As a follow-up to my last post I’m going to talk about Gender Dysphoria. What it is, what it feels like, why it is different from conditions such as body dysmorphia, and how it is treated.

What is it?

Gender Dysphoria (GD), also called Gender Identity Disorder (GID), is a medical diagnosis that describes a feeling of discomfort with one’s assigned gender. This discomfort stems from a mismatch between a person’s innate sense of themselves — their gender identity — and a combination of their physical characteristics and societal expectations of roles (appearance and behavior) for their assigned gender.

How does it feel?

Discomfort is a very loose term. You might feel discomfort if your clothing is too tight, or if asked to speak in front of an audience. There comes a point with discomfort, because of either the length of time you have suffered it or its degree, when it becomes more than you can endure.

Most forms of discomfort can be easily avoided. Take off the tight, scratchy sweater. Leave the noisy, crowded party. But when the cause of your discomfort is your own body there’s no escape.

The clichéd popular view of GID is that (for a trans woman) you are a woman “trapped” in a man’s body. But that’s not accurate: it’s more like feeling that the gender-specific aspects of your body are foreign, alien. That they don’t belong. Some people with GID even feel disgusted by them.

My own view is that I have a birth defect that caused my body to develop incorrectly. As its departure from my self-image became more marked following puberty, so my discomfort grew. I’ve never felt that I had “the wrong body”: it’s mine and mine alone. It’s just malformed because it looks male.

Isn’t that like body dysmorphia?

Body dysmorphia, or body dysmorphic disorder (BDD), is a psychological condition in which the sufferer believes that their physical appearance is defective, deformed or ugly. This belief persists despite evidence to the contrary. The condition is related to OCD and is generally treated in the same way using psychological therapies such as Cognitive Behavioral Therapy. Cosmetic surgical procedures rarely have successful outcomes as a treatment for BDD.

On the surface GD and BDD might appear similar. Both are conditions where the sufferer is not content with their body. But GD is certainly not the same as BDD as key characteristics illustrate.

Gender Dysphoria

• Accurate view of one’s physical appearance.
• Not a psychological disorder.
• Evidence suggests a physiological cause (such as abnormal hormone levels during fetal development).

Body Dysmorphic Disorder

• Distorted view of one’s physical appearance.
• Is an anxiety disorder.
• Significant correlation with emotional trauma and/or abuse during childhood.

Treatment

The principle behind treatment for GID is simple: since the dysphoria is caused by a person’s gender identity being at odds with their gender presentation — the way they look and act — it may be ameliorated by modifying this presentation.

Historically there have been efforts to modify a person’s gender identity through therapy, medication and what can only be described as torture. As with similar efforts to change a person’s sexual orientation, these are ineffective and even harmful. The overwhelming consensus these days is that the most effective treatment is to assist the person in altering their gender presentation. How this is achieved varies depending on the individual. There are a number of complementary approaches ranging from changing hair styles and clothing to major surgery.

Most countries where treatment is available have systems based on the WPATH Standards of Care or something similar in which the patient is referred for specialist assessment and an individual treatment plan is developed that takes into account their specific needs. This functions as the gateway to further treatment and services such as HRT (hormone replacement therapy), counseling and, where necessary, surgical procedures.

Obstacles

Transitioning — changing one’s gender presentation — is a lengthy, often challenging process. The first, most obvious obstacle is facing the reactions of family, friends and co-workers on coming out. While transgender people have a higher, more positive profile these days, thanks in a large part to the efforts of trans activists and trans people in the public eye, there are still too many bigots out there. It’s almost a certainty that you will encounter some among the people close to you; there will be broken relationships and/or friendships. But there will be others who react positively and support you.

Another obstacle is the financial cost. Even in a country like the UK where some treatments are provided free of charge there are still significant costs. Basic things such as new clothes and accessories, hair removal for trans women, change of name (it’s incredible how many different places you need to contact to update your details, and almost all want copies of the documentary evidence). There is the cost of medication such as hormones. And then there is the cost of travel to attend clinics, often requiring time off work, not to mention any time off for surgeries and subsequent recovery.

As if that weren’t enough there is the time it takes to progress through all this: it is a timescale measured in years. Patience is essential! A lot of time (months) at the outset will be spent waiting to receive dates for appointments before medical treatment even begins. Hormone treatment affects the body very slowly, often taking many months for the effects to become apparent and years for them to come to full fruition.

The alternative…

If you think this seems like a heck of a lot to go through you are right. But what’s the alternative? Trying to live with dysphoria is harder for many people. It is often associated with depression, anxiety, SIB and an increased risk of suicide. For me it was depression that pushed me into coming out. The strain of living with dysphoria had been too much and I couldn’t handle it any longer.

Afterword: A bit about gender

Gender is not binary — female/male — and I would hazard a guess that most people, whether they recognize it or not, have traits of both. This is not unexpected when you consider that all fetuses start out as female, and prenatal exposure to hormones (in most cases as a result of having XX or XY chromosomes) causes the development of female or male primary sexual characteristics.

But the human body is not some perfect machine; it is an exceedingly complex collection of physical, chemical and electrical systems, all interacting and influencing each other to produce the phenomenon we call life. Aspects such as hormonal balance are not constant: they fluctuate according to a multitude of internal and external factors.

There is evidence that a significant number of people with GID experienced abnormal hormone levels in utero which influenced the development of the brain differently to the development of the body. Whatever the reason, brain scans of transgender people have shown structural similarities to their identified (as opposed to assigned) gender.

This means that a person’s gender is not obvious; it cannot be determined by a physical examination. Yes, in the majority of cases the primary sexual characteristics match the person’s gender. But not always.