Table 1.

Definition and criteria for a diagnosis of gender dysphoria

The Diagnostic and Statistical of Manual of Mental Disorders, 5th edition (1) defines gender dysphoria as a marked incongruence between an individual’s experienced/expressed gender and their assigned gender that has been present for at least 6 months and is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.

In adolescents and adults, this is manifested by at least 2 of the following:

◦ A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics

◦ A strong desire to be rid of one’s primary and/or secondary sex characteristics (or in young adolescents, a desire to prevent the development of anticipated secondary sex characteristics)

◦ A strong desire for the primary and/or secondary sex characteristics of the other gender

◦ A strong desire to be of the other gender

◦ A strong desire to be treated as the other gender

◦ A strong conviction that one has the typical feelings and reactions of the other gender

In children, gender dysphoria is manifested by at least 6 of the following (one of which must be the first criterion):

• A strong desire to be of the other gender or an insistence that one is the other gender

• A strong preference for wearing clothes typical of the opposite gender

• A strong preference for cross-gender roles in make-believe play or fantasy play

• A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender

• A strong preference for playmates of the other gender

• A strong rejection of toys, games, and activities typical of one’s assigned gender

• A strong dislike of one’s sexual anatomy

• A strong desire for the physical sex characteristics that match one’s experienced gender