There are no physical symptoms of gender dysphoria, but people with the condition may experience and display a range of feelings and behaviours .

In many cases, a person with gender dysphoria begins to feel a mismatch between their biological sex and gender identity during early childhood. For others, this may not happen until adulthood.

Children

Gender dysphoria behaviours in children can include:

• insisting they're of the opposite sex
• disliking or refusing to wear clothes that are typically worn by their sex and wanting to wear clothes typically worn by the opposite sex
• disliking or refusing to take part in activities and games that are typically associated with their sex, and wanting to take part in activities and games typically associated with the opposite sex
• preferring to play with children of the opposite biological sex
• disliking or refusing to pass urine as other members of their biological sex usually do – for example, a boy may want to sit down to pass urine and a girl may want to stand up
• insisting or hoping their genitals will change – for example, a boy may say he wants to be rid of his penis, and a girl may want to grow a penis
• feeling extreme distress at the physical changes of puberty

Children with gender dysphoria may display some, or all, of these behaviours. However, in many cases, behaviours such as these are just a part of childhood and don't necessarily mean your child has gender dysphoria.

For example, many girls behave in a way that can be described as "tomboyish", which is often seen as part of normal female development. It's also not uncommon for boys to roleplay as girls and to dress up in their mother's or sister's clothes. This is usually just a phase.

Most children who behave in these ways don't have gender dysphoria and don't become transsexuals. Only in rare cases does the behaviour persist into the teenage years and adulthood.

Teenagers and adults

If the feelings of gender dysphoria are still present by the time your child is a teenager or adult, it's likely that they're not just going through a phase.

If you're a teenager or an adult whose feelings of gender dysphoria begun in childhood, you may now have a much clearer sense of your gender identity and how you want to deal with it. Many people with strong feelings of gender dysphoria are fully transsexual during their teenage years.

The way gender dysphoria affects teenagers and adults is different to the way it affects children. If you're a teenager or adult with gender dysphoria, you may feel:

• without doubt that your gender identity is at odds with your biological sex
• comfortable only when in the gender role of your preferred gender identity
• a strong desire to hide or be rid of the physical signs of your sex, such as breasts, body hair or muscle definition
• a strong dislike for – and a strong desire to change or be rid of – the genitalia of your biological sex

Without appropriate help and support, some people may try to suppress their feelings and attempt to live the life of their biological sex. Ultimately, however, most people are unable to keep this up.

Having or suppressing these feelings is often very difficult to deal with and, as a result, many transsexuals and people with gender dysphoria experience depression, self-harm or suicidal thoughts.

See your GP as soon as possible if you've been feeling depressed or suicidal.

Alternatively, you can call the Samaritans for free on 116 123. They're available 24 hours a day to talk through any issues you may be experiencing, and will do so in total confidence. Alternatively, you can email jo@samaritans.org.

You may also find it useful to contact The Beaumont Society on 01582 412220 (also available 24 hours a day) for advice and support. The Beaumont Society is a national organisation run by and for the transgender community.

Treatment for gender dysphoria aims to help people with the condition live the way they want to, in their preferred gender identity.

What this means will vary from person to person, and is different for children, young people and adults. Your specialist care team will work with you on a treatment plan that's tailored to your needs.

Treatment for children and young people

If your child is under 18 and thought to have gender dysphoria, they'll usually be referred to a specialist child and adolescent Gender Identity Clinic (GIC).

Read about how to find an NHS gender identity clinic.

Staff at these clinics can carry out a detailed assessment of your child, to help them determine what support they need.

Depending on the results of this assessment, the options for children and young people with suspected gender dysphoria can include:

• family therapy
• individual child psychotherapy
• parental support or counselling
• group work for young people and their parents
• regular reviews to monitor gender identity development
• hormone therapy (see below)

Your child’s treatment should be arranged with a multi-disciplinary team (MDT). This is a group of different healthcare professionals working together, which may include specialists such as mental health professionals and paediatric endocrinologists (specialists in hormone conditions in children).

Most treatments offered at this stage are psychological, rather than medical or surgical. This is because the majority of children with suspected gender dysphoria don't have the condition once they reach puberty. Psychological support offers young people and their families a chance to discuss their thoughts and receive support to help them cope with the emotional distress of the condition, without rushing into more drastic treatments.

Hormone therapy

If your child has gender dysphoria and they've reached puberty, they could be treated with gonadotrophin-releasing hormone (GnRH) analogues. These are synthetic (man-made) hormones that suppress the hormones naturally produced by the body.

Some of the changes that take place during puberty are driven by hormones. For example, the hormone testosterone, which is produced by the testes in boys, helps stimulate penis growth.

GnRH analogues suppress the hormones produced by your child’s body. They also suppress puberty and can help delay potentially distressing physical changes caused by their body becoming even more like that of their biological sex, until they're old enough for the treatment options discussed below.

