Causes of Gender Dysphoria

Gender dysphoria usually means a difficulty in identifying with the biological sex in an individual.

The causes of gender dysphoria are not fully clear.

Psychiatric and biological causes

It was traditionally thought to be a psychiatric condition meaning a mental ailment. Now there is evidence that this phenomenon may not have origins in the brain alone.

Studies suggest that gender dysphoria may have biological causes associated with the development of gender identity before birth.

More research is needed before the causes of gender dysphoria can be fully understood.

Genetic causes of biological sex

Research suggests that development that determines biological sex happens in the mother’s womb.

Anatomical sex is determined by chromosomes that contain the genes and DNA.

Each individual has two sex chromosomes. One of the chromosomes is from the father and the other from the mother.

A normal man has an X and a Y sex chromosome and a normal woman has two X chromosomes.

It is seen that during early pregnancy, all unborn babies are female because only the female sex chromosome (or the X chromosome) that is inherited from the mother being the active one.

After the eighth week of pregnancy, the chromosome from the father (an X for a female and a Y for the male), gains in activity.

If the father’s contribution is the X chromosome the baby continues to develop as female with a surge of female hormones.

This helps develop her female sex organs, reproductive organs and features. This makes her sex and gender female.

If the inherited chromosome from the father is a Y there is a surge of testosterone and other male hormones that lead to development of male characteristics, such as testes.

This makes the baby’s sex and gender male. (1)

Causes of gender differences

There are several different potential causes of gender differences, these include hormonal changes, exposure to estrogenic drugs and so forth. (1-4)

Hormonal causes

Hormones that trigger the development of sex and gender in the womb may not function adequately.

For example, anatomical sex from the genitals may be male, while the gender identity that comes from the brain could be female.

This may result from the excess female hormones from the mother’s system or by the foetus’s insensitivity to the hormones.

The latter condition is called androgen insensitivity syndrome (AIS).

Exposure to progesterone or other estrogenic drugs

Although there is no research that shows that males or females exposed to progesterone in the womb or other estrogenic drugs, such as diethylstilbestrol (DES) may have a raised risk of gender dysphoria; there may be an association in some atypical aspects of gender role behavior.

Rare conditions that may lead to gender dysphoria

There may be rare conditions like congenital adrenal hyperplasia (CAH), and intersex conditions (also known as hermaphroditism) which may also result in gender dysphoria.

In CAH a female foetus has adrenal glands (small caps of glands over the kidneys) that produce high level of male hormones. This enlarges the female genitals and the female baby may be confused with a male at birth.

Intersex conditions mean babies may be born with the genitalia of both sexes. In these cases the child is allowed to grow and choose his or her own before any surgery is carried out to confirm it.

Other causes of gender dysphoria

  • There may be chromosomal abnormalities that may lead to gender dysphoria.
  • Sometimes defects in normal human bonding and child rearing may be contributing factor to gender identity disorders.

Further Reading

Last Updated: Oct 31, 2023

Dr. Ananya Mandal

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.


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  1. Libby Ratten Libby Ratten Australia says:

    Compassion & understanding

  2. Pamela Grant-Stickney Pamela Grant-Stickney United States says:

    There is no evidence of GID starting in the womb, areas affected by sex hormones such as BSTc don't become different in men and women until adulthood. Intersex conditions can happen at birth, but GID cannot happen in the womb, I was told this by a endocrinologist who is a specialist in GID and intersex conditions with 30yrs experience to back it up.

    • Junie Aiko Junie Aiko Australia says:

      We don't know enough about the brain to make definite statements, except to say that at the moment, substantial evidence is absent, etc. If GID can only happen in adulthood, that doesn't add up with evidence considering how most transsexual people identified with their brain-gender well before adulthood.

    • Kit Slagle Kit Slagle United States says:

      Since my earliest memories I felt something was wrong. I felt like a freak from my childhood to an adult. I had to fake things that did not feel natural to me so I could blend in the best I could. You spend most of your life acting a part and otherwise I felt like I would not be accepted by my peers or my family. And you spend so much time acting and putting up walls that you forget why your doing it or who you are. I looked back on my life and I had many memories but in many ways it all felt like a fog. Even though I remember everything it felt like I was living some one ells's life. I could not make sense of why I felt that way. Back in 2013 my Dad past away and the walls I had put up started falling. Many memories I had stuffed away started coming back in a rush and realized why I spent so many years in depression and feeling miserable. At this point many would think I would go off and get HRT and get surgery, but no. I am one of the few that has elected not to because I can't stand the thought of losing everyone I love. And there are other reasons but many would not understand those. The reason why I commented is because its not something that comes about when you are an adult, you suffer from it your whole life. And I hate it when people that do not understand what a person like I and others like me go through talk about it as though they were an authority on my life. I have lived it, you have not and so can not begin to talk about what you do not know. I am not trying to be an ass but you have no idea what me and others have gone through our whole lives(not just adulthood). It is miserable existence, acting out a life that is not you at all. You realize that no one you know truly knows you but only the part you play. Like I said I love my family and even though they don't know me I know enough about them that I want to keep them in my life so I am one of the few that has chosen to remain silent, but your not family so I have no problem telling you.

