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Gender dysphoria


This information resource has been created with help from the transgender community and reviewed by clinical experts. We’d like to thank all those involved for their help and support.
Next review due May 2022

Gender dysphoria is when you feel distressed or uncomfortable because the gender that you identify with doesn’t match the sex that you were assigned at birth.

It’s important to understand that it’s perfectly legitimate for your gender identity not to match your assigned sex at birth. The mismatch isn’t a problem; it’s the way it can make you feel — uncomfortable or distressed — that’s not okay. If you’re feeling like this, it’s important to get the help and support you need.

A group of friends sat at a cafe table with a laptop

Your experience

It’s important to remember that everyone is unique and so too are their experiences. Some people notice the misalignment between the sex they were assigned at birth and their gender identity when they’re a child. For others, this is experienced for the first time as a teenager or adult. This can be very difficult to deal with.

If you’re experiencing gender dysphoria, you may:

  • feel very strongly that your gender identity doesn’t align with the sex you were assigned at birth
  • feel more comfortable when people treat you in line with your gender identity, for example, by using the appropriate pronouns like him, her or them
  • feel very uncomfortable with, and have a strong desire to hide or change, any characteristics that associate you with the sex you were assigned at birth – for example, your breasts, genitals, facial and body hair or voice

Children may show some of the following signs. They may:

  • prefer to dress in clothes, and involve themselves in play, that is often associated with the opposite sex
  • prefer to make friends with, and enjoy the company of, children of the opposite sex
  • have a strong desire to be, or tell you that they are, the opposite sex to the one they were assigned at birth
  • want to change their genitals
  • find puberty very troubling

Not every child who has the above signs will experience gender dysphoria as they develop and grow. Some girls are just more ‘boyish’ and boys more ‘girlie’. What’s important is that your child is happy and comfortable in themself. If they’re not, then they may need some help and support.

People who identify as non-binary can experience gender dysphoria too. If you identify as non-binary, you may feel that your gender identity falls between the binary models (eg boy and girl, man and woman), or outside of them completely. You may identify as having no gender or a different gender completely. Your gender identity may also be fluid or fixed.

Living with gender dysphoria can be very difficult. And for lots of people, it can be extremely damaging to their mental health, leading to high levels of anxiety, depression, self-harm and suicide. But help and support are available. See our Section below for more information.

Help and support

If you’re experiencing gender dysphoria, you may want to confide in someone you trust first — a friend, family member or work colleague, for example. You may also choose to speak to a counsellor, or approach your GP.

Your GP can help you to access the correct services and support. If it helps you to feel more comfortable, you can take someone with you to your appointment.

During your appointment, your GP will talk to you about how you’ve been feeling and may do a general check-up. They’ll also probably ask you about any medicines you’ve been taking. You shouldn’t buy hormone treatments over the internet as this can be very unsafe. But if you have, and are using these, you’ll need to let your doctor know.

Your GP may refer you to an NHS Gender Identity Clinic (GIC), although access to these services may be limited. Here you can access specialist advice and care and discuss your needs and options going forward. You can also access private gender specialist services that you pay for. Other health professionals such as psychologists, psychiatrists or a sexual health centre can also refer you to a GIC.

If feelings of distress and discomfort are affecting your mental health, your GP can refer you to get help from a mental health professional in the meantime.

Opening up and talking about how you’re feeling can be intimidating. But it’s important. Help and support is available and your GP can help you to access it in the best way possible. Your GP and other health professionals should be aware of your needs, but this awareness can sometimes vary. So, come to your appointment prepared. Be clear about what you want to get out of it and don’t be afraid to lead the conversation around how you want to be addressed and any other needs you have.

Your options

There are lots of things you can do and people to talk to who can help you to become more comfortable in yourself. What works for one person, might not work for another, and it’s possible that you won’t want to make any changes at all. This is your decision to make. Take your time, explore your options and make a decision that’s right for you.

Changing your gender expression to better match your gender identity

If you decide to change how you express your gender to better match your gender identity, you might, for example, alter your appearance, or adopt certain mannerisms. You might also ask people to use pronouns that better reflect your gender identity, such as he/his, she/her, or non-binary pronouns like them/their or ze/hir.

It’s important to understand that gender identity and gender expression are different – you can’t assume someone’s identity based on how they express themselves. We often make assumptions about people’s gender identity based on what they wear or how they talk, for example. But it’s important not to make these assumptions.

Support can be found in lots of different places. Mental health professionals can help you to explore this and support you through any difficult feelings or emotions. Or you may prefer to speak to people in a similar situation to yourself through online or offline peer-to-peer support groups. However, it’s important to understand that everyone’s experiences can be different and may not apply directly to you.

Other things you may want to explore around gender expression include the following.

