Gender Dysphoria: Optimizing Healthcare for Transgender and Gender Diverse Youth with a Multidisciplinary Approach

Figures & data

Table 1 Key Terminology in Gender Health Care

Term	Definition
Cisgender	Describes identifying with the gender corresponding to one’s designated sex at birth. For example, a designated female at birth individual identifying as a woman or a designated male at birth person identifying as a man.
Designated sex at birth	The sex label that a child is given at birth most often based on the appearance of the external genitalia but also can include hormones and chromosomes. Most people are designated male or female, and this is what is put on their birth certificate. Of note, more states in the United States now allow for a designation of “intersex” on the birth certificate of children born with variations in chromosomes, hormones, or genitalia that do not fit neatly within binary male-female categories.
Gender	The way cultures categorize and assign social norms to groups of people. These groups are often based on designated sex at birth but understandings of gender vary across time and culture.
Gender-affirming treatment	Medical or surgical treatments that help a person physically change their body to align more closely with their gender identity. Gender-affirming treatments can include puberty blockers, hormones like estrogen or testosterone, and surgery.
Gender dysphoria	A diagnosis introduced in the DSM-5 to capture clinically significant distress associated with identifying with a gender different from the one corresponding to designated sex at birth. A person might feel uncomfortable with their physical body or with the social roles associated with their perceived gender. The experience of gender dysphoria is highly individual and not every gender nonconforming person experiences gender dysphoria.
Gender expression	Cultures often relate physical appearance, clothing choices, accessories, communication patterns, social roles, and behaviors to gender. The way a person uses these gendered items and behaviors is called gender expression. Gender expression is highly individual and may or may not be reflective of a person’s other identities.
Gender fluid	Describes a non-binary gender identity that is a dynamic and changing, as opposed to being static. Gender fluid people can move between genders and may or may not use different gender expressions or pronouns at different times.
Gender identity	A person’s innate sense of their own gender. This can be the same or different from the gender corresponding to their designated sex at birth. A person could feel like a man, woman, non-binary or agender etc., regardless of their designated sex at birth.
Non-binary	Describes identifying outside of the male-female gender binary. Non-binary can be used as an adjective or an umbrella term encompassing several different gender identities.
Pronouns	Words used to substitute the name of a person. In English language, pronouns are gendered and can be an important part of someone’s gender expression. Using the appropriate pronouns for somebody can be a way to affirm their gender identity.
Transgender	Describes not identifying with the gender corresponding to one’s designated sex at birth.
Transition	Changes a person makes to their appearance, behaviors, or body to affirm their gender identity. There are different types of transitions. A social transition can include changing one’s appearance or asking others to use a different name and/or pronouns. A legal transition can include changing one’s name and gender marker on government issued documents, like a birth certificate. A medical transition can include using gender-affirming hormones to induce physical changes which affirm one’s gender identity. Surgeries?
Transphobia	On an internalized level, transphobia refers to the shame or discomfort experienced by TGD people as a result of internalizing stigmatizing messaging. On interpersonal and systemic levels, transphobia can refer to the harassment and discrimination of people based on their perceived gender identity. TGD people experience transphobia in different forms, ranging from internalized self-hatred and bullying to discrimination in medical and legal settings.

Figure 1 Timeline of gender-affirming pediatric medical care.

Notes: *Known as the Harry Benjamin Gender Dysphoria Association until 2011; **From Hsieh & Leininger, 2014.