Gender Dysphoria and the DSM-5 Criteria

What Is Gender Dysphoria

Gender dysphoria is the clinically significant distress a person feels when their experienced gender does not match the sex they were assigned at birth. It is a psychiatric diagnosis of that distress, defined in the DSM-5-TR, the current edition of the Diagnostic and Statistical Manual of Mental Disorders that American clinicians use (American Psychiatric Association). It is not the same thing as being transgender, and not every transgender person has it.

The distinction carries the whole topic. The diagnosis names a treatable problem, the distress, while being transgender names a person. The American Psychiatric Association says “not all transgender or gender diverse people experience gender dysphoria” (APA).

What the Distress Feels Like

The symptoms of gender dysphoria are specific, and the manual lists them. A person may feel a strong desire to be rid of the sex characteristics they have, or to have the ones they do not, and to be seen as a gender other than the sex assigned at birth. They may want to be treated as another gender, and be certain they feel and react the way people of that gender do. Some people first feel it in childhood, and some not until after puberty or much later (APA).

What the criteria describe is an ongoing mismatch rather than a single crisis, which is why the manual requires it to have lasted at least six months before it counts as a diagnosis. Gender dysphoria in children is assessed against its own list of eight indicators. A child must show at least six, and one of them must be a strong desire to be of the other gender.

Depression, anxiety and suicidal thinking often come with it. In a Seattle clinic study, 57% of the youths had moderate to severe depression when they enrolled, and 43% reported self-harm or suicidal thoughts. The authors link that burden to lower social support and more stigma and discrimination (Tordoff et al., 2022). In the Trevor Project’s 2025 survey, 40% of transgender and nonbinary young people seriously considered suicide in the past year (Trevor Project).

Diagnosis vs Identity

Gender dysphoria is a clinical diagnosis of distress. Being transgender is an identity. Treating them as the same is how “trans” gets misread as “mentally ill,” which the diagnosis itself does not say: the APA wrote that “gender nonconformity is not in itself a mental disorder” (APA, 2013).

	Gender dysphoria	Being transgender
What it is	A diagnosis of distress	An identity, not a diagnosis
Where it is defined	DSM-5-TR, assessed by a clinician	Self-known; no one diagnoses it
Who has it	Some trans people, plus the distress must be present	Anyone whose gender differs from their assigned sex
Is it a mental disorder	It is a DSM-5-TR diagnosis; the distress is what is treated	No. The APA says gender nonconformity is not in itself a mental disorder
What treatment targets	The distress	Not a condition to treat

Sources: American Psychiatric Association, DSM-5; World Health Organization, ICD-11.

Two more things get folded in here that do not belong. Gender identity is not sexual orientation: who a person is and who they are attracted to are separate questions, and a trans person can be straight, gay, bisexual, or anything else. Gender expression is separate again, describing how someone presents rather than who they are. The criteria include “some alternative gender different from one’s assigned gender,” so nonbinary people can meet them on the same terms (APA).

A person can be transgender without ever meeting the criteria for gender dysphoria, because the diagnosis requires the distress to be present and lasting. The diagnosis describes a state, not a category of people.

How Gender Dysphoria Is Diagnosed

A clinician makes the diagnosis, not a website. People searching for a “gender dysphoria test” will find online quizzes, but the DSM-5-TR criteria call for a clinician to judge incongruence lasting at least six months and clinically significant distress or impairment, which no quiz can do.

The manual sets out what the clinician looks for. For adolescents and adults, the American Psychiatric Association summarizes the DSM-5-TR this way:

“a marked incongruence between one’s experienced/expressed gender and their assigned gender, lasting at least 6 months, as manifested by at least two of the following”

American Psychiatric Association, summarizing the DSM-5-TR

Six indicators follow, from a strong desire to be rid of one’s sex characteristics to a strong conviction that one has the typical feelings of another gender. The condition must also come with “clinically significant distress or impairment.” Children have a separate set of criteria that requires six of eight indicators.

The distress requirement is the part most people miss. A person who is gender nonconforming but not distressed does not meet the criteria, which is the manual’s own way of saying that being different is not the same as being ill.

From Gender Identity Disorder to Gender Dysphoria

Gender identity disorder is the older name for this diagnosis, and the change of name is the story. The DSM-IV called it “gender identity disorder.” The DSM-5 renamed it “gender dysphoria” in 2013 to center the distress. The WHO then moved gender incongruence out of its mental-disorders chapter in the ICD-11, which member states approved in 2019 and which took effect in 2022.