  • Changing your name by deed poll or declaration. This is relatively easy to do and once completed, you can change your gender on identity documents, such as your passport and driving licence. Find out more about changing your name and gender on your driving licence. You can also find information on applying for a passport if you’re transgender.
  • Modifying your body shape using different products and garments. There are several underwear stores that specialise in creating garments for a diverse transgender community. For example, you may want to flatten your chest using a breast binder (or similar garment) or create the appearance of a bust by using padding. You can also get padding to add curves to your bottom and hips, or to create the appearance of a groin bulge. It’s important to understand that although breast binding can help your mental wellbeing, it can also cause physical symptoms. These include pain in your back and chest, and shortness of breath, for example. There aren’t any official, evidence-based guidelines to help individuals minimise these risks, but some people find taking days off from binding helps. Research around binding is limited. But if you’re considering it, speak to a medical professional for advice. They may be able to talk you through the risks, benefits and actions you can take to avoid harm.
  • Hair issues – there are lots of different options for hair removal from electrolysis to waxing or laser treatment. Help with hair pieces, transplants and wigs is also available. Ask at your GIC for further advice.
  • Voice and communication therapy. This can help you to learn about, and practise changes in the way you speak and communicate non-verbally that are more in line with your gender identity. Your GIC and possibly your GP can help with referrals for this.

For some people, help changing their gender presentation is all they need to feel more comfortable in themselves. But this isn’t the case for everyone.

Hormone therapy

Hormone therapy is when you take specific hormones that are designed to enhance either more masculine or feminine characteristics. You’ll need to have some checks and tests before starting this therapy.

There are lots of different types of hormones that have different jobs around your body, but the ones involved here are your sex hormones. In general, testosterone is known as the male sex hormone and oestrogen the female sex hormone.

As you get older, these hormones produce changes during puberty such as developing breasts or facial and body hair and changes to your voice and body shape.

The aim of hormone therapy is to suppress your current sex characteristics and enhance those of the gender you identify with.

Feminising hormone therapy includes the following.

  • Oestrogen hormones to enhance feminine characteristics.
  • Medicines called blockers, such as goserelin and leuprorelin, to suppress (slow down) the production and function of male hormones, mainly testosterone. Testosterone is the main male sex hormone, but it is part of a wider group of hormones called androgens. So, you might hear these medicines called anti-androgens.

Masculinising hormone therapy includes:

  • testosterone hormones to enhance male characteristics
  • blocker medicines, like goserelin or leuprorelin to suppress the release of oestrogen into your body

Cyproterone acetate is another blocker which may occasionally be prescribed.

The type and dose of hormone therapy differs from one person to the next. It’ll depend on things like your age, the effect you’re hoping to achieve, safety and whether or not you have any underlying medical conditions. You should be aware that taking hormones is not a guaranteed form of contraception – so you must practise safe sex to avoid becoming pregnant. For more information, speak to your doctor about this.

Your doctor will talk to you about the risks and benefits of different hormone therapy. Depending on what you want to achieve and your personal situation, you may need to take hormone therapy for the rest of your life. So, it’s important to consider this when making a decision on what you want to do next.

Amongst other things, hormone therapy can cause problems with your heart and circulation and increase your risk of certain cancers. It’s important to discuss these risks with your doctor so you feel well-informed, and in a position to consent to the therapy if you decide to go-ahead with it. No hormone is completely safe – they all come with an element of risk. But there are things you can do to help improve your chances of staying safe and well.


If you have hormone therapy, you will be monitored regularly by your healthcare team.

Before starting hormone therapy, it’s important to decide if you want to store your eggs or sperm, so that you can have children in the future. Your GIC may be able to advise suitable options and next steps. See our FAQ: What are my options for having children in the future? for more information.

Hormone therapy may be the first thing you try to combat the distress and discomfort you feel, or it may come later on in your journey. For some, it’s all that’s needed to feel more comfortable. But for others, there may be other options that need exploring too.

Here we outline some of the effects and timescales of hormone therapy. It’s important to understand that the timings aren’t exact and may change from one individual to another. Some changes may also be permanent, while others can be reversed. So, make sure you discuss your treatment fully with your doctor before you begin.

Masculinising hormones

A table showing the masculinising effects of hormones

Feminising hormones

A table outlining the effects of feminising hormones

If you started to lose your hair before having hormone therapy, it won’t grow back with hormone treatment. It’ll also take between one and three months for hair loss to stop. To completely remove hair from your face and body you’ll need to have electrolysis or laser treatment (sometimes both).

It’s important to speak to your GP if you’re considering hormone therapy. You may be considering buying hormones online or from other outlets, but this is dangerous so should be avoided. Your GP can arrange a referral for you to discuss and access hormone treatment safely at a GIC.

