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A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics)

A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics)

A strong desire for the primary and/or secondary sex characteristics of the other gender

A strong desire to be of the other gender (or some alternative gender different from one’s designated gender)

A strong desire to be treated as the other gender (or some alternative gender different from one’s designated gender)

A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s designated gender)

The condition exists with a disorder of sex development.

The condition is post-transitional, in that the individual has transitioned to full-time living in the desired gender (with or without legalization of gender change) and has undergone (or is preparing to have) at least one sex-related medical procedure or treatment regimen—namely, regular sex hormone treatment or gender reassignment surgery confirming the desired gender (e.g., penectomy, vaginoplasty in natal males; mastectomy or phalloplasty in natal females).