When to use this diagnosis

• Presentation includes distress or impairment related to gender incongruence but does not match specific diagnostic subtypes (e.g., atypical duration, partial symptom clusters).
• Insufficient information is available (emergency contact, limited history) but clinician wants a working label and a reason for the specification.
• Used to describe presentations such as gender distress limited to certain contexts (e.g., workplace), late‑onset gender incongruence, or complex presentations with coexisting neurodiversity or severe mental illness where standard criteria are hard to apply.

Common atypical presentations

• Late‑onset gender incongruence beginning in mid‑life without clear childhood history.
• Gender distress primarily from minority stress (discrimination, misgendering) where identity is fluid or nonbinary and does not fit classic subtypes.
• People with neurodevelopmental differences (ASD) or severe mental illness whose gender-related distress presents atypically.
• Context‑dependent dysphoria (e.g., distress only in social situations, while comfortable in private) where standard criteria may not capture impairment fully.

Assessment approach

1. Establish rapport and use inclusive language; document chosen name/pronouns early in the record.
2. Gather narrative history: onset, course, childhood gender experiences (if known), current triggers, supports, and any steps already taken towards social or medical transition.
3. Explore goals and expectations: social transition, hormones, surgery, none of the above; assess capacity for informed decision‑making regarding medical interventions.
4. Screen for comorbid mental health problems (depression, anxiety, PTSD), substance use, self‑harm risk and neurodivergence—these may alter presentation and require integrated care.
5. When history limited, arrange short‑term safety follow‑up and plan for comprehensive assessment when feasible; note the specific reason for using “Other Specified” in documentation.

Immediate management and support

• Address acute risks first—active suicidality or self‑harm requires urgent mental health input and safety planning.
• Provide psychosocial support: counselling, referral to gender‑affirming mental health services, and connection to peer support organisations.
• Ensure respectful care—use chosen name/pronouns and minimise unnecessary questioning that may increase distress.
• Discuss practical supports: workplace/school liaison, legal name/gender marker information, and social transition options where appropriate.

Referral & multimodal care

• Refer to specialist gender clinics when medical transition is sought; ensure multidisciplinary assessment involving mental health, endocrinology and surgical teams as per local pathways.
• Coordinate care for people with comorbidities—integrated treatment plans for mental health, substance use, or neurodevelopmental conditions enhance outcomes.
• Consider involving family or carers with consent, particularly for younger people, to build supportive environments and reduce rejection.

Key clinical points

• “Other Specified” is a pragmatic label—document the precise reason (e.g., late onset, context‑limited distress) to guide follow‑up.
• Prioritise safety, affirming communication, and timely referral to specialist gender services when medical transition is considered.
• Address comorbid mental health and social determinants as part of holistic, person‑centred care.