GENDER DYSPHORIA is the distress or discomfort that arises from the incongruence of one’s assigned gender at birth and one’s gender identity. Gender dysphoria is categorized under the DSM-V as a mental disorder as it incurs stress and discomfort to the person experiencing it. Older versions of the DSM (III and IV) used the terms ‘transsexualism’ and ‘gender identity disorder’, which both pathologize the actual transgender identity itself. The DSM-V aims to separate the distress (the gender dysphoria) which can be a disorder, from the identity of the person (the actual being transgender), which is NOT a disorder.
A Little History —
1980, DSM-III: Transsexualism was first included as a mental disorder, classifying people who struggled with “Gender Identity Disorder”(GID) as mentally ill. Individuals were also classified by sexuality –“homosexual”, “heterosexual”, and “asexual.”
1994, DSM-IV: Gender Identity Disorder (GID) replaced Transsexualism. Individuals were categorized by “attracted to males”, “attracted to females”, “attracted to both”, and “attracted to neither.”
2013, DSM-V: Gender Dysphoria replaced GID, and people with gender dysphoria are no longer classified by sexuality.
Note: DSM = Diagnostical and Statistical Manual of Mental Disorders. The mostly widely used resource to diagnose mental illness.
Learn more about gender dysphoria here:
Here are several questions from folks I’ve gotten over the years about dysphoria along with my answers!
What is gender dysphoria like for you?
Dysphoria has been a journey for me. I think a lot of it was rooted in recognizing myself in the mirror and how I felt in my body. I didn’t ever care so much about what others thought about it and how they saw me, although I’m human and social. It’s not other people didn’t/don’t matter, it’s more that I cared more about how I felt about my body in the shower by myself than I did as I lined up next to people. I think the word that resonates the most with me is incongruence. I felt incongruent with my body. When I went through female puberty and my body began screaming ‘woman’ as I simultaneously watched my brother grow into his manhood, I felt incongruent. Transitioning has felt like growing into myself.
What do you do when you get misgendered (if applicable)? How do you go about resolving these kind of situations? Do you get affected by people’s response to your gender in the bathroom/lock room time at public spaces?
So here’s my thing about pronouns. They’re really more about how other people box you than who you actually are. And I think this is a really important perspective shift that can greatly help trans people, especially those of us who are just beginning transitioning or don’t pass as the gender we identify as for whatever other reason. If someone called me female pronouns, it was because something about me checked off something on that person’s list of ‘female’ – and this does not mean that I am female. Pronouns, at least in public, are about recognition of presentation and not about who you actually are. All of this is to say that pronouns are important, but you can’t let them define you. You define you. I definitely had moments when being called female pronouns really hurt, but for the most part I tried to recognize it was about their definition of ‘female’ than who I actually was. Consequently, I didn’t always correct people. It depended on what the situation was. I hope this makes sense!
The following person, assigned female at birth, gave me background about their being an athlete on a sports team, worrying that if they came out, their experience on the team might be tainted by constantly having to explain themselves. This person then asked:
Do I come out as nonbinary and risk having to explain myself to everyone or do I just wait until I graduate? I feel like I might be giving something up if I come out.
I’m trans and I haven’t started my transition. I want to get top surgery and take T but I can’t yet. What do I do?
I think the first and most important thing is to find ways to love pieces of your body without any of those things (hormones etc). One of the greatest things that happened to me was that I learned to love & appreciate my body before I had surgery and started testosterone. (I went to a place for eating disorder rehab and that was when my breasts were the largest, when my body was the curviest, etc.) And it doesn’t have to come in huge I LOVE MY BODY bursts. It can be small things at first — I like my hands. I like my hair. I like the muscles in my forearms, whatever it is, try and start wherever you can. I know it sounds dumb, but the way you talk to yourself is so, so important, and learning to talk kindly about yourself to yourself can be life changing. I think one of the biggest things I realized was a twist to the narrative that “trans people are born in the wrong bodies.” The reality is, there is nothing wrong with birth. There is nothing wrong with my body, in fact, my body is healthy and it does everything I need it to. Yes, it didn’t feel like it matched my gender. And for a while, I had to let that be okay. And not hate my chromosomes and assigned sex for the way my body looked, because after all, my body is my body and has always been and always will, no matter what hormones are coursing through my veins.
Aside from all the thinking stuff — I’d say the best thing is to find clothes that make you comfortable, regardless of your body underneath. In terms of binding — the greatest binders are ones online at gc2b.co — I loved mine of those and I had a 36DD chest, and I passed totally fine with that binder. (It doesn’t look 100% flat, but it gives a good illusion.)
I’ve felt really stagnant in life lately. I’ve just been laying around scrolling through social media seeing guys on T and getting top surgery and it feels like that is so far for me. It’s really been affecting my mental health and I’ve started getting snappy with my parents. I’m hopefully starting gender therapy next month, but I don’t know what to do with myself until then and until I get on T. I’m so frustrated. It has been such a long time coming and I know it’ll be worth it, but I just don’t know what to do right now. Do you have any advice for an impatient, extremely frustrated guy?
I hear you. Waiting is so tough. I guess what was really helpful to me was just constantly reminding myself that I was going to eventually go through those things – top surgery, beginning testosterone. For me, the decision-making process was probably the most difficult part of it all and so once I’d concluded that I wanted top surgery/T, I found a lot of peace. Even though I didn’t know when I would get either. I wonder if this is a perspective shift you can practice.
