Gender dysphoria is distress caused by a mismatch between a person's gender identity and the sex assigned at birth. Respectful, affirming care improves mental health, and options range from social support to hormone therapy and surgery for eligible patients.
Key symptoms
- Strong, lasting sense of being a gender other than assigned
- Distress about the body or sex characteristics
- Wish to be treated as another gender
- Anxiety, depression or social withdrawal
- Stress from stigma, bullying or family rejection
What you find on exam
- Ask for the patient's name and pronouns and use them
- Mental status exam with screening for depression and suicidal thoughts
- Ask about support, safety and substance use
- Physical exam guided by the organs the patient has, with consent
Tests
- Diagnosis is clinical, using DSM-5 criteria
- PHQ-9 and suicide risk screening
- Baseline labs before hormones: blood count, metabolic panel, lipids
- Hormone levels during treatment
Treatment basics
- Affirming care and mental health support
- Social transition as the patient chooses
- Hormone therapy, such as estradiol or testosterone, for eligible patients
- Puberty suppression in some adolescents, by specialist teams
- Surgical options for eligible adults
Red flags
- Suicidal thoughts or self-harm
- Violence, abuse or unsafe home
- Use of hormones without medical supervision
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.