Gender incongruence

Gender incongruence is when your gender is different to the sex that you were assigned when you were born.

What is gender?

Sex and gender are different things.

Your sex is assigned to you at birth based on your external anatomy. That is, whether you have a penis or vagina. Most people will be male or female. If you have ambiguous genitals, you may be considered intersex.

Your gender identity is how you feel about yourself. There are many ways to experience gender, and it may change over time.

Cisgender is the term used to describe people whose gender matches their sex at birth.

If you have gender incongruence, you may describe yourself as transgender (trans) or gender diverse. These are umbrella terms. This means they cover a broad range of other identities, including binary and nonbinary genders.

Nonbinary is an umbrella term for identities outside the binary choice of male or female. Nonbinary people don't feel completely male or female. They may feel:

• like a mix of both male and female
• neither male nor female
• gender fluid — a person with changing gender
• agender — may not experience a sense of gender

Brotherboy is a term some Aboriginal and/or Torres Strait Islander people use to describe a man with transmasculine experience. Transmasculine people are assigned female at birth but identify with a masculine identity.

Sistergirl is a term some Aboriginal and/or Torres Strait Islander people use to describe a woman with transfeminine experience. Transfeminine people are assigned male at birth but identify with a female identity.

There are many other ways people may describe their gender. There are no right or wrong ways to experience or label gender.

Gender dysphoria is the distress or unease someone with gender incongruence may feel. If you are trans or gender diverse, you may feel dysphoric due to disconnection between your gender identity and:

• your body
• the gender that you are seen as by others
• the way you are legally recognised

Not all trans or gender diverse people experience gender dysphoria.

Gender dysphoria can be different for everyone. If you have gender dysphoria, you may feel:

• distressed
• uneasy
• irritable
• in discomfort

This may look like anxiety or depression.

If gender dysphoria is not managed, it can seriously affect your mental health and wellbeing.

Puberty can be a very difficult time for children with gender dysphoria, as this is when their bodies start to change.

Teenagers with gender dysphoria are more likely than others to self-harm or have suicidal thoughts. So, it's important to get help.

If you have gender incongruence, you may choose to see a doctor for many reasons. Remember — having gender incongruence or being transgender is not an illness.

If you have ongoing distress about your gender, see your doctor.

Your doctor can help by:

• providing general support
• referring you to a psychologist
• giving you information about gender affirming care
• discussing hormone treatment
• referring you to other health workers with knowledge of gender affirming care

See your doctor if you want to talk about options for gender affirming care.

How do I choose the right doctor?

Unfortunately, it can be hard to find gender affirming doctors.

You can look for a gender affirming clinician (Opens in new tab) on the AusPATH (Opens in new tab) website.

It is important to see a doctor that you trust and feel comfortable with. If a doctor is not right for you, it is OK to change your mind and get care somewhere else.

Your doctor should:

• help you understand the care options that may suit you and your health goals
• give you all the information you need to make choices about your health
• give you gender affirming health care that is respectful and non-judgemental
• help you make decisions, but ensure that your care is your choice

Affirming, respectful care is helpful in all medical contexts. This includes getting care for reasons unrelated to your gender.

Remember — no health professional should try to change your gender identity. They shouldn't support or recommend conversion services to you. In Australia, conversion practices are considered to:

• have no medical benefit
• be unethical
• cause serious harms

You can read more about finding the right healthcare professional.

If you have ongoing distress about your gender, see your doctor. Your doctor or a psychologist can help you understand if you have gender dysphoria.

They can ask you questions about what you have been feeling and help you access gender affirming care.

Gender affirming care can support your gender identity and treat gender dysmorphia. If you have gender incongruence, gender affirming care may help. This is especially true if you have gender dysphoria. Delays in care can make your symptoms worse and lead to declines in your mental health and wellbeing.

Different people need different types of gender affirming care. There is no right or wrong way to affirm your gender. You can advocate for yourself and your identity by expressing your gender.

Some trans people may not share their gender with others. They may not want to change themselves or their life in any way.

Your care might include making:

• social changes
• psychological changes
• medical changes

Social affirmation

You may choose to express your gender identity by:

• changing your name
• changing your pronouns
• changing your hair
• changing your clothes

This is 'social affirmation' or 'social transition'.

Legal affirmation

Legal affirmation might include changing your legal name or gender markers on documents.

Some documents need letters from your doctor or psychologist. Others require you to have received gender affirming surgery.

