Gender dysphoria and incongruence: what it is, support and NHS care

The NHS says gender dysphoria is when you feel distressed or uncomfortable for a long time because the gender you feel you are (your gender identity) is different to your sex registered at birth. The feeling of your gender identity being different to your sex registered at birth is known as gender incongruence.

The NHS page uses both terms together, "gender dysphoria and incongruence". In practice, the distress, rather than the difference alone, is what leads to assessment and support.

The NHS says the main sign of gender dysphoria and incongruence is feeling your gender identity is different to the sex you were registered at birth. You may want to live and be treated as a different gender, or feel your body or parts of your body do not match who you feel you are.

These feelings can make it hard to enjoy everyday life and may affect your mental health. For example, you may feel depressed or anxious, or feel like self-harming. If you are struggling with your mental health, the NHS says support is available if you or someone you know is having a mental health crisis or emergency, and you can find out where to get urgent help for mental health.

The NHS says to see a GP if you think you or your child might have gender dysphoria or incongruence. If you are aged 18 or over, a GP can refer you to the adult gender referral support service for an assessment at an NHS gender dysphoria clinic.

If you are aged 17 or under, a GP can refer you to a child specialist (paediatrician) or to children and young people's mental health services, who can refer you to the NHS children and young people's gender service.

The NHS says waiting times to get assessed at a gender dysphoria clinic are currently very long. Most clinics say on their website how long you can expect to wait.

If you are struggling with your mental health related to your gender identity, speak to a GP about what support is available while you wait. If you are aged 17 or under, you can get support from children and young people's mental health services. If you are aged 18 or over, you can refer yourself to an NHS talking therapies service for certain mental health conditions such as depression or anxiety. The NHS also notes there are private gender clinics with shorter waiting times, but you will need to pay for any treatment.

If you have been diagnosed with gender dysphoria or incongruence, the NHS says there are different treatments available. For adults, treatment may include hormone therapy, voice and communication therapy, talking therapy and counselling, and surgery to change parts of the body (gender reassignment surgery). A gender dysphoria clinic may refer you for surgery.

The NHS lists masculinising surgery that may include removing the breasts and chest reconstruction (top surgery), removing the womb, ovaries and fallopian tubes, and construction of an artificial penis, scrotum and testicles. Feminising surgery may include removing the penis and construction of an artificial vagina, and removing the testicles. Breast implants, hair transplants and facial feminisation surgery are available privately, but not usually on the NHS.

If you are aged 17 or under, the NHS says treatment will usually include talking therapy and counselling.

For children and young people the NHS says treatment will usually include talking therapy and counselling. NHS England says it has a National Programme Board for Gender Services covering specialised services for children and young people with gender incongruence.

It says that following the independent Review of Gender Identity Services for Children and Young People in 2024, an interim service specification was put in place in 2024, and a new service specification for specialist gender incongruence services for children and young people was published in April 2026. NHS England also publishes clinical policies, including on puberty suppressing hormones. If your child may have gender dysphoria, start with a GP, who can refer to local children and young people's services.

The NHS says some treatments may affect your fertility. You can be referred to a fertility service to preserve your eggs or sperm for future fertility treatment, and the Human Fertilisation and Embryology Authority has information about fertility treatment for trans and non-binary people.

The NHS strongly recommends that you do not use or buy treatment that has not been prescribed for you. If you are taking medicines such as hormones that are not prescribed by a health professional, speak to a GP.

If you or someone you know is having a mental health crisis or emergency, support is available no matter what you are going through. The NHS has a page on where to find urgent help for mental health. Call 999 or go to A&E if there is an immediate risk to life.

On the NHS, care starts with a GP and goes through an NHS gender dysphoria clinic for adults or the children and young people's gender service. Waiting times are currently very long.

The NHS says there are private gender clinics that have shorter waiting times, but you will need to pay for any treatment. It is sensible to check that any private clinician is appropriately regulated and will share information with your GP, particularly because the NHS advises against using treatment that has not been prescribed for you.