Gender Dysphoria 453
B. The condition is associated with clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
Specify if:
With a disorder of sex development  (e.g., a congenital adrenogenital disorder such
as 255.2 [E25.0] congenital adrenal hyperplasia or 259.50 [E34.50] androgen insensi-
tivity syndrome).
Coding note:  Code the disorder of sex development as well as gender dysphoria.
Specify if:
Posttransition:  The individual has transitioned to full-time living in the desired gender
(with or without legalization of gender change) and has undergone (or is preparing to
have) at least one cross-sex medical proc edure or treatment regimen—namely, regu-
lar cross-sex hormone treatment or gender reassignment surgery confirming the desired
gender (e.g., penectomy, vaginoplasty in a natal male; mastectomy or phalloplasty in
a natal female).
Specifiers 
The posttransition specifier may be used in th e context of continuing  treatment procedures
that serve to support the new gender assignment. 
Diagnostic Features 
Individuals with gender dysphoria have a ma rked incongruence between the gender they
have been assigned to (usually  at birth, referred to as natal gender) and their experienced/
expressed gender. This discrepancy is the core componen t of the diagnosis. There must
also be evidence of distress about this inco ngruence. Experienced gender may include al-
ternative gender identities beyond binary stereotypes. Consequently, the distress is not
limited to a desire to simply be of the other gender, but may incl ude a desire to be of an al-