Gender Dysphoria: A complete guide that clarifies everything about this dysphoria
Have you ever wondered what gender dysphoria is? In this article, we’ll show you not only what gender dysphoria is and the history of it, but also the signs and symptoms, how to recognize and manage it, and how gender dysphoria affects the brain.
What is Gender Dysphoria?
Gender Dysphoria, also known as Gender Identity Disorder (GID), is the feeling of identifying and feeling uncomfortable with the gender you were assigned at birth. Gender dysphoria can exit on a scale- it can be very mild or rather strong. Someone with gender dysphoria may dress like the opposite gender and use mannerisms that are associated with a different gender. For example, someone who was born as a boy may feel like a girl. Gender dysphoria does not mean homosexuality- your gender identity is not the same thing as your sexual orientation. People who have gender dysphoria are not always transgender.
Gender dysphoria is the product of complex neurodevelopmental, genetic, and psychological factors. Among people who are considered male at birth, approximately 0.005 to 0.014 percent of them identify with gender dysphoria. Among those who are considered female at birth, roughly 0.002 to 0.003 percent of them identify with gender dysphoria.
Gender Dysphoria Important Terms:
- Gender identity: What you identify as. Could be male, female, a mix of both, or neither.
- Transgender: The overall term for someone who feels that the gender they were assigned at birth doesn’t match their authentic gender identity. Transgender people can identify as straight, gay, or bisexual because gender identity is independent of sexual orientation. There are roughly 1.4 million people who identify as transgender in the United States.
- Gender non-conforming (GNC): GNC people, similar to transgender people, disagree with the gender they were assigned at birth. However, they may choose to express it differently or not at all (e.x. using gender-neutral pronouns like “they”). However, this term is difficult to define because of how personal it is to each individual and varies greatly from person to person.
- Genderqueer: A person who is fluid with their gender identity and expression. It’s possible to express themselves in ways that are traditionally thought of as male, female, or not define their gender as neither male nor female. Some people who are genderqueer may not even identify as transgender. Genderqueer people tend to be GNC, but not all GNC people identify as genderqueer.
- Cisgender: A person whose sense of gender identity relates to the gender they were born with.
- Crossdressing: the act of wearing the clothes of the opposite gender. For example, a male who wears “female” garments and makeup.
Gender Dysphoria Signs and Symptoms
In children, gender dysphoria symptoms can start between the ages of two and four. Some research shows that children who have had more intense symptoms, more persistent, insistent, and consistent in their statements and behavior about gender dysphoria (a boy who makes a declarative statement saying “I am a girl” rather than “I want to be a girl”), were more likely to become transgender adults (i.e. it wasn’t “just a phase”). These are examples, however, every case of gender dysphoria tends to be unique.
For adults, the adult-onset symptoms, those beginning in adulthood, usually begin in early to mid-adulthood. Some adults with gender dysphoria may adopt the behaviors, clothing styles, and mannerisms of the gender that they identify as.
The different feelings and symptoms aren’t only distinct with age groups, but also with genders. For example, young girls may have boy-like haircuts and get upset when their parents try to make them wear dresses. Young boys might avoid stereotypical masculine toys like cars and trucks. They may possibly pretend not to have a penis, either. Speech patterns for younger boys may also follow the typical speaking style of a female. One study claims that this is due to the fact that children are not born knowing how to speak like a man or a woman- they learn by watching. If a boy child chooses to watch and use the female speech patterns, it could be due to early-onset gender dysphoria. Children with gender dysphoria can also show symptoms of separation anxiety disorder, anxiety in general, and signs of depression.
In general, many people will become socially isolated which in turn can lead to low self-esteem. Some people may only participate in activities that lessen their gender distress (i.e. ballet is for girls, rugby is for boys). This participation in activities is often due to a concern about appearance and can be more common in the early stages of the transition between genders. It is not uncommon to have parental issues due to the desire to change genders.
What to do if you feel gender dysphoria?
