454 Gender Dysphoria
rarely, they may state that they find their penis or testes disgusting, that they wish them re-
moved, or that they have, or wish to have, a vagina.
In young adolescents with gender dysphoria,  clinical features may resemble those of
children or adults with the co ndition, depending on develo pmental level. As secondary
sex characteristics of young adolescents are no t yet fully developed, these individuals may
not state dislike of them, but they are co ncerned about imminent physical changes. 
In adults with gender dysphoria, the di screpancy between experienced gender and
physical sex characteristics is often, but not always, accompanied by a desire to be rid of
primary and/or secondary sex ch aracteristics and/or a strong desire to acquire some pri-
mary and/or secondary sex characteristics of  the other gender. To varying degrees, adults
with gender dysphoria may ad opt the behavior, clothing, and mannerisms of the experi-
enced gender. They feel uncomfortable being re garded by others, or functioning in soci-
ety, as members of their assigned gender. Some adults may have a strong desire to be of a
different gender and treated as such, and they may have an inner certainty to feel and re-
spond as the experienced gender without seek ing medical treatment to alter body char-
acteristics. They may find other ways to resolve the incongruence between experienced/
expressed and assigned gender by partially livin g in the desired role or by adopting a gen-
der role neither conventionally male nor conventionally female.
Associated Features Supporting Diagnosis
When visible signs of puberty develop, natal bo ys may shave their legs at the first signs of
hair growth. They sometimes bind their genitals to make erections less visible. Girls may