Gender dysphoria

Gender dysphoria is a diagnosis that describes the discomfort or distress a person can feel when there is a mismatch between their body and their gender or sense of self.

You may feel as though your physical anatomy does not reflect your gender (your social and personal identity as male, female, or another gender such as non-binary), or that your friends, whānau or others do not see you as the gender you identify with. The discomfort you feel because of this is called gender dysphoria. In the past, people with gender dysphoria may have been diagnosed with “gender identity disorder”, but this term is not used anymore.

Many (but not all) people who experience gender dysphoria are transgender. This is an umbrella term that describes people whose gender identity is different from the sex they were assigned at birth.

• Transgender identities are varied and diverse. Some of these include: Takatāpui, whakawahine, tangata ira tane, FtM, MtF, transsexual, fa’afafine, fa’atama, trans man, trans woman, akava’ine, leiti, non-binary, genderqueer, agender and gender-neutral. Not everyone who identifies with these words would describe themselves as transgender.
• Transgender people exist in every culture and community, and across all ages.
• Gender identity is not the same as sexual orientation. People who are transgender may identify as straight, gay, lesbian, bisexual, queer, asexual or any other sexual orientation.

Many transgender people experience gender dysphoria at some time in their lives. Some do not, and feel comfortable with their bodies, either with or without accessing gender-affirming healthcare.

Transgender identities, and gender diversity, are not mental illnesses.

However, people who are transgender often face discrimination, harassment and social rejection. Because of this, they may be more likely to experience depression, anxiety, suicidal thoughts or other mental health problems.

It is common for young children to play around with how they express gender – for example, not wanting to wear typical boys’ or girls’ clothes, or taking part in traditionally male or female games or activities. In most children, these behaviours do not mean they are transgender or experiencing gender dysphoria.

Children and young people who are experiencing gender dysphoria may:

• consistently say they are a boy or a girl, even though they were assigned the opposite sex at birth
• be disgusted by their own genitals or want to get rid of them
• believe they will grow up to be the gender they identify as
• strongly prefer friends of the gender they identify with
• reject clothes, toys and games that are designed for the “wrong” gender
• refuse to urinate in the way that is culturally typical for their assigned sex (i.e. standing or sitting)
• be extremely distressed or anxious about the changes that happen to their body during puberty.

If you are an adolescent or adult with gender dysphoria, you may:

• be certain that your gender does not match the sex you were assigned at birth
• feel disgust with your genitals or body
• have a strong desire to get rid of your genitals or undergo gender-affirming surgeries or hormone treatments.

Diagnosis

If you are experiencing gender dysphoria, access to gender-affirming healthcare is important to support your wellbeing. People who experience gender dysphoria have higher rates of other mental health conditions. These may include depression, anxiety, suicidal thoughts, alcohol or other drug addiction, or eating disorders.

It is worth talking to a doctor about your experience of gender dysphoria, and any medical intervention you are interested in accessing.

Your doctor will take a note of your history (what you have felt and for how long) and will talk to you about how you are feeling, to understand whether you are experiencing depression, anxiety or any other mental health problems. If needed, the doctor can then refer you to a mental health professional who is qualified to accurately diagnose gender dysphoria. In some DHB areas, this is required if you are interested in accessing gender-affirming healthcare, such as taking hormones or getting surgeries. In other areas, transgender people can access healthcare by providing informed consent (making the decision themselves, after being given all the necessary information), rather than needing an official diagnosis. A doctor should be able to advise you about the process to follow in your area.

The goal of any therapeutic support for gender dysphoria is to reduce the distressing feeling of having a mismatch between your body and gender. Support is not about changing your gender or who you are.

“Transitioning” is a process that many transgender people go through to change their appearance, presentation or physical anatomy to better reflect their gender. For most transgender people, being able to go through the transition process they choose helps to reduce gender dysphoria.

Transition means different things for different people. It could include:

• “coming out” to friends, family and others as transgender, or another identity
• dressing and living in a way that better reflects your gender
• changing your name
• asking people to use different pronouns to describe you (for example he, she, or they)
• having your gender changed on legal identification documents like your birth certificate, passport, or driver's license
• taking puberty blockers – medication that a young person can take to suppress physical changes associated with puberty. This means they can delay making a decision about whether they want to take hormones or have surgery until they are older
• taking hormones (e.g. oestrogen or testosterone), or having surgery, to change your body's appearance and functions
• having counselling to reduce distress, anxiety or other distressing feelings
• getting counselling for your family or friends to help them understand your experience and adjust to any changes.