[16] However, this declassification could carry implications for healthcare accessibility, as HRT and gender-affirming surgery could be deemed cosmetic by insurance providers, as opposed to medically necessary treatment, thereby affecting coverage.

[20][21] A 2021 review in Dialogues in Clinical Neuroscience found no relation to sexual orientation, but acknowledged that historically the two were often erroneously conflated.

[24][25] Symptoms of GD in children include preferences for opposite sex-typical toys, games, activities, or playmates as well as a great dislike of their own genitalia.

[31] Evidence from studies of twins suggests that genetic factors play a role in the development of gender dysphoria.

[47][48] Short-term side effects of puberty blockers include headaches, fatigue, insomnia, muscle aches and changes in breast tissue, mood, and weight.

[53] According to the American Psychiatric Association, "Due to the dynamic nature of puberty development, lack of gender-affirming interventions (i.e. social, psychological, and medical) is not a neutral decision; youth often experience worsening dysphoria and negative impact on mental health as the incongruent and unwanted puberty progresses.

[15] In its position statement published December 2020, the Endocrine Society stated that there is durable evidence for a biological underpinning to gender identity and that pubertal suppression, hormone therapy, and medically indicated surgery are effective and relatively safe when monitored appropriately and have been established as the standard of care.

[56] Some medical professionals disagree that adolescents are cognitively mature enough to make a decision with regard to hormone therapy or surgery, and advise that irreversible genital procedures should not be performed on individuals under the age of legal consent in their respective country.

[59] Nevertheless, they recommend the use of puberty blockers for minors on a case-by-case basis, and the American Academy of Pediatrics state that "pubertal suppression in children who identify as TGD [transgender and gender diverse] generally leads to improved psychological functioning in adolescence and young adulthood.

In the UK, in the case of Bell v Tavistock, an appeal court, overturning the original decision, ruled that children under 16 could give consent to receiving puberty blockers.

[67] In 2022, the National Board of Health and Welfare in Sweden issued new guidelines recommending that puberty blockers only be given in "exceptional cases" and said that their use was grounded in "uncertain science."

[68][69] Until the 1970s, psychotherapy was the primary treatment for gender dysphoria and generally was directed to helping the person adjust to their assigned sex.

[31] Psychotherapeutic treatment of GD involves helping the patient to adapt to their gender incongruence or to explorative investigation of confounding co-occurring[70][71][72][73] mental health issues.

Attempts to alleviate GD by changing the patient's gender identity to reflect assigned sex have been ineffective and are regarded as conversion therapy by most health organizations.

[21] Young people qualifying for biomedical treatment according to the Dutch model[82][83] (including having GD from early childhood which intensifies at puberty and absence of co-occurring psychiatric conditions that could challenge diagnosis or treatment) found reduction in gender dysphoria, although limitations to these outcome studies have been noted, such as lack of controls or considering alternatives like psychotherapy.

In its position statement published December 2020, the Endocrine Society stated that there is durable evidence for a biological underpinning to gender identity and that pubertal suppression, hormone therapy, and medically indicated surgery are effective and relatively safe when monitored appropriately and have been established as the standard of care.

[53] More rigorous studies are needed to assess the effectiveness, safety, and long-term benefits and risks of hormonal and surgical treatments.

[79] For instance, a 2020 Cochrane review found insufficient evidence to determine whether feminizing hormones were safe or effective, due to the lack of "completed studies that met [their] inclusion criteria.

[89] Studies on children and adolescents with gender dysphoria have found a high prevalence of autistic traits or a confirmed diagnosis of autism.

[91] It has been estimated that autistic children were over four times as likely to be diagnosed with GD,[89] with autism being reported from 6% to over 20% of teens referring to gender identity services.

[21] Children and adolescents with gender dysphoria are also more likely to have ADHD, depression and histories of suicidality, self-harm and adverse childhood experiences.

This suggests that the distress of gender dysphoria is significantly increased by difficulties encountered from social disapproval by one's culture.

"[109] Some researchers, including Spitzer and Paul J. Fink, contend that the behaviors and experiences seen in transsexualism are abnormal and constitute a dysfunction.

[16] An analysis of the Samoan third gender fa'afafine suggests that the DSM-IV-TR diagnostic component of distress is not inherent in the cross-gender identity; rather, it is related to social rejection and discrimination suffered by the individual.

"[113] In May 2009, the government of France declared that a transsexual gender identity will no longer be classified as a psychiatric condition,[114] but according to French trans rights organizations, beyond the impact of the announcement itself, nothing changed.

[122][123] The first attempt to rigorously define gender euphoria through an online survey took place in 2021, conducted by Will Beischel, Stéphanie Gauvin, and Sari van Anders.

[127][128][129] For example, in a 1988 interview with a trans man, the subject states, "I think that day [Dr. Charles Ilhenfeld] administered my first shot of the 'wonder-drug' must have been one of the 'peak-experiences' of my life -- talk about 'gender euphoria'!

In 1990, Virginia Prince used the phrase in the trans magazine Femme Mirror, ending an article with, "...from here on you can enjoy GENDER EUPHORIA - HAVE A GOOD LIFE!

[136] In 1989, Mariette Pathy Allen published an unnamed transgender person's quote in her photography book Transformations: "The shrinks may call it 'gender dysphoria,' but for some of us, it's gender 'euphoria,' and we're not going to apologize anymore!

[145] In 2019, the Midsumma festival in Australia hosted "Gender Euphoria," a cabaret focusing on "bliss" in transgender experiences, including musical, ballet, and burlesque performances.