Gender incongruence

What is gender incongruence?

Gender incongruence is the term used to describe when your gender is different to when you were born. People with gender incongruence may describe themselves as transgender (trans) or gender diverse.

What is gender?

Gender and sex are different things.

Your gender identity is how you feel about yourself. It reflects your experiences and your sense of self. Your gender might be the same or different to the sex you were given at birth. There are many ways to experience gender and it may change over time.

Your sex is assigned to you at birth based on your external genitals. That is, whether you have a penis or vagina. Most people will be male or female. Those with ambiguous genitals may be labelled intersex or another term.

What is trans?

Trans, transgender, and gender diverse are terms used to describe people with gender incongruence. These are umbrella terms. This means they cover a broad range of other identities, including binary and nonbinary genders.

Nonbinary is an umbrella term for identities outside the binary ‘man’ or woman’. Nonbinary people don’t feel completely male or female. They may feel:

• like a combination of both male and female
• neither male nor female
• may not experience a sense of gender

Cisgender is the term used to describe people whose gender matches their sex at birth.

Brotherboy is the term Aboriginal and/or Torres Strait Islander people use to describe a man with transmasculine experience. Transmasculine people are assigned female at birth but identify with a masculine identity.

Sistergirl is the term Aboriginal and/or Torres Strait Islander people use to describe a woman with transfeminine experience. Transfeminine people are assigned male at birth but identify with a female identity.

There are many other ways people may describe their gender. There are no right or wrong ways to experience gender.

What is gender dysphoria?

Gender dysphoria is the distress or unease someone with gender incongruence may feel. For some trans or gender diverse people, this may relate to:

• your assumed gender
• your body
• the way you are gendered and seen by others

Not all trans or gender diverse people experience gender dysphoria.

What are the signs and symptoms of gender dysphoria?

Gender dysphoria can look different for everyone. Most people will feel a level of distress, unease, or discomfort in themselves. This may look like anxiety, depression, irritability, or other changes in behaviour. If gender dysphoria is not managed it can seriously affect your mental health and wellbeing.

Puberty can be a very difficult time for children with gender dysphoria. This is when their bodies start to change. Teenagers with gender dysphoria are more likely than others to self-harm or have suicidal thoughts. So it is important to get help.

How is gender dysphoria treated?

People with gender dysphoria need to get gender affirming care. Delays in this can make symptoms worse and lead to further declines in your mental health and wellbeing.

Different people need different types of gender affirming care.

When should I see my doctor?

Having gender incongruence or being transgender is not in itself an illness. You may choose to see a doctor for many reasons. This might be for support with gender dysphoria or to get gender affirming care.

Your doctor can help by:

• providing general support
• referring you to a psychologist
• supplying hormone treatment
• referring you to other health workers experienced in gender affirming care

See your doctor if you want to talk about options for gender affirming care.

Gender affirmation

There is no right or wrong way to affirm your gender. Your gender is not defined by your:

• name
• pronouns
• clothes
• body parts

Some trans people may not share their gender with others. They may not want to change themselves or their life in any way.

Social affirmation

You may choose to express your gender identity by:

• changing your name
• changing your pronouns
• changing your hair
• changing your clothes

This is ‘social affirmation’ or ‘social transition’.

Legal affirmation

Legal affirmation might include changing your legal name or gender markers to reflect your gender.

TransHub have information on the legal processes. Some require letters from your doctor or psychologist. Others require you to have received gender affirming surgery.

Medical affirmation

Medical affirmation can include gender affirming hormone therapy and gender affirming surgery.

Some trans people want hormones or surgery to make their body appear more masculine or feminine.

Puberty blockers

Puberty blockers are medications given at the start of puberty. They supress your hormones. This stops the physical changes of puberty, such as breast growth or voice deepening.

The effects of this medication are reversible.

Puberty blockers work best when they are started at the beginning of puberty. This is usually between the age of 9 and 11 years.

Gender affirming hormone therapy

Hormone therapy will cause both permanent and reversible changes to the body. The effect of hormone therapy is different for everyone, but some common effects are discussed below.

People under the age of 18 will need consent from all parents or legal guardians to access medical affirmation.

For people who have already been through puberty, hormones can be started at any time.

Gender affirming hormone therapy, for someone who has taken puberty blockers, is usually started at 16 years.

Feminising hormone therapy

Oestrogen is used in gender affirming hormone therapy for people who were assumed male at birth. This can cause many physical changes including:

• breast growth
• a more feminine body shape

You will also require a medication to suppress your existing testosterone.

Masculinising hormone therapy

Testosterone is used in gender affirming hormone therapy for people who were assumed female at birth. This can cause many physical changes, including:

• a deeper voice
• more body hair
• a more masculine body shape

Doctors from different specialties can prescribe hormone therapy. Some doctors, endocrinologists, and sexual health doctors will give gender affirming care.

Gender affirming surgery

Some trans people want surgeries or procedures to change the physical features of their body. This is gender affirming surgery.

If you decide to take hormones, you will usually take these for at least one year before surgery.

Gender affirming care

Gender affirming care includes social, psychological, and medical treatments to help support your experienced gender. It can be hard to find gender affirming doctors. Unfortunately, many trans people have bad experiences. It is wrong for any health professional to try and change your gender or identity in any way.