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HandWiki. Gender Dysphoria. Encyclopedia. Available online: https://encyclopedia.pub/entry/29606 (accessed on 20 September 2026).
HandWiki. Gender Dysphoria. Encyclopedia. Available at: https://encyclopedia.pub/entry/29606. Accessed September 20, 2026.
HandWiki. "Gender Dysphoria" Encyclopedia, https://encyclopedia.pub/entry/29606 (accessed September 20, 2026).
HandWiki. (2022, October 17). Gender Dysphoria. In Encyclopedia. https://encyclopedia.pub/entry/29606
HandWiki. "Gender Dysphoria." Encyclopedia. Web. 17 October, 2022.
Gender Dysphoria
Edit

Gender dysphoria (GD) is the distress a person feels due to a mismatch between their gender identity—their personal sense of their own gender—and their sex assigned at birth. The diagnostic label gender identity disorder (GID) was used until 2013 with the release of the DSM-5. The condition was renamed to remove the stigma associated with the term disorder. People with gender dysphoria commonly identify as transgender. Gender nonconformity is not the same thing as gender dysphoria and does not always lead to dysphoria or distress. According to the American Psychiatric Association, the critical element of gender dysphoria is "clinically significant distress". The causes of gender dysphoria are unknown but a gender identity likely reflects genetic and biological, environmental, and cultural factors. Treatment for gender dysphoria may include supporting the individual's gender expression or their desire for hormone therapy or surgery. Treatment may also include counseling or psychotherapy. Some researchers and transgender people support declassification of the condition because they say the diagnosis pathologizes gender variance and reinforces the binary model of gender.

binary model gender dysphoria gender identity

References

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  11. Diamond, Milton (2013). "Transsexuality Among Twins: Identity Concordance, Transition, Rearing, and Orientation". International Journal of Transgenderism 14 (1): 24–38. doi:10.1080/15532739.2013.750222. "Combining data from the present survey with those from past-published reports, 20% of all male and female monozygotic twin pairs were found concordant for transsexual identity... The responses of our twins relative to their rearing, along with our findings regarding some of their experiences during childhood and adolescence show their identity was much more influenced by their genetics than their rearing.".  https://dx.doi.org/10.1080%2F15532739.2013.750222
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  19. "Gender incongruence (ICD-11)". WHO. https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/411470068. 
  20. "Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations". World Psychiatry 15 (3): 205–221. October 2016. doi:10.1002/wps.20354. PMID 27717275.  http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5032510
  21. "NHS - Treatment - Gender dysphoria". NHS. 2016. https://www.nhs.uk/conditions/gender-dysphoria/treatment/. 
  22. Leiblum, Sandra (2006). Principles and Practice of Sex Therapy, Fourth Edition. The Guilford Press. pp. 488–9. ISBN 978-1-59385-349-5. 
  23. Heyes, C. J., & Latham, J. R. (2018). Trans surgeries and cosmetic surgeries: The politics of analogy. Transgender Studies Quarterly, 5(2), 174-189.
  24. Committee On Adolescence (July 2013). "Office-based care for lesbian, gay, bisexual, transgender, and questioning youth". Pediatrics 132 (1): 198–203. doi:10.1542/peds.2013-1282. PMID 23796746. "However, adolescents with multiple or anonymous partners, having unprotected intercourse, or having substance abuse issues should be tested at shorter intervals.".  https://dx.doi.org/10.1542%2Fpeds.2013-1282
  25. "www.glma.org Compendium of Health Profession Association LGBT Policy & Position Statements". GLMA. 2013. http://www.glma.org/_data/n_0001/resources/live/GLMA%20Compendium%20of%20Health%20Profession%20Association%20LGBT%20Policy%20and%20Position%20Statements.pdf. 
