Gender Dysphoria DSM-5 302.85 (F64.9)


DSM-5 Category: Gender Dysphoria


Gender Dysphoria, while being a new addition to DSM-5, is the new term for Gender Identity Disorder. In order to prevent stigma guarantee clinical care for people who perceive and believe they are a different sex than their designated gender, the new term was introduced (American Psychiatric Publishing, 2013). The DSM-5 diagnostic measures for gender dysphoria include tough and unrelenting cross-gender classification that go further than a need for an alleged cultural benefit.

Adults and teenagers may have a fixation with doing away of primary and secondary gender features, and have the thought that they are not being characterized by the right sex. One should realize that individuals, who have gender dysphoria, do not have a coexisting physical intersex situation. Noted pain or difficulty is seen in the work place, dealing with others, as well as in other vital areas of life. This is the defining factor of gender dysphoria (American Psychiatric Publishing, 2013). It is significant to state that gender dysphoria is frequently seen in children, though many children do not end up being adults with gender dysphoria (Canadian Psychological Association, 2013).

Psychological involvement may help patients with gender dysphoria. Individual therapy that pinpoints appreciating and handling gender problems should be central. In addition, involving the individual’s support group through family, group and marital therapy can offer a safe and secure environment. If needed, the use of hormone therapy may also prove beneficial.

Symptoms of Gender Dysphoria

DSM-5 states that the initial condition for the identification of gender dysphoria in both adults and teenagers is a noticeable incongruence between the gender the patient believes they are, and what society perceives them to be. This disparity should be ongoing for at least 6 months and should consist of 2 or more of the subsequent criteria (American Psychiatric Association, 2013):

  • Noticeable incongruence between the gender that the patient sees themselves are, and what their classified gender assignment
  • An intense need to do away with his or her primary or secondary sex features (or, in the case of young teenagers, to avert the maturity of the likely secondary features)
  • An intense desire to have the primary or secondary sex features of the other gender
  • A deep desire to transform into another gender
  • A profound need for society to treat them as another gender
  • A powerful assurance of having the characteristic feelings and responses of the other gender
  • The second necessity is that the condition should be connected with clinically important distress, or affects the individual significantly socially, at work, and in other import areas of life.


The DSM-5 indicates that the prevalence of gender dysphoria is 0.005-0.014% for adult born as males, whereas it is 0.002-0.003% for adult born as females (American Psychiatric Publishing, 2013). Among children, it is higher in those born as boys, where it is 2-4.5 times greater than those born as girls. Among teenagers, there is no real difference, between males and females.


Current case reports offer no evidence that psychotherapy offers total and long-standing about face of cross-gender identity. It is important to state that all transsexuals are not the same, and thus are not part of a uniform group. Early diagnosis and treatment decreases the chance for individuals to suffer depression, emotional agony, and to attempt suicide. It is equally significant to state that gender dysphoria is not identical to homosexuality. Each individual goes through a unique change, some may want a short-term change, and be content with cross-dressing, while others may desire a complete change, and seek gender assignment surgery (Royal College of Psychiatrists, 2013). Those who are born having ambiguous genitalia may meet the criteria for the identification of gender dysphoria.

Treatment for Gender Dysphoria

Fortunately treatment options exist that are beneficial for gender dysphoria, and these consist of psychotherapy, pharmacologic therapy, as well as other nonpharmacologic therapies, and sexual reassignment surgery (SRS) (Royal College of Psychiatrists, 2013). Professionals are changing pessimistic attitudes regarding SRS, plus more scientific evidence has shown the benefit of this procedure (Royal College of Psychiatrists, 2013). All the same, it should be stated that SRS does not automatically mean any issue is resolved, and much psychotherapy may be needed after the procedure in order to improve outcome generally (Cohen-Kettenis & Pfaf?in, 2009).


The use of psychotherapy, involving psychology and speech therapy, can help individual with gender dysphoria (Royal College of Psychiatrists, 2013) Individuals can be taught about self awareness and confidence needed to handle any issues arising in their daily lives. The support of family members can be engaged through the use of group, marital, and family therapy, which can help in creating an accommodating and encouraging environment (Royal College of Psychiatrists, 2013).

Through the use of speech therapy, male-to-female individuals with gender dysphoria can learn how to engage their voice and sound a lot female while talking (Royal College of Psychiatrists, 2013). Additionally, hair therapy may be beneficial for males seeking to become females.

Pharmacologic Therapy

Many individuals, especially those desiring a complete transformation will need hormonal therapy to enable that process (Royal College of Psychiatrists, 2013). For males seeking a female transformation, certain sex features can be covered up with particular types of hormone known as luteinizing hormone–releasing hormone (LHRH) agonists, progestational compounds, spironolactone, flutamide, and cyproterone acetate. For breast development, and to create a more female type of physical appearance, hormones such as ethinyl estradiol and conjugated estrogen are necessary. For females seeking a male transformation, the hormone testosterone will be helpful in promoting body hair.

Some individuals may also have comorbid psychiatric diagnoses, such as depression, anxiety, or psychosis. These are best treated with medications like antidepressants, anxiolytics, and antipsychotics.

Sexual Reassignment Surgery

SRS among teenagers remains a controversial topic, and much debate continues on this issue. In many countries, SRS is not available to teenagers, on the other hand, having this treatment done in the early stages when secondary sex characteristics are not fully formed, may be helpful. In adults, there is a reported satisfactory result in 87 percent of male-to-female and 97 percent of female-to-male SRS patients (Royal College of Psychiatrists, 2013).

While most SRS is successful, complications still exist (Royal College of Psychiatrists, 2013). For male to female gender surgery, in some cases, there may be scarring of the vagina, which can result in a shorter and narrower vagina, and increase the risks of recurrent cystitis. For those who desire the removal of breast tissue, while transforming from female to male, there can be substantial scarring. Furthermore, the creation of a penis, scrotum and testicles, known as phalloplasty, can also result in surgical complications.


American Psychiatric Association. (2013). Gender Dysphoria. In Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition ed.). Washington, DC: American Psychiatric Publishing Inc.

American Psychiatric Publishing. (2013). Gender Dysphoria. Retrieved March 13, 2014, from American Psychiatric Publishing:

Canadian Psychological Association. (2013). “Psychology Works” Fact Sheet: Gender Dysphoria in Children. Retrieved March 14, 2014, from Canadian Psychological Association:

Cohen-Kettenis, P., & Pfaf?in, F. (2009). The DSM Diagnostic Criteria for Gender Identity Disorder. Arch Sex Behav. doi:10.1007/s10508-009-9562-y

Royal College of Psychiatrists. (2013, October). Good practice guidelines for the assessment and treatment of adults with gender dysphoria. Retrieved March 14, 2014, from Royal College of Psychiatrists:

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