Gender Dysphoria

The causes of gender dysphoria are not fully understood.  It was traditionally thought to be a psychiatric condition, which meant that its causes were believed to originate in the mind.  This does not mean that gender dysphoria is a mental illness.

However, recent studies have suggested that gender dysphoria may have biological causes associated with the development of gender identity before birth.  More research is needed before the causes of gender dysphoria can be fully understood.

Much of the development that determines your gender identity – that is, the gender that you feel yourself to be – happens in the womb (uterus).

Your biological sex is determined by chromosomes.  Chromosomes are the parts of a cell that contain genes (units of genetic material that determine your characteristics).  You have two sex chromosomes: one from your mother and one from your father.

During early pregnancy, all unborn babies are female because only the female sex chromosome (the X chromosome), that is inherited from the mother, is active.  At the eighth week of gestation, the sex chromosome that is inherited from the father becomes active, this can be either an X chromosome (female) or a Y chromosome (male).

If the sex chromosome that is inherited from the father is X, the unborn baby (foetus) will continue to develop as female with a surge of female hormones.  The female hormones work in harmony on the brain, gonads (sex organs), genitals and reproductive organs, so that the sex and gender are both female.

If the sex chromosome that is inherited from the father is Y, the foetus will go on to develop as biologically male.  The Y chromosome causes a surge of testosterone and other male hormones, which initiates the development of male characteristics, such as testes.  The testosterone and other hormones work in harmony on the brain, gonads (sex organs) and genitals, so that the sex and gender are both male.

Therefore, in most cases, a female baby has XX chromosomes and a male baby has XY chromosomes.

Gender development is complex and there are many possible variations that can cause feelings of a mismatch between a person’s biological sex and their gender identity.

In rare cases, the hormones that trigger the development of sex and gender may not work properly on the brain, gonads and genitals, causing variations between them.  For example, the biological sex (as determined physically by the gonads and genitals) could be male, while the gender identity (as determined by the brain) could be female.

This could be caused by additional hormones in the mother’s system, or by the foetus’s insensitivity to the hormones, known as androgen insensitivity syndrome (AIS).  In this way, gender dysphoria may be caused by hormones not working properly within the womb.

Other rare conditions, such as congenital adrenal hyperplasia (CAH), and intersex conditions (also known as hermaphroditism) may also result in gender dysphoria.

In CAH, the adrenal glands (two small, triangular-shaped glands located above the kidneys) in a female foetus cause a high level of male hormones to be produced.  This enlarges the female genitals.  In some cases, they may be so enlarged that the baby is thought to be biologically male when she is born.

Intersex conditions cause babies to be born with the genitalia of both sexes (or ambiguous genitalia).  In such cases, it used to be recommended that the child’s parents should choose which gender to bring up their child as.  However, it is now thought to be better to wait until the child can choose their own gender identity before any surgery is carried out to confirm it.

There are no physical symptoms of gender dysphoria, but there are a range of feelings that people with the condition may experience, and behaviours that they may display.

The symptoms of gender dysphoria can appear at a very young age.  For example, a child may refuse to wear typical boys’ or girls’ clothes, or dislike taking part in typical boys’ or girls’ games and activities.  In most cases, this type of behaviour is just a normal part of growing up, but in cases of gender dysphoria, it persists into later childhood and through to adulthood.

Adults with gender dysphoria can feel trapped inside a body that does not match their gender identity. This can cause feelings of discomfort and anxiety. They may also feel so unhappy about social expectations that they live according to their anatomical sex, rather than according to the gender that they feel themselves to be.  They may experience a strong desire to change, or get rid of, physical signs of their biological sex, such as facial hair or breasts.

It is estimated that 1 in 11,500 people experience gender dysphoria.  However, there may be many people with the condition who do not seek help.  On average, men are diagnosed with gender dysphoria five times more than women.

While gender dysphoria is rare, the number of people being diagnosed with it is increasing due to growing public awareness about the condition.

However, many people with gender dysphoria still face prejudice and misunderstanding about their condition.

If you think you have gender dysphoria, see your GP.  Your GP may refer you to a gender dysphoria clinic, which can offer you a personalised assessment.

Treatment for gender dysphoria aims to help people remove the feeling of a mismatch between their biological sex and their gender identity.  This can mean different things for different people.  For example, for some people it can mean dressing and living as their preferred gender.  For others, it can mean taking hormones or having surgery to change their physical appearance.  Many transgender people seek to have treatment to permanently change their bodies, so that they are more consistent with their gender identities.

Info derived from NHS Choices.