Expert Q & A: Gender Dysphoria

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Expert Q & A: Gender Dysphoria

What is the difference between transgender and transsexual?

Transgender is a non-medical term that has been used increasingly since the 1990s as an umbrella term describing individuals whose gender identity (inner sense of gender) or gender expression (outward performance of gender) differs from the sex or gender to which they were assigned at birth. Some people who use this term do not consider themselves as matching a binary gender category. In addition, new terms such as genderqueer, bigendered, and agendered are increasingly in use.

Transsexual is a historic, medical term that refers to individuals who have undergone some form of medical and/or surgical treatment for gender reassignment (historically referred to as sex reassignment). Some transsexual individuals may identify as transgender, although others primarily identify as the male or female gender to which they have transitioned.

People who identify as transgender but who do not seek medical or surgical treatment are not transsexual.

Is there a general age that people realize they are transgender or experience gender dysphoria? Can it happen late in life?

Not all transgender people suffer from gender dysphoria and that distinction is important to keep in mind. Gender dysphoria and/or coming out as transgender can occur at any age.

The DSM-5* distinguishes between Gender Dysphoria in Childhood for those who experience GD before puberty. The diagnosis of Gender Dysphoria in Adolescents and Adults can occur at any age. For those who experience gender dysphoria later in life, they often report having secretly hidden their gender dysphoric feelings from others when they were younger.

How does hormone therapy affect a person’s emotional state? (From WPATH SOC)

Many transgender people who take feminizing or masculinizing hormones report improvement of emotions as their gender dysphoria lessens or resolves. A person transitioning from male to female (MTF, transwoman) takes feminizing hormones that may reduce libido. A person transitioning from female to male (FTM, transman) takes masculinizing hormones that may increase libido. Less commonly, masculinizing hormones may provoke hypomanic, manic, or psychotic symptoms in patients who have an underlying psychiatric disorder that include such symptoms. This adverse event appears to be associated with higher doses or greater than average blood levels of testosterone.

As with any medical treatment, the anticipated risks and benefits should be considered by a patient and prescribing doctor on an individual basis.

How can a person deal with gender dysphoria without gender reassignment?

Not all individuals with gender dysphoria choose to undergo gender reassignment. For one, gender reassignment that includes surgery is very expensive and usually not covered by most insurance. Nor do all individuals with gender dysphoria desire a complete gender reassignment. Some are satisfied with taking hormones alone. Some are satisfied with no medical or surgical treatment but prefer to dress as the felt gender in public. Some people make use of Trans affirming social networks online and in local supportive communities to cope with gender dysphoria and claim a gender identity and forms of expression that do not require medical treatments. Some individuals choose to express their felt gender in private settings only because they are either uncomfortable or fearful of publicly expressing their felt gender. However some people who are denied or have no access to gender reassignment treatments can become anxious, depressed, socially withdrawn and suicidal.

If a man likes to dress in women’s clothes but does not want to be a woman and otherwise lives typically as a male, that would be just a choice or preference and not considered any type of disorder. Correct?

I’m not sure it’s a “choice” or a “preference” but it is not necessarily a disorder. I would rewrite this question as well:

If a man likes to dress in women’s clothes but does not want to be a woman and otherwise lives typically as a male, does he have a psychiatric disorder?

No. Such a desire is called transvestitism and it is not a psychiatric disorder. DSM-5 does have a diagnosis of Transvestic Disorder that specifically states it “does not apply to all individuals who dress as the opposite sex, even those who do so habitually.” It is only considered a disorder if “cross-dressing or thoughts of cross-dressing are always or often accompanied by sexual excitement.”


  1. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Fifth edition. American Psychiatric Association. 2013

About the Experts:


Jack Drescher, M.D.
Clinical Professor of Psychiatry, New York Medical College
Adjunct Professor, New York University


Jack Pula, M.D.
Psychiatrist in private practice in New York City

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