Gender Dysphoria and Islamic Perspectives: Navigating Faith and identity

 

Abstract

Gender dysphoria is an increasingly recognized global phenomenon, yet its prevalence remains underreported
due to stigma and lack of research, particularly i
Manual of Mental Disorders (DSM-5) estimates that gender dysphoria affects 0.005% to 0.014% of individuals
assigned male at birth and 0.002% to 0.003% of individuals assigned female at birth, thou
underestimate the true prevalence. Within Islamic contexts, discussions on gender identity are often shaped by
religious, legal, and cultural perspectives, leading to varied responses ranging from acceptance to complete
denial.
This paper explores gender dysphoria through both medical and Islamic lenses, addressing biological,
psychological, and sociocultural factors. It examines the complex interplay between faith and identity,
highlighting how Islamic jurisprudence has historic
ambivalence toward transgender identities. Key fatwas and legal rulings from different Muslim
countries illustrate the diverse approaches taken by Islamic scholars and governments regarding gend
affirming medical interventions.
Additionally, the paper discusses the significant stigma faced by transgender individuals in Muslim societies,
where they often encounter discrimination, violence, and socioeconomic marginalization. While Western
nations have made strides in legal protections and medical support for transgender individuals, the Muslim
world grapples with reconciling traditional religious teachings with contemporary understandings of gender
identity.
Ultimately, this article underscores the need for a nuanced approach that integrates medical advancements with
theological considerations. Encouraging informed discussions within Muslim communities can foster greater
awareness, reduce stigma, and ensure compassionate care for individuals experiencing gender dysphoria.

Introduction:

Gender dysphoria is a condition characterized by a deep
and persistent discomfort or distress due to a mismatch
between an individual’s assigned sex at birth and their
experienced gender identity. Often the term transgender is used as well, this relates to a person who has taken on
the gender identity not corresponding to their registered
sex at birth. Gender dysphoria is recognized in
the Diagnostic and Statistical Manual of Mental
Disorders, Fifth Edition (DSM-5) as a condition that can
lead to significant psychological distress, social difficulties, and emotional struggles. While gender
dysphoria itself is not classified as a mental disorder, the
distress it causes can have profound mental
implications, including anxiety, depression, and suicidal
ideation if left unaddressed.

In recent years, discussions surrounding gender identity
have become more prominent globally. The prevalence
of gender dysphoria is estimated to be between
to 0.014% for individuals assigned male at
birth and 0.002% to 0.003% for individuals assigned
female at birth, this figure from the DSM
those who have attended a clinic and have been given a
diagnosis of gender dysphoria. Hence these f
likely underreported (Zucker et al 2017). In a 2016 CDC
(Centre for disease control) survey found about 0.6% of
U.S. adults identify as transgender. There has been a shift
in approach since the DSM-5’s rewording from “Gender
Identity Disorder” to “Gender Dysphoria a move to help
reduce stigma.

In the Muslim world, however, gender dysphoria remains
a largely underexplored topic due to sociocultural stigma,
legal restrictions, and religious debates. Many Muslim
majority societies hold strict gender binaries, which can
create significant challenges for individuals experiencing
gender incongruence.From an Islamic perspective, the
discussion around gender and identity is deeply rooted in
religious teachings, cultural traditions, and jurisprudential
interpretations. Islam traditionally recognizes
primary sexes, and religious obligations, inheritance
laws, and social roles are often structured around this
binary framework. However, Islamic scholars and jurists
have also acknowledged individuals who d
these binary categories, such as intersex individuals
(khuntha) and effeminate males (mukhannathun), and
have historically provided legal and social guidelines for
their integration into society.

The discourse surrounding transgender identi
gender dysphoria in Islam is complex and varies across
different Islamic schools of thought. While some scholars
argue that gender-affirming interventions contradict
Islamic teachings on preserving one’s natural form, others
support medical transitions in cases of
psychological necessity. Countries such as
and Egypt have issued religious fatwas permitting gender
reassignment surgery under certain conditions, while
others, like Saudi Arabia and the UAE, strictly prohibit
such procedures for transgender individuals without
intersex conditions.
This paper aims to explore the intersection of gender
dysphoria and Islamic perspectives, focusing on the medical, psychological, and theological
dimensions of the issue. It will ex
treatments, analyse Islamic jurisprudential views, and
discuss the challenges faced by transgender individuals in
Muslim-majority societies. The goal is to provide
a nuanced understanding of how gender dysphoria is
perceived, treated, and debated within the framework of
Islamic faith and identity.

Stigma

While theological interpretations and legal frameworks
shape the discourse on gender identity in Islam, the
everyday experiences of transgender individuals in
Muslim-majority societies tell a different story. Beyond
religious doctrine, deeply ingrained
social exclusion, and systemic discrimination
significant challenges for those navigating gender
dysphoria. In many communities, public discussion on
gender variance remains taboo, leading
to marginalization, limited healthcare access, and
heightened mental health struggles
individuals. Understanding the impact of
societal attitudes is crucial to grasping the full
complexity of gender dysphoria within the Muslim
world.

