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Gender Dysphoria

Not long ago, in the Did You Know? section of our website, we briefly discussed some ideas on gender identity. We talked about genderfluid individuals, who may feel masculine one day, feminine the next, and somewhere in between at other times. We also mentioned bi-gender people, who switch gender roles depending on the situation. For instance, a person may identify as a woman at work and as a man with family and friends.

Today, we’re going to go a step further and look at gender dysphoria (GD), sometimes called gender identity disorder. People with GD feel uncomfortable and distressed with the gender of their birth and identify strongly with the opposite gender. They often feel they were born the “wrong” sex.

Each person with GD handles it differently. Some relieve their distress by living as the opposite sex. For example, they may dress or behave in ways that are typical for their desired sex. They may ask to be called a different name and be treated as a member of the opposite sex.

Others feel that changing their bodies to align with their desired sex is especially important. They may feel that they aren’t meant to have a penis or vagina, facial hair or breasts. Making physical changes may be the way to make them feel comfortable with who they are.

One might think that a person in this situation might immediately seek gender-reassignment surgery (a “sex change operation”). For males transitioning to females, this might involve surgically removing the penis and creating a vagina and breasts. For women who wish to become men, it could mean a mastectomy (removal of the breasts) and phalloplasty (creation of a penis).

But not all people with GD have surgery. Some find that cross-sex hormonal treatment alone is sufficient for their goals. Such treatment can help suppress the secondary sex characteristics of the biological sex and promote the development of characteristics of the desired sex.

In a study published in the Journal of Sexual Medicine in December 2013, Italian researchers reported on their work with 125 individuals with GD who had not had gender-reassignment surgery. Some of the participants took hormones to aid their transition and some did not.

Sixty-six participants were undergoing a male-to-female transition. In this group, 42 patients were taking hormones, mainly estrogens (“female hormones”) and antiandrogens (hormones to suppress male characteristics). Twenty-four took no hormones.

Fifty-nine people were transitioning from women to men. Twenty-six were undergoing cross-hormone therapy (taking forms of testosterone) and 33 took no hormones.

Using a variety of assessment tools, the researchers learned more about the participants’ levels of distress and how uneasy or dissatisfied they felt with their bodies.

The results were different depending on the transition. In the male-to-female group, those who took hormones were more comfortable with their bodies than those who didn’t.

However, for people transitioning from female to male, there were no significant differences in body uneasiness between those who took hormones and those who did not.

Why? One possible explanation involves the degree of bodily change that hormones can deliver for this group. For example, people transitioning from male to female may find that hormones increase the size of their breasts, a desired effect. However, for those moving from female to male, hormones may not necessarily decrease the size of the breasts, leading to dissatisfaction.

What do you think? Have your or someone you know gone through cross-hormonal treatment for gender dysphoria? Did the treatment bring about the desired changes? Or was surgery the next step? Please feel free to tell us your story in the comments.

Print this article or view it as a PDF file here: Gender Dysphoria


The Journal of Sexual Medicine

Fisher, Alessandra D., MD PhD, et al.

“Cross-Sex Hormonal Treatment and Body Uneasiness in Individuals with Gender Dysphoria”

(Full-text. First published online: December 16, 2013)


“Gender Dysphoria Symptoms”

(Last reviewed: May 26, 2013)

Sexual Medicine Society of North America

“Gender Identity”


“Gender Identity Disorder”

(Reviewed on March 4, 2010)