1. 1994 DSM-IV: "gender identity disorder" The criteria the DSM-5 later revised used this name.
2. 2013 DSM-5 renames to "gender dysphoria" The focus shifts to the distress, with its own chapter, to reduce stigma and protect care access.
3. 2019 ICD-11 adopted by the WHO Member states adopt the revision that reclassifies gender incongruence.
4. 2022 ICD-11 takes effect; DSM-5-TR published Gender incongruence moves to sexual health, out of mental disorders. The DSM text revision is the edition clinicians use now.

Sources: American Psychiatric Association; World Health Organization, ICD-11.

How the diagnosis moved from the person to the distress, 1994-2022: 1994: DSM-IV: "gender identity disorder" (The criteria the DSM-5 later revised used this name.). 2013: DSM-5 renames to "gender dysphoria" (The focus shifts to the distress, with its own chapter, to reduce stigma and protect care access.). 2019: ICD-11 adopted by the WHO (Member states adopt the revision that reclassifies gender incongruence.). 2022: ICD-11 takes effect; DSM-5-TR published (Gender incongruence moves to sexual health, out of mental disorders. The DSM text revision is the edition clinicians use now.).

1994: The DSM-IV used “gender identity disorder.” The APA later described the DSM-5 diagnosis as “a revision of DSM-IV’s criteria for gender identity disorder” (APA, 2013).

2013: The DSM-5 “replaces the diagnostic name ‘gender identity disorder’ with ‘gender dysphoria’” and gave it its own chapter, the APA wrote at the time. The goal, it said, was to “avoid stigma and ensure clinical care” (APA, 2013).

2019 and 2022: Member states approved the ICD-11 at the World Health Assembly in 2019, and it took effect in 2022 (WHO). It replaced ICD-10’s “transsexualism” and “gender identity disorder of children” with “gender incongruence,” placed in a chapter on sexual health rather than mental disorders (WHO). The APA published the DSM-5-TR text revision in 2022.

The DSM and the ICD now treat the topic differently, and the difference is the depathologization made concrete. The crosswalk below shows what each manual calls it, where it sits, and what it requires.

The WHO was explicit about why it moved the category. Its guidance says trans and gender diverse identities “are not conditions of mental ill-health, and that classifying them as such can cause enormous stigma” (WHO).

What Helps Gender Dysphoria

Most medical organizations with a formal position support this care. A 2024 study in the Annals of Surgery screened U.S. professional organizations through October 2023 and found that 35 of the 55 relevant ones had formal statements, and 34 of those were supportive (LaValley et al., 2024). WPATH published its Standards of Care, Version 8, in 2022.

In practice, the APA describes several kinds of affirmation: social (a new name, pronouns or clothing), legal (changing gender markers on documents), medical (puberty blockers or gender-affirming hormones) and surgical. Support may also include open-ended exploration with a therapist who has no preferred outcome. “Not all people who are transgender desire all domains of gender affirmation,” the APA says (APA). Our gender-affirming care explainer covers each stage, who provides it, and what is reversible.

The vocabulary has shifted, which matters when you read anything more than a few years old. What current standards call gender-affirming hormone therapy was long called cross-sex hormones, a term federal rules still use. GLAAD’s Media Reference Guide calls “sex reassignment surgery” outdated and offensive and advises avoiding “sex change” (GLAAD).

The outcome studies point toward benefit, and they are observational, which is the center of the dispute over them. Getting any care at all is a problem of its own: the Trevor Project’s 2025 survey found that 44% of LGBTQ+ young people who wanted mental health care in the past year could not get it (Trevor Project).

The same evidence has limits. England’s Cass Review, led by Hilary Cass for NHS England in 2024, found “the poor quality of the published studies.” It called the evidence for early puberty suppression weak and said a planned puberty blocker trial should be part of a wider research program. It also said “a medical pathway may not be the best way” for most young people to manage their distress, while setting out care for those “for whom a medical pathway is clinically indicated.” In the United States, the Department of Health and Human Services released its own review on May 1, 2025, and revised it with peer reviews on November 19, 2025. It found that the overall quality of evidence on psychological outcomes, quality of life, regret, or long-term health “is very low,” and said “there is no evidence that pediatric medical transition reduces the incidence of suicide” (HHS). The gender-affirming care explainer covers the dispute over both reviews.