Data from numerous contemporary western studies have
shown that transgender individuals
stigmatized, bullied and have been victims of prejudice
both overtly and covertly. The 2011 National School
Climate Survey conducted in the USA reported that as
many as 90% of the transgender students had suffered
harassment, and 25% had experienced physical assault
merely because of their gender expression. However,
gender dysphoria awareness is growing in Western
countries. They are opening up to transgender
and talking about the issues that transgender communities
face. Western societies have begun instituting rapid
sociopolitical reforms in favour of transgender rights and
medical assistance is freely access
gender-affirming surgery in line with their gender
expression (National Gay and Lesbian Task Force 2008,
Reisner et al. 2015a).

Although gender dysphoria has been contested globally,
it is challenged to a greater extent in the Muslim world
and is a culturally sensitive topic. Juristic debates aside,
the lived reality of transgender individuals in Muslim
societies is shaped by social attitudes and stigma. A
literature review carried out by Taslim et al (2021)
discovered that social and economic statuses of
transgender individuals are a cause for concern in some Muslim countries such as Malaysia, Indonesia, and
Pakistan. They are marginalised, stigmatised and live in
poverty. They are victims of violence, neglect and lack of
education, healthcare and employment opportunities
(Gibson et al. 2016, Saeed et al. 2018, Shah et al. 2018).
Furthermore, transgender individuals in Pakistan reported
depression, isolation, violence, and rejection in families
and from society and their communitie
experiences raise their lifetime risk of anxiety,
depression, and suicidal ideation to higher levels than in
the general population (Faiza et al 2024). Research has
demonstrated familial rejection as one of the largest
stressors, most of the transgenders are rejected or kicked
out of their homes, thereby becoming homeless and
economically helpless (Brennan et al., 2017). There is
minimal or no representation of transgender
from Arab nations or the rest of the Muslim countries
indicating avoidance or lack of attention on transgender
matters in these countries.

Additionally, high prevalence of human
immunodeficiency virus and other sexual transmitted
diseases among local transgender individuals in these
developing countries further stigmatises them and is also
a major public health issue that has raised international
concern (Akhtar et al. 2012, Wong 2012, Gibson et al.
2016, Barmania&Aljunid 2017, Vijay et al. 2018, Akhtar
et al. 2020, Robbins et al. 2020)

Scientific Explanations of Gender Dysphoria

Beyond societal perceptions, scientific research has
sought to understand the origins of gender dysphoria
through biological, genetic, and psychological lenses.
While stigma and cultural opposition persist, emerging
evidence from neuroscience and endocrinology suggests
that gender identity is influenced by complex biological
and environmental factors.
The aetiology of gender identity remains elusive. There
are no definitive extrinsic or intrinsic stimuli or
motivators identified that can fully explain why
transgender individuals are as they are.This uncertainty
about transgender aetiology has caused scepticism about
its legitimacy and is the root cause of the universal
debate and controversy that surrounds it. However,
transgenderism has gained huge media attention, public
interest, and awareness over the last 2–3 decades, at the
global level. During this time, academic literature and
multi-disciplinary research output on this subject have
also increased exponentially to highlight the social,
economic, behavioural, and health aspects of the
transgender community.

Biological factors

The presentation of gender dysphoria has been
considered as a complex interaction of genetic, hormonal,
and environmental factors. There may also be some
evidence of differences in brain development and
physiology. Twin studies have implicated a genetic role
in the formation of gender identity with additional
environmental contributors. In a large
of Dutch twins (N=23,393) aged 7 and 10 (Coolidge et
al, 2002), monozygotic (MZ) and dizygotic (DZ) twins
were compared; genetic factors contributed to 70% of
cross-gender behaviour (as assessed via the two CBCL
gender items). Another study of 314 mono
and dizygotic (DZ) twins (mean ages 9.4 and 10.1 years,
respectively) roughly replicated this finding, with genetic
factors contributing up to 62% of the variance on a
DSMIV-based gender dysphoria scale (Coolidge et al,
2002). In animal studies, where prenatal hormones can be
manipulated, the strong effect of prenatal testosterone on
gender role behaviour is clear (Hines, 2011). Individuals
with a disorder of sex development may be exposed to
high levels of prenatal testosterone, and individual
two X chromosomes with congenital adrenal hyperplasia
(Merke& Bornstein, 2005) do have higher rates of gender
dysphoria and cross-gender identification (Pasterski et al,
2015). However, the majority of female-raised
individuals with congenital adrenal hyperplasia (CAH)
(95%), appear to develop a female gender identity
(Dessens et al, 2005). Other evidence for the importance
of prenatal testosterone comes from studies in XY
individuals with complete androgen insensitivity
syndrome who lack the receptors necessary to respond to
endogenous testosterone. The vast majority of these
patients develop a female gender identity, suggesting that
downstream testosterone signalling may be important for
the development of a male gender identity (Hines, 2015).
Some have noted that these patients were reared
unambiguously as females and that social factors may
have played a strong role in their female identity
formation (Hines, 2009). Some studies have shown that
those with complete androgen insensitivity syndrome
have lower scores on female identity scales (Richter
Appelt et al, 2005) and there are case reports of gender
dysphoria ultimately leading in these patients to gender
affirming surgeries (T’Sjoen et al, 2011). This could be
secondary to the psychological stress of learning about
the diagnosis, as well as the possibility of undetected
functional androgen receptors (Steensma et al, 2013a).
Overall, studies of gender identity in individuals with
disorders of sex development, while implicating
androgens in the development of gender identity, have
yet to show a direct relationship.

