When to use this label

• Person reports distress or impairment related to gender incongruence but history is incomplete (e.g., brief emergency contact, lack of collateral).
• Presentation is atypical or does not meet full criteria for a specific gender dysphoria subtype.
• Used as a provisional designation pending fuller psychosocial, developmental and medical assessment.

Key presenting features

• Marked incongruence between experienced/expressed gender and assigned sex, with associated distress.
• Social withdrawal, mood symptoms, self‑harm, or functional impairment linked to gender distress.
• Desire to live as another gender, seek hormonal or surgical interventions, or adopt different gender role—may be present or not expressed yet.

Assessment essentials

1. Create a safe, non‑judgmental environment; use inclusive language and ask about pronouns and names.
2. Obtain developmental history (gender identity milestones), onset and course of distress, social supports, and mental health history.
3. Screen for comorbidities: depression, anxiety, substance use, self‑harm risk, neurodiversity (ASD) and trauma.
4. Explore goals: desire for social transition, hormone therapy, surgery, or other supports; assess informed consent capacity.
5. Use validated tools where helpful (e.g., gender identity questionnaires) but prioritise narrative history and patient goals.

Immediate management & safety

• Address urgent risks: active suicidality, self‑harm, or violence—prioritise safety planning and urgent psychiatric care when required.
• Provide psychosocial support: referral to gender‑affirming counselling, peer support groups and local trans health services where available.
• Document chosen name/pronouns in the record and ensure respectful communication across the care team.
• Avoid unnecessary or pathologising language; focus on distress and functional impact rather than identity itself.

Referral pathways & gender‑affirming care

• For people seeking medical transition, refer to specialist gender services for multidisciplinary assessment (mental health, endocrinology, surgery) as per local pathways.
• Ensure assessments include exploration of realistic expectations, fertility counselling, and screening for contraindications to hormones.
• For those not seeking medical interventions, offer social supports, workplace/school liaison, legal name/pronoun assistance and psychotherapy focused on coping and minority stress.

Psychological and social interventions

• Gender‑affirming counselling: supportive psychotherapy, CBT for coexisting mood/anxiety, and trauma‑informed care where needed.
• Family interventions: education and family therapy can reduce rejection and improve outcomes, especially in adolescents.
• Peer support and community resources: connect with local trans and gender‑diverse groups to reduce isolation and minority stress.

Key clinical points

• Unspecified label is pragmatic—use when distress is evident but fuller assessment is pending or presentation is atypical.
• Prioritise safety, affirming care, clear documentation of names/pronouns and timely referral to gender services when needed.
• Address comorbid mental health needs and social determinants (family support, housing, legal name change) as part of holistic care.