Gender Dysphoria: 8 Useful Questions

The diagnosis of Gender Dysphoria has significantly been on the rise during the last few years, especially in Western countries. An increasing number of people are searching online how to take on their very own transition path for gender and name change (MtF or FtM).

I am lawyer Gianluca Piemonte, specialized in the gender transition process in Italy. During these years, I have been actively involved in assisting people who want to change their gender and name on their personal documents.

In another article of mine, I had already written a complete guide on how to change gender in Italy, in which I described the 3 + 1 steps of the transition process:

  • Psychological path
  • Hormonal therapy
  • Legal process
  • Surgical operation (possible choice, not mandatory)

However, in this article we will primarily shift our focus onto a particular aspect belonging to the first step, which concerns the psychological path. As a matter of fact, this step aims to obtain an official report by either a psychologist, psychotherapist or psychiatrist confirming the state of gender dysphoria.

And it is precisely for this reason, that I have decided to ask the following questions to Dr. Alessandra Merola, both psychologist and psychotherapist, expert in gender dysphoria.

1 – What is gender dysphoria?

Gender dysphoria is characterized by strong emotional and cognitive distress in relation to one’s own gender assigned at birth.

Transgender refers to those individuals who transiently or persistently identify themselves with a different gender than the one assigned at birth.

Transsexual is a term used in order to descrive an individual who wishes to pursue or who has already initiated a personal transition from male to female or vice versa. In most cases, but not all, the person concerned begins a hormonal treatment with the hormones of the opposite sex and undergoes genital organ surgery.

2 – What are the symptoms?

A Transgender person can suffer from anxiety, depression, irritability, and substance abuse associated with the persistent identification with their opposite sex.

Teenagers and adults with gender dysphoria who have not yet undergone gender reassignment have an increased risk of suicidal ideation, suicide attempts and suicide.

It is common to encounter in teenagers and adults with gender dysphoria: relationship builiding difficulties, sexual problems, as well as comprimised school and work performance due to the strong stigmatization, discrimination and victimization that all lead to a negative self-perception.

3 – At what age do these symptoms manifest?

The onset of behaviors tied to the opposite gender generally spark between the ages of 2 and 4 years old: commonly, at this stage, children begin to manifest gender-related behaviors and interests.

4 – Is there a difference between gender dysphoria in children and adults?

According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition) gender dysphoria in children, teenagers and adults is characterized by a marked inconsistency between the experienced / expressed gender and the assigned gender, lasting at least 6 months.

Gender dysphoria manifests itself differently within the various age groups.

5 – How does gender dysphoria manifest itself in girls and boys?

Girls with gender dysphoria may express a personal desire to be a boy or explicitly claim to be a boy. They dress or would like to dress like a boy, often wear boy-like hairstyles, and would like to be called with masculine names. They typically prefer male games and choose solely male playmates. Sometimes they refuse to urinate in a sitting position and express the desire to possess a penis. In some cases, they may even claim that they do not want their breasts to grow or menstruate.

Other way around, boys with gender dysphoria express the desire to be girls, want to dress like a girl, avoid the stereotypical male games and prefer the company of girls. Some boys may insist on urinating in a sitting position and claim that they do not have a penis. Whereas others may ultimately feel disgusted with their penis or testicles and would rather prefer to have a vagina.

6 – What about teenagers and adults?

In teenagers with gender dysphoria, the clinical characteristics may resemble the same as children or adults with dysphoria, and there is often a concern about the imminent development of secondary sexual characteristics.

In adults with gender dysphoria, in addition to the discrepancy between the experienced gender and the physical characteristics, there is often the desire to get rid of the primary and secondary sexual characteristics of the opposite gender compared to the one experienced within.

Adults with gender dysphoria often adopt the typical clothing and behaviors of the opposite gender rather than to the one assigned to them at birth. They feel uncomfortable when they are treated by other people with attitudes tied to their birth-assigned sex. Within these people there is a strong belief that they possess the typical feelings and reactions of the opposite gender. In adults with a dislike towards their genitals, sexual activity is limited due to the desire for their partner to avoid touching their sexual organs.

Some adults may request both hormonal therapy and surgery for their gender reassignment process, whereas other people, on the other hand, may choose to proceed either only with a hormonal treatment or only surgery.

MORE INFORMATION: Read my other article Gender Change for minors. When is this possible?

7 – How is gender dysphoria diagnosed?

In order to diagnose gender dysphoria, the diagnosis must base itself on the DSM-5 diagnostic criteria.

Individuals with gender dysphoria show an inconsistency between the gender they were assigned at birth and the gender they experience within: this mismatch is the key aspect for being able to bring forward gender dysphoria diagnosis.

8 – What is the treatment?

In order to be able to obtain an official diagnosis of gender dysphoria, a psychotherapeutic path is mandatory. However, since the transition path is a very delicate period in the life of the transgender person involved, it is strongly advised to continue with the psychotherapeutic path even after obtaining the official diagnosis.


Are you looking for the legal assistance of an Italian lawyer specialized in gender transition?

If you have Italian citizenship or are permanently resident in Italy with a residence permit, write to me at or fill out the form on our CONTACT US page

MORE INFORMATION: Read my other article Changing gender in Italy: How to do? How much?

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