Gender dysphoria

This information is aimed at people aged 18 and older.

The biological sex assigned to you at birth may not match the gender you feel yourself to be (identify with). This is described as gender incongruence. If this causes you to feel persistent discomfort or distress for over six months, it’s called gender dysphoria. If you’re feeling like this, it’s important to get support to help improve your quality of life.

About gender dysphoria

Everyone is unique and has their own experiences. This means there is variation in when people might notice a misalignment between the sex they were assigned at birth and the gender they identify with. Some people notice the misalignment in early childhood, some in their teens, and some when they’re an adult.

This gender incongruence may cause you to dislike or feel uncomfortable with the characteristics of your assigned sex– for example, genitals, body hair, or voice. This is because they’re different from the gender you feel and experience. You may have a strong desire to possess the sex characteristics that align with the gender you experience. And you may want to be treated, live, and be accepted as a person of this gender.

If you feel this way for longer than 6 months, the medical term for this mismatch is gender dysphoria. Gender dysphoria is when gender incongruence causes you distress and affects how you function in life.

Your experience

If you have gender dysphoria, you may experience the following.

• You may feel very strongly that your gender identity doesn’t align with the sex you were assigned at birth.
• You might feel more comfortable or affirmed when people respond to you in line with your gender identity. For example, if they refer to you using your preferred pronouns such as him, her, or them.
• You may feel uncomfortable and have a strong desire to hide or change characteristics that associate you with the sex you were assigned at birth. For example, your chest, genitals, body hair, or voice.

As well as transgender (trans) people, non-binary people may also experience gender dysphoria.

If you don’t get the right support, gender dysphoria can potentially affect your mental health and lead to conditions such as depression or anxiety.

Help and support

If you feel that your gender doesn’t match the sex you were assigned at birth, you might need some support. You may find it helps to talk first to someone you trust such as a friend or family member. Or you could speak to a counsellor or your GP. You can take someone along to your appointment if you’ll feel more comfortable.

Your GP can help you to access services and support in the best way possible. They’ll talk to you about how you’ve been feeling, and they may do a general check-up to prepare for any future gender dysphoria treatment.

It helps to prepare for your appointment. You might want to think about what type of support would help you – for example, hormone therapy or mental health support. Not all GPs have experience of gender dysphoria, so don’t be afraid to lead the conversation about your needs, including how you want to be addressed.

If you don’t feel that your GP can help you, make an appointment to see a different doctor. You could also contact a charity or organisation that can help you to access the care you need (see our section on other helpful websites).

You might also find it helps to speak to people in a similar situation through online or offline peer-to-peer support groups. If your feelings are affecting your mental health, support is available.

Support your mental health

If you feel uncomfortable with your gender, it can affect your mental health. Or you may experience mental health symptoms because of how society perceives you. You might also experience upsetting reactions from your family or friends. If your feelings are affecting your mental health, your GP can refer you to a mental health professional. Ask if this person has experience in working with transgender people. There are specialists available.

You can also access these services yourself without seeing a GP first. Organisations such as the Gender Identity Research & Education Society can help you to find someone.

Mental health professionals can help you to understand the different types of gender identity and explore your own. They can also help you with coming out to family and friends. Their goal is to help you to feel comfortable and equipped to deal with challenges, and to thrive.

Mental health professionals may use talking therapies such as cognitive behavioural therapy (CBT) or psychotherapy to help you. They can also help you if you have anxiety and depression, or any other mental health problems. They play an essential role in assessing your mental wellbeing before your doctor refers you to a specialist – for example, an endocrinologist for hormone therapy.

Gender expression

There are things you can do that might help you to feel more comfortable in yourself. Specialist health professionals such as a gender-informed counsellor, psychologist or gender specialist endocrinologist can help you identify what might help you feel less gender-related discomfort. What feels right for one person might not feel right for another. You might not want to make any changes at all. It’s your decision to make. Take your time to explore your options and to decide what’s right for you.

Changes that may help you feel more comfortable include:

• removing unwanted body hair
• using pronouns that better reflect your gender identity – for example, he/his, she/her or non-binary pronouns them/their or ze/hir
• modifying your body shape – for example, flattening your chest with a breast binder
• changing your voice and mannerisms – speech and language therapy can help you learn and practice changes in the way you communicate
• changing your name

These are all forms of gender expression – that is, how you show your gender identity to other people. Changes like these may help you feel closer to the gender you identify with. You might choose to do any, none, or all of these.

Gender affirmation surgery

There are operations that may help you to feel closer to your gender identity. Your healthcare team – including your surgeon and mental health professionals – will discuss if this is available for you. Together, you can decide what’s right for you. Before you go ahead with any procedures, your healthcare team will make sure that you’re physically and mentally well enough to have the surgery. Depending on the type of surgery, you may need one or two referrals from a mental health professional.

Your healthcare team will also make sure you have all the information you need to give your informed consent for a procedure to go ahead. This will include information on the risks and benefits. If you have any doubts, talk to your surgeon and don’t be afraid to change your mind. This is your decision, so make sure that you feel comfortable with it.

Breast or chest surgery

You can have surgery (often known as ‘top surgery’) to:

• masculinise your chest, for example by removing your breasts (mastectomy)
• • feminise your chest, for example by enhancing or creating breasts (breast augmentation)

Genital surgery

Genital surgery is also gender affirmation surgery. You might sometimes hear it called gender reassignment surgery.

You may also hear people referring to this type of surgery more generally as ‘bottom surgery’. There are lots of different types and what you have done will depend on your personal situation and goals.

If you were assigned female at birth, you may have the following.

• surgery to remove your womb (a hysterectomy) and ovaries (ovariectomy, also known as oophorectomy).
• surgery to remove and/or seal your vagina (vaginectomy).
• surgery to create a scrotum (scrotoplasty).

You can also have surgery to create a penis. Speak to your surgeon about which type of surgery would be best for you. There are two main types.

• Metoidioplasty (‘meta’ surgery) involves creating a penis from your clitoris. The penis will be small and will depend on how large your clitoris grew following hormone therapy. Your surgeon can add tissue to increase the length and the girth.
• Phalloplasty involves using donor skin (a graft) from another part of your body – for example, your forearm – to create an entirely new penis. Some surgeons can leave your clitoris uncovered to make sexual stimulation easier after your operation.

If you were assigned male at birth, you can have surgery to remove your penis (penectomy) and testicles (orchiectomy), and to create:

• a vaginal opening (vaginoplasty)
• the outer part of the genitals (the vulva and labia) known as a vulvoplasty
• a clitoris (clitoroplasty)

Other procedures

There are also many other surgical and cosmetic options, such as:

• facial feminisation surgery to change features such as the shape of your jaw, Adam's apple, and hair line
• liposuction and lipofilling (removing or adding fat to parts of your body)
• injectable fillers which can enhance features such as your lips, cheekbones, and jawline
• hair transplants to replace hair loss or change your hair line
• voice feminising surgery to change the pitch and tone of your voice