  26. "APA Policy Statements on Lesbian, Gay, Bisexual, & Transgender Concerns". American Psychological Association. 2011. http://www.apa.org/about/policy/booklet.pdf. "BE IT FURTHER RESOLVED that APA recognizes the efficacy, benefit, and necessity of gender transition treatments for appropriately evaluated individuals and calls upon public and private insurers to cover these medically necessary treatments;" 
  27. Wallien, M. S. C., & Cohen-Kettenis, P. T. (2008). Psychosexual outcome of gender-dysphoric children. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 1413–1423.
  28. Drummond, K. D., Bradley, S. J., Badali-Peterson, M., & Zucker, K. J. (2008). A follow-up study of girls with gender identity disorder. Developmental Psychology, 44, 34–45.
  29. Steensma, T. D., McGuire, J. K., Kreukels, B. P. C., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 52, 582–590.
  30. Ristori, Jiska; Steensma, Thomas D. (2 January 2016). "Gender dysphoria in childhood". International Review of Psychiatry 28 (1): 13–20. doi:10.3109/09540261.2015.1115754. PMID 26754056.  https://dx.doi.org/10.3109%2F09540261.2015.1115754
  31. The Transgendered Child: A Handbook for Families and Professionals (Brill and Pepper, 2008)
  32. Alleyne, Richard (15 April 2011). "Puberty blocker for children considering sex change". The Telegraph. https://www.telegraph.co.uk/news/health/news/8454002/Puberty-blocker-for-children-considering-sex-change.html. 
  33. Rafferty, Jason; Health, Committee on Psychosocial Aspects of Child and Family; Adolescence, Committee On; Section on Lesbian, Gay (2018-10-01). "Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents" (in en). Pediatrics 142 (4): e20182162. doi:10.1542/peds.2018-2162. ISSN 0031-4005. PMID 30224363. https://pediatrics.aappublications.org/content/142/4/e20182162. 
  34. "Quincy Bell and A v. Tavistock and Portman NHS Foundation Trust". https://www.judiciary.uk/wp-content/uploads/2020/12/Bell-v-Tavistock-Judgment.pdf. 
  35. "Puberty blockers: Under-16s 'unlikely' to be able to give informed consent". BBC News. 1 December 2020. https://www.bbc.com/news/uk-england-cambridgeshire-55144148. 
  36. "Evidence review: Gonadotrophin releasing hormone analogues for children and adolescents with gender dysphoria". https://arms.nice.org.uk/resources/hub/1070905/attachment. ""The critical outcomes for decision making are the impact on gender dysphoria, mental health and quality of life. The quality of evidence for these outcomes was assessed as very low certainty using modified GRADE."" 
  37. "Finnish guidelines for treatment of child and adolescent gender dysphoria (published march 2021)". https://palveluvalikoima.fi/documents/1237350/22895008/Alaik%C3%A4iset_suositus.pdf/c987a74c-dfac-d82f-2142-684f8ddead64/Alaik%C3%A4iset_suositus.pdf. "p. 6: ”Terveydenhuoltolain mukaan (8§) terveydenhuollon toiminnan on perustuttava näyttöön ja hyviin hoito- ja toimintakäytäntöihin. Alaikäisten osalta tutkimusnäyttöön perustuvia terveydenhuollon menetelmiä ei ole.”--- (Google translate:) “According to the Health Care Act (Section 8), health care activities must be based on evidence and good care and operating practices. There are no research-based health care methods for minors.”" 
  38. Safer, Joshua D. (17 February 2020). "Controversial pubertal blocker legislation may bring unintended consequences for children". Healio. https://www.healio.com/news/endocrinology/20200217/controversial-pubertal-blocker-legislation-may-bring-unintended-consequences-for-children#. 
  39. "Endocrine Society urges policymakers to follow science on transgender health". https://www.endocrine.org/news-and-advocacy/news-room/2019/transgender-custody-statement. 
  40. "AMA fights to protect health care for transgender patients". https://www.ama-assn.org/print/pdf/node/66096. 
  41. "Criminalizing Gender Affirmative Care with Minors". https://www.apa.org/pi/lgbt/resources/policy/issues/gender-affirmative-care. 
