The DSM-V, unlike the DSM-IV and ICD-10, separates gender dysphoria from sexual paraphilias and diagnoses it on the basis of a strong conviction that one has feelings typical of the other sex, or a strong desire to be treated as the other sex or be rid of one's sex characteristics.
The second requirement for undertaking hormone replacement therapy is readiness.
This means that the patient is likely to take hormones in a responsible manner; has made progress in addressing other identified problems, leading to improved or stable mental health; and has consolidated gender identity through psychotherapy or by life experience in their desired gender role.
Some organizations—but fewer than in the past—require, based on guidelines such as the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, that patients spend a certain period of time living in their desired gender role before starting hormone replacement therapy.
Male-to-female hormone replacement therapy (MTF HRT) is a type of hormone replacement therapy for transgender and transsexual people.