July 21, 2016

What is Gender Dysphoria?

Photo by Patrick Miko 

Gender dysphoria refers to the distress that may accompany a mismatch between one's experienced gender and one's assigned gender.

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.

Experiencing Gender Dysphoria

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 of Gender Dysphoria

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 of Gender Dysphoria

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 of Gender Dysphoria

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.
Illustration by sabishiidesu13 from deviantart

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.

You can read the DSM-5 text on transgender and gender dysphoria here.

See also: Are all transgender people gender dysphoric?


  1. I'm grateful to Jack for posting and to Lisa for writing this article. I find my feelings about my gender vary in intensity quite a lot and when they are at their low point (when I don't really think about it much) I question whether I am or am not transgender. Intellectually and from work with therapists there is little doubt that I am but the modulation of needs/desires/envies and so forth is very disconcerting. So I'm often looking for and reading posts such as this one.

    I very much like the way Lisa broke it down into Physical, Behavioral, and Visual. I imagine we could also add Emotional? And maybe Mental but that's so subjective: how do I really know how a cis woman thinks? :-)

    I will add that, for me, much of my feelings are around contemplating and missing how a woman "feels" herself to be, as if my psyche knows what it's missing and longs for it. I have no idea which category that fits into, if any.

    It's also hard for me to rate how much my dysphoria is scaled for each of those aspects. As a young child I didn't really think about the physical part - I didn't really think about or was aware of much difference. Behavioral was somewhere in the 8-10 range as I often avoided rough and tumble play for fear of getting hurt, embarrassing myself, and would have loved to dance but knew that that would be dangerous: the bullies would have had a field day. Perhaps Visual was a big one, too, since I wanted to be and be seen wearing girl's clothing. It just seemed like it would be better.

    But I also felt at an early age (say 6-10 years) that what I was feeling/thinking was wrong, and that I needed to somehow banish those thoughts. As if I was at fault somehow, like I was feeding my own dysphoria and needed to move on.

    Last, I fully agree that for cis people this is all just so incomprehensible. They have no reference in themselves or probably via others, so they just see it as an affectation or chosen lifestyle. I suppose in some ways this is like the gradual acceptance (such as it is) of gay/lesbian sexuality. The more that everyone has witnessed its honest and real existence the less it's assumed to be chosen vs. innate.


  2. @Niceguy,

    I have removed your comments, not because they were sexually explicit, but because you provided information that can be used to identify you.

    I will send you an email.

  3. Emma, so true "But I also felt at an early age (say 6-10 years) that what I was feeling/thinking was wrong, and that I needed to somehow banish those thoughts."

    I hid it from my parents though not so much from other relatives, never got caught dressing up (as some trans friends of mine did). I didn't know what I was back then there was no knowledge, even thought I was gay for awhile until I started being attracted to girls...which confused me even more, how could I want to be a girl and fancy girls.

    For me my crunch time was 13/14. I knew I couldn't go on the way I did, being an moderately effeminate boy was sort of ok'ish pre-pubescent, a death sentence (back then where I was) as an adolescent. Plus I was attracted to females and that (even now) is much harder for a trans women than being male attracted.

    I do wonder how many chose the closet just because of that factor.
    Especially back and to a fair extent even now, going through the gay male route was much easier, you got some acceptance at least, as well as some sex, more opportunities and being able to meet more like yourself.

    So I jumped right into the closet and created a 'cis male act' and stayed there with only short term 'outbreaks' and my fantasies to help me along. Eventually they all broke down, because they required so much mental and emotional energy to maintain.

  4. Your post is wonderfully beautifully written. You explain gender dysphoria in an easy to understand gentle way., thank you.l

  5. As the parent of a transgender teen, I very much appreciate your effort here to explain gender dysphoria. It helps me greatly and reassures me that supporting them in their gender (non-binary) expression is the right thing to do.

  6. @Ginni! I am so glad you found this article helpful. And: Your kid is lucky to have you as a parent!

  7. Hi
    As someone who has hidden my gender feelings for almost 50 years, and only really now through my partner (I'm heterosexual male body, female emotionally, desperately seeking Katie..) is able to start to properly think about my inner self and to get rid of all the anguish and very terrible feelings I have had over the years. I do explore parents to listen and look to their children's development. Mine was quite brutally questioned and stopped in the 1970's.., and it has meant that for the last several decades I have had inner battles many many times in every day with my gender, wondering, longing, hating and questioning and unable to have the courage to speak to anyone... I dont hate myself just miss the years of being who I should have been.
    You guys who listen to your kids properly and not force them into gender roles are all saints to me,
    Love you all, just have and make sure you have fun, Katie xx

  8. Yeah, many of us have lost a lot of time due to external as well as internalized transphobia (and homophobia!). I guess we will all have to find way to grieve over the lost years, while at the same time looking forward, living more genuine lives.

  9. That artwork needs a proper credit. Not just a found on tumbler lazy blurb. You cant in one hand advocate for trans ppl but not give credit to creators of trans art/products. Seriously not cool.

  10. Yes, you are right about this. When I posted this blog post, I was unable to retrace the artist online. Thanks to Google's reverse image search, now I have. The artist is sabishiidesu13. She says that for "this particular piece, I'm just glad that the message is out there." I have updated the image text from "By unknown artist. (Found on tumblr)" to "Illustration by sabishiidesu13 from deviantart".


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