  42. "AACAP Statement Responding to Efforts to ban Evidence-Based Care for Transgender and Gender Diverse Youth". https://www.aacap.org/AACAP/Latest_News/AACAP_Statement_Responding_to_Efforts-to_ban_Evidence-Based_Care_for_Transgender_and_Gender_Diverse.aspx. 
  43. Schmidt, Samantha. "FAQ: What you need to know about transgender children". https://www.washingtonpost.com/dc-md-va/2021/04/22/transgender-child-sports-treatments/. 
  44. Kaltiala-Heino, Riittakerttu; Sumia, Maria; Työläjärvi, Marja; Lindberg, Nina (2015). "Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development". Child and Adolescent Psychiatry and Mental Health 9: 9. doi:10.1186/s13034-015-0042-y. ISSN 1753-2000. PMID 25873995. "" "for the majority of adolescent-onset cases, GD presented in the context of severe mental disorders and general identity confusion. In such situations, appropriate treatment for psychiatric comorbidities may be warranted before conclusions regarding gender identity can be drawn.","There is still no clear consensus regarding hormonal treatment for adolescents because long-term data are unavailable;","In a nationwide long-term follow-up study of adult cases, psychiatric morbidity, suicide attempts and suicide mortality persisted as elevated after juridical and medical SR."".  http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4396787
  45. Swedish National Board of Health and Welfare (Feb 2020). "Development of the diagnosis gender dysphoria (Swedish)". https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/ovrigt/2020-2-6600.pdf. 
  46. Kozlowska, Kasia; Chudleigh, Catherine; McClure, Georgia; Maguire, Ann M.; Ambler, Geoffrey R. (2021-01-12). "Attachment Patterns in Children and Adolescents With Gender Dysphoria". Frontiers in Psychology 11: 582688. doi:10.3389/fpsyg.2020.582688. ISSN 1664-1078. PMID 33510668.  http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7835132
  47. D’Angelo, Roberto; Syrulnik, Ema; Ayad, Sasha; Marchiano, Lisa; Kenny, Dianna Theadora; Clarke, Patrick (2021-01-01). "One Size Does Not Fit All: In Support of Psychotherapy for Gender Dysphoria" (in en). Archives of Sexual Behavior 50 (1): 7–16. doi:10.1007/s10508-020-01844-2. ISSN 1573-2800. PMID 33089441.  http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7878242
  48. George R. Brown, MD (July 20, 2011). "Chapter 165 Sexuality and Sexual Disorders". The Merck Manual of Diagnosis and Therapy (19th ed.). Whitehouse Station, NJ, USA: Merck & Co., Inc.. pp. 1740–1747. ISBN 978-0-911910-19-3. 
  49. Bockting, W; Knudson, G; Goldberg, J (January 2006). "Counselling and Mental Health Care of Transgender Adults and Loved Ones". International Journal of Transgenderism 9 (3–4): 35–82. doi:10.1300/J485v09n03_03. ""As per Figure 1, delusions about sex or gender, dissociative disorders, thought disorders,or obsessive or compulsive features should be evaluated and treated prior to proceeding with hormone therapy or surgery. Thought disorders, dissociative disorders, and obsessive-compulsive disorders can, rarely, cause a transient wish for sex reassignment which disappears or significantly lessens when the underlying mental health condition is treated. It is important to treat these disorders before proceeding with hormones or surgery to ensure that the desire for alteration of primary or secondary sex characteristics is not a temporary desire." See also WPATH Standards of Care, version 7, page 23:“The role of mental health professionals includes making reasonably sure that the gender dysphoria is not secondary to or better accounted for by other diagnoses.” And the paradigmatic Dutch model for consideration of comorbid conditions before proceeding with treatment for childhood onset.".  https://dx.doi.org/10.1300%2FJ485v09n03_03
  50. "Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People". World Professional Association for Transgender Health. pp. 28–29. https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_English.pdf. 