Why the Desistance Numbers Swing So Widely

“Desistance” means a child’s gender dysphoria resolving so they no longer identify as transgender, and it is one of the most contested numbers in the debate over trans youth. Reported rates differ widely because studies chose their participants differently and defined “desisting” differently.

Two of the most cited studies measure different groups, which is why their numbers cannot be compared directly.

The Cass Review drew a cautious conclusion from the evidence: “Clinicians are unable to determine with any certainty which children and young people will go on to have an enduring trans identity” (Cass Review). The Olson study’s authors concluded that “retransitions are infrequent” among children who socially transitioned (Olson et al., 2022). Both can be true at once, because the studies followed different children.

The most defensible statement is also the least satisfying. A single desistance rate for all children with gender dysphoria is not established, so anyone who quotes one figure as settled is choosing a study, not reporting a fact.

Telling Dysphoria Apart From Other Conditions

Clinicians distinguish gender dysphoria from conditions it gets confused with, because the distress can look similar from the outside while pointing at something different. Body dysmorphic disorder and anxiety both involve distress, but the distress is about a different thing. The table below sets the APA’s own descriptions side by side.

The difference shows in treatment. For body dysmorphic disorder, the APA describes therapy that stops rituals such as mirror checking (APA). For gender dysphoria, it describes open-ended exploration and the forms of affirmation a person chooses (APA).

The Fight Over Treating Gender Dysphoria, 2025-2026

The American Psychiatric Association defines the diagnosis, and most U.S. medical bodies with a formal position support treating it. The law is moving the other way. The Supreme Court upheld a state ban on care for minors, more than half the states have passed bans, and federal agencies are cutting off public money for the care.

The Supreme Court ruled in United States v. Skrmetti on June 18, 2025, upholding Tennessee’s ban on gender-affirming care for minors in a 6-3 decision. The Court held that the law classifies by age and medical use rather than by sex or transgender status, so it gets only rational-basis review. The ruling lets states ban minors’ care.

The federal government is acting on two tracks. Executive Order 14187, signed January 28, 2025, directed agencies that give research or education grants to medical institutions to ensure those institutions stop this care for patients under 19. A nationwide injunction in PFLAG v. Trump has blocked that funding cutoff since March 4, 2025, and the Fourth Circuit refused to lift it on April 16, 2026 (Lambda Legal case page). Separately, a Medicaid and CHIP rule takes effect October 13, 2026. It ends federal payment for this care for patients under 18 in Medicaid and under 19 in CHIP, with up to six months of continued hormone coverage for patients already receiving it (Federal Register).

The state numbers need to be stated precisely. 27 states have banned the care for minors, and 24 of those full bans are in force. Courts have blocked the bans in Kansas and Montana, Arizona bans surgery only, and Arkansas’s ban took effect in August 2025 after the Eighth Circuit reversed the ruling against it (Movement Advancement Project).

Where the Fight Over Treating Gender Dysphoria Stands

As of September 25, 2026

• State bans for minors Law, 24 of 27 in force

  Courts have blocked the bans in Kansas and Montana; Arizona bans surgery only. (source)

• United States v. Skrmetti Final ruling, bans upheld

  The Supreme Court upheld Tennessee's ban 6-3 on June 18, 2025. (source)

• Executive Order 14187 funding cutoff Blocked by a court, funding provisions

  A nationwide injunction in PFLAG v. Trump, and one covering Washington, Oregon, Minnesota, and Colorado, still block it. The Fourth Circuit denied a stay on April 16, 2026, refused full-court review of that denial on May 21, and the appeal continues. (source)

• Medicaid and CHIP funding ban Agency action, final rule

  Takes effect October 13, 2026. (source)

• HHS evidence review Agency action, final

  Finalized with peer reviews on November 19, 2025. (source)

• Care in federal prisons Blocked by a court

  On June 17, 2026, a federal court in D.C. issued a new preliminary injunction in Kingdom v. Trump blocking the Bureau of Prisons' February 2026 policy of tapering hormone therapy. (source)

Source: Supreme Court; Movement Advancement Project; Federal Register; Lambda Legal; HHS; Prison Legal News

The gender-affirming care explainer has the state-by-state map and what each ban permits. Title IX covers the fight over school sports, and the gender ideology explainer covers the executive order that redefined sex in federal law.

