Treatment

Treatment can help people who have gender dysphoria to explore their gender identity and find the gender role that feels comfortable for them, easing distress. But treatment needs to be individualized. What might help one person might not help another. The process might or might not involve a change in gender expression or body modifications. Treatment options might include changes in gender expression and role, hormone therapy, surgery, and behavioral therapy.

If you have gender dysphoria, seek help from a doctor who has expertise in the care of transgender people.

When coming up with a treatment plan, your provider will screen you for mental health concerns that might need to be addressed, such as depression or anxiety. Failing to treat these concerns can make it more difficult to explore your gender identity and ease gender dysphoria.

Changes in gender expression and role

This might involve living part time or full time in another gender role that is consistent with your gender identity.

Medical treatment

Medical treatment of gender dysphoria might include:

• Hormone therapy, such as feminizing hormone therapy or masculinizing hormone therapy
• Surgery, such as feminizing surgery or masculinizing surgery to change the breasts or chest, external genitalia, internal genitalia, facial features, and body contouring

Some people use hormone therapy to seek maximum feminization or masculinization. Others might find relief from gender dysphoria by using hormones to minimize secondary sex characteristics, such as breasts and facial hair. Treatments are based on your goals, as well as an evaluation of the risks and benefits of medication use, the presence of any other conditions, and consideration of your social and economic issues. Many people also find that surgery is necessary to relieve their gender dysphoria.

The World Professional Association for Transgender Health provides the following criteria for hormonal and/or surgical treatment of gender dysphoria:

• Persistent, well-documented gender dysphoria.
• Capacity to make a fully informed decision and consent to treatment.
• Age of majority in a given country or, if younger, follow the standard of care for children and adolescents.
• If significant medical or mental concerns are present, they must be reasonably well controlled.

Additional criteria apply to some surgical procedures.

A pretreatment medical evaluation is done by a doctor with experience and expertise in transgender and intersex care before hormonal and surgical treatment of gender dysphoria. This can help rule out or address medical conditions that might affect these treatments or make the treatments inadvisable. This evaluation may include:

• A personal and family medical history
• A physical exam, including an assessment of your reproductive organs
• Lab tests to check your lipids, fasting blood glucose, complete blood count, liver enzymes, electrolytes, prolactin and sex steroid hormones, and a pregnancy test
• Immunizations status, including HPV
• Age- and sex-appropriate screenings
• Identification and management of tobacco use, drug abuse and alcohol abuse
• Identification and management of HIV and other sexually transmitted infections
• Assessment of desire for fertility preservation and referral as needed for sperm, egg, embryo and/or ovarian tissue cryopreservation
• History of potentially harmful treatment approaches, such as unprescribed hormone use, industrial-strength silicone injections or self-surgeries

Behavioral health treatment

This treatment aims to improve your psychological well-being, quality of life and self-fulfillment. Behavioral therapy isn't intended to alter your gender identity. Instead, therapy can help you explore gender concerns and find ways to lessen gender dysphoria. The goal is to help transgender and gender-nonconforming individuals become comfortable with their gender identity expression, enabling success in relationships, education and work. Therapy can also address any other mental health concerns.

Therapy might include individual, couple, family and group counseling to help you:

• Explore and integrate your gender identity
• Accept yourself
• Address the mental and emotional impacts of minority stress
• Build a support network
• Develop a plan to address social and legal issues related to your transition and coming out to loved ones, friends, colleagues and other close contacts
• Become comfortable expressing your gender identity
• Explore healthy sexuality in the context of gender transition
• Make decisions about your medical treatment options
• Increase your well-being and quality of life

Therapy might be helpful during many stages of your life.

A pretreatment behavioral health evaluation by a doctor with experience and expertise in transgender and intersex health is needed before hormonal and surgical treatment of gender dysphoria. This evaluation might assess:

• Gender identity and dysphoria
• Impact of gender identity in work, school, home and social environments, including issues related to discrimination, abuse and minority stress
• Mood or other mental health concerns
• Risk-taking behaviors and self-harm
• Substance abuse
• Sexual health concerns
• Social support from family, friends and peers — a protective factor against developing depression, suicidal ideation, suicide attempts, anxiety or high-risk behaviors
• Goals, risks and expectations of treatment and trajectory of care

Other steps

Other ways to ease gender dysphoria might include use of:

• Peer support groups
• Voice and communication therapy to develop vocal characteristics matching your experienced or expressed gender
• Hair removal or transplantation
• Genital tucking
• Breast binding
• Breast padding
• Packing
• Aesthetic services, such as makeup application or wardrobe consultation
• Legal services, such as advanced directives, living wills or legal documentation
• Social and community services to deal with workplace issues, minority stress or parenting issues