Psychosocial factors

There have been no proven psychosocial factors in the
development of gender identity. Mothers of gender
dysphoric boys have been noted to have higher scores on
the Beck Depression Inventory and the Diagnostic
Interview for Borderlines (Marantz & Coates, 1991), but
these higher scores might be due to external pressures
placed on these parents by unaccepting social
environments and such studies cannot determine the
direction of causation. One study noted that gender
dysphoric boys were rated as more feminine and
“beautiful” by blinded college students (Zucker et al,
1993), while another study of gender dysphoric girls
showed that these girls were rated as less “cute” (Fridell
et al, 1996), raising the question of whether perceived
physical appearance and resultant social treatment may
contribute to gender incongruence.

Cultural factors

Culture plays an important role in the gender
determination of patients with atypical somatic sex
development (Kuhnle&Krahl, 2002; Meyer
1998). Cultural influences may contribute to patients
with Disorders of Sexual Development (DSD) and their
families’ acceptance or rejection of their assigned gender,
to the psychosexual development of the patient, and
medical management. There are reports from several
countries such as Saudi Arabia (Taha, 1994), Turkey
(Özbey, Darendeliler, Kayserili, Korkmazlar, & Salman,
2004), and Egypt (Zainuddin and Mahdy 2016) that
indicate increased rates of assignment to the male gender
regardless of karyotype, gonadal makeup, and fertility
potential, because the male gender has a dominant role in
society and is thus the preferred sex. In India and
Pakistan, DSD children are more likely to be raised as
males simply in order to ensure a better future for these
children when they grow up (Warne & Raza, 2008). Even
if they are infertile as males, they are more likely than
infertile females to achieve economic independence.

Gender identity and Autism

People who do not identify with the sex they were
assigned at birth are three to six times as likely to fall on
the autistic spectrum compared to cisgender (denoting or
relating to a person whose gender identity corresponds
with the sex registered for them at birth) individuals
according to the largest study yet to examine the
connection (Warrier et al 2020). Gender-diverse people
are also more likely to report autism traits and to suspect
they have undiagnosed autism. A number of studies show that autism spectrum disorder (ASD) symptoms are over
represented among transgender individuals. Autistic
females seem to experience this more than Autistic males
(Cooper et al 2018). The rate of ASD among the general
population is estimated at around 1% (Lai et al, 2014).
Clinical level rates of ASD symptomatology in
transgender adults have been reported in 5-20% (Jones et
al, 2012; Pasterski et al, 2014; Pohl et al, 2014).
Although to date definitive findings have not been
shown.

Gender identity and Islam

As scientific research continues to uncover the
underlying mechanisms of gender dysphoria, these
findings raise important theological and ethical questions.
How do Islamic teachings reconcile the existence of
gender dysphoria with religious doctrines on gender and
creation? The following section explores how Islamic
scholarship has historically addressed gender variance
and how contemporary scholars interpret these
developments.

Historically, Middle Eastern, North African and
European cultures recognized and had terms for
transgender individuals. This includes “hijra” in
subcontinent, “Mukhannath” in Islam and Arabic
cultures, “Phrygia” in ancient Greek, and “Cybele” in
ancient Roman. These individuals were often intersex
people or natal males castrated for religious or other
reasons. It is important to note that the recognition did
not necessarily protect these individuals from stigma and
marginalization, and in some places like the
subcontinent, Hijras, although believed to have power to
remove a “bad spell” from newborns, were highly
stigmatized. Meanwhile there have been new movements
to support and protect transgender in this
region. The Rights of Transgender Persons Bill, which
provisions anti-discrimination and employment for
transgender individuals, was introduced in 2014 in India
it may result in positive changes in the future.

The traditional gender binary constitutes an integral
aspect of Islamic social ethics, which has a pivotal role in
shaping religious obligations, legal proceedings, and
interpersonal judgments within Muslim communities.
Within the familial sphere, this gender binary
underscores fundamental responsibilities encompassing
parenthood, filial duties, and inheritance rights.