GnRH analogues will only be considered for your child if assessments have found they're experiencing clear distress and have a strong desire to live as their gender identity.

The effects of treatment with GnRH analogues are considered to be fully reversible, so treatment can usually be stopped at any time after a discussion between you, your child and your MDT.

Transition to adult services

Teenagers who are 17 years of age or older may be seen in an adult gender clinic. They are entitled to consent to their own treatment and follow the standard adult protocols.

By this age, doctors can be much more confident in making a diagnosis of gender dysphoria and, if desired, steps can be taken towards more permanent hormone or surgical treatments to alter your child’s body further, to fit with their gender identity.

Treatment for adults

Adults with gender dysphoria should be referred to a specialist adult GIC. As with specialist children and young people GICs, these clinics can offer ongoing assessments, treatments, support and advice, including:

• mental health support, such as counselling
• cross-sex hormone treatment (see below)
• speech and language therapy – to help alter your voice, to sound more typical of your gender identity
• hair removal treatments, particularly facial hair 
• peer support groups, to meet other people with gender dysphoria
• relatives' support groups, for your family

For some people, support and advice from a clinic are all they need to feel comfortable in their gender identity. Others will need more extensive treatment, such as a full transition to the opposite sex. The amount of treatment you have is completely up to you.

Hormone therapy

Hormone therapy for adults means taking the hormones of your preferred gender:

• a trans man (female to male) will take testosterone (masculinising hormones) 
• a trans woman (male to female) will take oestrogen (feminising hormones)

The aim of hormone therapy is to make you more comfortable with yourself, both in terms of physical appearance and how you feel. These hormones start the process of changing your body into one that is more female or more male, depending on your gender identity. They usually need to be taken indefinitely, even if you have genital reconstructive surgery.

Hormone therapy may be all the treatment you need to enable you to live with your gender dysphoria. The hormones may improve how you feel and mean that you don't need to start living in your preferred gender or have surgery.  

Changes in trans women

If you're a trans woman, changes that you may notice from hormone therapy include:

• your penis and testicles getting smaller
• less muscle
• more fat on your hips
• your breasts becoming lumpy and increasing in size slightly
• less facial and body hair

Hormone therapy won't affect the voice of a trans woman. To make the voice higher, trans women will need voice therapy and, rarely, voice modifying surgery.

Changes in trans men

If you're a trans man, changes you may notice from hormone therapy include:

• more body and facial hair
• more muscle
• your clitoris (a small, sensitive part of the female genitals) getting bigger
• your periods stopping
• an increased sex drive (libido)

Your voice may also get slightly deeper, but it may not be as deep as other men’s voices.

Risks

There's some uncertainty about the possible risks of long-term masculinising and feminising hormone treatment. You should be made aware of the potential risks and the importance of regular monitoring before treatment begins.

Some of the potential problems most closely associated with hormone therapy include:

• blood clots
• gallstones
• weight gain
• acne
• hair loss from the scalp
• sleep apnoea – a condition that causes interrupted breathing during sleep

Hormone therapy will also make both trans men and trans women less fertile and, eventually, completely infertile. Your specialist should discuss the implications for fertility before starting treatment, and they may talk to you about the option of storing eggs or sperm (known as gamete storage) in case you want to have children in the future. However, this isn't likely to be available on the NHS.

There's no guarantee that fertility will return to normal if hormones are stopped.

Monitoring

While you're taking these hormones, you'll need to have regular check-ups, either at your GIC or your local GP surgery. You'll be assessed, to check for any signs of possible health problems and to find out if the hormone treatment is working.

If you don't think that hormone treatment is working, talk to the healthcare professionals who are treating you. If necessary, you can stop taking the hormones (although some changes are irreversible, such as a deeper voice in trans men and breast growth in trans women).

Alternatively, you may be frustrated with how long hormone therapy takes to produce results, as it will take a few months for some changes to develop. Hormones can't change the shape of your skeleton, such as how wide your shoulders or your hips are. It also can't change your height.

Hormones for gender dysphoria are also available from other sources, such as the internet, and it may be tempting to get them from here instead of through your clinic. However, hormones from other sources may not be licensed and safe. If you decide to use these hormones, let your doctors know so they can monitor you.

Social gender role transition

If you want to have genital reconstructive surgery, you'll usually first need to live in your preferred gender identity full time for at least a year. This is known as "social gender role transition" (previously known as "real life experience" or "RLE") and it will help in confirming whether permanent surgery is the right option.

You can start your social gender role transition as soon as you're ready, after discussing it with your care team, who can offer support throughout the process.

The length of the transition period recommended can vary, but it's usually one to two years. This will allow enough time for you to have a range of experiences in your preferred gender role, such as work, holidays and family events.

For some types of surgery, such as a bilateral mastectomy (removal of both breasts) in trans men, you may not need to complete the entire transition period before having the operation.

