Gender is now understood to be on a spectrum that can evolve over time. There’s still a lot of room for improvement regarding acceptance, education, and policy, but awareness of gender identity and transgender issues has definitely become more widespread. In particular, gender dysphoria has gained a lot of attention after celebs like Caitlyn Jenner and Elliot Page have publicly opened up about struggling with the condition.
In an interview with Oprah Winfrey, Page discussed how he had panic attacks at movie premieres and after-parties because he felt like he wasn’t being viewed by the world as the correct gender.
“There was so much press, so many premieres all around the world,” he said of movie releases. “I was wearing dresses and heels to pretty much every single event.” Page said he “lost it” while getting ready for press around the movie Inception, remembering how his manager had offered up several dresses for him to wear to parties around the film.
“I already had to wear a dress I already had picked out and I went in and there were three dresses laid out, like new dresses to maybe see, and I just like, I lost it,” he recalled. “It was like a cinematic moment, like the kind of thing that would be in a movie, you know?” He also said he collapsed the night after the Inception premiere and at the after-party. “That was something that’s happened frequently in my life, usually corresponding with a panic attack,” he said.
Jenner has also come forward about her struggles with gender dysphoria throughout her athletic career. “During my Olympic training, I was so far away from Caitlyn. I honestly just ignored my gender issues the best I could. But it was always present. When you suffer from gender dysphoria, it’s not something you can take two aspirin for, get plenty of sleep, wake up the next morning, and everything’s fine. You’re just kind of stuck with it,” she wrote for WH in 2020.
There is a mental health term to describe these feelings and experiences: gender dysphoria. Here’s what it means, and how people are officially diagnosed.
Meet the experts: Johanna Olson-Kennedy, MD, is an adolescent medicine physician specializing in the care of gender non-conforming children and transgender youth. She has been providing medical intervention for transgender youth and young adults for the 16 years, and is considered a national expert in this area.
Nazneen Meacham, LPC, has more than 10 years of experience in providing therapy. She’s completing a post-masters specialization program in transgender mental health. Her interests as a therapist include trauma, resiliency, gender and sexuality, identity development, anxiety and coping with life changes and transitions.
Jessica Schenider, PsyD, is a clinical psychologist and the founder and executive director of Evidence Based Therapy Partners. She also works for the Treatment Implementation Collaborative, LLC, conducting trainings and consultation for programs throughout the country, and frequently lectures at universities including UCLA, UCI, and Pepperdine.
“Gender dysphoria is when an individual’s gender does not match their sex assigned at birth, physical body, or sex-related physical characteristics, and the individual is aware and experiences discomfort in the discrepancy,” says clinical psychologist Jessica Schneider, PsyD, the founder and executive director of Evidence Based Therapy Partners.
It’s important to note that gender identity is your innate sense of being a woman, man, some combination of both, or no gender at all, while gender expression refers to the outward manifestation of your gender, like the way you dress or your mannerisms, per the American Psychiatric Association (APA). Gender expression doesn’t always reflect someone’s gender identity because they may feel pressured to conform to cultural and social expectations of how they should appear to others.
Some people feel significant distress when how they present themselves to the world does not match their gender identity. “Often times, more distress and dysphoria are experienced when their sex assigned at birth is more apparent and their physical traits make it hard to show up in the world according to their gender identity,” says Schneider.
And gender dysphoria affects people who are transgender, which is the biggest distinction, says Johanna Olson, MD, a pediatrician in the Division of Adolescent Medicine at Children’s Hospital Los Angeles and the medical director of the Children’s Hospital Los Angeles’ Center for Transyouth Health and Development
But not all transgender or gender-diverse people experience gender dysphoria, according to the APA. As a whole, though, “gender dysphoria can impact many different people for a variety of reasons,” says Nazie Meacham, LPC, the co-director of the Gender & Sexuality Development Clinic of NJ, Children’s Hospital of Philadelphia.
To be clinically diagnosed with gender dysphoria, children, teens, and adults need to have symptoms for at least six months, Meacham says. Those symptoms include the following, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
The DSM-5 includes this statement on gender dysphoria: “In order to meet criteria for the diagnosis, the condition must also be associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.” Essentially, it’s not enough for someone to feel that they’re being viewed as the wrong gender—they have to be distressed by it, Dr. Olson notes.
For many people, “gender has always sort of hovered around them,” Dr. Olson notes. But that’s not the case for everyone.
“Especially for transmasculine kids—young people who were designated female at birth—the changes of puberty can trigger gender dysphoria,” Dr. Olson says. For transfeminine children (those who were designated male at birth), they are “born with a penis and misgendered perpetually from the time they’re very young because of their genitals,” she says.
Still Dr. Olson points out that’s not everyone’s story. “Gender dysphoria is multi-layered and complicated.”
Gender dysphoria can “definitely evolve over time,” Meacham says. A lot depends on what’s happening with the person, she says. For example, if they’re able to outwardly present to people as the gender they prefer, they may have less gender dysphoria. “It is very common for dysphoria to shift as individuals continue to adapt to changing supports, environments, bodies, and the world around them,” she says.
It’s possible for people to no longer experience gender dysphoria if they experience it as a child. But when people experience it as a teen, “it’s unlikely that they’re going to want to live with or settle down in their designated sex at birth,” Dr. Olson says.
People with gender dysphoria tend to have a “disproportionate amount” of mental health issues, according to Dr. Olson. That can include any of the following.
If someone is younger, their grades may suffer, Dr. Olson says. They may also struggle in certain social situations. That’s why it’s so important to find support.
People are diagnosed with gender dysphoria by a mental health or medical professional—ideally someone who has training in understanding gender, Meacham says. From there, they’d be evaluated by the care provider to see if they meet the criteria for gender dysphoria, spelled out by the DSM-5.
“How dysphoria is presented from one person to another is unique, and when assessed accurately, treatment resources can be explored,” Schneider says. A clinical and formal diagnosis can help individuals access the best available resources and treatments, whether that be social support, medical resources, or financial contributions, such as insurance or grants, she adds.
There’s a wide range. “Treatment can include physiological, medical, hormonal, and surgical care,” says Schneider. It can also cover “open-ended exploration” of feelings and experiences with gender identity and expression with or without the help of a therapist, according to the APA.
“Treatment depends on how the distress is showing up,” says Schneider. “A lot of treatment is helping people exist in their reality as it is, navigating through what they want to do about it, and how they are going to define and cope with whatever comes up.”
People who struggle with gender dysphoria may also find relief using certain pronouns, names, and other forms of gender expression that match their gender identity. Some may prefer to go through medical treatments, like hormone blockers and gender-affirming hormones like estrogen and testosterone. Others may elect to have different surgeries, like chest reconstruction, facial surgeries, and surgeries to change the genitals and reproductive organs, Dr. Olson says.
The goal of treatment for gender dysphoria is to help people live the way they want to and be accepted as such. Gender dysphoria can often change how you relate to other people, and vice versa, so whether you’re looking to strengthen ties with family members or navigate your relationship with a significant other, family or couple’s therapy can help build a supportive environment at home. This is especially important because family and societal rejection is one of the strongest predictors of mental health struggles among transgender individuals, according to research published in LGBT Health.
Online resources from the Human Rights Council or the Trevor Project can also help you find a community of support, Dr. Olson says. And, she says, if you live in a larger city, there may even be groups you can join that have meet-ups. Legally changing your name and gender can be helpful in embracing your gender identity too, Meacham says.
If you suspect that you’re struggling with gender dysphoria, experts say it’s important to reach out to a provider who specializes in the disorder. “There is help available,” Dr. Olson stresses.