Unlike gender dysphoria, intersex individuals have a
clearer standing in Islamic law. Intersex are individuals
who have reproductive or sexual anatomy that doesnt fit into an exclusive male or female classification. Out of
every 1000 to 4500 births, approximately one case
involves the presence of atypical genitalia, previously
referred to as ambiguous genitalia (Congress House
Report, 2023). Besides ambiguous genitalia, other
disorders of sex development (DSDs) also include
genetic conditions such as Klinefelter or Turner
syndrome that rarely present ambiguous genitalia
(Nowotny&Reisch, 2023). DSDs are not restricted to
medical discussions, but their psychosocial aspects have
also attracted much attention from gender and sexuality
researchers, who have also investigated the religious
aspects, such as in the field of Islamic jurisprudence

It is agreed that the Quran unequivocally states that there
exist two biological sexes. This distinction is
fundamental to the Shariah, permeating various aspects
of life and articulated in the chapters of Islamic juristic
texts from the chapter of cleanliness (taharah) to matters
of inheritance (mirath), each gender carrying its own set
of rights and responsibilities. It is essential to understand
that gender dysphoria, the feeling that one’s biological
sex does not align with their gender identity, is
recognized in Islam as a valid emotional experience.
Within these variations, one can categorize individuals.
as intersex (khuntha), effeminate (mukhannath), or
masculine women (Mutarajjilah). Notably, Islamic
jurisprudence (fiqh) literature addresses these distinctions
by assigning distinct legal regulations to each of these
categories (Haneef, 2011) Shariah respects the
complexity of human emotions and identities but
underscores the significance of adhering to established
gender roles and distinctions, recognizing that human
beings are multifaceted and that not every feeling should
lead to action (Fiqh Council of North America, 2022). In
fiqh, the matters concerning intersex and transgender
individuals are typically considered exceptional cases, as
they involve atypical sexual development and ambiguity
in biological sex recognition, which fall outside the
norms and generally perceived notions discussed in the
Quran and ḥadith.

Further exploration of how these were described and
managed historically are found in the following
definitions. Khuntha (hermaphrodite/intersex) refers to
an individual who either does not have male and female
genitalia or has both (Al-Kasani, 1986). Al-Nawawi
(1991) classified hermaphrodites into two distinct
groups: (1) those with ambiguous or problematic
genitalia (khunthamushkil) and (2) those with non
problematic or unambiguous genitalia (khuntha ghayr
mushkil). The latter group includes individuals with both
male and female genitals, yet their social/legal gender
assignment is typically based on the genitalia with more predominant functionality. In contrast, the former group
includes individuals who do not conform to the
conventional binary gender classification because their
genital organs may be either fully functional or non
functional, but they have an alternative anatomical
structure for excretion.

In a report from Sunan al-
companion of the Prophet (PBUH
was asked about the inheritance rights of an intersex
person, specifically regarding whether their inheritance
should be determined based on their male or female
characteristics. His response was, “according to how they
urinate” (Book 21, Hadith 2880). This tradition appears
to have fixed the benchmark of social/ legal gender
assignment in the case of khuntha. Classical Muslim
jurists recognized the social/legal gender of Khuntha
based on the functioning of urinary orifices and also by
the signs of puberty as a secondary option.

Additionally, in cases where no conclusive biological
indicators were present, these jurists considered feelings
or sexual attraction as a means to determine social/legal
gender (Collier et al 2013). Following progress in
medical technology, the above-mentioned criteria of
social/legal gender assignment have been updated and
“the distinction today should be between a real
hermaphrodite’ (who has both testicles and ovaries) and a
‘pseudo-hermaphrodite’ (khuntakadib), who is born with
either ovaries or testicles but has external sexual
characteristics that are different from those expected
when looking at the gonads” (Tolino, 2018, p. 233). With
the aid of modern medical tests and scientific
advancements, it has become possible to recognize the
biological sex of intersex individuals with greater
precision. This can be achieved through examinations to
identify the presence of internal structures such as
testicles or ovaries, sex chromosomes, the womb,
fallopian tubes, and other characteristics that may not be
externally visible.

Social/legal gender assignment of intersex individuals
can also be based on psychosocial studies, which
demonstrated that some disorders of sex development
arising from specific genetic conditions predispose
individuals to identify more predominantly with one
particular gender. For example, in the case of individuals
with 46, XX CAH (congenital adrenal hyperplasia) with
Prader stage 4 or 5, assignment to the female gender at
birth appears justified even in severely masculinized
cases whereby the intact and functional clitorophallus is
commonly surgically reduced, because of a much higher
incidence of serious gender identity problems among those raised as males compared to those raised as females
(Dessens et al., 2005). Nevertheless, for such individuals
raised as females who develop gender dysphoria later in
life, as reported by the case study of Zainuddin and
Mahdy (2017), gender reassignment may be considered.
For individuals with 46, XY CAIS (complete androgen
insensitivity syndrome), assignment to the female gender
at birth is justified by the relatively low incidence of
gender dysphoria (1.7%) among those raised as females
(Babu& Shah, 2021), even though the testes may be fully
functional but are often removed. By contrast, for
individuals with 46, XY 5-alpha reductase deficiency
who were raised as females, there was a significantly
higher incidence of gender dysphoria (53%), which made
gender assignment at birth much trickier (Babu& Shah,
2021).

