Medicines for Gender dysphoria and incongruence

What it is

Gender incongruence describes a lasting mismatch between a person’s experienced or felt gender and the sex they were assigned at birth. Gender dysphoria is the term for the sense of unease, discomfort, or distress that can arise from this mismatch. Being trans or experiencing gender incongruence is not in itself a mental illness; rather, gender dysphoria refers to the distress that can result from the incongruence, and this distress — and a person’s needs and wishes around it — is what support and care aim to address. Gender incongruence and dysphoria can be experienced by people of any age, including children, young people, and adults, and experiences vary widely from person to person. The feelings can include a strong and lasting sense that one’s gender is different from the sex assigned at birth, discomfort with one’s body or with the gender role expected, and distress that can affect wellbeing, mental health, and daily life. It is important to approach this topic — and people experiencing it — with compassion, respect, and without judgement, as understanding, acceptance, and support make a significant difference to wellbeing, and stigma and lack of support can be harmful. Support and care are individual and based on the person’s own needs and wishes: for some, this may involve support and exploration of their feelings and identity, and for some, social changes (such as name, pronouns, and presentation) and, for adults, potentially medical options as part of transition; care is provided through specialist gender services, and pathways and options depend on the person, their age, and the current services and guidance. Because people experiencing gender dysphoria may also experience associated distress, anxiety, or low mood — and because acceptance and support improve wellbeing — access to compassionate support, and to mental health support where needed, is important. The key messages are that gender dysphoria is the distress that can arise from a mismatch between experienced gender and sex assigned at birth (and that being trans is not itself a mental illness), that compassion, respect, and support matter greatly, and that individualised care is available through specialist services.

How it is treated

The approach to gender dysphoria and incongruence is person-centred, compassionate, and based on the individual’s own needs and wishes, with specialist care and support available; a respectful, non-judgemental approach and access to support are central. Because being trans or experiencing gender incongruence is not itself a mental illness, and because the distress (dysphoria) and a person’s needs vary widely, care is individual and involves supporting the person to explore and understand their feelings and identity, and to access the support and options appropriate for them. A first step is often talking to a GP, who can provide support, discuss the person’s needs and wishes, and refer to specialist gender services (gender identity services for adults, and, for children and young people, the relevant specialist services), where assessment, support, and, where appropriate, further options are provided. The support and options are individual and may include: psychological and emotional support, and support for exploring identity and coping with dysphoria and any associated distress; social aspects of transition, which some people choose (such as changes to name, pronouns, and gender expression), where support and information can help; and, for adults, potential medical options as part of transition (which are provided through specialist services after appropriate assessment and discussion, and depend on the person’s wishes, needs, and the current services and guidance). For children and young people, care is provided through specialist services with careful, individualised assessment and support, and this is an area where services and approaches continue to develop. Throughout, support for mental health and wellbeing is important, as people experiencing gender dysphoria may also experience anxiety, low mood, or other distress — which can be helped — and because acceptance, understanding, and support (from services, family, and society) significantly improve wellbeing. Support is also available from LGBTQ+ and trans support organisations, which provide information, community, and peer support. It is important to seek help for significant distress, low mood, or anxiety, and urgent help if there are ever thoughts of self-harm. The reassuring and respectful messages are that being trans or experiencing gender incongruence is not a mental illness, that gender dysphoria (the distress that can arise) can be helped, that care is individual, compassionate, and available through specialist services, and that support, acceptance, and mental health care all improve wellbeing — so reaching out for support is encouraged.