Gender Dysphoria

What is gender dysphoria? And is it real?

Gender is a loaded word. In one sense, you could argue it doesn’t exist – it’s abstract and in our minds. In another sense, it is very real and has a way of creeping into every corner of our lives. I arague that if gender is real, then so too is gender dysphoria. We can think of gender as either a joyous freedom of expressing one’s feminine and masculine natures. Or we can think of it as an oppressive force that controls people’s lives and tells them how they should be. It is in the latter that gender dysphoria finds it’s nemesis.

You already can guess how I feel about this. To me, we should all celebrate the autonomy of gender expression. There should be no shame in how that expression manifests, whether in a masculine behavior, feminine behavior or something in between, or something very fluid.

The trouble comes in when we want to force femininity onto those assigned female at birth (AFAB) and masculinity onto those assigned male at birth (AMAB). We want our girls to grow up to be mothers, and our boys to become fathers. Some say this the bedrock of society and anything but this is anthema to life itself. We don’t have to look far to see how politcal gender is in our culture. The personal is political in this way. We expect gender role placement. And there is something warm and fuzzy about family, mom’s and dad’s, grammas and grampas, sons and daughters. Sometimes that sense of normal is painful to those that don’t fit in.

Children know they must conform to gender roles. Children know that to survive, they must have acceptance by their peers and parents. Rejection at it’s most extreme is being outcast – one of the strongest fears that transgender people face. To be outcast it to be lonely and unloved and to have a fear of not surviving.

Some families and environments foster autonomy of gender expression. Others value raising their kids in a traditional home trying to do their best. The latter can be a challenge for kids that find gender rules go against their nature. We seem to do better empracing tomboys than we do femmeboys. The male expectation too is more rigid as is the restricted range of male expression. The majority of kids manage their roles well and at some age, our peers become the gender police keeping us in line. “You can’t wear nail polish, you’re a boy!” “No, girls can’t play football!” Who can push back? Perhaps one should stay in a closet.

Just because a child has a gender discomfort and finds themself to not fit in, it doesn’t mean that they are transgender or gender diverse (TGD). In most cases, an adjustment of gender expression helps them to fit right in. In some cases though, the gender discomfort becomes so intense it becomes dysphoria. This is when kids might be candidates to be described as gender dysphoric. If this gender dysphoria persists in time long enough, then it qualifies as a mental health diagnosis. Not everyone agrees that this should be the case. Let me desribe first gender dysphoria and we’ll revisit that.

The American Psychological Association is the governing body that desribes what gender dysphoria is. (In previous years, terms such as transsexual identity disorder, gender identity disorder and eonism were used and are now archaic.) Gender dysphoria is defined for children (pre-pubescent) as having a persistently strong inner conflict or incongruence between their assigned gender at birth (whether AMAB or AFAB) and how they experience and express their natural gender. The incongruence has to be strong enough to create distress in various contexts of their lives. Some of the criteria might include the following:

  • A strong desire to be of the other gender
  • An insistence that one is the other gender
  • A desire to dress as the other gender
  • A desire for role-playing or participating in fantasy as the other gender
  • A desire to play with toys, games and activities associated with the other gender
  • A desire to play with peers of the other gender
  • A rejection of activities that are typical of one’s birth assigned gender
  • A dislike of one’s physical body
  • A desire to have the body of the other gender

If one’s child has a number of these symptoms for at least six months, then they are experiencing gender dysphoria. But, that does NOT mean they should immediately begin hormone therapy and certainly NOT have gender surgery. This is NOT a gender emergency and the best thing to do is simply breathe a bit and take your time. Of course, this could also good time to seek out help from a mental health professional. Medical interventions are needed in some cases, but with GREAT caution as children’s identities are still developing. If they are persistent, consistent and insistent for a solid period of time, then you could consider a medical treatment, but even then taking it very slow. There’s a lot to unpack here! And even more if your child has an intersex developmental issue.

Now adolescents and adults are in their own category. Gender dysphoria for adolescents and adults is defined as also experiencing incongruence between one’s birth sex and gender expression/experience, and it also needs to be consistent for at least six months. The incongruence has to be strong enough to create distress in various contexts of your lives, such as work, school or intimate relationships. Some of the criteria might include the following:

  • An incongruence between one’s experienced/expressed gender and one’s primary sex characteristics (i.e., sexual organs) and secondary sexual sex characteristics (e.g., facial hair, breasts). The secondary sexual characteristics may be those that are anticipated, such as the lowering of the voice.
  • A desire not to have the primary and secondary sex characteristics of your assigned gender
  • Or the desire to have the primary and secondary sex characteristics of the other gender (other gender is inclusive of both binary and nonbinary)
  • A desire to be of the other gender
  • A desire to be considered part of the other gender and treated as such
  • A conviction that one has the typical feelings and reactions that the other gender typically has

As with children, the distress has to be clinically significant and there could be an associated intersex condition as well. When an adolescent or adult has gender dysphoria for a persistent amount of time, then speaking to a mental or medical health professional that is transgender affirming would be a good next step.

To me of course, transgender is real. Nonbinary is real. And for many that have gender dysphoria, the appropriate treatment is mental health and medical care. One has to find closure in some way regarding their gender expression. One hopes to find peace in their own skin. A medical gender transition for many is a much needed step in that journey. For others, a change in gender expression is the right path.

As I wrap this up, I wanted to revisit gender dysphoria diagnosis. Not every transgender person has dysphoria. One has to have distress or impairment of functionality, using the DSM definition. If one has adapted naturally into their chosen gender expression, then there is no need to have the diagnosis. The diagnosis is typically needed for those choosing medical care. Doctors use a diagnosis/treatment model and at the moment, GD is the coding terminology. When a transition is complete, the diagnosis of “in remission” can be specified if desired in future records.

Above all, be proud!

In summary, one should be of course very mindful in their choices so that maximum self-awareness drives one’s decisions. Hence, try not to think of the journey as an emergency, but a joyful road ahead into self-discovery and expression. Don’t rush! It is better to find peace along the way, than to desperately seek to be there. It is okay to be where we are, and also okay to change and create authenic lives of love. Of course, I’m here because I know how hard this is!