Mukhannath (effeminate male) is indirectly referred to in
the Quran by the term ghayr uli al-Irbah (This term also
refers to old men and those with low IQ who have lost
any sexual desire) which literally means “male attendants
free from sexual desire” in Surah al-Nur: 31 (al-Qurtubi
2003). Mutarajjilah is the corresponding term to
Mukhannath which refers to a masculine woman.
Efeminate male (Mukhannath) refers to those who are
anatomically male but exhibit female traits like gait,
speech, dressing, and posture (Haneef, 2011). The
masculine woman (Mutarajjilah) is vice versa. Regarding
Mukhannath, a ḥadith reported by Ummu Salamah gives
some important insights. She said, “When the Prophet
(PBUH) was with her, there was an effeminate man in
the house. The effeminate man said to Ummu Salama’s
brother, ʿAbd Allah ibn Abi Umayyah, if Allah should
make you conquer Taif tomorrow, I recommend that you
take the daughter of Ghailan (in marriage) for (she is so
fat) that she shows four folds of flesh when facing you
and eight when she turns her back. Thereupon the
Prophet (PBUH) said (to us), this (effeminate man)
should not enter upon you (anymore)” (Al-Bukhari
1987). This ḥadith portrays two aspects of the treatment
of Mukhannath. Firstly, Mukhannath was identified
along with their distinctions, generally accepted in so far
as they were permitted to mingle with females in a
society where gender segregation was a predominant
social norm (Mohamad Rusli&Azmi, 2021).

It must be the Prophet (PBUH)’s tacit approval for
mukhannath as a special case, giving them freedom of
interaction with women (Tolino, 2018). But, once they
were noticed as describing women with intimate details
that were likely to arouse erotic feelings in a man, they
were banished.

Contrasting Healthcare Approaches: West vs Islam

Available treatments

Given the diverse Islamic perspectives on gender
identity, the question of medical intervention remains a
subject of debate. In Western contexts, gender dysphoria
is typically managed through a combination of
psychological support, hormone therapy, and surgical
options. However, these treatments raise theological and
ethical concerns within Islamic discourse, particularly
regarding bodily modification and the notion of altering
God’s creation.

The approaches to treating gender dysphoria in the West
and the Islamic world differ significantly due to
variations in medical, psychological, socio
religious perspectives. The West has developed a
structured medical framework for gender
whereas Islamic perspectives, influenced by religious
jurisprudence, show a spectrum of responses ranging
from acceptance to prohibition.

In Western societies, treatment for gender dysphoria has
evolved into a multi-faceted approach that includes
medical, psychological, and surgical interventions.
Psychological therapy plays a critical role in supporting
transgender individuals before and after
transitioning.Gender identity clinics offer counselling,
voice training, and peer support to help individuals cope
with dysphoria.Social transitioning, such as changing
names, pronouns, and appearances, is encouraged as a
non-invasive step.

Medical interventions for gender dysphoria range from
hormonal treatments to moreinvasive surgical
procedures. Oestrogen is given to transgender women to
induce feminization.Testosterone is given to transgender
men to induce masculinization.
have been linked to improvements in mental health and
quality of life, reducing depression and anxiety. Puberty
blockers were previously used to delay puberty for
transgender youth, allowing them time to explore their
identity before making irreversible changes. This has
been severely restricted in the UK pending safety reviews
since 2024due to concerns over safety and long
outcomes, but is still available in some parts of the US
and Europe.

Lastly, surgical interventions include top surgery which
involves breast removal for trans men or augmentation for trans women and bottom surgery which involves
genital reconstruction surgeries such as vaginoplasty or
phalloplasty. Other procedures are facial
feminization/masculinization which involves procedures
to alter facial features.The effectiveness of surgeries in
improving quality of life is debated, with some studies
showing improvements while others highlight risks such
as regret or medical complications.

Evidence so far

A growing body of evidence suggests that medical
interventions can significantly improve mental health
outcomes for gender dysphoric individuals. Studies show
notable improvements in anxiety, depression, and overall
quality of life (Costa & Colizzi, 2016; Nguyen et
2018; Rowniak et al., 2019).Hormone therapy has been
linked to better psychosocial well-being and mental
health resilience. Surgical procedures have been found to
enhance quality of life, particularly for transgender men
(Defreyne et al., 2017; Passos et al., 2020) and
transgender women (Zagami et al., 2019).Most studies
indicate no immediate post-operative mental health
improvements, but significant benefits emerge after more
than six months.Some research suggests a ceiling effect,
where prior hormonal therapy already improves mental
health, limiting the additional gains from surgery. The
quality of studies varies from medium to weak, often due
to small sample sizes, high risks of bias, and lack of
control for confounding factors (Baker et al., 2021;
Dhejne et al., 2016).There is a lack of qualitative
research capturing the personal experiences of gender
dysphoric individuals before and after medical
interventions.

For some gender dysphoric individuals, medical
interventions may not be necessary or available.
Alternative interventions include gender
psychotherapy. This provides a supportive environment
to explore gender identity (Austin & Craig, 2015).Peer
support groups help individuals build resilience and
reduce isolation. Other non-medical strategies can also
help manage gender dysphoria, including:Breast binding
(for transgender men), genital tucking (for transgender
women), body sculpting exercises and voice and
communication therapy. There is little research on the
mental health impact of these non
interventions.No known systematic reviews examine
their effectiveness in reducing gender dysphoria.
Even with medical and non-medical interventions, mental
health outcomes for gender dysphoric individuals depend
on broader social factors.Peer-support networks,
community connectedness, and safe spaces play a critical role in mental health resilience (Matsuno& Israel, 2018;
Pflum et al., 2015; Puckett et al., 2019).
chosen names by family members is associated with
reduced depressive symptoms and suicidal ideation
(Russell et al., 2018).Having role models and supportive
online communities contribute to better mental health
outcomes (Pilecki, 2015).Post
well-being improves when individuals receive strong
social support (Schultz, 2002).Furthermore, recent
research suggests that the presence of autism spectrum
disorder (ASD) is higher among transgender individuals
(Thrower et al 2020), raising
consent and decision-making capacity.

