a number of challenges when doing so.

How you come out will depend on you and 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. Remember, coming out may be difficult and takes an immense amount of courage.

If you have decided that you are ready to tell people, it can help to sit and really think about how you want to tell them. Consider where and how you 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.

I was fortunate enough to have a mother and sister who were more understanding than I could have dreamt. Even though it upset them that they were losing a daughter and sister, they were happy to see the confident, care-free young man I was becoming.

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.

young child - close up of face

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, or a psychotherapist or 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

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

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 full transition and requiring surgery, you are typically required to first live in your preferred gender identity full time for at least one year. This is known as ‘social gender role transition’ (previously known as ‘real life experience’) and will help in confirming whether permanent 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.

The goal I’d been striving towards for so long was now a reality, my normal.

Finding support

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.

Content reviewed by transgender specialist Alex Drummond BACP (Accred) in March 2018. All content displayed on Counselling Directory is provided for general information purposes only, and should not be treated as a substitute for advice given by your GP or any other healthcare professional.

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