July 21, 2016

Explaining Gender Dysphoria

Photo by Patrick Miko 

Lisa Mullin, a transgender woman, explores the nature of gender dysphoria or that deep sense of discomfort and suffering that may come from living in a body and a social role that does not match your inner sense of self.

By Special Guest Writer Lisa Mullin

It is incredibly hard to explain to others what gender dysphoria actually feels like. The concepts can be so alien to an ordinary cis (non-transgender) person that it would be easier to explain quantum theory….

It is hard enough for trans adults to understand and explain but even more difficult for parents trying to understand their child and work out whether they are transgender or not.

But here is my attempt.

Is see this as having three dimensions that vary for every trans person:

(1) Physical

(2) Behavioural

(3) Visual

Each can be broken down further.

Physical Aspects

This is the simplest and the easiest for others to understand. Basically you miss bits you should have and don’t like bits you do have. They just feel ‘wrong’ to you.

It never goes away, though you can distract yourself from it, even suppress the feelings for periods of time. It can become very intense at puberty when, especially for trans boys, things like breasts start growing.

Here's a personal example: I didn’t want my penis as a kid, even tried to cut it off (stopped real fast when it hurt though, I barely broke the skin).

I missed having a vagina (even though I didn’t know what that was) and kept feeling between my legs as a young (6-10) kid to see if it was there and if it had grown in yet (as I expected).

The sadness I felt when I was older and knew it would not happen was intense.

Behavioural Aspects

This is complicated because it covers a range of things. Body movements, hand movements, voice, games played, types of friends, toy preferences and so many others.

We tend to over simplify all this by calling non stereotypical behaviour as gender non conforming (GNC, the DSM psychiatric manual used to pathologise this as GID or "gender identity disorder"). It also gets stereotyped for trans kids as boys wanting to play with Barbies or girls with trucks.

But that is too simple. A trans girl might not be into dolls and be into spaceships (like me as a kid) but act in an effeminate way in terms of body language and much prefer to play with girls. They might like sports but not the standard male contact ones (say swimming vs football). They might like to dress up, but not sing and dance because they are shy…. A trans boy might love dolls and also playing football. And so on.
There is as much diversity as regards interests
and abilities among trans kids as there are
among cis kids. Their gender identity cannot be
reduced to stereotypic behaviour.

This can be confusing for parents with trans kids (heck it is confusing for trans adults) trying to work them out. This is because other factors come into play as well. Such as how extroverted they are, how sensitive they are to signals from parents (etc) that ‘this is bad’.

A quiet shy, introverted and sensitive kid can quickly learn to hide such behaviour, as they pick up that their parents (etc) are uncomfortable with it, they are not naturally demonstrative in public in any case and prefer to ‘fit in’ quietly and not be a centre of attention.

The 'possible' link between childhood expressed gender dysphoria and ASD (autism spectrum disorder) might be explained by this; those with a degree of it are more immune to negative social signals and are more prepared to push their personal desires in the face of it.

This is almost certainly a factor for those kids who ‘come out’ as transgender at early puberty, with no ‘apparent’ symptoms beforehand. They have been hiding it due to fear of rejection and only the greater fear of the impacts of puberty finally motivates them.

Never underestimate how well kids can hide things from their parents and the smarter and more sensitive they are, the better they are at it.

There is this damaging Trans Myth that EVERY trans kid is extremely and stereotypically feminine or masculine acting and presenting as such in EVERY way as a young kid.

Personal Example #1: (which I had forgotten until told to me by my relatives recently): I was very careful not to be caught at home putting on my mums or aunts clothes as a kid, but when I stayed with my cousins I did dress ups and played with the girls.

Personal Example #2: I once did some imaginary play in front of my parents, pretending to be Robin climbing up a wall (like in the Batman TV series). My father made a derogatory comment and I never once did it in front of him again. That's all it took ..a single negative comment.

Visual Aspects
In some way the most complex because it covers actual self image, preferred self image, how distressed you feel at mismatches in self image.

How you see yourself (say) fully dressed. Or just your face, or your genitals or your breasts.

Human beings are visual creatures and how you look, how you imagine you look to others and how others actually see you can have an extremely powerful impact on how you feel.
By unknown artist. (Found on tumblr)

Typically those with gender dysphoria have very critical feelings about their original looks, especially things like their face which you see in the mirror so often. It just looks wrong to you when you see yourself, there is this ‘wrong face’ all the time.

Clothing and other things like hair cuts, wigs and makeup can help a lot in matching preferred self image to what is actual.

A classic example is Facial Surgery (FFS) which is commonly desired by those adults that badly suffer from face related 'visual dysphoria' if they have been damaged by puberty and testosterone, it reduces their dysphoria caused by seeing the ‘real’ face versus their ‘internal’ one. Which, because this is the most common thing seen, can cause serious distress.

Yet another argument for transitioning as young as possible as those who do avoid this very difficult issue that can be so traumatic for so many trans adults.

Similar things apply to many other visually related areas (you could write a book on this).

Everyone is a Combination

Every trans person has different levels of these aspects though they all will have some level of all three of them. Some may be far more Visual than Physical, others more Physical than Behavioural.

In my case I would score myself as in terms of my dysphoria as a kid as (out of 10):

Physical: 9.

Behavioural: 8, varying with who I was with, 8 with parents (hiding it), 5 with my cousins as I could relax more with them and act more naturally.
Visual: 5, I was less worried about how I looked than I was about how I felt and wanted to act.

One Dimension Can Affect Another

The complexities increase as one dimension will affect another creating complex feedback loops.

An example of such a loop is how you really look impacts your physical feelings, the feeling of having the wrong ‘bit’ can be made much worse by seeing it.

Equally, being all dressed up and seeing yourself can make you feel more like the correct gender.

Personal example: When I dressed as a woman (pre transition) I relaxed, not so much because of how I looked, but it gave me permission to act more naturally. I could sit, move, walk in ways I would not let myself do when acting as a male where I ‘policed’ my movements and actions very carefully to ‘fit in’ (even when on my own).

Acting Cis is Exhausting

One thing that is so very common to all, adults and kids, is that when they can present in the correct gender and act naturally they are more relaxed. less stressed and happier.

Even if just for a short period, being able to drop the 'cis act' reduces stress considerably. Policing yourself to copy other's behaviour to 'fit in' is just exhausting.

This is one way that can help a parent understand their child -- and an adult understand themselves, by having periods of socially transitioning. If someone is demonstrably more relaxed, less stressed and happier doing so, then the odds of them being transgender is pretty damn high.


The American psychiatric manual no longer considers gender incongruence (or being transgender) a mental illness. Gender incongruence may and most often will, however, cause suffering. The manual defines gender dysphoria in this way:

Gender dysphoria  refers to the distress that may accompany the incongruence between one's experienced or expressed gender and one's assigned gender. Although not all individuals will experience distress as result of such incongruence, many are distressed if the desired physical interventions by means of hormones and/or surgery are not available. The current term is more descriptive than the previous DSM-IV term gender identity disorder and focuses on dysphoria as the clinical problem, not identity per se. 
The DSM has a long history of homophobia and transphobia and must be read with this in mind. The latest edition (No. 5) represents, however, a long step forward towards depathologizing transgender identities. 

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