There is a need for high quality research and rigorous,
prospective studies measuring pre
outcomes.Future reviews need to examine all types of
interventions, including m
social, and adaptive strategies.Research should also focus
on the relative effectiveness of different interventions on
mental health outcomes.Addressing gender dysphoria
alone may not be sufficient to improve mental
health.Social, psychological, and structural factors must
also be considered.

This evidence so far highlights the positive impact of
gender-affirming medical interventions while
emphasizing the importance of social support and
alternative interventions. It also unders
current research, particularly the need for higher
studies and qualitative research. A holistic approach that
integrates medical, psychological, and social support
systems is crucial for improving mental health outcomes
in gender dysphoric individuals.

Islam

Islamic perspectives on gender identity are more complex
and vary across different schools of thought. The
approach to treatment largely depends on whether gender
dysphoria is considered a valid medical condition or a
social/religious issue.

Traditional Islamic texts recognize intersex individuals
(Khuntha) and have legal frameworks for their social
inclusion.The concept of transgender identity
(Mukhannath) existed historically but was often linked to
eunuchs or those with ambiguous biological traits.There
is a clear divide in Islamic rulings:Permissive Stance
(Shia View):Iran allows gender
on Ayatollah Khomeini’s 1987 fatwa.The Iranian
government provides financial aid for transgender
individuals to transition.Restrictive Stance (Sunni View):Countries such as Saudi Arabia, Egypt, and the
UAE prohibit gender transition unless the individual has
a disorder of sex development (DSD).Fatwas from Sunni
scholars emphasize the immutability of biological sex,
discouraging transitions based on gender identity alone.
Lastly, there is the conditional stance (some Sunni
scholars):Some scholars, such as Sheikh Tantawi of
Egypt, have allowed surgeries if they are medically
justified by a doctor.

Mental health support for gender dysphoric individuals is
minimal due to stigma and a lack of medical
recognition.Social rejection is high, with many
transgender individuals facing economic hardship,
homelessness, and violence.Unlike in the West, where
gender clinics exist, Muslim-majority countries often
lack formal institutions to support gender
individuals.Hormone therapy is rarely provided unless
medically justified by a diagnosed intersex
condition.Gender reassignment surgery is mostly illegal
or inaccessible, except in Iran.Alternative approaches
include religious counselling and psychotherapy, often
aimed at discouraging transition rather than affirming
gender identity.

In managing Muslim patients with disorders of sex
development (DSD), clinicians should not foc
on the medical and psychological aspects, but also
recognize the religious aspects in communities where
religion plays a large part in the daily lives of the
individual and the family (Al Jurayyan, 2011; Dessouky,
2001; Warne & Raza, 2008): “The clinician’s role is not
to superimpose her/his cultural values on those of others,
but to come to a decision that likely minimizes potential
harm to the patient in his/her cultural environment”
(Meyer-Bahlburg, 2001). The Muslim DSD patient may
be living in a community where the Muslim culture is not
dominant in which case the Islamic aspects of gender
related issues may not be recognized or considered unless
the patient his/herself or the family or the clinician are
aware of these and bring it up for consideration.

There is a disparity in Islam on how gender dysphoria
and DSD are managed, it would make sense to include a
religious authority in the multidisciplinary team that
manages these patients in Islamic countries. As many
decisions made in the course of the clinical management
of individuals with gender dysphoria and DSD affect the
religious aspects of life and, therefore, the outcome of the
individual patient, their families, and the community. It
will be helpful to consider both the religious authori
and medical experts to cooperate with and educate each
other about the various aspects of care of the patient withgender dysphoria/DSD. The confidentiality of
information exchanged with regard to the patients and
their families is highly important, keeping in mind
the aim is the achievement of optimal outcome for the
patient and families living in still quite stigmatising
societies.

Persistence of Gender Dysphoria from Childhood to Adolescence

A key consideration in the medical and religious
discourse on gender dysphoria is whether the condition
persists from childhood into adulthood. Some Islamic
scholars argue that early signs of gender dysphoria may
be temporary and, therefore, should not warrant
irreversible medical interventions. However, longitudinal
studies suggest that while some children may desist,
others continue to experience gender incongruence well
into adulthood.

