Gender dysphoria

**Gender dysphoria** is a medical term described as being clinically distressed or impaired accompanied by a strong desire to be of another gender. It may include the desire to change primary or secondary sex characteristics. Though gender dysphoria typically begins in childhood, some may not experience the condition until after puberty or much later in life. Additionally, not all transgender or gender diverse people experience dysphoria. It can range from a mild discomfort to unbearable distress, with intensity varying from person to person.

## Etymology

The term "dysphoria" means "a state of feeling unwell or unhappy; a feeling of emotional and mental discomfort and suffering from restlessness, malaise, depression or anxiety." When coupled with the term "gender", it means "a profound and persistent unhappiness related to one's physical sex."

## Diagnosis

Individuals who experience gender dysphoria receive the diagnosis from a family physician, psychologist, or psychiatrist. It is part of the *Diagnostics and Statistical Manual of Mental Disorders* (DSM-5) for one overarching diagnosis, with specific varying criteria needing to be met by children, adolescents, and adults. One of the most significant markers for gender dysphoria diagnosis is feeling inconsistent or discordant between an experienced/expressed gender and the assigned gender. This feeling has been present for a minimum of six months and is accompanied by at least two of six symptoms.

For a teenager or adult:

* A marked incongruence between your experienced and expressed gender and your primary or secondary sex characteristics
* Strong desire to be rid of your primary or secondary sex characteristics
* Strong desire for the primary or secondary sex characteristics of the other gender
* Strong desire to be of the other gender
* Strong desire to be treated as the other gender
* Strong conviction that you have the typical feelings and reactions of the other gender

For a child:

* Strong desire to be of the other gender or an insistence that they are the other gender
* Strong preference for wearing clothes typical of the opposite gender
* Strong preference for cross-gender roles in make-believe play or fantasy play
* Strong preference for the toys, games or activities stereotypically used or engaged in by the other gender
* Strong preference for playmates of the other gender
* Strong rejection of toys, games and activities typical of their assigned gender
* Strong dislike of their sexual anatomy
* Strong desire for the physical sex characteristics that match their experienced gender

Non-binary individuals can also experience gender dysphoria, though it may present differently than it does in binary transgender people. A 2018 survey of more than eight hundred transgender and LGBTQIA+ youth found that 13% of nonbinary youth sought hormone therapy, compared to 52% of binary trans youth. Non-binary people were also more likely to report encountering barriers to accessing hormone therapy for their dysphoria. The following markers can be present for a non-binary person experiencing gender dysphoria:

* A shifting attitude toward gender signifiers. For example, a person might dislike their breasts one day but feel fine with them on another day.
* Feeling troubled by some gender signifiers but not others. For instance, a person might want to be rid of their chest hair but like their penis.
* Feeling pressured to defend their gender identity. Some non-binary people report being told that they are adopting a trend, not expressing their identity and lived experience.
* Facing pressure to conform to multiple gender roles. Some non-binary people present in androgynous ways or embrace signifiers of two or more gender identities. They may face pressure to conform to conflicting gender identities.

## Treatment

Recognizing and treating gender dysphoria reduces the chances of depression, distress, and suicide for patients. A key factor in treatment and outcome is a supportive environment. It includes the freedom to express gender identity and understanding all medical options.

In the United States, medical treatment for gender dysphoria varies depending on the treatment plan created by a medical physician. To be diagnosed, it is best to find a doctor who specializes in gender identity disorders. A provider will review medical histories and, in some cases, perform a psychiatric evaluation. The main goal of any treatment plan is to help combat the distress of gender dysphoria. It can range from counseling the patient to understand their feelings, providing support and coping skills. Family or couple counseling is also popular to help create an understanding and supportive environment. In some cases, but not all, gender-affirming hormone therapy and gender-affirming surgery is an option. Before deciding on surgery, a patient typically has to partake in gender-affirming hormone therapy and live as their chosen gender for a minimum of one year before they can reconsider the option. Not everyone chooses to have surgery.

In the United Kingdom, a child must be diagnosed with gender dysphoria by a GP (general physician), who will then refer to a gender dysphoria clinic (GDC). A team of GID (gender identity disorder) specialists then assesses the child. This process is called the Gender Identity Development Service (GIDS). While a self-referral is possible, a GP referral is preferred. Once diagnosed fully, the GDC team then makes a treatment plan. It can range from creating a feeling of self-acceptance or affirmation to more significant changes such as hormone treatment and surgery. In England during 2018–19, 8,000 people were referred to adult gender dysphoria services.

## Distinction

Gender dysphoria is critically different than gender expression. The former refers to a psychological sense of gender. Gender expression is how a person presents to the world in a gendered way.

Gender dysphoria is also different than the questioning of sexual orientation. Sexual orientation refers to the type of person one is sexually attracted to. Gender dysphoria refers to how one views their gender.

Body dysmorphia is a disorder that results in someone perceiving a major flaw or problem with their body, even if that perception is not based on reality. Many describe this as seeing themselves "distorted". Gender dysphoria, however, refers to not feeling as though one's body reflects their actual in terms of gender.

