hair growth. They sometimes bind their genitals to make erections less visible. Girls may
bind their breasts, walk with a stoop, or use lo ose sweaters to make breasts less visible. In-
creasingly, adolescents request, or may obta in without medical prescription and supervi-
sion, hormonal suppressors (“blockers”) of gonadal steroids (e.g., gonadotropin-releasing
hormone [GnRH] analog, spironolactone). Clinically refe rred adolescents often want hor-
mone treatment and many also wish for gender reassignment surgery. Adolescents living in
an accepting environment may open ly express the desire to be and be treated as the experi-
enced gender and dress partly or completely as the experienced gender, have a hairstyle typ-
ical of the experienced gender, preferentially s eek friendships with peer s of the other gender,
and/or adopt a new first name consistent with the experienced gender. Older adolescents,
when sexually active, usually do  not show or allow partners to touch their sexual organs. For
adults with an aversion toward their genitals, sexual activity is constrained by the preference
that their genitals not be seen  or touched by their partners. Some adults may seek hormone
treatment (sometimes without medical prescrip tion and supervision) and gender reassign-
ment surgery. Others are satisfied with either hormone treatment or surgery alone.
Adolescents and adults with gender dysphoria before gender reassignment are at in-
creased risk for suicidal ideation, suicide a ttempts, and suicides. After gender reassign-
ment, adjustment may vary, an d suicide risk may persist.
Prevalence 
For natal adult males, prevalence ranges from 0.005% to 0.014%, and for natal females,