Follow-up studies have classified participants as either
“persisters” or “desisters” with regard to gender
dysphoria using various metrics (semi
interviews based on DSM criteria for gender identity
disorder, dimensional scores on standardized
questionnaires, etc.). A 10-year follow up study (Ristori
and Steensma 2016) summarized and reported that the
percentage of participants classified as persisters ranged
from 2% to 39% (collapsed across natal boys and girls).
In one study (Wallien& Cohen
percentage of natal girls who were “persisters” was
substantially higher than the percentage of natal boy
(50% vs. 12%), but in two other studies from the same
clinic the percentage was similar across natal sex
(Drummond et al, 2008; Singh, 2012). A criticism of
these studies is that either formal diagnostic criteria were
not used or that subthreshold cases were included. These
subthreshold cases may have included individuals with
cross-gender interests or behaviours who did not actually
identify as transgender. Hence these patients did not
identify as transgender at follow-up. Some studies have
found that threshold cases were more likely to be
classified as persisters (Steensma et al, 2013b), but other
have not (Singh, 2012).

It has also been suggested that more recent cohorts (after
the year 2000) have found higher rates of persistence
(12% to 39%) (Zucker& Bradley, 1995; Wallien&
Cohen-Kettenis, 2008; Drummond et al, 2008; Singh,
2012) than older cohorts (2% to 9% prior to 2000)
(Green, 1987; Zucker et al, 1999), suggesting that, as
society becomes more accepting of these individuals, fewer report “desisting,” which may represent going back
into the closet due to social pressures rather than a true
desistence of cross-gender identification. Comparisons of
persisters with desisters have found that the intensity of
gender dysphoria (using dimensional metrics)
at the time of assessment in childhood, a lower social
class background, and having a female gender assigned at
birth are associated with higher rates of persistence
(Steensma et al, 2013).

Despite this work, it remains difficult to predict t
likelihood of cross-gender identification persistence from
childhood into adolescence for an individual child
(Steensma et al, 2013). Persistence of gender dysphoria
from adolescence to adulthood in contrast to the low rates
of persistence from childhood into adolescence, it seems
that the majority of transgender adolescents persist in
their transgender identity (Cohen-Kettenis&Pfäfflin,
2003). In a study of 55 transgender adolescents receiving
gender affirmative care, 100% continued to identify as
transgender in young adulthood (deVries et al. 2014).
Larger longitudinal studies such as this are needed.
Childhood Gender Variant Behaviour and Sexual
Orientation Childhood gender variant behaviour has been
found to be a strong predictor of a same-sex sexual
orientation in adulthood (using gender assigned at birth
as a reference point). In a study of 879 Dutch boys and
girls, gender variant behaviour was assessed using the
Child Behaviour Checklist (CBCL) and sexual
orientation was assessed 24 years later (Ste
2013c). It was found that the prevalence of a same
sexual orientation was, depending on the domain
(attraction, fantasy, behaviour, and identity), between 8.4
and 15.8 times higher in the gender variant subgroup as
compared to the non-gender-variant subgroup.

In summary, the current literature, though limited,
suggests that the majority of gender nonconforming pre
pubescent children will grow up to endorse identification
as cisgender individuals with either a bisexual or a same
sex sexual orientation (Wallien& Cohen
Singh et al, 2021; Green, 1987).

Two main contemporary fatwas that were issued to do the with gender dysphoria

The first one was by a Sunni Mufti of Egypt, Tantawi
This was following the case of a male patient who
experienced gender dysphoria affecting his mental health.
The psychologist treating him referred him for sex
reassignment surgery. The surgeon referred him for a
second opinion to another psychologist who concurred that he needed sex reassignment surgery to treat his
depression. The patient then addressed herself as
female.The medical university he was studying at didn’t
accept his new gender. This case was eventually brought
to Tantawi. He satisfied all c
by first referring to the scriptures (Quran and Hadiths)
before moving to the second stage: doing ijtihad through
his opinion (ray) and analogy (qiyas) (Alipour 2017). As
a Sunni scholar under the Shafii school of thought,
Tantawi followed this legal school in resorting to ijtihad
by only doing it if: a) one has sufficient knowledge and
skill to first return issues into Quran, Hadiths, and a
consensus of Muslims; when these sources are found not
to deal sufficiently with certai
return the cases involved to qiyas or analogy (Al
1938). Transwomen did not nominally exist during the
Prophet (PBUH)’s time, hence resulting in this ijtihad
decision. In Alipour’s work, the explanation of the
Tantawi fatwa is clarified: Based on Al
understanding of the Hadith, Tantawi acknowledged that
the Prophet (PBUH) did not forbid the hermaphrodite
and mukhannath from entering the women’s quarters
until he heard them giving a description of the women in
great detail. Tantawi thus concludes that the person who
is naturally a hermaphrodite or a mukhannath is not to be
blamed but, as s/he has a disease, s/he must be cured.
Tantawi, however, excludes persons who are not
mukhannath by nature.
The second main fatwa issued was by Khomeini. This
was prompted again by a male who felt like a female and
started dressing up like one. He personally took his case
to Khomeini who then after consulting 3 medical doctors
gave the fatwa. He did not cite the Quran or Hadith
sources that influenced him in making his fatwa.
However, he used a similar ijtihad method within the
Shia context. He applied the ijtihad method of al
al-Fiqhiyyah (Islamic legal maxims) and al
Amaliyyah (procedural principles) because there is
nothing in the scriptures, Quran, or hadiths that clearly
refers to being transgender (Alipour, 2017). There are
two legal maxims through al
Khomeini used in making the decision. Firstly, the
“principle of permissibility” (isalat a
secondly, the “principle of lawfulness” (isalat al
hillyyah), support the Shi’a belief that everything, or
every action, that cannot be clearly regarded as being
forbidden or permissible in Islam, is permitted and lawful
(Alipour, 2017).These general maxims are also in line
with the Islamic jurisprudence principle of “necessity
overrides prohibition”, as long as those things or actions
are not clearly prohibited in conventional Islamic
sources.

