Gender Dysphoria and Gender Incongruence
Terms and Definitions
Core definitions: [Ref]
| Term | Definition |
|---|---|
| Gender incongruence | State of mismatch or misalignment between a person’s inner gender identity (their psychological sense of their gender) and their assigned sex at birth
Example: A person assigned female at birth (AFAB) whose inner gender identity is male |
| Gender dysphoria | A formal psychiatric diagnosis (defined in the DSM-5-TR) where gender incongruence results in clinically significant psychological distress or impairment in social, occupational, or other important areas of functioning |
Some other related terms: [Ref]
| Category | Terms and definition |
|---|---|
| Internal and external experience | Gender identity: an individual’s inner sense of being a girl / woman, boy / man, some combination of both, or some other gender (which may or may not correspond to their sex assigned at birth)
Gender expression: the outward, public manifestation of a person’s gender (this includes how they carry themselves, their dress, accessories, grooming, voice/speech patterns, and conversational mannerisms) |
| Core identities | Transgender: an umbrella term describing individuals whose gender identity does not align with their assigned sex at birth
Cisgender: a term describing an individual whose gender identity aligns with the sex assigned to them at birth Non-binary: a term describing an individual whose gender identity is neither girl / woman nor boy / man |
| Medical and physical baselines | Sex assigned at birth refers to assignment made at birth, usually based on external genitalia; this includes
Intersex or disorders of sexual development (DSD): a group of physical medical conditions involving the reproductive system where biological sex characteristics do not fit typical male or female development (e.g. androgen insensitivity syndrome, congenital adrenal hyperplasia, 5-alpha-reductase deficiency) |
Sexual orientation: an individual’s erotic attraction or romantic tendencies [Ref]
- Sexual orientation is distinct from and independent of gender identity
- Sexual orientations include heterosexual, homosexual, bisexual, or asexual
Gender incongruence is the underlying misalignment that defines being transgender. However, NOT all transgender or gender-diverse individuals experience gender dysphoria.
An individual can live with gender incongruence as part of their identity without experiencing the distressing, clinically significant impact of gender dysphoria.
Clinical Features and Diagnosis
The DSM-5 criteria for gender dysphoria differ between pre-pubertal children and post-pubertal individuals (adolescents and adults).
| Patient population | DSM-5 criteria |
|---|---|
| Post-pubertal individuals (adolescents and adults) | Marked gender incongruence (state of mismatch or misalignment between a person’s inner gender identity and their assigned sex at birth) for at least 6 months
Characterised by the presence of at least 2 of the following:
The above features must be associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning |
| Pre-pubertal children | Marked gender incongruence (state of mismatch or misalignment between a person’s inner gender identity and their assigned sex at birth) for at least 6 months
Characterised by the presence of at least 6 of the following, and the first criterion must be met:
The above features must be associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning |
Referral
≥18 y/o → NHS gender dysphoria clinic
<18 y/o → paediatric or children and young people’s mental health services (who can then refer to NHS children and young people’s gender service)
Management
Key management principles: [Ref]
| Age group | Management |
|---|---|
| <18 y/o | Treatment is highly restricted
|
| ≥18 y/o | Options include:
As medical and surgical treatments can impact future fertility, referrals to fertility services to preserve eggs or sperm prior to starting treatment should be supported |