Gender dysphoria involves a conflict between a person’s assigned gender and the gender with which one identifies. The diagnosis for adolescents and adults requires two of the following for at least 6 months:

• A marked incongruence between one’s perceived gender and one’s assigned gender.
• A strong desire to be rid of one’s primary and/or secondary sex characteristics.
• A strong desire for the primary and secondary sex characteristics of the other gender.
• A strong desire to be treated as the other gender.
• A strong desire to be the other gender.
• A strong conviction that one has the typical feelings and reactions of the other gender.

The diagnosis for children requires six of the following for at least 6 months:

• A strong desire to be 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-belief 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 desire for the physical sex characteristics that match one’s perceived gender.

Cross-gender behaviours may start between the ages of 2 and 4 though gender-atypical behaviour is common in young children. Children who meet the diagnostic criteria might not persist into adolescence and adulthood. The children with more intense symptoms and distress were more persistent. Furthermore, gender dysphoria at the beginning of puberty is predictive of persistence.

There are several gender-affirming treatments:

• Hormone therapy to accomplish pubertal suppression (i.e. puberty blockers).
• Hormone therapy to masculinize or feminize the body.
• Chest surgery (i.e. top surgery).
• Genital surgery (i.e. bottom surgery).
• Counselling

There are transgender adults who only want support and counselling rather than altering their body. Social transition refers to the process in which trans people live openly in a way that matches their gender identity rather than their natal gender. Social transition requires social support and social support leads to better psychological outcomes. In trans people, there is brain differentiation in the direction of the gender identity.

Gender dysphoria is associated with high levels of stigmatization (1), discrimination (2) and victimization (3). This contributes to a negative self-image and increased rates and other mental disorders. Preoccupation with cross-gender issues can interfere with daily activities and cause problems in functioning.

Genderqueer refers to people who blur the lines around gender identity and sexual orientation. There often is a fluid gender identity and sexuality. Gender expansiveness refers to a wider, more flexible range of gender identity than typically associated with the gender binary.