What is Gender Dysphoria?

Firstly, what GD is not.   Though cultures sometimes unfairly pick favorites, differences in personality and expression are a normal part of being human. Biological sex is also innately human. Like other mammals, we reproduce by combining male and female genes. So, "male" and "female" are words for these biological reproductive categories, nothing more. Though there are some traits which tend to be more male or female, on average, not everyone is average. It would sadden us if any girl felt like less of a girl just because she likes trucks, sports or short hair; or for a boy to wonder if he's not really a boy at all just because he likes dolls, the colour pink or dancing. Sex stereotypes are not Gender Dysphoria.​

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Though there’s still a lot we don’t yet know about GD, it has been studied for decades. Leading psychologists and researchers in the field have identified several different types:

 

The most common types

Homosexual GD (Early Onset):

  • Starts in early childhood

  • Occurs in both boys and girls

  • Children show signs of gender non-conformity from a young age

  • Most kids with this type of GD become adult gay or lesbian people and stop having GD, but a small percentage of gay and lesbian people continue to experience GD into adulthood.

 

Autogynephilia (Late Onset):

  • Seen only in natal boys

  • Onset can seem sudden, usually in adolescence

  • Is a kind of heterosexual inversion in which one is attracted to the idea of oneself as female and feels uncomfortable as male. This should not be understood as a mere fetish. That is overly simplistic and degrading.

Uncommon/Rare types

 

Autohomoerotic GD

  • Natal females only, who are attracted to males

  • Aren’t typically gender non-conforming in childhood

  • Attracted to the idea of becoming gay men

  • Is not the same as autogynephilia because they are attracted to men, not themselves as men

 

GD related to having a Disorder of Sex Development

  • Not all people with DSDs have GD, but a small percentage do

  • Especially common in those with Ovotesticular DSD and Congenital Adrenal Hyperplasia

  • Gender non-conformity seen in childhood

  • Developmental and treatment pathway for this type of GD is different than other types of GD

GD Related to Psychosis

  • A person may believe they are the opposite sex as a psychotic delusion

  • Very uncommon

  • Treatment would be the same as for any other psychotic symptoms

 

 

Other (recent developments)

 

Rapid Onset Gender Dysphoria

ROGD is not a formal diagnostic term but a name of a phenomenon studied by Dr Lisa Littman, based on parent reports. Further studies are needed to understand this better, but many leading researchers and clinicians who work with trans youth are seeing a shift in who’s coming to gender clinics. Some traits reported include:

  • Mostly natal girls, but seen in both boys and girls

  • Often no signs of gender non-conformity in childhood

  • First appears in adolescence, quite suddenly

  • Often very intelligent and sensitive youth

  • May have conditions that make them more vulnerable (e.g. Borderline Personality Disorder, Autism or ADHD - all of which impact social skills, emotions and processing)

  • Worsening mental health and behaviour after coming out as trans

  • Firm and intense focus on gender ideology and subculture

A Deeper Dive

Hear some of the leading researchers talk about different kinds of GD

Ray Blanchard

 

Gender dysphoria is not one thing

 

The concept of autogynephilia and the typology of male gender dysphoria. Journal of Nervous and Mental Disease

Evidence for an altered sex ratio in clinic‐referred adolescents with gender dysphoria

The classification and labeling of nonhomosexual gender dysphorias

Typology of male-to-female transsexualism

Heterosexual and homosexual gender dysphoria

Early history of the concept of autogynephilia

Nonhomosexual gender dysphoria

Prediction of regrets in postoperative transsexuals

Interim report of the DSM-IV subcommittee on gender identity disorders

Varieties of autogynephilia and their relationship to gender dysphoria

Birth order and sibling sex ratio in two samples of Dutch gender-dysphoric homosexual males

Erotic target location errors in male gender dysphorics, paedophiles, and fetishists

Measuring masculine gender identity in females.

Gender dysphoria, gender reorientation, and the clinical management of transsexualism.

Partial versus complete autogynephilia and gender dysphoria

The she-male phenomenon and the concept of partial autogynephilia

 

 

Michael Bailey

The Man Who Would Be Queen The Science of Gender-Bending and Transsexualism (2003). 

James Cantor

 

New MRI Studies Support the Blanchard Typology of Male-to-Female Transsexualism. 

 

Anne Lawrence

A Validation of Blanchard’s Typology: Comment on Nuttbrock et al. (2010)

Lisa Littman

 

Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria.

 

The Use of Methodologies in Littman (2018) Is Consistent with the Use of Methodologies in Other Studies Contributing to the Field of Gender Dysphoria Research: Response to Restar (2019).

Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners

Ken Zucker

Gender Identity Disorder and Psychosexual Problems in Children and Adolescents

A Follow-Up Study of Boys With Gender Identity Disorder

Debate: Different strokes for different folks

The myth of persistence: Response to “A critical commentary on follow-up studies and ‘desistance’ theories about transgender and gender non-conforming children”

Other

 

A higher rate of hyperandrogenic disorders in female-to-male transsexuals

Desisting and persisting gender dysphoria after childhood: a qualitative follow-up study

Desisting and persisting gender dysphoria after childhood: a qualitative follow-up study

Structural connections in the brain in relation to gender identity and sexual orientation

 

Debate: The pressing need for research and services for gender desisters/detransitioners

Neurobiology of gender identity and sexual orientation

Australian children and adolescents with gender dysphoria: Clinical presentations and challenges experienced by a multidisciplinary team and gender service.

A Typology of Gender Detransition and Its Implications for Healthcare Providers

Ovotesticular differences of sex development: male or female? Case series