Lebogang, a 17-year-old

assigned female at birth, presents at a mental health clinic reporting an

8-month history of significant discomfort with his body, specifically his hips

and breasts. He has expressed a strong desire to prevent the development of

further female secondary sex characteristics and would like to start hormone

treatment. Lebogang prefers masculine pronouns and has adopted a traditionally

male name. He avoids situations where feminine clothing is required and becomes

distressed when addressed as a girl. He reports feeling misunderstood by his

peers and has withdrawn from school activities, citing bullying and worsening

low mood.

Lebogang’s school avoidance

and social withdrawal are best captured by which DSM-5-TR criterion?