What is gender incongruence?

Gender incongruence is when your gender is different to the sex that was assigned 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 anatomy. 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.

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

What is nonbinary?

Nonbinary is an umbrella term for identities outside the binary choice of male or female. Nonbinary people don't feel completely male or female. They may feel:

• like a mix of both male and female
• neither male nor female
• gender fluid — a person with changing gender
• agender — may not experience a sense of gender

Brotherboy is a term some 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 a term some 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 trans?

Trans, transgender, and gender diverse are terms used to describe people with gender incongruence. That is their assigned sex at birth does not match their gender identity. These are umbrella terms. This means they cover a broad range of other identities, including binary and nonbinary genders.

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 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
• 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, as 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's important to get help.

How is gender dysphoria diagnosed?

If you have ongoing distress about your gender, see your doctor.

People with gender incongruence need gender affirming care. This is especially true if you have gender dysphoria. Delays in this can make your symptoms worse and lead to declines in your mental health and wellbeing.

Different people need different types of gender affirming care.

When should I see my doctor?

You may choose to see a doctor for many reasons. This might be to get gender affirming care or for support with gender dysphoria.

Having gender incongruence or being transgender is not in itself an illness.

Your doctor can help by:

• providing general support
• referring you to a psychologist
• supplying hormone treatment
• referring you to other health workers with knowledge of gender affirming care

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

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.

Gender affirming care

Gender affirming care recognises your gender identity and is linked to a range of positive health outcomes.

Gender affirming care includes social, psychological, and medical changes that can help support your experienced gender.

Gender affirming health care:

• is non-judgemental
• is respectful
• uses shared-decision making
• tailors support based on you and your health goals

Gender-affirming is helpful in all medical contexts. This includes getting care for reasons unrelated to your gender.

Unfortunately, it can be hard to find gender affirming doctors.

It's wrong for any health professional to try and change your gender or identity in any way.

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 on documents.

TransHub have information on the legal processes. Some documents need 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.

Puberty blockers (Stage 1 treatment)

Puberty blockers are medicines that are given at the start of puberty to suppress your hormones. This stops the physical changes of puberty, such as breast growth or voice deepening. It allows time for you to develop and explore your gender identity. This treatment is reversible.

Puberty blockers work best when they are started at the beginning of puberty. This is usually anywhere from the age of 8 to 14 years.

Health authorities in some European countries have placed restrictions on the use of puberty blockers.

Gender affirming hormone therapy (Stage 2 treatment)

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

Gender affirming hormone therapy is usually started at 16 years for someone who has taken puberty blockers. People under the age of 18 years will need consent from their parents or legal guardians to access medical affirmation.

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

Feminising hormone therapy

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

• breast growth
• a more feminine body shape
• decreased libido

Most people using feminising hormone therapy also take medicine to suppress testosterone.

Masculinising hormone therapy

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

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

Doctors from different specialties can prescribe hormone therapy.

Gender affirming surgery (Stage 3 treatment)

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

Gender affirming surgery is often referred to as:

• 'top' surgery — chest surgery
• 'bottom' surgery — genital removal and creation

If you decide to take hormones, you will usually take these for at least one year before surgery. Surgery is not commonly undertaken before adulthood.

Conversion practices

In Australia, the medical profession is in strong agreement that conversion practices have no medical benefit. In fact, there is evidence of serious harms resulting from such practices.

Complications of transitioning

Research looking at gender-affirmation surgery in nearly 8,000 people found that fewer than 1 in 100 people had any regret.

Resources and support

It's important to get help if you have gender dysphoria. There are many sources of information and support available.

You may like to contact:

• qlife.org.au for webchat or call 1800 184 527

• www.lifeline.org.au for webchat, call 13 11 14 or text 0477 13 11 14

Gender affirming clinicians

You can find a list of gender affirming clinicians at TransHub and AusPATH.

They both have lots of information about gender incongruence and gender affirming care.

Resources and support for young people

Young people can find information at:

• headspace — provides mental health services for 12-25 year olds
• kidshelpline.com.au for webchat or call 1800 55 1800 — for young people aged 5-25 years
• minus18 — champions for LGBTQIA+ youth
• Reach Out — offers online, anonymous and confidential support for young people
• Transcend Australia — provides peer support, for trans, gender diverse and non-binary young people their parents and carers

Most youth services will have information on local LGBTIQ+ support groups. Parents can find support at Parents of Gender Diverse Children.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.