  51. Baker, Kellan E.; Wilson, Lisa M.; Sharma, Ritu; Dukhanin, Vadim; McArthur, Kristen; Robinson, Karen A. (2021). "Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review". Journal of the Endocrine Society 5 (4): bvab011. doi:10.1210/jendso/bvab011. PMID 33644622. PMC 7894249. https://doi.org/10.1210/jendso/bvab011. "This systematic review of 20 studies found evidence that gender-affirming hormone therapy may be associated with improvements in QOL scores and decreases in depression and anxiety symptoms among transgender people. Associations were similar across gender identity and age. The strength of evidence for these conclusions is low due to methodological limitations.". 
  52. Hembree, Wylie C; Cohen-Kettenis, Peggy T; Gooren, Louis; Hannema, Sabine E; Meyer, Walter J; Murad, M Hassan; Rosenthal, Stephen M; Safer, Joshua D et al. (2017-11-01). "Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology & Metabolism 102 (11): 3869–3903. doi:10.1210/jc.2017-01658. ISSN 0021-972X. PMID 28945902. ""In the future, we need more rigorous evaluations of the effectiveness and safety of endocrine and surgical protocols.Specifically, endocrine treatment protocols for GD/gender incongruence should include the careful assessment of the following: (1) the effects of prolonged delay of puberty in adolescents on bone health, gonadal function, and the brain (including effects on cognitive, emotional, social, and sexual development); [...] and (4) the risks and benefits of gender-affirming hormone treatment in older transgender people.” “Future research is needed to ascertain the potential harm of hormonal therapies (176).” "The satisfaction rate with surgical reassignment of sex is now very high (187).“Owing to the lack of controlled studies, incomplete follow-up, and lack of valid assessment measures, evaluating various surgical approaches and techniques is difficult." "Several postoperative studies report significant long-term psychological and psychiatric pathology (259–261).” "We need more studies with appropriate controls that examine long-term quality of life, psychosocial outcomes, and psychiatric outcomes to determine the long-term benefits of surgical treatment.”".  https://dx.doi.org/10.1210%2Fjc.2017-01658
  53. Murad, Mohammad Hassan; Elamin, Mohamed B.; Garcia, Magaly Zumaeta; Mullan, Rebecca J.; Murad, Ayman; Erwin, Patricia J.; Montori, Victor M. (February 2010). "Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes". Clinical Endocrinology 72 (2): 214–231. doi:10.1111/j.1365-2265.2009.03625.x. ISSN 1365-2265. PMID 19473181. https://pubmed.ncbi.nlm.nih.gov/19473181/. ""The evidence in this review is of very low quality9, 10 due to the serious methodological limitations of included studies. Studies lacked bias protection measures such as randomization and control groups, and generally depended on self-report to ascertain the exposure (i.e. hormonal therapy was self-reported as opposed to being extracted from medical records). Our reliance on reported outcome measures may also indicate a higher risk of reporting bias within the studies. Statistical heterogeneity of the results was also significant."". 
  54. Sutcliffe, P. A.; Dixon, S.; Akehurst, R. L.; Wilkinson, A.; Shippam, A.; White, S.; Richards, R.; Caddy, C. M. (March 2009). "Evaluation of surgical procedures for sex reassignment: a systematic review". Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS 62 (3): 294–306; discussion 306–308. doi:10.1016/j.bjps.2007.12.009. ISSN 1878-0539. PMID 18222742. https://pubmed.ncbi.nlm.nih.gov/18222742/. ""The evidence concerning gender reassignment surgery in both MTF and FTM transsexism has several limitations in terms of: (a) lack of controlled studies, (b) evidence has not collected data prospectively, (c) high loss to follow up and (d) lack of validated assessment measures. Some satisfactory outcomes were reported, but the magnitude of benefit and harm for individual surgical procedures cannot be estimated accurately using the current available evidence."". 
