with the desire for hormone treatment and reas signment surgery. Parents of natal adoles-
cent females with the late-onset form also report surprise, as no signs of childhood gender
dysphoria were evident. Expressions of anat omic dysphoria are mu ch more common and
salient in adolescents and adults than in children.
Adolescent and adult natal females with early-onset gender dysphoria are almost
always gynephilic. Adolescents and adults with  the late-onset form of gender dysphoria
are usually androphilic and after gender transit ion self-identify as gay men. Natal females
with the late-onset form do not have co-occu rring transvestic behavi or with sexual ex-
citement. 
Gender dysphoria in association with a disorder of sex development. Most individuals
with a disorder of sex development who develop gender dysphoria have already come to
medical attention at an early age. For many, st arting at birth, issues of gender assignment
were raised by physicians and parents. More over, as infertility is quite common for this
group, physicians are more willing to perfor m cross-sex hormone treatments and genital
surgery before adulthood.
Disorders of sex development in general are frequently as sociated with gender-atypi-
cal behavior starting in early childhood. Howeve r, in the majority of cases, this does not
lead to gender dysphoria. As individuals with a disorder of sex development become
aware of their medical history and condition, many experience uncertainty about their
gender, as opposed to developing a firm co nviction that they are another gender. How-
ever, most do not progress to gender transit ion. Gender dysphoria and gender transition
may vary considerably as a function of a disord er of sex development, its severity, and as-
signed gender.