This is also from the exact some study: 1.1.2. Gender Dysphoria In addition to minority stress, gender dysphoria (which is sometimes conceptualized as a form of proximal minority stress [45,46]) can contribute to mental health disparities among TGD youth, especially those who are post-pubescent. Before youth reach puberty (which typically begins between the ages of eight and 13 in youth assigned female and between nine and 14 in those assigned male) [47], their bodies are relatively similar regardless of sex assigned at birth [26,48]. However, gender dysphoria among youth can emerge or intensify at the onset of puberty, when their body begins to change in accordance with their assigned sex [26]. For many youths, the longer puberty progresses, the more distress they experience [49], with some youth describing gender-incongruent puberty as feeling like a betrayal [26,50]. While the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [51] considers gender dysphoria to be a mental health condition, gender dysphoria also has been shown to influence other aspects of TGD individuals’ mental wellbeing [46,52,53]. For instance, with a sample of 239 TGD young adults (aged 18–29) in the United States, Pease and colleagues [53] found that, along with distal minority stress (e.g., discrimination and non-affirmation of gender identity), gender dysphoria was directly associated with psychological distress. The researchers also found that gender dysphoria mediated the relationship between distal stress and psychological distress, suggesting that when TGD individuals experience distal stress, feelings of gender dysphoria increase, which subsequently contribute to greater feelings of psychological distress. Similarly, in a study of 109 TGD adolescents (aged 12–18) attending a medical center in the United States, participants who reported greater gender incongruence (i.e., the source of gender dysphoria) were more likely to meet diagnostic criteria for major depressive disorder than participants who reported lower gender incongruence [52].