A. Defining the Term
In general terms, gender dysphoria describes individuals who believe they were born in the
wrong biological body.44 More specifically, the Diagnostic and Statistical Manual of Mental
Disorders (“DSM”) explains that “[g]ender dysphoria refers to the distress that may accompany
the incongruence between one’s experienced or expressed gender and one’s assigned gender.”45
Although not every individual diagnosed with gender dysphoria will be distressed as a result of
the incongruence, the lack of availability of desired physical interventions by means of hormones
and/or surgery is distressing to many.46 Gender dysphoria is not only more descriptive than gender
identity disorder, the previous DSM-IV term, but is also focuses less on identity and more on
dysphoria as the clinical problem.47
Currently, the diagnostic criteria for gender dysphoria in children requires:
A. A marked incongruence between one’s experienced/expressed gender and assigned
gender, of at least 6 months’ duration, as manifested by at least six of the following
(one of which must be Criterion A1):
1. A strong desire to be of the other gender or an insistence that one is the other gender
(or some alternative gender different from one’s assigned gender.
2. In boys (assigned gender), a strong preference for cross-dressing or simulating
female attire; or in girls (assigned gender), a strong preference for wearing only
typical masculine clothing and a strong resistance to the wearing of typical feminine
3. A strong preference for cross-gender roles in make-believe play or fantasy play.
4. A strong preference in toys, games, or activities stereotypically used or engaged in
by the other gender.
5. A strong preference for playmates of the other gender.
6. In boys (assigned gender), a strong rejection of typically masculine toys, games,
and activities and a strong avoidance of rough-and-tumble play; or, in girls
(assigned gender), a strong rejection of typically feminine toys, games, and
7. A strong dislike of one’s sexual anatomy.
8. A strong desire for the primary and/or secondary sex characteristics that match
one’s experienced gender.
B. The condition is associated with clinically significant distress or impairment in
social, school, or other important areas of functioning.48
The American Psychological Association uses the following definition for gender identity:
“as a person’s deeply felt, inherent sense of being a girl, woman, or female; a boy, a man, or male;
a blend of male or female; or an alternative gender.49 For gender nonconforming persons, their
assigned sex at birth is not congruent with their gender identity, where there is a spectrum of the
44 Spiegel, supra note 29.
45 AM. PSYCHIATRIC ASS’N, Gender Dysphoria, in DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS
(5th ed. 2013),
49 AM. PSYCHOLOGICAL ASS’N, GUIDELINES FOR PSYCHOLOGICAL PRACTICE WITH TRANSGENDER AND GENDER
NONCONFORMING PEOPLE 832, 834 (2015).