Gender Dysphoria De-Mystified
By: The Resource Group Team
So What is it Like to be Transgender and Experience Gender Dysphoria
Imagine waking up one morning and looking into the mirror. You don’t see yourself. You see a body. It stares back at you and mirrors your movements but it feels entirely alien. You close your eyes and try to perceive yourself. How you look, feel, and sound. But when you open your eyes again that truest version of you is gone, replaced with some other body. You can’t stand to look at it for even a second longer. You know that your reflection is how the world outside yourself looks at you. And you sink at the realization that no one – not your friends, not your family, not your lovers – have ever actually seen you. The real you is trapped inside this body that makes no sense to you. It doesn’t look like how you feel. You begin to feel homesick for a place you have never been. You can feel the lack of weight on your chest. You can see where your curves aren’t. You feel genuine confusion at the sight of facial hair. You wonder whose body is this, because there is no way it could be yours.
This is how many trans people on the reddit forum AskTransgender respond to the question “What does gender dysphoria feel like?” Gender dysphoria is a complicated and highly personalized psychological concept with no two persons’ experience being exactly the same. Many cisgender individuals (an individual whose gender identity matches their sex assigned at birth) can have trouble conceptualizing what it is like to be transgender and what something like gender dysphoria means. While transgender rights and the trans experience have become increasingly politized, it is helpful to take a step back and look at gender dysphoria from both an anecdotal description of the experience as well as a clinical analysis of the psychological concept.
What are the Clinical Definitions?
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines gender dysphoria as “clinically significant distress or impairment related to a strong desire to be of another gender, which may include desire to change primary and/or secondary sex characteristics.” It is important to note that not all transgender people experience gender dysphoria and not all those who experience gender dysphoria should be considered transgender.
The DSM-5 states that this diagnosis should be considered only after a marked incongruence between one’s experienced/expressed gender and their assigned gender, lasting at least 6 months, as manifested by at least two of the following:
- A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics)
- A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics)
- A strong desire for the primary and/or secondary sex characteristics of the other gender
- A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)
- A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)
- A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)
In order to meet criteria for the diagnosis, the condition must also be associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning. It should be noted that the inclusion of Gender Dysphoria in the DSM-5 as a mental disorder does not imply that a transgender person is necessarily mentally ill. A disorder is a description of something with which a person might struggle, not a description of the person or the person’s identity. A diagnosis for such dysphoria often facilitates access to health care and can guide further research into effective treatments.
How Many People Experience Gender Dysphoria?
Figuring out solid data on the transgender community can be a difficult endeavor. Population-based surveys – meaning those that are designed to allow researchers to generalize findings to the population – rarely ask questions to identify transgender people and, therefore, cannot be used to provide estimates of the size and characteristics of the transgender population. The federal government administers several large, national population-based surveys like the American Community Survey and the National Health Interview Survey that track the demographics, health, and well-being of U.S. residents. Unfortunately, these surveys do not currently measure gender identity.
By using a combination of several state-level population-based surveys and data from the Centers for Disease Control’s Behavioral Risk Factor Surveillance System, we can reliably estimate that around 0.6% of US adults identify as transgender. This works out to be almost one and half million people, slightly more than the population of Maine.
Is Being Transgender a New Concept?
The short answer is: no. While many people believe that there is a new and sudden increase in the amount of transgender people in the Millennial and Gen Z generations, the fact is that transgender people have existed for thousands of years.
Transgender history, in the loosest terms, includes examples of gender variance and gender nonconformity in cultures and societies around the world since at least ancient times. Since this history is prior to the creation of the term “transgender” in modern times, discussions of how to categorize and identify these people can vary wildly and is still subject of considerable debate. This history also spans time frames before the usage of “gender” and associated terms such as “gender identity” and “gender roles” were popularized and put into use in clinical psychology in the mid-twentieth century.
Deviations of the gender binary is something that can be identified as far back as the early Bronze Ages between the sixth and fifth millennium BCE. Sumerian and Akkadian texts from 4,500 years ago document priests known as “gala,” individuals with neither male nor female gender identities. Archaeologists in Europe have found several instances of anatomically male remains being buried in a fashion only reserved for women. A body that is believed to date from between 2900 and 2500 BCE was uncovered in Prague in 2011. Kamila Remišová, the head of the research team, said: “From history and ethnology, we know that when a culture had strict burial rules they never made mistakes with these sorts of things.”
Elagabalus or Heliogabalus – officially known as Antoninus – was Roman emperor from AD 218 to 222. A Roman statesman and historian named Lucius Cassius Dio referred to Elagabalus using feminine pronouns. According to Dio, the emperor reportedly wore makeup and wigs, preferred to be called a lady and not a lord, and offered vast sums to any physician who could provide him with female genitalia.
In the Americas prior to European colonization, as well as in some contemporary North American Indigenous cultures, there are social and ceremonial roles for third gender people, or those whose gender expression transforms, such as the Navajo nádleehi or the Zuni lhamana.
Does Gender Dysphoria = Transgender?
