develop an alternative, nonmale/nonfemale ge nder identity do have  a presentation that
meets criteria for gender dys phoria. However, some males seek castration and/or penec-
tomy for aesthetic reasons or to remove psychological effects of androgens without chang-
ing male identity; in these cases, the cr iteria for gender dysphoria are not met. 
Comorbidity 
Clinically referred children with gender dysphoria show elevated le vels of emotional and
behavioral problems—most commonly, anxiety, disruptive and impulse-control, and de-