456 Gender Dysphoria
dysphoria during childhood. Expressions of anatomic dysphoria are more common and
salient in adolescents and adults once seco ndary sex characterist ics have developed. 
Adolescent and adult natal males with earl y-onset gender dysphoria are almost al-
ways sexually attracted to men (androphilic). Adolescents and adults with late-onset gen-
der dysphoria frequently engage in transves tic behavior with sexual excitement. The
majority of these individuals are gynephilic or  sexually attracted to other posttransition
natal males with late-onset ge nder dysphoria. A substantia l percentage of adult males
with late-onset gender dyspho ria cohabit with or are marrie d to natal females. After gen-
der transition, many self-identify as lesbian. Among adult natal males with gender dyspho-
ria, the early-onset group seeks out clinical  care for hormone treatment and reassignment
surgery at an earlier age than does the late-onset group. The late-onset group may have more
fluctuations in the degree of gender dyspho ria and be more ambivalent about and less
likely satisfied after gender  reassignment surgery. 
In both adolescent and adult natal females, the most common  course is the early-onset
form of gender dysphoria. The late-onset fo rm is much less common in natal females com-
pared with natal males. As in natal males with gender dysphoria, there may have been a
period in which the gender dysphoria desisted and these individuals self-identified as les-
bian; however, with recurrence of gender dysphoria, clinical consultation is sought, often
with the desire for hormone treatment and reas signment surgery. Parents of natal adoles-