Not always. Not everyone who experiences gender dysphoria is transgender, and conversely, not every transgender person experiences gender dysphoria.
In an article for Everyday Feminism, writer Sam Dylan Finch recalls a conversation with a transgender friend of his. “I remember talking with a friend of mine who is transgender with the assumption that we both experienced dysphoria,” he writes. “At that point, I had never heard of a transgender person not experiencing some kind of dysphoria. But there they were, right in front of me.”
Finch then explains in the article how he came to the understanding that not only do not all transgender people experience gender dysphoria, but believing that comes with several problematic connotations.
The first is that it suggests that gender identity is for outsiders to decide. “When we allow other people to make the rules, we strip away the rights of trans people to self-identify. If we tell trans people that their identities don’t belong to them, we uphold a culture where the naming of gender identities belongs to outsiders instead of ourselves,” he says.
Secondly, it equates being trans with distress and dysfunction. “I want to live in a world where transgender doesn’t equate to pain and suffering. Because ultimately, the pain we feel is not what unites us. It’s the identity we claim and the unique journey we each took to find it,” Finch says.
Lastly, it means that we privilege some narratives over others. “I’m just not interested in creating a power dynamic where some trans people are inherently better, more worthy, more trans, or more important than other trans people. That, to me, is not what social justice looks like,” he writes.
Similar to how not every transgender person experiences gender dysphoria, not everyone who experiences gender dysphoria is transgender.
Late last year, actor Elliot Page came out on Instagram as being transgender and announced that he would be using he/him and they/them pronouns. In an interview with Time, he described the negative impact that the instant fame of Juno (2007) had on him. Having struggled with his gender identity since his youth, seeing photos and videos of himself on a mega-scale was difficult for Page to cope with. “I just never recognized myself. For a long time, I could not even look at a photo of myself,” he said. Page explained that just the act of putting on women’s clothing was a daily struggle throughout the shooting of the film.
In comparison, cisgender actress Amanda Bynes had a strikingly similar experience when filming the 2006 movie “She’s the Man.” According to her interview in Paper Magazine, her role as Viola Hastings had a severely negative effect on her mental health. “When the movie came out and I saw it, I went into a deep depression for four to six months because I didn’t like how I looked when I was a boy,” Bynes said. Bynes said that watching herself on screen, outfitted with short hair, thick eyebrows, and sideburns, was “a super strange and out-of-body experience.”
While Amada Bynes is still cisgender, her experience mirrors closely that of Elliot Page, suggesting that gender dysphoria is not always about being transgender. Rather, gender dysphoria is about not seeing yourself as you believe yourself to be, and that is something that everyone can experience.
What Treatment or Support is Available for Those With Gender Dysphoria?
Not everyone who experiences gender dysphoria will seek out affirming treatment, but for those who do there are many different approaches to take and no two individuals are going to have the same path. Some forms of treatment include:
Changes in gender expression and role
This might involve living part time or full time in another gender role that is consistent with your gender identity.
Medical treatment of gender dysphoria might include hormone therapy or gender affirming surgery.
Behavioral health treatment
This treatment aims to improve your psychological well-being, quality of life, and self-fulfillment. Psychotherapy isn’t intended to alter your gender identity. Instead, it can help you explore gender concerns and find ways to lessen gender dysphoria.
Other ways to ease gender dysphoria might include use of peer support groups, changing your name or pronouns, voice therapy, hair removal or transplantation, binding, padding, tucking, packing, Aesthetic services, such as makeup application or wardrobe consultation, and legal services, such as advanced directives, living wills or legal documentation.
How Effective are These Treatments?
A meta-study conducted by the School of Public Policy at Cornell University reviewed all peer-reviewed articles published in English between 1991 and June 2017 that assess the effect of gender transition on transgender well-being. This totaled 55 studies that focus on this topic. 93% of the studies found that gender transition improves the overall well-being of transgender people while 7% report mixed or inconclusive findings. They found no studies concluding that gender transition causes overall harm.
The researchers also found that the scholarly literature makes clear that gender transition is effective in treating gender dysphoria and can significantly improve the well-being of transgender individuals.
Among the positive outcomes of gender transition and related medical treatments for transgender individuals are improved quality of life, greater relationship satisfaction, higher self-esteem and confidence, and reductions in anxiety, depression, suicidality, and substance use.
Very rarely do individuals express regret after gender transition, and regrets have become even rarer as both surgical techniques and social support have improved. Pooling data from numerous studies demonstrates a regret rate ranging from .3% to 3.8&. Regrets are most likely to result from a lack of social support after transition or poor surgical outcomes using older techniques.
Gender dysphoria and the transgender experience is complicated due to the unreliable nature of historical documentation, the decades of bad science, and the systematic erasure of transgender people throughout history. It is further complicated due to the fact that the experience is something that can vary wildly from person to person and is subjective in nature.
However, making use of the best information we currently have, and approaching the topic with compassion and openness, we can continue to build on the work of millions of activists and researchers and get ever closer to true acceptance and understanding.
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