  55. Cohen-Kettenis, Peggy T.; Delemarre-van de Waal, Henriette A.; Gooren, Louis J. G. (2008). "The treatment of adolescent transsexuals: changing insights". The Journal of Sexual Medicine 5 (8): 1892–1897. doi:10.1111/j.1743-6109.2008.00870.x. ISSN 1743-6109. PMID 18564158. https://pubmed.ncbi.nlm.nih.gov/18564158/. 
  56. de Vries, Annelou L. C.; McGuire, Jenifer K.; Steensma, Thomas D.; Wagenaar, Eva C. F.; Doreleijers, Theo A. H.; Cohen-Kettenis, Peggy T. (2014). "Young adult psychological outcome after puberty suppression and gender reassignment". Pediatrics 134 (4): 696–704. doi:10.1542/peds.2013-2958. ISSN 1098-4275. PMID 25201798. https://pubmed.ncbi.nlm.nih.gov/25201798/. 
  57. Zucker, Kenneth J. (2019-10-01). "Adolescents with Gender Dysphoria: Reflections on Some Contemporary Clinical and Research Issues" (in en). Archives of Sexual Behavior 48 (7): 1983–1992. doi:10.1007/s10508-019-01518-8. ISSN 1573-2800. PMID 31321594. https://doi.org/10.1007/s10508-019-01518-8. ""In the Dutch model, several factors were identified in deeming adolescent eligibility for early biomedical treatment. According to Cohen-Kettenis, Delemarre-van de Waal, and Gooren (2008), these included the following: (1) the presence of gender dysphoria from early childhood on; (2) an exacerbation of the gender dysphoria after the first signs of puberty; (3) the absence of psychiatric comorbidity that would interfere with a diagnostic evaluation or treatment; (4) adequate psychological and social support during treatment; and (5) a demonstration of knowledge of the sex/gender reassignment process. Several studies have reported on the benefits of this therapeutic protocol in reducing gender dysphoria (e.g., de Vries et al., 2014, which is the best study to date). Of course, one should bear in mind some of the limitation to these outcome studies, including the fact that not all assessed adolescents were deemed eligible for the treatment protocol (and thus we know relatively little about the longer-term outcomes of these youth) and that study designs have not included alternative treatment options (such as psychosocial therapy) or even being assigned to a wait-list control condition;"". 
  58. Haupt, Claudia; Henke, Miriam; Kutschmar, Alexia; Hauser, Birgit; Baldinger, Sandra; Saenz, Sarah Rafaela; Schreiber, Gerhard (2020-11-28). "Antiandrogen or estradiol treatment or both during hormone therapy in transitioning transgender women". Cochrane Database of Systematic Reviews 11: CD013138. doi:10.1002/14651858.cd013138.pub2. ISSN 1465-1858. PMID 33251587. PMC 8078580. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013138.pub2. "We found insufficient evidence to determine the efficacy or safety of hormonal treatment approaches for transgender women in transition.". 
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  62. Stusiński, Jarosław; Lew-Starowicz, Michał (2018-12-29). "Gender dysphoria symptoms in schizophrenia". Psychiatria Polska 52 (6): 1053–1062. doi:10.12740/PP/80013. ISSN 2391-5854. PMID 30659566.  https://dx.doi.org/10.12740%2FPP%2F80013
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  69. Conron, KJ; Scott, G; Stowell, GS; Landers, S (January 2012), "Transgender Health in Massachusetts: Results from a Household Probability Sample of Adults", American Journal of Public Health (American Public Health Association) 102 (1): 118–222, doi:10.2105/AJPH.2011.300315, ISSN 1541-0048, OCLC 01642844, PMID 22095354, "Between 2007 and 2009, survey participants aged 18 to 64 years in the Massachusetts Behavioral Risk Factor Surveillance System (MA-BRFSS; N = 28 662) were asked: "Some people describe themselves as transgender when they experience a different gender identity from their sex at birth. For example, a person born into a male body, but who feels female or lives as a woman. Do you consider yourself to be transgender?" […] We restricted the analytic sample to 28176 participants who answered yes or no to the transgender question (excluding n=364, 1.0% weighted who declined to respond. […] Transgender respondents (n=131; 0.5%; 95% confidence interval [CI]=0.3%, 0.6%) were somewhat younger and more likely to be Hispanic than were nontransgender respondents."  http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3490554
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  77. Giordano, Simona (2012). Children with Gender Identity Disorder: A Clinical, Ethical, and Legal Analysis. New Jersey: Routledge. p. 147. ISBN 978-0-415-50271-9. 