- Contact a therapist to talk about your options
- Know that you’re not alone
Gender Dysphoria Causes
There are no officially known causes of gender dysphoria. It was initially thought that it was a mental illness. Now there is evidence that gender dysphoria may not be something cased in the brain. Rather, it is suspected from several studies that the hormonal influences in the womb are to be at play and that there may be biological causes that are associated with the development of gender identity before birth. The hormones that trigger the development of the sex/gender of the fetus in the womb may not function properly (e.x. excess female hormones from the mother’s system or the fetus’s insensitivity to hormones). This hormone mishap could cause the fetus to have the genitals of a male, but the gender identity (coming from the brain) of a female. However, more research is needed in this area.
Gender Dysphoria Diagnosis
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) gives overall general criteria for a gender dysphoria diagnosis with separate criteria for children, adolescents, and adults. In order to be officially diagnosed with gender dysphoria as an adolescent or as an adult, the symptoms must have been happening for at least six months with at least two of the following symptoms:
- A strong desire to be the other gender
- A strong desire to be treated like the other gender
- A strong belief that one has the usual feelings and reactions as the other gender
- A strong desire to get rid of one’s primary and/or secondary sex characteristics (penis, vagina, breasts)
- A strong desire to have the primary and/or secondary sex characteristics of the other gender
- An obvious difference between one’s experienced/expressed gender and their primary and/or secondary sex characteristics.
In order to be diagnosed with gender dysphoria as a child, the symptoms must have been happening for at least six months and involve at least six of the following symptoms:
- A strong desire to be the other gender or insistence that one is the other gender
- A strong dislike for one’s sexual anatomy
- A strong rejection of the toys, games, and activities that are typical of one’s assigned gender. (e.x. a girl who refuses to play with dolls)
- A strong preference and desire for the toys, games, and activities that are typical of the opposite gender
- A strong preference for friends of the other gender
- A strong desire to be the other gender or insistence that one is the other gender
- A strong preference to wear clothes that are stereotypical of the other gender (e.x. a boy wears a dress)
- A strong liking for cross-gender roles in make-believe play or fantasy.
- A strong desire for the physical sexual characteristics that match one’s wanted gender
The World Health Organization (WHO) recently (June 2018) announced that it no longer considers gender dysphoria to be a mental illness. This announcement means taking their definition of “gender incongruence” out of their chapter on mental disorders and putting it into their chapter on sexual health. They plan to make this change official when their next catalog, the International Classification of Diseases (ICD) catalog, comes out in 2022.
Gender Dysphoria Management
The treatment goal isn’t to make the man (who feels like a woman) feel like a man, but rather it is to deal with the distress caused by these feelings of gender identity. The treatments of gender dysphoria vary from case to case. This is because how people feel about their gender differs from case to case. Some people would prefer to have sexual reassignment surgery (SRS) also known as gender reassignment surgery (GRS), while some might prefer to crossdress to express how they feel. Although, those aren’t the only two options. Either way, the diagnosing and treating can reduce the chances of depression, emotional distress, and in some cases, suicide. After transitioning, it’s possible for the person to no longer feel dysphoria, but they may still need therapy.
In Europe, 1 in every 30,000 adult males and 1 in every 100,000 females seek to have sexual reassignment surgery. Although, the real number of those with gender dysphoria is higher because these official numbers include only the people who have treatment of some sort.
Psychotherapy is the treatment of a mental issue by psychiatry and psychological methods rather than by medication. Psychotherapy is a common treatment and essential at the beginning of all treatment courses. According to some studies, psychotherapy alone does not produce a complete and long-term reversal of cross-gender identity. However, it does prove to be beneficial and was proven to be essential in ⅓ of patients. The goal of helping the person feel more at ease with their gender identity is achieved by showing them empathy, working out coping strategies, and giving psychological support (helping them through the coming-out process, for example). Many studies have shown that psychotherapy has encouraging effects after someone has the sex-change surgery.
Some people use biological treatments, known as triadic therapy, like hormone replacement therapy (HRT), a hormone treatment to develop the traits of the sex that they want to present as. A common hormone treatment is that a man (wanting to be a woman) will take estrogen and a female (wanting to be a man) will take testosterone. Some people also choose to have the sexual reassignment surgery, also known as a sex-change operation. Others choose to have more minor procedures simply to align their looks more so with their feelings. These minor surgeries can involve breast augmentation or facial feminization surgery (FFS). Those who identify with being male don’t typically opt for facial surgeries because they grow beards and their voices drop while on hormone replacement therapy.
