Gender dysphoria is defined by severe or persistent distress associated with an incongruence between one's gender identity and
biological sex. It is estimated that 1.4 million Americans and 25 million people worldwide identify as transgender and that 0.6% of Americans experience
gender dysphoria. The pathophysiology of
gender dysphoria is multifactorial and incompletely understood. Genetics,
androgen exposure, neuroanatomy, brain connectivity, history of
trauma, parents with psychological disorders, and being raised by less than two parents are associated with
gender dysphoria.
Gender dysphoria most frequently presents in early teenage years but can present earlier or later. Anxiety and depression are the two most common comorbid diagnoses and may be the reason for presentation to medical care. Diagnosis is established through history and or validated questionnaires. Treatment includes psychosocial
therapy,
pharmacotherapy for underlying depression and/or anxiety, hormonal
therapy, non-genital and/or genital
feminization or masculinization operations. The frequency and severity of treatment related morbidity increases progressively as treatments go from conservative to more invasive.
Gender dysphoria and its treatment is individualized and not completely understood.