AKT · Psychiatry/Personality & otherlow yield

Gender dysphoria and/or incongruence

Overview

Marked and persistent incongruence between a person’s experienced gender and their assigned sex, associated with clinically significant distress or impairment (dysphoria). Gender incongruence itself is not a mental illness (ICD-11).

Recognise

Persistent identification with a gender different from assigned sex
Distress related to the incongruence and/or body
Variable; may seek social, hormonal or surgical transition

Red flags

High rates of depression, anxiety and suicidality — screen and support

Differentials & how to tell them apart

Body dysmorphic disorderdistress about a specific body feature, not gender identity

Coexisting depression/anxietycomorbid, not causal

Investigations

Specialist Gender Identity Clinic assessment; rule out and manage coexisting mental health conditions (do not assume they cause the identity).

Management

1Refer to a specialist Gender Identity Clinic; provide affirming, non-judgemental support and treat coexisting mental illness.

Gender-affirming hormones — initiated via specialist gender services

Key points

Use the person’s affirmed name/pronouns; ICD-11 reclassified gender incongruence out of the mental-disorders chapter.

Monitor & prognosis

Mental health, suicide risk, support needs.

Distress often eases with appropriate support/affirmation.

Source: ICD-11; specialist gender services