Some prepubescent children are able to take puberty blockers, puberty inhibitors, puberty suppressors, or hormone suppressors,– a prescribed hormone (testosterone or estrogen) that suppresses the physical changes that puberty causes (like growing facial hair, deep voices, breasts, and menstruation). The hope is that the puberty blocker gives the child enough time to make sure a gender change is what they want to do or to help their bodies begin to transform into the other gender. The risks include bone mineralization, damaged fertility, and unknown effects on the brain development. Some claim that psychological development will be stunted while others claim that the effects are completely reversible. However, a 2015 study published by the Principles of Transgender Medicine and Practice observed that there was no difference in performance between 20 transgender youth treated with puberty blockers and transgender youth untreated. If the dysphoria continues past puberty, studies have shown that the young adult will likely continue to feel that way unless properly treated.
History of Gender Dysphoria
It has been thought that the concept of gender dysphoria has been known about since ancient times due to a Greek myth. In the myth, there was a woman who was raised as a male who ended up falling in love with another woman. Before the wedding ceremony, the woman raised as a male was turned into a male. In the 1900’s there were many stories told about people who felt uncomfortable with their gender. In modern times, gender dysphoria has also been known as “transsexualism.” However, this term is outdated and no longer used because some people consider it offensive.
Gender Dysphoria and the brain
It’s been proven that male and female brains are not identical. Our brains are all incredibly individual and unique. There are many studies comparing transgender brains to those of non-transgender.
One study done by Spanish researchers examined the brains before and after hormone treatments of 24 female-to-males and 18 male-to-females. They found that transgender people have brains that are different from male and female brains. However, because our experiences and behaviors shape our brain’s anatomy, it’s impossible to say whether these subtle differences in the brain are there from the time of birth or not.
Another study done in the Netherlands used an MRI to examine how prepubescent and adolescent boys and girls with gender dysphoria would respond to androstadienone, a steroid that has pheromone-like properties in it. Pheromones are known as “nature’s perfume” and are naturally emitted with the hope of mating. Androstadienone is known to cause different chemical responses in the brains of men verse women. The results concluded that those who had gender dysphoria responded to the pheromone much like those who did not feel gender dysphoria.
Another study done by the same group of people measured the echo-like sounds produced in the inner ear as a response to a clicking noise. The study found that transgender boys reacted to the sounds like non-transgender girls – girls have a stronger response to these sounds. However, transgender girls also reacted to the sounds like non-trans girls. These types of studies are incredibly important because sex differences in response to odors and smells cannot be influenced by training or by environment – only by how our brain naturally perceives them.
Overall, these studies, among many others done, suggest that there is a biological basis for gender dysphoria in the brain. However, due to the variety and variation of transgender people and the knowledge of brains in general, it’s impossible to look at a brain and say, “Yes, this person is transgender.”
In many sociological and anthropological aspects, gender is thought to be a socially constructed idea. This means that gender identity can be affected by the society that one grew up in by factors like how the roles of women and men are thought of, religion, family values, and cultural background. Some people classify sex as the biological way we are born. However, one could also say that we born with our sex but that we learn our gender.
Gender Dysphoria: Controversy over classifying it as a disorder
We cannot stress this enough gender dysphoria is not a mental illness. Rather, the stress, depression, and anxiety that go along with it need to be diagnosed and treated. In 2012, the American Psychological Association (APA) removed the term “Gender Identity Disorder” (GID) from The Diagnostic and Statistical Manual of Mental Disorders.
Advantages and disadvantages exist to classifying gender dysphoria as a disorder. Due to the fact that gender dysphoria had been classified as a disorder in previous medical text, many insurance companies were willing to cover GRS (gender reassignment surgeries). However, without this classification GRS are considered cosmetic surgeries. In the US, transgender people are less likely than others to have health insurance, and often face hostility and insensitivity from healthcare providers.
Have you or someone you know dealt with gender dysphoria? Do you have any tips? Let us know in the comments below!
Anna is a freelance writer who is passionate about translation, psychology, and how the world works.