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  81. Lev, Arlene Istar (2004). Transgender Emergence: Therapeutic Guidelines for Working with Gender-Variant People and Their Families. Haworth Press. p. 172. ISBN 978-0-7890-2117-5. https://books.google.com/books?id=LwxvazLRmiEC&q=homosexuality+dsm-iii+transsexuality&pg=PA172. 
  82. Rudacille, Deborah (February 2005). The Riddle of Gender: Science, Activism, and Transgender Rights. Pantheon. ISBN 978-0-375-42162-4. 
  83. Zucker, KJ; Spitzer, RL (Jan–Feb 2005), "Was the gender identity disorder of childhood diagnosis introduced into DSM-III as a backdoor maneuver to replace homosexuality? A historical note.", Journal of Sex and Marital Therapy 31 (1): 31–42, doi:10.1080/00926230590475251, PMID 15841704  https://dx.doi.org/10.1080%2F00926230590475251
  84. "Controversy Continues to Grow Over DSM's GID Diagnosis". Psychiatric News. http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=106462. 
  85. Ranna Parekh. "What Is Gender Dysphoria?". American Psychiatric Publishing. https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria. 
  86. "Gender Dysphoria". American Psychiatric Publishing. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM-5-Gender-Dysphoria.pdf. 
  87. Coleman E (2011). "Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7". International Journal of Transgenderism (Routledge Taylor & Francis Group) 13 (4): 165–232. doi:10.1080/15532739.2011.700873. http://www.wpath.org/uploaded_files/140/files/IJT%20SOC,%20V7.pdf. Retrieved August 30, 2014. 
  88. Ford, Zack. "APA Revises Manual: Being Transgender is No Longer a Mental Disorder". http://thinkprogress.org/lgbt/2012/12/03/1271431/apa-revises-manual-being-transgender-is-no-longer-a-mental-disorder/?mobile=nc. 
  89. Mallon, Gerald P. (2009). Social Work Practice with Transgender and Gender Variant Youth. New Jersey: Routledge. ISBN 978-0-415-99482-8. 
  90. "Government Policy concerning Transsexual People". People's rights/Transsexual people. U.K. Department for Constitutional Affairs. 2003. http://www.dca.gov.uk/constitution/transsex/policy.htm. 
  91. "La transsexualité ne sera plus classée comme affectation psychiatrique". Le Monde. May 16, 2009. http://www.lemonde.fr/societe/article/2009/05/16/la-transsexualite-ne-sera-plus-classee-comme-affectation-psychiatrique_1193860_3224.html. 
  92. "La France est très en retard dans la prise en charge des transsexuels" (in fr). Libération. May 17, 2011. http://www.liberation.fr/societe/2011/05/17/la-france-est-tres-en-retard-dans-la-prise-en-charge-des-transsexuels_736344. "En réalité, ce décret n'a été rien d'autre qu'un coup médiatique, un très bel effet d'annonce. Sur le terrain, rien n'a changé." 
  93. "Denmark will become first country to no longer define being transgender as a mental illness". The Independent. May 14, 2016. https://www.independent.co.uk/news/world/europe/denmark-will-be-the-first-country-to-no-longer-define-being-transgender-as-a-mental-illness-a7029151.html. 
  94. Benestad, E.E.P. (October 2010). "From gender dysphoria to gender euphoria: An assisted journey". Sexologies 19 (4): 225–231. doi:10.1016/j.sexol.2010.09.003. ISSN 1158-1360. http://dx.doi.org/10.1016/j.sexol.2010.09.003. 
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