451 Gender
 Dysphoria
In this chapter,  there is one overarching diagnosis of gender dysphoria, with sepa-
rate developmentally appropriate criteria sets  for children and for adolescents and adults.
The area of sex and gender is highly controve rsial and has led to a proliferation of terms
whose meanings vary over time and within and between disciplines. An additional source
of confusion is that in English “sex” connotes  both male/female and se xuality. This chapter
employs constructs and terms as they are wide ly used by clinicians from various disci-
plines with specialization in this area. In this chapter, sex and sexual  refer to the biological
indicators of male and female (understood in  the context of reproductive capacity), such
as in sex chromosomes, gonads, sex hormon es, and nonambiguous internal and external
genitalia. Disorders of sex deve lopment denote condit ions of inborn somatic deviations of
the reproductive tract from the norm and/or discrepancies among the biological indica-
tors of male and female. Cross-sex  hormone treatment denotes the use of feminizing hor-
mones in an individual assigned male at birth based on traditional biological indicators or
the use of masculinizing hormones in an individual assigned female at birth.
The need to introduce the term gender  arose with the realization that for individuals
with conflicting or ambiguous biological indicato rs of sex (i.e., “intersex”), the lived role in
society and/or the identification as male or female could not be uniformly associated with
or predicted from the biological indicators and, later, that some individuals develop an
identity as female or male at variance with their uniform set of classical biological indica-
tors. Thus, gender is used to denote the public (and usually legally recognized) lived role as