One of the points of difference between the fatw
Khomeini’s fatwa on gender-affirming surgery was more
insistent in getting a medical doctor’s permission, it
states “In the Name of God sex-reassignment surgery is
not prohibited in sharia law if reliable medical doctors
recommend it. Inshallah you will be safe and hopefully
the people whom you had mentioned might take care of
your situation” (cited in Alipour 2017).
Alipour concludes his explanation of Tantawi’s fatwa
when he states:“To sum up: It is permissible to perform
the operation in order to reveal what was hidden of male
or female organs. Indeed, it is obligatory to do so on the
grounds that it must be considered a treatment, when a
trustworthy doctor advises it. It is, however, not
permissible to do it at the mere wish to change sex fro
woman to man, or vice versa (2017, p. 97)”.
Both Tantawi and Khomeini, in issuing the fatwa, have
explained the Islamic jurisprudence principle “necessity
overrides prohibition”, in which a gender transition
through gender affirming medical intervention
accepted as it becomes permissible given the desperate
need of transgender individuals as part of a medical
remedy (Alipour, 2017; Barmania&Aljunid, 2017). In
recent times, this has been extended to include social
welfare to support freedom, human dignity and human
fraternity (Al-Qaradawi, 1999), fundamental rights and
liberties, economic development, as well as research and
development in science and technology (Kamali, 1989).
One view point for surgical treatment for gender
dysphoria as stated by Sarcheshmehpour et al. (2018) in
their conclusion: “they should not be prohibited
according to Islamic ethics and their surgical treatment
should not be considered as a manipulation of Allah’s
creation”.

On the other hand, the Fiqh Council of North America
(FCNA) has addressed the topic of transgender
individuals in a comprehensive fatwa authored by
Dr.YasirQadhi. The fatwa emphasizes the Quranic
perspective that humanity is created from a male and a
female, underscoring a fundamental gender binary. It
acknowledges that while feelings of gender dysphoria
might be beyond one’s control and are not sinful if not
acted upon, Islam distinguishes between feelings, actions,
and identity. The fatwa explicitly prohibits cross-dressing
and any deliberate attempt to appear as the opposite
gender. Regarding gender reassignment, the FCNA
deems it impermissible to actively attempt to change
one’s biological sex or gender through medical
interventions, except in cases involving intersex
individuals which has a clearer ruling.

Conclusion

The intersection of gender dysphoria and Islamic
perspectives presents a complex and evolving discourse
that requires careful consideration of medical,
psychological, theological, and social factors. While
gender dysphoria is now well-documented in medical
literature and recognized as a legitimate condition
requiring compassionate care, its acceptance and
management within Islamic jurisprudence remain a
subject of ongoing debate.

Islamic teachings uphold the binary framework of
gender, which forms the basis for religious obligations,
inheritance laws, and social roles. However, classical
Islamic scholarship has historically acknowledged
intersex individuals (khuntha) and effeminate males
(mukhannathun), offering specific legal rulings for their
inclusion in society. The more recent discourse on
transgender identity has led to divergent fatwas, with
some scholars permitting gender-affirming medical
interventions as a form of treatment, while others strictly
prohibit elective transitions as an alteration of God’s
creation.

Across the Muslim world, transgender individuals
continue to face social stigma, discrimination, and legal
restrictions, leading to mental health struggles, economic
hardships, and societal exclusion. Some countries, like
Iran and Pakistan, recognize transgender rights to varying
degrees, while others, like Saudi Arabia and the UAE,
impose legal and religious barriers against gender
transition. The lack of open discussion and safe spaces
further exacerbates the challenges faced by those
experiencing gender dysphoria within Islamic
communities.

From a medical perspective, gender-affirming treatments
such as hormone therapy and surgery have been shown to
improve the mental health and well-being of transgender
individuals. However, recent shifts in Western medical
policies, particularly the increasing scrutiny of hormone
therapy for minors, indicate that the field is still evolving.
Islamic medical ethics must engage with these
developments to ensure that any intervention aligns with
both scientific evidence and religious considerations.

Moving forward, it is crucial for Islamic scholars,
healthcare professionals, and policymakers to engage in
compassionate, evidence-based discussions on gender
dysphoria. A more nuanced, interdisplinary approach
one that integrates faith, science, and mental health
awareness, can help foster greater understanding, reduce stigma, and provide practical guidance for those
navigating gender dysphoria within the framework of
Islamic beliefs.

Ultimately, as society continues to evolve, there is an
opportunity for Islamic perspectives on gender identity to
be revisited with greater emphasis on human dignity,
justice, and compassion- principles that are deeply rooted
in Islamic tradition

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