## Controversy

### Rapid-onset gender dysphoria

Rapid-onset gender dysphoria (**ROGD**) is a proposed subtype of gender dysphoria caused by "peer influence and social contagion." The term, despite gaining popularity, is not supported by the American Psychological Association, the American Psychiatric Association, and other medical organizations. In August 2018, the proposed subtype was published by Lisa Littman of Brown University with the public support of the academic institution. Nearly two-weeks later, Brown retracted its initial press release in lieu of student, activist, clinicians, and public outcry condemning the paper for being "fatally flawed" among other reprehensible errors. The paper was eventually republished with corrections.

While some condemned the article, others believed the proposed diagnosis be investigated further, including Zenneth Zucker. He claimed that "*ROGD is a provisional label that has been used to characterize a new subgroup of adolescents, mainly biological females, who appear to have a developmental history leading to gender dysphoria that has not been previously described. They are as likely to meet the DSM-5 criteria for Gender Dysphoria as adolescents.*" A November 2021 study examined the proposed diagnosis further, performing a case study on over 100 patients to determine if there was evidence for a rapid-onset pathway for gender dysphoria. The authors concluded there to be no such evidence.

### Transmedicalism

Main article: Transmedicalism
**Transmedicalism** is the belief that all transgender people experience some level of **gender dysphoria**, a medical term for feeling psychological distress based on having an assigned sex at birth that does not match one's gender identity. That distress may range from mild discomfort to extreme self-hatred regarding how their body does not match their gender identity; therefore, transmedicalists feel that anyone who does not experience any gender dysphoria is cisgender, not transgender. People with a strong belief in this position are generally called transmedicalists, shortened to "transmeds", or derogatorily referred to as "truscum". Some transmedicalists also believe that transgender people must additionally want and choose to alleviate gender dysphoria by pursuing a medical transition using Hormone Replacement Therapy (HRT) and/or Gender Confirmation Surgery.

Those with a strong belief that the only requirement for being transgender is self-identification, thus the medical condition of gender dysphoria is not necessary to be transgender, are called "anti-transmeds" or "tucutes". Some describe transgender people as experiencing gender incongruence, a "disconnect between a person's gender identity and their body, which may or may not result in dysphoria". Many anti-transmeds also embrace new identity terms that are not widely accepted among transmeds, including microlabels, xenogenders, neopronouns, and other recently coined terms.

## Media

### Anime

* Lily Hoshwika - *Zombie Land Saga* (2018)

### Manga

* Nitori Shuichi - *Wandering Son* (2011)

## Resources

**General**

* Transgender Equality Network Ireland (TENI)'s *19 Ways to Help Gender Dysphoria*
* Insider's *5 Ways to Handle Everyday Gender Dysphoria*
* World Professional Association for Transgender Health

**United States**

* National Suicide Prevention Lifeline at 988. (call or text)

**United Kingdom**

* NHS information on signs of gender dysphoria
* If you're feeling depressed over gender dysphoria, call NHS 111 or see your general practitioner.
	+ Additionally, call Samaritan for free on 116 123 to talk in confidence. Open 24/7.

## Notes

1. ↑ This article has used more affirming language rather than the language of the cited source, which uses the term "sex reassignment surgery" for what is now commonly known as gender confirmation surgery or gender affirmation surgery.

## References

1. ↑ 1.0 1.1 1.2 1.3 Psychiatry.org: "What Is Gender Dysphoria?". psychiatry.org.
2. ↑ "The Language of Gender". *Gender Spectrum*.
3. ↑ Etymologeek: "Dysphoria definition". etymologeek.com.
4. ↑ 4.0 4.1 "Gender Dysphoria" (2022). childrenshospital.org. Boston Children's Hospital.
5. ↑ Villenes, Zawn: "Can Non-Binary People Expierence Gender Dysphoria?" (2019-02-26). goodtherapy.org. Good Therapy.
6. ↑ 6.0 6.1 "Mount Sinai's Library regarding Gender Dysphoria". mountsinai.org. Mount Sinai, New York.
7. ↑ NHS.uk: "Gender dysphoria in the UK". nhs.uk.
8. ↑ https://www.talkspace.com/blog/body-dysphoria-vs-dysmorphia/
9. ↑ 9.0 9.1 Littman, Lisa. *Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria*. PLoS One, 2018-08-16. (web archive)
10. ↑ World Professional Assoication of Transgender Health (WPATH): "WPATH POSITION ON "Rapid-Onset Gender Dysphoria (ROGD)"" (2018-09-04). wpath.org.
11. ↑ Coalition for the Advancement & Application of Psychological Science: "CAAPS Position Statement on Rapid Onset Gender Dysphoria (ROGD)". caaps.co.
12. ↑ Retraction Watch: "Brown Retracts Press Release". retractionwatch.com.
13. ↑ Littman, Lisa. *Correction: Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria*. PLoS One, 2019-03-19. (web archive)
14. ↑ Kearns, Madeleine: "‘Rapid Onset Gender Dysphoria’ Should Be Investigated, Not Smeared". nationalreview.com. National Review.
15. ↑ Bauer, Greta; Lawson, Margaret; & Metzger, Daniel: "Does Clinical Data from Transgender Adolescents Support the Phenomenon of "Rapid Onset Gender Dysphoria"?" (2021-11-05). doi.org. The Journal of Pediatrics.
16. ↑ 16.0 16.1 16.2 Jacobsen, Kai; Devor, Aaron; & Hodge, Edwin. *Who Counts as Trans? A Critical Discourse Analysis of Trans Tumblr Posts*. vol. 46, no. 1. (web archive)