Common Misconceptions About Gender Dysphoria

Six claims come up again and again in the debate over the diagnosis. Each is set against the documented record.

• “Gender dysphoria proves being trans is a mental illness.” The DSM-5 diagnoses the distress, not the identity, and the APA says gender nonconformity is not in itself a mental disorder. ICD-11 moved gender incongruence out of mental disorders.
• “All transgender people have gender dysphoria.” No. The diagnosis requires lasting distress, and the APA says not all transgender or gender diverse people experience it.
• “There is a test you can take for it.” The DSM-5-TR criteria call for a clinician’s judgment of incongruence and distress over at least six months, which no quiz can make.
• “Most kids just grow out of it.” Desistance figures depend on study design. The Cass Review said clinicians cannot predict with certainty which children will have an enduring trans identity, and a 2022 study found 94% of socially transitioned youths still identified as binary transgender about five years later.
• “It is a social contagion.” The 2018 study that coined “rapid-onset gender dysphoria” surveyed parents recruited through three websites where parents had reported sudden onsets, and PLOS ONE published a correction in 2019 (Littman, 2018). A 2022 study of the Youth Risk Behavior Survey in 16 states found the share of teens identifying as transgender or gender diverse fell from 2.4% in 2017 to 1.6% in 2019 (Turban et al., 2022).
• “The distress means transition is the problem.” In one observational study of 104 youths, starting blockers or hormones was associated with 73% lower odds of self-harm or suicidal thoughts (JAMA Network Open, 2022). The Cass Review questioned the evidence for specific treatments in minors, not the diagnosis.

Sources: APA; WHO, ICD-11; Cass Review; Olson et al. (2022); Littman (2018); Turban et al. (2022); Tordoff et al. (2022).

Frequently Asked Questions

Is gender dysphoria a mental illness?

The diagnosis names a distress, not a disorder of identity. The DSM-5 places gender dysphoria in its manual, but the American Psychiatric Association says “gender nonconformity is not in itself a mental disorder.” The World Health Organization went further in its ICD-11, moving gender incongruence out of the mental-disorders chapter because trans and gender diverse identities “are not conditions of mental ill-health.”

Is there a gender dysphoria test I can take?

No. A clinician makes the diagnosis by assessing a person against the DSM-5-TR criteria, which require a marked incongruence lasting at least six months and clinically significant distress or impairment. An online quiz cannot make that judgment.

Is gender dysphoria the same as gender identity disorder?

It is the revised version of that diagnosis. The DSM-5 replaced “gender identity disorder” with “gender dysphoria” in 2013, and the American Psychiatric Association said the change aimed to “avoid stigma and ensure clinical care.” The critical element is clinically significant distress, so a person who is not distressed does not meet the criteria.

Do all transgender people have gender dysphoria?

No. The American Psychiatric Association says “not all transgender or gender diverse people experience gender dysphoria,” because the diagnosis requires lasting, clinically significant distress.

Can gender dysphoria go away, and do most children grow out of it?

The answer depends on which children a study followed. The Cass Review said clinicians “are unable to determine with any certainty which children and young people will go on to have an enduring trans identity.” A 2022 study of 317 youths who had socially transitioned found 94% still identified as binary transgender about five years later, and 2.5% as cisgender.

What You Can Do

1. Tell your members of Congress to oppose federal bans that override the diagnosis. Ask them by name to protect access to individualized, evidence-based care for gender dysphoria and to oppose any federal measure that lets lawmakers override a clinician’s judgment. Use the letter and call script below.

2. Oppose federal funding cutoffs that extend the bans. Executive Order 14187’s funding cutoff is blocked in court, but a Medicaid and CHIP rule ending federal payment for minors’ care takes effect October 13, 2026. Ask your representatives to oppose any federal measure that uses funding to deny care, including in states where it stays legal, and reference the KFF Gender-Affirming Care Policy Tracker for where the bans stand.

3. Correct the record with sources, not slogans. When someone says gender dysphoria proves being trans is a mental illness, the “Common Misconceptions” list above gives the APA’s and the WHO’s own words to share.

4. Support the youth crisis services. The Trevor Project (1-866-488-7386, text START to 678-678) and Trans Lifeline (877-565-8860, weekdays 1 to 9 p.m. Eastern) reach people in the moments that matter. Donate, volunteer, or make sure a young person in your life knows the numbers.

5. Write your representative about protecting evidence-based care for gender dysphoria. Use the letter below and ask for a clear position.