Gender Dysphoria

Gender Dysphoria

“Diverse sexual orientations and gender identities exist as part of the human condition.”

Introduction to gender dysphoria

When a baby is born, the first descriptors exclaimed are typically related to gender. “It’s a girl,” or “It’s a boy!” From that point forward, a culturally determined set of attributes and expectations shapes both perception and personality. Mainstream gender typing expects so-called “normal” boys and girls to exhibit conventional interests and behaviors for their gender. Yet diversity in gender orientation and identity has a place within the normal spectrum of human sexuality.

The binary revelation that identifies a person as girl or boy is based solely on visual anatomy. Yet, anatomical features are not predictors of true gender for everyone and biology is not destiny for all people. The fact is, a mismatch between identity and anatomy, known as gender incongruence, does occur. Diversity of gender orientation and expression exists across the human spectrum.

Widespread stigmatizing of those who are gender diverse, contributes to poor mental health. Whereas, inclusion and acceptance, support and fortify mental health.

What does gender dysphoria feel like?

The diagnosis of Gender Dysphoria, refers to the feeling of distress that a person experiences due to an incompatibility or incongruency between their anatomical sexual characteristics and their gender identity. The person knows, at a core level, that they are male or female, but their genitals and secondary sex characteristics indicate otherwise. Some people with symptoms of gender dysphoria may identify as nonbinary, meaning neither female nor male.

The awareness of having a body that contradicts a person’s pervasive gender reality, can be the cause of intense emotional confusion and distress. The recognition that their lived gender experience does not match their anatomy may develop gradually and intermittently, or may be consistently present from the start.

An important point is that not everyone who is transgender experiences dysphoria. Of those who do, only some will report distress severe enough to rise to the level of a diagnosis of Gender Dysphoria.

What does gender dysphoria look like?

Gender dysphoria presents differently throughout the lifespan. A natal boy of preschool age may insist on wearing girls' clothing and freeze or refuse when the teacher asks them to line up with the boys to go to the bathroom. They may feel a disgust for their penis and fantasize about having a vagina. They may reject contact sports, and competitive games, or other interests conventionally thought of as male, in favor of playing with dolls or other pastimes, conventionally reserved for girls.

At school they may be excluded, teased, or bullied for being different. In puberty, they may want no part of the accumulating effects of testosterone on their body and feel more and more betrayed by their body with every passing day.

Anatomical girls may shun stereotypical girls’ attire and interests, in favor of wearing boys’ clothing and hair styles. Often, the pre-pubescent natal girl is regarded as a tomboy, with the expectation that they will grow out of it, in time. The biological girl may express a strong desire or conviction that they will grow up to be a man and express the hope of developing a penis, when they are older. When they are pressured by their parents to wear dresses or attend activities where traditionally feminine attire is required, they may respond with intense protests and opt to stay at home. During puberty, the development of breasts and hips, and the onset of menses make crystal clear that things are going in exactly the wrong direction.

For various reasons, parents may be completely in the dark as to what is really going on. With, sometimes, well intended but misguided intentions, parents may decide to implement punitive consequences. In addition to pressure at home, there may be pressure going on at school in the form of academic struggles, exclusion or bullying in person and on social media. Often this may be completely outside of the awareness of parents and teachers. Sometimes, when all these pressures are in play, a full blown mental health crisis may erupt.

For transgender pre-adolescents, puberty can intensify the pressures and, often, the sense of desperation and despair, due to the effects of estrogen and testosterone. Puberty is a time of increased risk of severe depression and suicidal acting out for gender diverse pre-adolescents. Puberty is, therefore, a time when it is critical for parents to obtain specialized mental health care, if their child is exhibiting signs of isolation, depressed mood, or other symptoms of gender dysphoria.

Gender dysphoria can appear at any time in the lifespan and affirming mental health care can be helpful, whenever the need arises. People who reach out for transgender counseling for the first time during adulthood, often report feelings of gender dysphoria, when they were younger. Adults of advanced age may decide to liberate themselves from the decades-long charade of conforming to conventional gender stereotypes. They may want to live out their remaining years expressing the truth of who they are and fully enjoy being their true selves. It is never too late to transition to truth.

