What is Gender Dysphoria?
Gender dysphoria is a somewhat broad and difficult to define term, particularly because the experience of dysphoria can vary significantly from one person to another. That said, gender dysphoria is characterized by a deep-seated, chronic state of discomfort originating from mental dissonance between one’s sense of self as it relates to gender, and either the gendered characteristics of one’s body (secondary sex characteristics, genitalia, and reproductive organs), the gendered ways one is treated by others in terms of pronouns, titles, etc, or both. Gender dysphoria is something that many, though not all, transgender people experience and may seek relief for.
Note: the term “transsexual” is occasionally used in place of “trans” or “transgender.” This term can be highly offensive and should never be used to describe anyone unless they explicitly say they prefer it.
Clinical Gender dysphoria is sometimes also referred to by the older term “Gender Identity Disorder,” (GID) but the use of “disorder” in the term is somewhat contentious and largely considered disrespectful, and is cautioned against in the 7th edition of the World Professional Association of Transgender Health (WPATH) Standards of Care (SOC). This is primarily because individuals who experience gender dysphoria can find relief through hormonal treatment, counseling, and/or surgeries. Further, it is offensive and antiquated to apply a blanket diagnosis of a “disorder” to anyone who does not conform to socially constructed expectations of gender. On that note, the WPATH SOC are an excellent resource for professionals working with transgender individuals, and the SOC have a detailed description of Gender Dysphoria as a medical condition, including guidelines for diagnosing and treating Gender Dysphoria.
Alleviating Gender Dysphoria
The goal when treating gender dysphoria is to alleviate dysphoric feelings in an affirmative way by helping the trans person in question make the changes they need to be more comfortable with their body and the way they are treated by others. This can involve many different things depending on the person, as no two trans people are exactly alike in their needs, identities, or the way they experience dysphoria, or even if they do at all. That said, there are several different established means of helping trans people control dysphoria, including hormone replacement therapy (HRT), genital reconstruction surgery (GRS) and other various surgical options, legal name and/or gender marker change, permanent hair removal, and psychological counseling (this list is not exhaustive). Any given trans person may wish to pursue some, all, or none of these means, and they should all be considered medically necessary for every trans person who wants them. In other words, not every trans person will want facial reconstruction surgery, as an example, but for those who do feel they need it, it is medically necessary to help them control dysphoria. Not every transgender person’s transition—the process by which they move to a place in which they are more comfortable with themselves and have significantly alleviated their dysphoria—will look quite the same, but every trans person should be allowed to pursue transition in whatever way they, personally, need to alleviate their gender dysphoria.
Gender Dysphoria Vs Gender Nonconformity
One important note to keep in mind is that, as explained in the SOC, gender dysphoria (aka GID) is not the same thing as gender nonconformity, though they often correlate. Before continuing with this differentiation, it is useful to define some terms. “Assigned male at birth” (AMAB) and “assigned female at birth” (AFAB) refer to the gender one is assumed to be at birth based on genitalia, and is the respectful alternative to saying “born male” or “born female.” A transfeminine person is someone who is AMAB and identifies as a woman, or as nonbinary with some female aspect to their gender. A transmasculine person is someone who is AFAB and identifies as a man, or as nonbinary with some masculine aspect to their gender. Nonbinary people are people who do not identify as fully male or female, regardless of assigned sex at birth.
With those terms defined, gender dysphoria, as described above, is a deep feeling of discomfort and dissonance based on one’s identity. Gender nonconformity, on the other hand, is any behavior that would be considered “abnormal” by a person of a given assigned sex at birth based on society’s rather limited beliefs on the construction of gender. For example, someone AMAB wearing makeup, or someone AFAB wearing a “men’s” suit and tie, would be considered gender nonconformity. Gender dysphoria and gender nonconformity do frequently correlate, but it is important to understand that they do not always, and only some gender nonconforming individuals experience dysphoria. Further, do note that the term “gender nonconforming” is somewhat contentious in the transgender community, because some trans people (though not all), may in fact conform quite closely to the social expectations of their actual gender, but would nonetheless be labeled gender nonconforming because of their assigned sex at birth.
