A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics).The DSM-5-TR defines gender dysphoria in adolescents and adults as a marked incongruence between one’s experienced/expressed gender and their assigned gender, lasting at least 6 months, as manifested by at least two of the following:
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The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) 1 provides for one overarching diagnosis of gender dysphoria with separate specific criteria for children and for adolescents and adults. A s with people who are cisgender (people whose sex assigned at birth aligns with their gender identity), people who are transgender have a diverse range of sexual orientations. Sexual orientation refers to the types of people towards which one is sexually attracted. Gender identity is also different from sexual orientation.
Diverse gender expressions, much like diverse gender identities, are not indications of a mental disorder. One’s gender expression does not necessarily align with their gender identity. Such expectations are culturally defined and vary across time and culture. For example, in much of the U.S., wearing a dress is considered a “feminine” gender expression, and wearing a tuxedo is considered a “masculine” gender expression. Whereas gender identity refers to one’s psychological sense of their gender, gender expression refers to the way in which one presents to the world in a gendered way. It is important to note that gender identity is different from gender expression. Of note, not all people who are transgender will desire all domains of gender affirmation, as these are highly personal and individual decisions. People who are transgender may pursue multiple domains of gender affirmation, including social affirmation (e.g., changing one’s name and pronouns), legal affirmation (e.g., changing gender markers on one’s government-issued documents), medical affirmation (e.g., pubertal suppression or gender-affirming hormones), and/or surgical affirmation (e.g., vaginoplasty, facial feminization surgery, breast augmentation, masculine chest reconstruction, etc.). Though gender dysphoria often begins in childhood, some people may not experience it until after puberty or much later. Some people who are transgender will experience “gender dysphoria,” which refers to psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity. the sex assigned at birth, usually based on external genitalia) does not align their gender identity (i.e., one’s psychological sense of their gender). The term “transgender” refers to a person whose sex assigned at birth (i.e.
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