Symptoms of gender dysphoria

Many transgender people have reported feeling trapped and alone in a world of confusion, shame, and despair during their lives. Due to widespread stigma, many families are unsupportive, rejecting, or simply unaware of the complex and delicate situation their family member is facing. Frequently, there is a lack of access to gender aware professionals or gender affirming services.

Unfortunately, when these two ingredients are baked into the cake, the suffering of gender dysphoria is virtually assured. The Diagnostic and Statistical Manual, Fifth Edition, Text Revised, (DSM-V-TR), published by the American Psychiatric Association, provides the following definition. “Individuals with gender dysphoria have a marked incongruence between the gender to which they have been assigned (usually based on phenotypic sex at birth, referred to birth-assigned gender) and their experienced/expressed gender.” There must be distress and impairment for a diagnosis of gender dysphoria.

There are two different sets of diagnostic criteria in the DSM-V-TR, one for adolescents and adults; the other for children. The criteria below has been taken directly from the DSM-V-TR, and pertains to the criteria for gender dysphoria for adolescents and adults.

DSM-V-TR Diagnostic Criteria: Gender Dysphoria in Adolescents and Adults A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, 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 to be of 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). (DSM-V-TR)

**It is worth noting that the DSM-V-TR specifies that the diagnosis of gender dysphoria, refers to the distress that some transgender people experience. The diagnosis does not refer to the state of being transgender, which is not a psychiatric diagnosis in the DSM-V-TR.**

How common is gender dysphoria?

According to the DSM-V-TR, there are no large scale studies of the prevalence of gender dysphoria. According to gender-affirming populations that seek treatment, the prevalence has been estimated to be 1/1000, or less than 0.1% for both individuals assigned male at birth, and individuals assigned female at birth. These prevalence rates are thought to be underestimates.

Based on self-report surveys conducted in the United States and Europe, 0.5% to 0/6% self identified as transgender, and 0.1% to 2.6% endorsed feeling like they are of a different gender. The desire to pursue medical treatment ranged from 0.2% to 0.6%.

Current social and political issues

Research suggests that transgender people are victimized by stigmatization, discrimination, bullying, social media bullying, ostracism, and rejection. Furthermore, transgender individuals are targeted with violence and hate crimes. Access to gender affirming care may be denied, due to medical and insurance discrimination or lack of financial resources. The denial of services runs contrary to research that suggests that gender affirming surgery and hormonal treatment can significantly improve Gender Dysphoria.

Several states have launched alarming media campaigns to stigmatize and villainize transgender people, castigating parents who obtain gender affirming treatment for their children, as child abusers. In some states it is illegal to access, receive, or provide gender re-affirming treatment.

The gender diverse community today is facing a tidal wave of organized political ignorance, bigotry, and homophobia, as never before. Media campaigns and legislative actions to criminalize gender affirming treatment and force unethical and lethal treatment modalities on the transgender community will be at the expense of many lives. This malignant trend of legalized discrimination and civil rights violation is alarming and egregious. Despite current protections at the federal level, the civil rights and protections of the gender diverse community, as a whole, are in peril. Peaceful activism and advocating for gender diverse civil rights, protections, and access to ethical, evidence based treatment is urgently needed.

Outlook

With support and integrated behavioral and medical treatment, an optimistic outlook is within reach, as is taking pride in and celebrating oneself. But achieving that is not something a person needs to do on their own. Stigma and lack of access to specialized gender affirming mental health care are chief obstacles to attaining gender affirming treatment.

Having gender dysphoria can feel like the end of the world, when a person is stuck in stigma and shame. Interpersonal pressure to conform to anatomy based gender roles or face rejection, can paralyze people for years.

Clients have shared their transition stories and, clearly, it is a stressful journey. But there is stress that comes from being stuck and there is stress that comes from finding solutions. The first is unproductive stress and the second is productive stress.

For the MindMetrix participant who is reading this report right now, and identifies with the symptoms of Gender Dysphoria, consider talking to a qualified therapist and, if one is not available, a trusted physician. Get in touch with the PFLAG support group and share with a trusted human, because those are the first steps of becoming unstuck and moving forward to a new beginning.