Current medical standards for diagnosing and treading gender dysphoria can be found in the International Classification of Diseases-10 (ICD-10) and the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
It is also relevant to note that more and more evidence is surfacing that suggest that being transgender often has a biological component to it in terms of brain wiring, as it were. This lends further credence to the notion that being trans is not a choice (of course, even if it was, that’s still no reason to consider it a bad thing) and in many or most cases, there is a biological component.
As part of a holistic approach to treating gender dysphoria, holistic therapy in the form of psychological counseling is often incredibly useful, even foundational. It is important to note that counseling should focus on helping the trans person in question understand and make peace with their identity, and to alleviate dysphoria. It should never attempt to “fix” one’s trans identity by attempting to force an identification with their assigned sex at birth.
This holistic therapy can be incredibly important for many trans people, as it offers a solid foundation and a first step in transition. A good therapist is a guide to self-acceptance, and helps the trans person to determine their own path, and what will work best for them.
Hormone Replacement Therapy
Another treatment considered highly effective for those trans people who feel they need it, hormone replacement therapy (HRT) involves medical administration of hormones that better match the patient’s identity, through oral tablets, injections, patches, creams, or other methods. For example, a transfeminine person would typically be given anti-androgens to decrease testosterone levels, and estradiol to increase estrogen levels. Conversely, a transmasculine person is typically given testosterone, which will both decrease estrogen levels and increase testosterone levels. Some nonbinary people also seek hormone replacement therapy, and may desire mixed hormone levels (moderate levels of both testosterone and estrogen), or may have their own specific needs. For example, a transfeminine nonbinary person may wish to obtain full-dose anti-androgens and estradiol despite not identifying as purely female. Individual needs such at this should be listened to and accommodated as much as possible.
Hormone replacement therapy helps to alleviate dysphoria on multiple levels. HRT has the benefit of altering one’s secondary sex characteristics significantly. AMAB people on estrogen HRT will develop breasts, experience softening of the skin, facial feminization, and feminine body fat redistribution, among other affects. AFAB people on testosterone HRT will experience deepening of the voice, roughening of the skin, masculine body fat redistribution, and they will grow facial hair, among other effects. This happens over a long period of time, and is highly effective at decreasing dysphoria in the long term. Hormone replacement therapy also frequently has significant emotional and mental effects, because sex hormones do penetrate the blood-brain barrier and affect mood, and HRT will very quickly alter one’s brain chemistry. For the vast majority of trans people, the emotional effects are highly positive (though there may be ups and downs) and their mental state feels much more agreeable with their identity shortly after starting HRT. Positive mental effects can result from both the direct impact of hormones on the brain, but also from the feeling of satisfaction inherent in knowing that you’re taking steps to change your body to the way you want it to be.
Regarding the direct impact on the brain, this goes back to what was said earlier regarding there frequently being a biological component to being transgender. Several studies indicate that HRT through cross-sex hormones for trans people is feeding the brain exactly what it needs; in other words, many trans people’s brains may in fact be wired to correspond with their actual identity rather than their assigned sex at birth, and need the appropriate hormones to function well as a result, which can cause an immediate or near-immediate drastic reduction in dysphoria early on when starting HRT.
Another avenue of alleviating dysphoria that some—though not all—trans people pursue is re-constructive surgeries. These most commonly include genital reconstruction surgery, or GRS (typically vulvaplasty or vaginoplasty for transfeminine people and phalloplasty for transmasculine people), facial reconstruction surgery (most typically facial feminization surgery), and chest surgeries such as breast reduction or mastectomy for transmasculine people, and breast augmentation for transfeminine people. Note that not all trans people will pursue all of the possible surgery options, and some may not desire any at all. Also note that the above list is far from exhaustive, and there are several other surgical options trans people may need to alleviate their dysphoria, which is why an individualized approach is most effective.
Facial feminization surgery is also particularly notable here because it can often be just as effective as GRS in reducing dysphoria for AMAB trans people. For those who feel they need it, this can be an excellent option to reduce dysphoria and improve self-confidence greatly.
Finally, it is important to note that further treatments besides those listed above may or may not be necessary to reduce dysphoria in a given trans person. Examples of such treatments include, but are not limited to, permanent hair removal (such as laser hair removal or electrolysis) and voice training to make one’s voice more feminine, masculine, androgynous, etc, to match one’s identity. Again, an individualized, personal approach is most effective, because every dysphoric trans person will have a unique set of needs and a unique experience with gender dysphoria.