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change) and has undergone (or is preparing to have) at least one cross-sex medical procedure or treatment

regimen–namely, regular cross-sex hormone treatment or gender reassignment surgery confirming the

desired gender (e.g., penectomy, vaginoplasty in a natal male; mastectomy or phalloplasty in a natal



Gender Dysphoria Disorder.

Between 1994 and 2013 the American Psychiatric Association defined “Gender

Identity Disorder” as a condition where the person has a “strong and persistent cross-gender identification,

which is the desire to be, or the insistence that one is, of the other sex.” The diagnosis also requires “evidence

of persistent discomfort about one’s assigned sex or a sense of inappropriateness in the gender role of that

sex.” In order for the condition to be considered a “disorder,” “there must be evidence of clinically significant

distress or impairment in social, occupational, or other important areas of functioning.”


In 2013, the American Psychiatric Association published the Diagnostic and Statistical Manual (5th edition)

(DSM-5). The Manual dropped the “Gender Identity Disorder” reflected in the Fourth Edition of its Manual and

in its stead has the new Gender Dysphoria Disorder. The Association said: “[P]eople whose gender at birth

is contrary to the one they identify with will be diagnosed with gender dysphoria.” The Association states:

For a person to be diagnosed with gender dysphoria, there must be a marked difference between the

individual’s expressed/experienced gender and the gender others would assign him or her, and it must

continue for at least six months. In children, the desire to be of the other gender must be present and

verbalized. This condition causes clinically significant distress or impairment in social, occupational, or other

important areas of functioning.


DSM-5 does not consider cross-gender identity in and of itself a disorder. Rather the disorder exists only

if the cross-gender identity causes distress or impairment. The focus of treatment thus is not attempting to

reduce or eliminate the cross-gender identity, but rather to reduce or eliminate the distress associated with

the condition. This view is supported by assigning Gender Dysphoria Disorder to its own chapter, in contrast

to Gender Identity Disorder which was lumped together in the same chapter with Sexual Disorders in DSM-

4. The subgroup that developed the new Disorder indicated that separating the Gender Dysphoria Disorder

from Sexual Disorders was intended to reduce the stigma associated with the diagnosis.