A note on language
Language around gender identity is continually evolving, and different people may use different words to describe their experiences. On this page, we use terms such as ‘gender dysphoria’, ‘trans’ and ‘gender identity’ because they are widely recognised and are consistent with current clinical terminology and relevant UK guidance. We also recognise that not everyone will identify with these terms, and we respect the language each individual chooses to describe themselves.
What is gender dysphoria?
Gender dysphoria describes the distress or discomfort some people experience when their gender identity differs from the sex registered at birth. Not everyone whose gender identity differs from their registered sex experiences gender dysphoria.
In this video, Dr Dane Duncan Mills discusses gender identity, what to look for in a therapist and where to find support.
Non-binary gender identity
Some people describe themselves as non-binary, meaning they do not identify exclusively as male or female. Non-binary is an umbrella term that includes a range of gender identities, such as androgyne, polygender and third gender. People may identify as both male and female, neither, or somewhere along the gender spectrum.
Is gender dysphoria a mental illness?
Gender dysphoria describes the distress or discomfort that some people experience when their gender identity differs from their sex registered at birth. Being trans or experiencing gender incongruence is not, in itself, considered a mental illness.
In the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013, the diagnosis 'gender identity disorder' was replaced by 'gender dysphoria'. The change shifted the focus of the diagnosis towards clinically significant distress or impairment, rather than treating a person's gender identity itself as a disorder.
The World Health Organisation (WHO) has taken a different approach in the International Classification of Diseases (ICD-11). It replaced earlier diagnostic categories with 'gender incongruence' and moved the diagnosis out of the chapter on mental and behavioural disorders and into a new chapter on conditions related to sexual health. The WHO explains that this reflects current understanding that trans and gender-diverse identities are not conditions of mental ill health, while retaining a diagnosis can help people access appropriate healthcare.
ICD-11 was adopted by the World Health Assembly in 2019 and came into effect in January 2022.
What can gender dysphoria feel like?
Gender dysphoria can be experienced in different ways and at different stages of life. For some people, feelings of discomfort or distress may become more noticeable during puberty or at other times when their body, gender identity or how others perceive them feel out of alignment. Experiences may include:
- distress or discomfort relating to certain physical or sex characteristics;
- distress about physical changes during puberty;
- discomfort when being perceived or treated as a gender that does not reflect your identity;
- a strong desire for your body or appearance to better reflect your gender identity;
- anxiety, low mood or isolation associated with these experiences.
Not everyone experiences gender dysphoria in the same way, and gender expression alone does not mean that someone has gender dysphoria.
Many children explore and express their gender in different ways as they grow up. For some people, feelings of distress or discomfort related to gender may emerge or become more noticeable during childhood or adolescence, particularly during puberty. Others may not recognise or understand these feelings until adulthood.
Only you can say how you feel. You may feel certain about your gender identity or still be exploring it, and understanding your experiences can take time.
I sat down on the arm of the sofa, head feeling like it was about to explode, when it hit me. A strong, resonate thought that shook me to the core: I don’t want to be a girl anymore.
- Read Zach's story.
How gender dysphoria can affect everyday life
Keeping these feelings to yourself can be difficult, particularly if you are worried about judgement, rejection or discrimination, or don't feel you have the support you need.
Gender dysphoria can significantly affect a person's mental health and wellbeing. Open, respectful conversations can help reduce stigma, increase understanding and make it easier for trans people experiencing distress to seek support.
Some people choose to transition so that aspects of their life or appearance better reflect their gender identity. Transition can mean different things to different people and may involve social changes, such as using a different name or pronouns, and for some people, medical treatment.
Not everyone who is trans chooses or needs to take the same steps.
Your rights and protection from discrimination
In England, Scotland and Wales, gender reassignment is a protected characteristic under the Equality Act 2010. This provides protection from unlawful discrimination and harassment in areas including work, education and access to services. You do not need to have undergone medical treatment or have a Gender Recognition Certificate to be protected.
Northern Ireland has separate equality and anti-discrimination legislation.
For more information, visit our discrimination page.
