Some cultures have three or more defined genders. The existence of accepted social categories other than man or woman may alleviate the distress associated with cross-gender identity. For example, in Samoa, the fa'afafine, a group of feminine males, are mostly socially accepted. The fa'afafine appear similar to transgender women in terms of their lifelong identities and gendered behavior, but experience far less distress than do transgender women in Western cultures. This suggests that the distress of gender dysphoria is significantly increased by difficulties encountered from social disapproval by one's culture. Overall, it is unclear whether or not gender dysphoria persists in cultures with third gender categories.
Some cultures have three or more defined genders. The existence of accepted social categories other than man or woman may alleviate the distress associated with cross-gender identity. For example, in Samoa, the fa'afafine, a group of feminine males, are mostly socially accepted. The fa'afafine appear similar to transgender women in terms of their lifelong identities and gendered behavior, but experience far less distress than do transgender women in Western cultures. This suggests that the distress of gender dysphoria is significantly increased by difficulties encountered from social disapproval by one's culture. Overall, it is unclear whether or not gender dysphoria persists in cultures with third gender categories.