Gender Dysphoria Test

The sex that a physician assigns to a person at birth is generally based on external genitalia, but the person’s gender identity—their psychological sense of their gender—does not necessarily match their sex assigned at birth. The term “transgender” refers to a person whose gender identity does not match their sex assigned at birth. Gender dysphoria occurs when a transgender person experiences psychological distress because of the mismatch between their assigned sex and their gender identity.¹

While it can start in childhood, gender dysphoria may not be experienced until after puberty or much later. When this happens, it is called adult gender dysphoria.¹

A person who feels they may have gender dysphoria should start with a visit to their doctor. The doctor may then refer the individual to a psychiatrist, psychologist, social worker, or another mental health professional. A set of diagnostic criteria will be reviewed with the person, explains Francisco J. Sánchez, PhD, an associate professor of educational, school, and counseling psychology at the University of Missouri. “If the person meets enough of these criteria, they will be diagnosed with gender dysphoria,” he says.

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the criteria for being diagnosed with gender dysphoria include the desire to change one’s primary sex characteristics (genitals) and/or secondary sex characteristics (such as facial and chest hair in men or breasts in women), and the wish to be of another gender.¹

Although there is a lot of interest in this topic today, “you can’t just go to a doctor and say, ‘I have gender dysphoria,’” says Francisco J. Sánchez, PhD, an associate professor of educational, school, and counseling psychology at the University of Missouri. “There is an assessment that you need to go through before a determination can be made.”

Many adults who present with gender dysphoria will say that they believed for a long time prior to their diagnosis that “something felt different,” says Francisco J. Sánchez, PhD, an associate professor of educational, school, and counseling psychology at the University of Missouri. “But they chose not to tell anyone about it until they were around 40 or 50 years old,” he says.

“There used to be some sociocultural differences between those who were diagnosed in childhood and those who were diagnosed as middle-aged adults,” Sánchez adds. “Some of these trends included white (non-Latino) patients and those attracted to women waiting until later in life to seek help. But these differences may be lessening now that there is greater awareness of and support for transgender issues.”

Sánchez notes that a small number of practitioners continue to believe that if a middle-aged man feels that he has gender dysphoria, it could actually be autogynephilia, which is a male’s propensity to be sexually aroused by the thought of himself as a female.² However, this is a highly controversial concept that has been deemed harmful by several professional organizations.²

Gender dysphoria is not caused by trauma, says Francisco J. Sánchez, PhD, an associate professor of educational, school, and counseling psychology at the University of Missouri. At one time, it was theorized that gender dysphoria—like same sex attraction—was the result of childhood trauma. “But there is no reputable, scientific evidence that this is true,” he says.

Yes and no. Once you are diagnosed with gender dysphoria, it becomes part of your medical records, says Francisco J. Sánchez, PhD, an associate professor of educational, school, and counseling psychology at the University of Missouri. “With sufficient treatment, the diagnosis may qualify as going into remission if a person is no longer reporting distress due to their identity,” he explains. “But the diagnosis typically remains in their records.”

Although several professional organizations have offered guidelines (recommendations) for working with transgender and gender non-conforming patients, no major US medical or psychology organization has established official standards of care. There is an international association—called the World Professional Association for Transgender Health—however, that has developed standards of care that many practitioners refer to. (*Note: Standard of care distinction requires a higher threshold typically requiring empirical support and is adopted as a consistent response to a presenting concern. Deviating from a standard of care must come with well-supported justification.)

In general, people diagnosed with gender dysphoria are offered individualized treatments that can include hormone therapy, surgery, and counseling or psychotherapy. It should be noted that psychological attempts to force the transgender person to be cisgender (which means the person’s gender identity aligns with the sex assigned to them at birth) are considered unethical by some associations.¹

In the US, the American Psychiatric Association estimates that as many as about 1 in 7,100 people assigned male at birth and as many as 1 in 33,300 people assigned female at birth meet diagnostic criteria for gender dysphoria.

Around 0.6% to 0.7% of the US population identifies as transgender. Many transgender individuals first experience gender dysphoria early in childhood. In fact, some 73% of transgender women and 78% of transgender men first experience gender dysphoria by the age of 7.³

It’s possible, but not probable, says Francisco J. Sánchez, PhD, an associate professor of educational, school, and counseling psychology at the University of Missouri. “Most people with gender dysphoria would have sensed something earlier in life,” he says. Still, some individuals may first notice feelings of gender dysphoria as late as middle age, Sánchez says.