Coming out and exploring your gender identity
Telling other people about your gender identity is often described as ‘coming out’. This is a highly individual process and isn't necessarily a one-off event. LGBTQ+ people may have to come out many times during their lives.
How you come out will depend on what you feel comfortable with. For example, you may feel comfortable speaking about your gender identity with your close friends, but not with your family. Not everyone chooses to come out, and that's OK. It's a personal decision, and only you can decide if, when and who you want to tell.
If you decide you're ready to tell someone, it can help to think about who you'd like to talk to, and when and where you'll feel most comfortable having the conversation. You don't have to have all the answers, and it's OK to tell someone if you're still figuring things out yourself.
People may respond in different ways. Some may be immediately supportive, while others might need time to process what you've shared or learn more about your experience. If someone doesn't react as you'd hoped, remember that their response is not a reflection of your identity or its validity. If possible, consider speaking to someone you trust or reaching out for professional support.
There's no right or wrong time to come out. If you choose to, do so when you feel ready and in a way that feels right for you. If you'd like guidance on starting the conversation with loved ones, Stonewall offers helpful information and resources.
Treatment and support for gender dysphoria
Support for gender dysphoria will depend on a person's age, individual circumstances and the difficulties they are experiencing. This may include psychological support and, for some adults, medical treatment.
If you're looking for support, it can help to speak to a professional, such as your GP, a psychotherapist or a counsellor. They can listen to your experiences, discuss the support available and help you explore your thoughts and feelings.
Children and young people
If you are aged 17 or under and would like support with gender-related distress or concerns, you can speak to your GP. They may refer you to a children and young people's mental health service or a paediatric service for further assessment and support.
In England, referrals to the specialist NHS Children and Young People's Gender Service are made through NHS children and young people's mental health services or community and hospital paediatric services. Support is based on individual needs, with the specialist service taking a holistic approach that considers a young person's physical and mental health, development and wider circumstances.
Waiting times for specialist assessment can be long. If you are struggling with your mental health while waiting, speak to your GP or the healthcare team supporting you about the help available.
Adults
If you are 18 or over and think you may have gender dysphoria, your GP can refer you to an NHS gender dysphoria clinic for assessment.
Adults may be offered treatment including:
- hormone therapy;
- voice and communication therapy;
- talking therapy or counselling;
- surgery.
Hormone therapy
Hormone therapy may be prescribed to help a person feel more comfortable in their body and support physical changes that better align with their gender identity. Depending on the treatment prescribed, this may involve taking testosterone or oestrogen, which can lead to gradual physical changes over time.
Hormone therapy may be long-term and should be discussed with an appropriate healthcare professional, including its potential benefits, risks and effects on fertility.
What is social transition?
Social transition is when someone begins living in a way that reflects their gender identity. This might include changing their name or pronouns, updating the way they dress or present themselves, or asking others to recognise their gender identity. Everyone's transition is different, and not everyone chooses to socially transition or pursue medical treatment.
Some people choose to have gender-affirming surgery as part of their transition, while others do not. There is no single 'right' way to transition, and the steps a person takes will depend on their individual needs and goals. If you are considering surgery, your care team will explain the assessment process and any preparation required before treatment.
Counselling for gender dysphoria
Gender dysphoria can cause significant distress and affect your mental health and wellbeing. You may experience feelings such as anxiety, stress, isolation or low mood, particularly if you don't feel able to express your identity or access the support you need.
Talking to someone you trust can help, but opening up isn't always easy. A counsellor with experience supporting trans people and those exploring their gender identity can offer a confidential, non-judgmental space to talk about your experiences, thoughts and feelings at your own pace. They can support you with the difficulties you're experiencing without making assumptions about your identity or what feels right for you.
Professional counselling bodies consider conversion practices that seek to change or suppress a person's sexual orientation or gender identity to be unethical and potentially harmful. Counselling can offer a safe, non-judgmental space to explore your thoughts, feelings and identity openly, without pressure to reach a particular conclusion.
If you're looking for a counsellor, you may wish to ask about their experience of working with gender identity and their approach to therapy.
