# Gender Incongruence

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: Gender Dysphoria - StatPearls - NCBI Bookshelf (NBK532313) - https://www.ncbi.nlm.nih.gov/books/NBK532313/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class PS08 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care
- Verified date: 2026-08

## Verified against

- No dose - referral pathway, no medicine given in primary care
- Gender Incongruence - disease-level clinical article (gender-incongruence-full.txt)

## Treatment metadata

- No drug therapy in primary care (Referral & Advice)

## Complete treatment card

```text
GENDER INCONGRUENCE
Sources: Gender Dysphoria - StatPearls - NCBI Bookshelf (NBK532313) -
         https://www.ncbi.nlm.nih.gov/books/NBK532313/ · ICPC-3 (WONCA International Classification
         of Primary Care, 3rd edition) class PS08 - condition scope only, no dose · No dose -
         referral pathway, no medicine given in primary care
Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care,
               Gender Incongruence - disease-level clinical article (gender-
               incongruence-full.txt)  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (5)
    - A full history covers psychiatric, substance use, social, family, and developmental factors,
      including any trauma or past suicide attempts
    - In children, diagnosis needs at least six of eight listed features present for at least six
      months, including a strong desire for the other gender
    - In adolescents and adults, at least two of six listed features must be present for at least
      six months to meet criteria
    - Red flag: the stigma and the rejection bring depression and anxiety, substance use, a poor
      sense of well-being and low self-esteem, and a raised risk of self-harm and of suicide
      [anxiety · low mood · suicidal thoughts]
    - A child or adolescent who cannot see themselves in the traditional binary male or female roles
      may meet cultural stigmatisation for it  [loss of vision]
  SIGNS - what you find (3)
    - A newborn genital exam can reveal ambiguous genitalia from congenital adrenal hyperplasia or
      androgen insensitivity syndrome
    - Congenital adrenal hyperplasia can show early dehydration, low sodium, and high potassium, or
      virilization in the late-onset form  [dehydration · virilisation]
    - Androgen insensitivity syndrome means a genetically male patient does not respond to androgens
      and is often raised as female
  TESTS (1)
    - Genetic testing is warranted for anyone born with ambiguous genitalia
  IF NOT THIS - what else fits (9)
    - Autogynephilia
    - Body dysmorphic disorder
    - Intersex states (disorders of sex development)
    - Psychosis
    - Paraphilic disorders
    - Self-amputation
    - Schizophrenia
    - Transvestitism
    - Gender is not sexual orientation: a transgender man, born female, may identify as heterosexual
      and still be attracted to women
  Source  StatPearls "Gender Dysphoria" - disease-level clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)    [1st line]
   Adult    A marked, persistent incongruence between experienced gender and sex assigned at birth;
            in the Egyptian context this is a recognise-and-refer presentation where the GP listens
            respectfully and refers to psychiatry/endocrinology, since hormonal or surgical
            management is specialist-led and there is real uncertainty about how consistently such
            referral pathways are available locally. - Refer, with advice
   Peds     Children follow the same pathway: recognise and refer. No primary-care medicine is
            implied.
   Source   No dose - referral pathway, no medicine given in primary care
   Why      A marked, persistent incongruence between experienced gender and sex assigned at birth;
            in the Egyptian context this is a recognise-and-refer presentation where the GP listens
            respectfully and refers to psychiatry/endocrinology, since hormonal or surgical
            management is specialist-led and there is real uncertainty about how consistently such
            referral pathways are available locally.
   Caution  Rare in Egyptian primary care.
            No medicine is prescribed for this in primary care - this entry is for recognition and
            referral. Anything given is decided by the service it is referred to.
            RED FLAG - There is a high risk of self-harm and suicidality, requiring active suicide
            risk assessment and psychiatric safety netting.
            RED FLAG - There is a high prevalence of comorbid psychiatric disorders and substance
            abuse.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
```

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