The exact cause of gender dysphoria is unknown, and there is much debate over its possible causes.
The condition was traditionally thought of as a purely psychiatric condition, which meant that its causes were considered to originate only within the mind. However, recent studies have challenged this, and suggested that gender dysphoria may have biological causes associated with the development of gender identity before birth.
More research needs to be done before the causes of gender dysphoria can be fully understood, but it is widely agreed that it can no longer be thought of as just a psychiatric condition.
Typical gender development
Much of the crucial gender development that determines your gender identity happens in the womb. To understand how gender identity can be affected by development in the womb, it is necessary to know how it works normally.
To begin with, all unborn babies are female, as only the female sex chromosome (X chromosome) inherited from the mother is active. At the eighth week of gestation, the sex chromosome inherited from the father becomes active, which can be either an X chromosome (female) or a Y chromosome (male).
If the sex chromosome inherited from the father is X, the unborn baby, or foetus, will carry on developing as female with a surge of female hormones. These female hormones work in harmony on the brain, gonads (sex organs), genitals and reproductive organs, so that the sex and gender are both female.
However, if the sex chromosome inherited from the father is Y, the foetus will go on to develop as male. The Y chromosome causes a surge of testosterone and other male hormones, which initiates the development of male characteristics, such as testes. The testosterone and other hormones work in harmony on the brain, gonads (sex organs), and genitals, so that the sex and gender are both male.
Therefore, in most cases, a female baby has XX chromosomes, and a male baby has XY chromosomes.
Changes to gender development which may cause gender dysphoria
Gender development is complex, and there are many possible variations that may cause confusion between a person’s sex, gender identity, and gender role. Some examples of these possible variations are outlined below, but it is important to remember that these are not yet fully understood.
Malfunctioning hormones
In rare cases, the hormones which trigger the development of sex and gender may not work properly on the brain, gonads and genitals, causing variations between them. For example, the sex (as determined physically by the gonads and genitals) could be male, while the gender (as determined by the brain) could be female.
This could be caused by additional hormones in the mother’s system, or by the foetus’s insensitivity to the hormones, known as androgen insensitivity syndrome (AIS). In this way, gender dysphoria may be caused by hormones not working properly within the womb.
Other rare conditions
Other rare conditions, such as congenital adrenal hyperplasia (CAH), and intersex conditions (also known as hermaphroditism), may also result in gender dysphoria.
In CAH, a female foetus’s adrenal gland causes a high level of male hormones to be produced, which enlarges the female genitals. In some cases, they may be so enlarged that the baby is assumed to be male when she is born.
Intersex conditions cause babies to be born with genitalia of both sexes (or ambiguous genitalia), which used to mean that the parents would have to choose the gender in which to bring up their child. However, it is now often thought best to wait until the child can choose their own gender identity, before any surgery is carried out to confirm it.