Medical affirmation

Medical affirmation can include:

• puberty blockers
• hormone therapy
• gender affirming surgery

There are different types of medical gender affirmation.

Your access to medical gender affirmation may change depending on where you live in Australia.

In some states including Queensland and the Northern Territory, puberty blockers and gender affirming hormone therapy are not available to people aged under 18 in the public health system. You can access these treatments privately, but this can be expensive.

Puberty blockers

Puberty blockers are the first stage of medical gender affirmation. They are medicines that are given at the start of puberty to suppress your hormones. This stops the physical changes of puberty, such as breast growth or voice deepening.

It allows time for you to develop and explore your gender identity. This treatment is reversible.

Puberty blockers work best when they are started at the beginning of puberty. This is usually anywhere from the age of 8 to 14 years.

Gender affirming hormone therapy

Gender affirming hormone therapy is the second stage of medical gender affirmation. It is usually started at 16 years for someone who has taken puberty blockers. People under the age of 18 years will need consent from their parents or legal guardians to access medical affirmation.

For people who have already been through puberty, hormones can be started at any time.

Doctors from different specialties can prescribe hormone therapy.

Hormone therapy will cause both reversible and permanent changes to your body. The effect of hormone therapy is different for everyone. Some common effects are described below.

Feminising hormone therapy

Oestrogen is used in gender affirming hormone therapy for people who were assigned male at birth. This can cause many physical changes, including:

• breast growth
• a more feminine body shape
• decreased libido

Most people using feminising hormone therapy also take medicine to suppress testosterone.

Masculinising hormone therapy

Testosterone is used in gender affirming hormone therapy for people who were assigned female at birth. This can cause many physical changes, including:

• a deeper voice
• more facial and body hair
• a more masculine body shape

Gender affirming surgery

Some trans people want surgery to change the physical features of their body. This is gender affirming surgery.

Gender affirming surgeries include:

• 'top' surgery — chest surgery
• 'bottom' surgery — genital removal and creation
• facial surgery
• vocal surgery — this changes the sound of your voice

If you decide to take hormones, you will usually take these for at least 6 months to 1 year before surgery. It's uncommon to have surgery before reaching adulthood.

You can learn more about preparing for surgery.

It is important to talk to your doctor about any risks of gender affirming treatment. This way, you can make an informed choice about your treatment.

Gender affirming care recognises your gender identity. If you have gender incongruence, gender affirming care can also support your:

• social wellbeing
• mental wellbeing
• physical wellbeing

Gender dysphoria can cause distress and impact your life. Gender affirming care can help prevent this.

Few people who have gender affirming care regret their decision.

Puberty blockers and hormone therapy may have some side effects. This may include impacts on your fertility. Your doctor can talk to you about your options if you wish to preserve your fertility. This can include freezing your eggs or sperm.

Gender affirming surgery can have some complications such as infection.

It may also take some time to get used to the changes in your body that come with gender affirming care.

Your doctor can also help you prevent any problems.

It's important to get help if you have gender dysphoria. There are many sources of information and support available.

You can contact qlife.org.au (Opens in new tab) for webchat or call 1800 184 527.

You can also visit Lifeline (Opens in new tab) for webchat, call 13 11 14 or text 0477 13 11 14.

Resources and support for young people

If you are a young person looking for support, there are organisations that can help.

• headspace (Opens in new tab) provides mental health services for 12-25 year olds — call 1800 650 890 or chat online
• kidshelpline.com.au (Opens in new tab) provides support for young people aged 5-25 years — call 1800 55 1800 or chat online
• minus18 (Opens in new tab) supports LGBTQIA+ youth — find resources (Opens in new tab) on their website
• Reach Out (Opens in new tab) offers online, anonymous and confidential support for young people
• Transcend Australia (Opens in new tab) provides peer support for trans, gender diverse and non-binary young people their parents and carers
• In NSW, Twenty10 (Opens in new tab) works with young people in gender-affirming ways to support their rights, agency and wellbeing

Most youth services will have information on local LGBTQIA+ support groups.

If your child is gender diverse, you can find support at Parents of Gender Diverse Children (Opens in new tab). You can also find information for families, parents and carers (Opens in new tab) on the Transcend Australia website.

Languages other than English

You can read Transcend Australia's fact sheet on How To Support Your Child When They Tell You They Are Non-Binary (Opens in new tab) via Health Translations Victoria. It is available in: Arabic, Chinese (Simplified and Traditional), Greek, Spanish and Vietnamese.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.