Surgery

There are lots of different types of surgery that may help you to feel closer to your gender identity. What and how much surgery you have done is up to you – everyone is different. Your healthcare team – including your surgeon and mental health professionals – will discuss the different options with you. Together, you can decide what’s right for you. Before going ahead with any procedures, they’ll make sure that you’re well enough both physically and mentally to have the surgery. If you smoke, you’ll be asked to stop.

Depending on the type of surgery, you may need one or two referrals from a mental health professional.

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

Surgery can be broadly split up into three types and includes the following.

Breast or chest surgery

You may have surgery to remove your breasts (mastectomy) and achieve a more masculine chest, this is often known as ‘top surgery’. Or surgery to enhance or create them (you might hear this called breast augmentation).

Genital surgery

Genital surgery may be called:

  • gender reassignment surgery (GRS)
  • sex reassignment surgery (SRS)
  • gender realignment surgery
  • gender reconstructive surgery
  • gender confirmation 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 gender goals.

If you were assigned female at birth, you may have:

  • surgery to remove your womb (a hysterectomy) and ovaries (ovariectomy, also known as oophorectomy)
  • surgery to remove and seal the vagina (vaginectomy)
  • surgery to create a penis – there are two main types of surgery: metoidioplasty (‘meta’ surgery) or phalloplasty
  • surgery to create a scrotum (scrotoplasty)

Meta surgery involves creating a penis from your clitoris. The penis will be small. Its size will depend on how large your clitoris grew following hormone therapy. Phalloplasty involves using a graft (donor skin) from another part of your body – for example your forearm – to create an entirely new penis. If you’re having a phalloplasty, ideally avoid having tattoos until your surgeon confirms where they’ll take the graft from.

If you were assigned male at birth, surgery will include removing your penis (penectomy) and testicles (orchiectomy), while also creating:

  • a vagina (vaginoplasty)
  • the outer part of the vagina (vulva) known as a vulvoplasty
  • a clitoris (clitoroplasty).

Other procedures

These may include procedures to add or remove fat in certain places (liposuction and lipofilling). Other procedures include ones to make your face more feminine, your Adam’s apple less noticeable, or to change your voice to make it either more masculine or feminine.

Some people choose to pay for these procedures abroad. This increases the risk considerably as they may not adhere to UK safety standards.

Supporting your mental health

Feeling uncomfortable with your gender or being part of a minority can affect your mental health, so looking after yourself is really important. There are lots of different ways that your healthcare team can help.

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 well equipped to deal with challenges and thrive going forward.

Mental health professionals may use talking therapies, such as cognitive behavioural therapy (CBT) or psychotherapy to help you. They’re not like conventional therapies, such as medicines and procedures, which are used to ‘fix’ physical problems like a broken bone or heart conditions. Instead, they’re used to help you explore and manage your thoughts and feelings, which can impact on your overall mental and emotional wellbeing.

Therapy may be one-to-one, in a group, or between a couple or family. Although group therapy might sound intimidating at first, support from your peers can be invaluable.

Mental health professionals can also help you with anxiety and depression, or any other mental health problems that you might be facing either as a result of gender dysphoria or otherwise.

They also play an essential role in assessing your mental wellbeing before referring you to an appropriate specialist, for example an endocrinologist for hormone therapy or any other specialists for the options discussed above, depending on your needs.

There’ll be lots of different healthcare professionals who will help you along the way. It’s important that you speak to them openly and frankly, and that they speak to each other to help you get the best possible care.

Other helpful resources

If you’d like to know more about gender dysphoria, we’ve pulled together some helpful resources – from books, films and TV programmes, to information, advice, and online support.

Information, advice and online support

  • Mermaids
    www.mermaidsuk.org.uk

    This organisation works to reduce isolation and loneliness for gender variant and transgender children, young people and their families. Their helpline can be reached on 0344 334 0550.

  • Depend
    www.depend.org.uk

    Depend provides support, advice and information for anyone who knows, or is related to, a transgender individual in the UK. You can join different support lists based on your own personal situation.

  • Gender Identity Research and Education Society (GIRES)
    www.gires.org.uk

    GIRES is a membership charity operated by volunteers. Its purpose is to improve the lives of trans and gender non-conforming people, including non-binary and non-gender individuals, of all ages. They help to educate and improve the wellbeing of individuals using evidence from lived experience and research into gender identity development from the scientific community.

  • Gender Identity Development Service (GIDS)
    www.gids.nhs.uk

    Commissioned by NHS England, GIDS provides services for young people presenting with difficulties with their gender identity. They also have lots of helpful and practical information for both parents and young people.

  • Gender Identity Clinic (GIC)
    www.gic.nhs.uk

    The GIC provides services and support to adults who are struggling with their gender identity. Their services are provided by the Tavistock and Portman NHS Foundation Trust. On their site you can find information about gender dysphoria, your appointments and a further list of support groups and resources


Books, TV and film, podcasts and more

Reading a book, listening to a podcast or watching a TV programme, YouTube channel or film addressing transgender issues may help to increase understanding and awareness.