      • Ven Vara Ven Vara Oman says:

        when i was  in young age i didnt know what to do . Then i started to act of course unsuccessfully . Still today now i am 50 years old no marriage or no friends still suffering in loneliness depression

      • Ven Vara Ven Vara Oman says:

        I feel guilty that i never was a good son to my mother more of rebellious . two times i run away from my family . My mother could not help me for this problem  but she loved me . Now i cry everyday that I was not a good son for her

      • Patricia Schaefer Patricia Schaefer United States says:


        Even though your comment was posted a long time ago, I felt I had to respond. i'm very moved by what you have written. I recently started a relationship with a MTF transgender person.  She is a wonderful, smart, kind and beautiful person and she gave up quite a bit later in life to transition.  She lost a career in finance, and moved locations, but in the end, it was worth it to her to save her life.  I can't claim to know or really fully understand her transition.  But I admit that, and do the best I can to love and support her, even if at times I wonder at this complex thing we both grapple.  My point is that there is hope, and a loving full relationship, both emotional and sexual, with someone who loves you is not a dream. It is not impossible.  I have never felt closer to anyone than I do her and I admire her courage.  I  truly hope you find love and happiness, and the intimate joy of being known by another. You have my best. Thank you for your insightful comments.

      • Alan Alan Alan Alan United Kingdom says:

        Kit, I hear what you’re saying, I read your reply and it was my life completely.  The acting a part, you’re always on the outside looking in at what you should have been.  It is a hard life, as a child the things you desire are denied to you and substituted with other unwanted things.  And yes it is a fog.

    • Lee Kidd Lee Kidd United States says:

      Most transgender children know their true gender by age two, according to my doctors and multiple documentaries I've seen. I knew by at least age 5 and it was a huge issue for me my entire life, especially during grade school through high school. It has caused numerous health problems in my adult life because I didn't have the support and correct info. that I needed. The American Psychiatric Association no longer considers being transgender or transexual a mental disorder or illness.

    • Steven Stone Steven Stone United States says:

      Another Christian bigot promoting faux science by the other Chrisitan bigot named "Dr McHugh" who has been discredited by all medical and psychological consensus? I find it fascinating how trolls so suspiciously interested in this subject seem to crawl their way to every legitimate scientific journal/research in order to disseminate false information on the subject.
      Seek help from a qualified psychologist because your well known behavior is pathological

      • Todd Reinerio Todd Reinerio United States says:

        When one uses terms like "Chrisitan bigot" (which you misspelled), "trolls" and other such terms, you reveal your own inner hate and bigotry. The average person could give two craps until there becomes such time as to be forced to endure the constant barrage of 'you have to accept me" or "you have to like it" or, much like you just did, ad hom attacks they are forced to choose a stance. Considering that less than 1% of the total population has this condition, it should have special rights considerations since as most state, actual cause is unknown.

        • Lilly Faye Crowson Lilly Faye Crowson United States says:

          Since I am a Christian I will not use "such terms". But you cannot speak about what you don't know about. When you have walked a mile in my shoes, then you may comment on how I feel.
          Blessings and peace...

      • Linda White Linda White United States says:

        Not a mental disease

    • R S R S United States says:

      One of the things that an endocrinologist treats is hormonal sexual dysfunction and may not have studied transgender origin and is just giving you her/his opinion from her/his understanding, without the knowledge about the research.  Research on cadavers shows opposite sex brain structures in transgender people.  The origin is from pre birth.  The brain was formed differently and the theory is that biologically it happens at conception or at the 8 week mark of pregnancy.  The article is correct.  A endocrinologist or any doctor should know the difference between assumption and knowledge gained from studying and research.  Your endocrinologist made quite a leap in judgment.  Just because you have an area of knowledge doesn't mean you know everything about a specific specialty withint that field.  This is why we have the judgmental society with have.  Doctors giving opinions like it is fact.

    • Jane Ruge-Petz Jane Ruge-Petz United States says:

      What someone says is never written in stone when it comes to a complicated topic such as this.  The medical profession certainly doesn't have a 100% understanding on how our body works.  As it becomes easier to study issues like this with better technology the understanding grows.   Being closed minded never helps our understanding of a complicated biological topic such as this.

  3. Junie Aiko Junie Aiko Australia says:

    From what I've gathered, the genitalia is “decided” on the first 9 weeks of pregnancy, while the brain only starts developing after about the 9th weeks. By default, w/o testosterone all fetuses starts off as a “female”. For a male baby, any hormonal changes or imbalance may disrupt the brain to develop properly into "male" even if the genitalia has already been formed completely into male (and if the genitalia development is disrupted, this results in intersex characteristic too). And thus, the physically-male baby is born with a mental map of its physical body (akin to how some amputees may experience “phantom limbs” perhaps?), psychology and emotion of a female with a physical body of a male from since they were young. If this is true, a similar mechanism would also exist for FTM Transsexual men, but this may also perhaps explains why there are more MTF Transsexuals than FTM Transsexuals. No doubt what I've proposed isn't proven, but it is palpable IMO -- considering our understanding of how babies are developing in the mother's womb (that is, if I am not mistaken).

