2. A strong desire to be rid of one’s primary and/or secondary sex characteristics be- cause of a marked incongruence with one’s experienced/expressed gender (or in young adolescents. a desire to prevent the development of the anticipated second- ary sex characteristics).
3. A strong desire for the primary and/or secondary sex characteristics of the other gender.
4. A strong desire to be of the other gender (or some alternative gender different from one's assigned gender).
5. A strong desire to be treated as the other gender (or some alternative gender dif- ferent from one’s assigned gender).
6. A strong conviction that one has the typical feelings and reactions of the other gen- der (or some alternative gender different from one's assigned gender).
B. The condition is associated with clinically significant distress or impairment in social, occupationalxor other important areas of functioning.
Specify it:
With a disorder 01 sex development (e.g., a congenital adrenogenital disorder such as 255.2 [E25.0] congenital adrenal hyperplasia or 259.50 [E3450] androgen insensi- tivity syndrome).
Coding note: Code the disorder of sex development as well as gender dysphoria.
Specify if:
Posttransition: The individual has transitioned to full-time living in the desired gender (with or without legalization of gender change) and has undergone (or is preparing to have) at least one cross-sex medical procedure or treatment regimen—namely, regu- lar cross-sex hormone treatment or gender reassignment surgery confirming the desired gender (e.g., penectomy, vaginoplasty in a natal male; mastectomy or phalloplasty in a natal female).
The posttransition specifier may be used in the context of continuing treatment procedures that serve to support the new gender assignment.
Individuals with gender dysphoria have a marked incongruence between the gender they have been assigned to (usually at birth, referred to as natal gender) and their experienced/ expressed gender. This discrepancy is the core component of the diagnosis. There must also be evidence of distress about this incongruence. Experienced gender may include al- ternative gender identities beyond binary stereotypes. Consequently, the distress is not limited to a desire to simply be of the other gender, but may include a desire to be of an al- ternative gender, provided that it differs from the individual’s assigned gender.
Gender dysphoria manifests itself differently in different age groups. Prepubertal natal girls with gender dysphoria may express the wish to be a boy, assert they are a boy, or as- sert they will grow up to be a man. They prefer boys’ clothing and hairstyles, are often perceived by strangers as boys, and may ask to be called by a boy’s name. Usually, they dis- play intense negative reactions to parental attempts to have them wear dresses or other feminine attire. Some may refuse to attend school or social events where such clothes are required. These girls may demonstrate marked cross-gender identification in role-playing, dreams, and fantasies. Contact sports, rough-and-tumble play, traditional boyhood games, and boys as playmates are most often preferred. They show little interest in stereotypically feminine toys (e.g., dolls) or activities (e.g., feminine dress—up or role—play). Occasionally, they refuse to urinate in a sitting position. Some natal girls may express a desire to have a penis or claim to have a penis or that they will grow one when older. They may also state that they do not want to develop breasts or menstruate.