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=                          Gender dysphoria                          =
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                             Introduction
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Gender dysphoria (GD) is the distress a person feels due to a mismatch
between their gender identity and their sex assigned at birth. People
who experience gender dysphoria are typically transgender. The
diagnostic label gender identity disorder (GID) was used by the DSM
until it was renamed 'gender dysphoria' in 2013 with the release of
the DSM-5. The diagnosis was renamed to remove the stigma associated
with the term 'disorder'.

Gender nonconformity is not the same thing as gender dysphoria, and
the American Psychiatric Association states that "gender nonconformity
is not in itself a mental disorder. The critical element of gender
dysphoria is the presence of clinically significant distress
associated with the condition."

Evidence from studies of twins suggests that gender dysphoria likely
has genetic causes in addition to environmental ones. Some transgender
people and researchers support declassification of the condition
because they say the diagnosis pathologizes gender variance and
reinforces the binary model of gender.

Treatment for gender dysphoria may involve supporting the person
through changes in gender expression.  Hormone therapy or surgery may
be used to assist such changes. Treatment may also include counseling
or psychotherapy.


                          Signs and symptoms
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Gender dysphoria in those assigned male at birth tends to follow one
of two broad trajectories: early-onset or late-onset. Early-onset
gender dysphoria is behaviorally visible in childhood. Sometimes
gender dysphorics identify as gay for a period of time. This group is
usually attracted to members of their natal sex in adulthood.
Late-onset gender dysphoria does not include visible signs in early
childhood, but some report having had wishes to be the opposite sex in
childhood that they did not report to others. Trans women who
experience late-onset gender dysphoria will often be attracted to
women and may identify as lesbians. They frequently engage in
transvestic behavior with sexual excitement. In those assigned female
at birth, early-onset gender dysphoria is the most common course.

Symptoms of GD in children include preferences for opposite
sex-typical toys, games, or activities; great dislike of their own
genitalia; and a strong preference for playmate of opposite sex
children.  Some children may also experience social isolation from
their peers, anxiety, loneliness, and depression. According to the
American Psychological Association, transgender children are more
likely to experience harassment and violence in school, foster care,
residential treatment centers, homeless centers and juvenile justice
programs than other children. Additionally, some child psychologists
continue to use misgendering and pathologizing language and approaches
with transgender children, contrary to APA policy statements.

In adolescents and adults, symptoms include the desire to be and to be
treated as the other gender. Adults with GD are at increased risk for
stress, isolation, anxiety, depression, poor self-esteem, and suicide.
Studies indicate that transgender people have an extremely high rate
of suicide attempts; one study of 6,450 transgender people in the
United States found 41% had attempted suicide, compared to a national
average of 1.6%. It was also found that suicide attempts were less
common among transgender people who said their family ties had
remained strong after they came out, but even transgender people at
comparatively low risk were still much more likely to have attempted
suicide than the general population. Transgender people are also at
heightened risk for eating disorders and substance abuse.


                                Causes
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A twin study (based on seven people in a 314 sample) suggested that
GID may be 62% heritable, indicating the possibility of a genetic
influence as its origin, in these cases.


                              Diagnosis
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The American Psychiatric Association permits a diagnosis of 'gender
dysphoria' in adolescents or adults if two or more of the following
criteria are experienced for at least six months' duration:

* A strong desire to be of a gender other than one's assigned gender
* A strong desire to be treated as a gender other than one's assigned
gender
* A significant incongruence between one's experienced or expressed
gender and one's sexual characteristics
* A strong desire for the sexual characteristics of a gender other
than one's assigned gender
* A strong desire to be rid of one's sexual characteristics due to
incongruence with one's experienced or expressed gender
* A strong conviction that one has the typical reactions and feelings
of a gender other than one's assigned gender
In addition, the condition must be associated with clinically
significant distress or impairment.

The DSM-5 moved this diagnosis out of the sexual disorders category
and into a category of its own. The diagnosis was renamed from gender
identity disorder to gender dysphoria, after criticisms that the
former term was stigmatizing. Subtyping by sexual orientation was
deleted. The diagnosis for children was separated from that for
adults, as "gender dysphoria in children". The creation of a specific
diagnosis for children reflects the lesser ability of children to have
insight into what they are experiencing, or ability to express it in
the event that they have insight. 'Other specified gender dysphoria'
or 'unspecified gender dysphoria' can be diagnosed if a person does
not meet the criteria for gender dysphoria but still has clinically
significant distress or impairment. Intersex people are now included
in the diagnosis of GD.

The International Classification of Diseases (ICD-10) lists several
disorders related to gender identity:
* Transsexualism (F64.0): Desire to live and be accepted as a member
of the opposite sex, usually accompanied by a desire for surgery and
hormonal treatment
* Gender identity disorder of childhood (F64.2): Persistent and
intense distress about one's assigned gender, manifested prior to
puberty
* Other gender identity disorders (F64.8)
* Gender identity disorder, unspecified (F64.9)
* Sexual maturation disorder (F66.0): Uncertainty about one's gender
identity or sexual orientation, causing anxiety or distress

The ICD-11, which will come into effect on 1 January 2022,
significantly revises classification of gender identity-related
conditions. Under "conditions related to sexual health", the ICD-11
lists "gender incongruence", which is coded into three conditions:

* Gender incongruence of adolescence or adulthood (HA60): replaces
F64.0
* Gender incongruence of childhood (HA61): replaces F64.2
* Gender incongruence, unspecified (HA6Z): replaces F64.9

In addition, sexual maturation disorder has been removed, along with
dual-role transvestism. ICD-11 defines gender incongruence as "a