    Philosophically speaking, the mind dictates “who we are” and not our body. Transsexualism is an inter-sex condition of a brain, and the lack of immediate physical sign does not discount the horrible suffering these individuals experienced with their physical birth defects.

  4. Jodiee Hart Jodiee Hart United Kingdom says:

    It's not a disease. It's not catchable!

    • madcapper6 . madcapper6 . United States says:

      Catchable you mean as in, contagious?  Lou Gehrig's disease or MS isn't "catchable" neither but they are still diseases.

    • Rachael Claiborne Rachael Claiborne United States says:

      The main point of replacing "gender identity disorder" with gender dysphoria in the DSM-5 was to end the very type of stigma expressed in your comment. Nowhere in the DSM-5 does is say that gender nonconformity is a disease or mental illness. Gender dysphoria refers to the significant stress caused by the discrepancy between one's gender assigned at birth and the gender to which that person identifies. When the level of stress is significant enough to impair normal social and emotional functioning, a diagnosis of gender dysphoria is suitable. Science has yet to produce definitive evidence as to the cause (if any exist) so to declare GD as a choice is pure conjecture and should be dismissed as such.

  5. Ven Vara Ven Vara Oman says:

    I have question . Does pregnant lady's thinking about baby's sex has impact on GID ? My mother expected to get a girl baby . I am transgender silent transgender

    • Dianne Colbert Dianne Colbert Australia says:

      I have heard of children who have gender dysphoria as a result of parents saying "I wish you were a (opposite sex)."  Things that happen while in the parents womb can impact a child - so if your mum talked to you as a girl etc it is possible that this caused gender dysphoria.

  6. Elisa Brogan Elisa Brogan Australia says:

    interested. would like to know if carrying twins ( separate sacs), one male,one female affects the surviving Female twin's gender. My daughter is the surviving twin, lost the male twin close to 12 weeks of pregnancy. She has been undergoing traits of gender dysphoria since the start of early puberty. Curious to whether that relates to the male twin ( hormones,chromosomes, etc)

    • Anne-Marie Thomas Anne-Marie Thomas Canada says:

      Interesting take on the subject. The birth of my daughter 12 years ago was almost the exact same story as yours, except they had a "vanishing" twin that has passed in the womb and was re-absorbed by my body. I don't know if the fetus was male or not. I'm very curious as to how maternal hormonal states may affect the fetus as well. My daughter says they're trans now, with no evidence before now. I hope you and yours are healthy and happy, no matter what has transpired since your post.

      • leslie landberg leslie landberg United States says:

        Explosive growth of transitioning in recent years among girls suggest that there is no genetic cause.  There may be some kind of neonatal chemical imbalance going on but the complete lack of evidence so far suggests that this is implausible.  There is ample evidence that our children are being brainwashed and inducted into some very twisted ideologies in school and on social media. You might want to investigate the curriculum and web browsing history of your child.  Children are very susceptible to influence.  If I am correct, then these are crimes against humanity.  A good test to see if there is undue influences to take your child out of school and away from the internet and her phone and go on an extended vacation in the country. Let her see what life is like among forests and horses with good food and good books. Let her make new friends. Chances are excellent that she will lose her interest in this topic. I have been dysphoric all of my life and I knew something was different when I was still a toddler. This is very common. This condition especially among girls is extremely rare, so there really is no good explanation for this explosion outside of undo malign influence. But please do not take my word for it and do your own due diligence.

  7. Dianne Colbert Dianne Colbert Australia says:

    There is no scientific evidence for gender ideology.  Feelings are not facts.  One of the 10 common thinking distortions that causes mental distress is "mistaking feelings for facts."  A lot of evidence shows that there are psychological causes for gender dysphoria - you can't treat a psychological problem with a physical solution.  Imagine if people who have panic attacks - they really FEEL like they are having a heart attack - were given heart surgery.

  8. Naomi Aldort Naomi Aldort United States says:

    Its hard to say that it is only emotional as choosing to become transgender is a horrible choice one wouldn't do easily. But, if indeed these people feel these strongly, then may be it is biological, but not natural. What is vaccines, toxins in the air, pesticides etc... are actually causing a biological mix message. Vaccines use embrio's DNA...??? Could that be a cause? Or perhaps the way vaccines cause autoimmune disease, they may cause the cells going against one's own gender? Just thinking out loud here.

  9. Dawn Johnson Dawn Johnson United States says:

    What if it is all of the things that she says, BUT it started from the contamination of the environment.  Generation after generation of ingesting the food, water, drinks, and everyday use of soaps, lotions, everyday essentials.  There are two factors in all of those things which are pesticides and chemicals.  Both disrupt our entire body. From our parents to the sperm and egg hooking up.  It alters our DNA after decades of continuous use.  Check out the TedTalk of Professor Tyrone Hayes.  The influx of transgenderism isn't because people are opening up to it.  No, the environment was altered.  Everything in the evnvironment was altered and Oligarch's of the world knew it then and now.    You can study each molecule or will always come back to contamination or posioning.

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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