Surgery

Once you've completed your social gender role transition and you and your care team feels you're ready, you may decide to have surgery to permanently alter your sex.

The most common options are discussed below, but you can talk to members of your team and the surgeon at your consultation about the full range available.

Trans man surgery

For trans men, surgery may involve:

• a bilateral mastectomy (removal of both breasts)
• a hysterectomy (removal of the womb)
• a salpingo-oophorectomy (removal of the fallopian tubes and ovaries)
• phalloplasty or metoidioplasty (construction of a penis)
• scrotoplasty (construction of a scrotum) and testicular implants
• a penile implant

A phalloplasty uses the existing vaginal tissue and skin taken from the inner forearm or lower abdominal wall to create a penis. A metoidioplasty involves creating a penis from the clitoris, which has been enlarged through hormone therapy.

The aim of this type of surgery is to create a functioning penis, which allows you to pass urine standing up and to retain sexual sensation. You'll usually need to have more than one operation to achieve this.

Trans woman surgery

For trans women, surgery may involve:

• an orchidectomy (removal of the testes)
• a penectomy (removal of the penis)
• vaginoplasty (construction of a vagina)
• vulvoplasty (construction of the vulva)
• clitoroplasty (construction of a clitoris with sensation)
• breast implants 
• facial feminisation surgery (surgery to make your face a more feminine shape)

The vagina is usually created and lined with skin from the penis, with tissue from the scrotum (the sack that holds the testes) used to create the labia. The urethra (urine tube) is shortened and repositioned. In some cases, a piece of bowel may be used during a vaginoplasty if hormone therapy has caused the penis and scrotum to shrink a significant amount.

The aim of this type of surgery is to create a functioning vagina with an acceptable appearance and retained sexual sensation.

Some trans women can't have a full vaginoplasty for medical reasons, or they may not want to have a functioning vagina. In such cases, a cosmetic vulvoplasty and clitoroplasty is an option, as well as removing the testes and penis.

Life after surgery

After surgery, most trans women and men are happy with their new sex and feel comfortable with their gender identity. One review of a number of studies that were carried out over a 20-year period found that 96% of people who had genital reconstructive surgery were satisfied.

Despite high levels of personal satisfaction, people who have had genital reconstructive surgery may face prejudice or discrimination because of their condition. Treatment can sometimes leave people feeling:

• isolated, if they're not with people who understand what they're going through
• stressed about or afraid of not being accepted socially
• discriminated against at work

There are legal safeguards to protect against discrimination (see guidelines for gender dysphoria), but other types of prejudice may be harder to deal with. If you're feeling anxious or depressed since having your treatment, speak to your GP or a healthcare professional at your clinic.

Sexual orientation

Once transition has been completed, it's possible for a trans man or woman to experience a change of sexual orientation. For example, a trans woman who was attracted to women before surgery may be attracted to men after surgery. However, this varies greatly from person to person, and the sexual orientation of many trans people doesn't change.

If you're a trans man or woman going through the process of transition, you may not know what your sexual preference will be until it's complete. However, try not to let this worry you. For many people, the issue of sexual orientation is secondary to the process of transition itself.

There are a number of laws and guidelines that protect transgender people and outline how they should be treated by medical professionals.

Gender Recognition Act 2004

The Gender Recognition Act 2004 gives certain legal rights to trans men and women.

Under the Gender Recognition Act of 2004, trans men and women can:

• apply for and obtain a Gender Recognition Certificate to acknowledge their gender identity
• get a new birth certificate, driving licence and passport
• marry in their new gender

To apply for a Gender Recognition Certificate, you must be over 18.

The application process requires you to prove that:

• you have or have had gender dysphoria
• you have lived as your preferred gender for the last two years
• you intend to live permanently in your preferred gender

Find out about:

• the Gender Recognition Act 2004
• how to apply for a Gender Recognition Certificate

Equality Act 2010

The Equality Act 2010 brought together over 116 previously separate pieces of legislation into one single act.

The act covers what was previously protected under the Sexual Discrimination Act 1975 – namely legal protection for trans people in the workplace and wider society against:

• victimisation
• harassment
• discrimination

If you're suffering discrimination at work, you should report it. The GOV.UK website has more information about what you can do if you think you've been unfairly discriminated against.

You can also read about the Equality Act 2010 on the Equality and Human Rights Commission (EHRC) website.

Clinical guidelines

In addition to the legislation, there are also clinical guidelines for health professionals that outline what high-quality care for trans people should involve.

Such guidelines include:

• the WPATH Standards of Care – produced by the World Professional Association for Transgender Health (WPATH)
• NHS England Service Specification for Gender Identity Development Service for children and adolescents (PDF, 1.15MB) – produced by NHS England
• Trans healthcare - produced by the General Medical Council (GMC)