Members of the transgender community have pulled together a list of their favourite books, films TV shows and more. The resources you find most useful may vary from one individual to another, and personal preferences may differ. If you have any suggestions for additional resources, or recommendations around those currently included, please do email us with your feedback.

Books

  • The Argonauts (2015) by Maggie Nelson
    In this book, Maggie tells of her relationship with Harry Dodge, an artist who identifies as gender fluid. She describes her experiences and relationship with pregnancy, and explores and challenges things as we know them.

  • The Gender Games (2017) by Juno Dawson
    Juno Dawson is an award-winning author of titles including Spot the Difference, Margot and Me and The Gender Games. In this memoir, Dawson tells the story of how society shapes our understanding of gender and what can be done to overcome it.

  • Redefining Realness (2014) by Janet Mock
    Mock declares: “This book is my truth and personal history”. It dives deep into her journey as a transgender woman finding her true identity, and lets the reader share in her experiences and views along the way.

TV programmes

  • Boy meets girl (2015)
    Boy meets girl is a comedy TV series about a couple – Judy and Leo – who meet and fall in love. Starring Rebecca Root (a transgender actress) as Judy, the series explores themes around transgender relationships and those with an age gap.

Films

  • Boy meets girl (2014)
    Starring Michelle Hendley, a transgender actress playing the role of Ricky, Boy meets girl is a romantic comedy-drama. Ricky is from a small, rural town in Kentucky and one day dreams of moving to New York where she’ll study fashion. The film explores relationships between Ricky, her new friend Francesca, Francesca’s fiancé (David) and Robby (Ricky’s best friend).

Podcasts

  • Marsha’s plate (2017)
    Marsha’s plate is a podcast hosted by Diamond Stylz, Mia Mix and Zee. Together they join forces every Thursday to tell their story and share opinions from a black, transgender perspective. The Marsha’s plate podcast is freely available on Soundcloud.

  • Kicking the kyriarchy (2016)
    Sidone and Elena, the host of this podcast, invite guests to speak about, and share, their opinions and experiences on a range of different topics. Their aim is to, “provide a platform for all voices, stories and narratives that are ignored by the mainstream media.” Episode 3 focuses on non-binary and episode 10 talks about all things trans. Listen to the Kicking the kyriarchy podcast.

  • The gender rebels (2016)
    This question-and-answer format podcast hosted by Kathleen and Faith, answers the people’s questions. Faith, a transgender woman, and Kathleen a cis-gender woman are partners in both life and podcasting! Together they are answering ‘the people’s questions’ in their podcast The gender rebels

Youtube

  • My genderation (2013)
    My genderation is a YouTube channel created by Fox, Lewis and Owl. Created by trans people for trans people, My genderation films provide a snapshot into the lives of transgender individuals. Their aim is to combat myths, misconceptions and stereotypes by showing transgender people in a realistic way.

Frequently asked questions

  • We don’t know exactly how many people experience gender dysphoria, but it’s safe to say that you’re not alone.

    Researchers have been working hard to find out how many people are affected by gender dysphoria, but it’s not that easy. Sometimes people don’t feel safe enough or want to talk about or accept the way they’re feeling, or perhaps they aren’t ready to do so. This, along with lots of other factors, can influence our understanding of how common it is. What we do know, however, is that there’s been an increase over the years in the number of young people being referred to GICs. Figures from 2017 to 2018 show that there has been a total of 2,519 referrals (including adults and children), compared to 2,016 referrals from 2016 to 2017.

  • Hormone therapy and surgery on the parts of your body that help you to reproduce (have babies), can affect your chances of having children in the future. If you want to have biological children, it’s important to consider and discuss this with your healthcare team beforehand.

    If you were assigned male at birth, storing your sperm in a sperm bank may be an option for you. If you were assigned female at birth, you can also talk to your healthcare team about storing your gametes (sex cells). This may include storing your eggs or an embryo (an egg that has already been fertilised).

    Sperm can be used to artificially inseminate an egg, and eggs or embryos can be carried, for example, by a female surrogate.

    Adoption is another route to consider if you want to have children in future. UK law supports the Lesbian, Gay, Bisexual and Transgender (LGBT) community when it comes to adoption, whether you’re in a relationship or doing this alone. Organisations such as New Family Social can provide further information and support if you need it.

    If you’ve already started hormone therapy, you will need to stop for a while to let your body start producing sperm or eggs again. This might not always be possible, or work, so it’s important that you talk to your healthcare team about your reproductive health when considering your options. More information about preserving your fertility can be found on the Human Fertilisation and Embryology Authority website.


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  • Created by Laura Blanks, Specialist Health Editor, Bupa Health Content Team, with support from members of the transgender community, March 2019
    Medical review, May 2019
    Next review due May 2022



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