Also, in the meantime, I would recommend working on your relationship with your body. I worked really hard on learning to love & appreciate my body before surgery/T and I think that did wonders for my mental health. I get that this might sound kind of dumb – dysphoria is very difficult. But, I think it is possible to learn to at least appreciate one’s body, even if it feels incongruent. Affirmations (I know, they sound so dumb, but I promise you. So important. So effective.) like “My body is capable,” and “I am thankful for my legs that carry me,” etc., are so important. How you talk to yourself becomes your reality. Browse around my website/YouTube for some of my writing pre-medical transition. wait for top surgery or testosterone to learn to love yourself and your body. Your life does not begin when you transition or when your body meets some standard. Your life is right now. Don’t waste it!
In general, surround yourself with love and support and people who see you for you.
There is not cure-all for impatience, unfortunately. I hope these thoughts help, though.
On wearing women’s clothes, a women’s swim suit, being boxed as a woman:
Don’t think of the [item of clothing, like a swim suit] as women’s clothes. “Women’s clothes” are just clothes that other people have deemed “female,” but the reality is all of these gender boxes are completely arbitrary boxes that humans have shoved into categories because we like categories. The reality is wearing those clothes or suit doesn’t make you a woman, or even womanly. They are just clothes. It is just a swim suit. Hundreds of years ago in Korea, men wore dresses! Men used to wear full body swim suits for racing like women do now. That was considered appropriate attire! (If you’re a swimmer, you’ll remember they got banned not for gender reasons but for cost reasons.) So I guess what I’m trying to say is shifting that perspective so that you can recognize just for yourself that the clothes/swim suit does not define you – you define you. Even if other people might use the clothes to define you. YOU know that that isn’t true. You are you, all the same. This might not be a panacea, but if you feel trapped by what you feel you must wear or have to show, this perspective shift might be helpful! I know it was for me.
For more about swimming as a trans guy visit this page.
My dysphoria has been really bad recently and today, it started a fight that led to an almost break up with my girlfriend. She told me that she was tired of me because my dysphoria always got in the way, that I was always sad and that the decisions I make that induce dysphoria is my fault. I’m not sure how to deal with this because she also wished for a normal boyfriend. She told me that she couldn’t live a life with someone knowing they’d be like this forever. What would the best next step be for you?
I’m so sorry to hear that your dysphoria is taking such a toll and that your girlfriend is not responding well. I can’t tell you exactly what to do because I am not you, but I will provide some thoughts from personal experience.
My immediate reaction is to suggest the idea of not being with her. I have dated a few girls that worsened my dysphoria and, as a result, I would caution you against continuing to date her. It has taken me a long time to heal from that pain — and I am still healing. It sounds like she is hugely unsupportive of you, especially during times of need and that is a pretty harsh reality. I hope you realize that her saying she wants a “normal boyfriend,” is really, really unkind. There is nothing wrong with you. Being transgender is part of the normal human experience. Her shaming you for this, in my opinion, is unacceptable.
I will also add, though, that it is no one’s job to take care of your dysphoria for you. It is your job to learn about yourself and improve. It is your job to care for yourself and recognize that you are more than just a trans-guy. That your existence is greater than your being transgender. I do think that one of the problems we as trans people encounter, especially early in/before our transitions is that our experience as trans people is all consuming and we don’t actually allow ourselves to live.
If you do decide to leave your girlfriend, I promise there will be other people. Like I said, I’ve dated girls who have made me feel pretty awful about my body and, as a result, I thought I’d never find someone who was patient about it. I resolved that was how it was supposed to be. But the last girl I dated was absolutely wonderful about my dysphoria and she told me all the time that it was okay and she understood and she would always sit with me through it and reassure me about it. She was incredibly patient with me about it. She also encouraged me to evolve on my own as well, and find my own healing, which was really important. My point in sharing this is to show you that people like this exist. There are plenty of other trans people in healthy relationships with people who are patient and kind about dysphoria.
All of this said, it is up to you. It is obviously way easier for me to say you shouldn’t date her when I’m on the outside looking in. And if you really think she is worth it and you want to try to make it work, then I would suggest trying to get her to understand this part of you. Be patient with her, too. You could also try finding other people to reach out to when you’re feeling especially dysphoric — in an effort to remove some of that pressure from her.
But overall, I would ask you to ask yourself why you are with her. Is it worth it? Is she worth it? Does the good outweigh the bad? Does she make you happy? Does she make you happy more than she makes you sad?
I hope this helps. If you take anything away from this answer it is this: You are valid. Your dysphoria is valid. But you are also more than your dysphoria. You are not wrong or abnormal. You can find love beyond this relationship. There are plenty of other people who will love you exactly where you are and for exactly who you are and be patient with your dysphoria.
Best of luck. I’m rooting for you.
Do you experience any height dysphoria? I’m not sure if I understand the term correctly, but I’m pretty sure I feel that a lot since I’m only 5’2″ and constantly wish I were taller so I could look more androgynous.
I don’t believe that height dysphoria is gender dysphoria. Feeling insecure about your height can trigger gender dysphoria, but the height insecurity itself is not gender dysphoria, in my opinion. Mostly because it is not gender or trans specific. Like I said, though, this doesn’t mean that you can’t be insecure about being short. You sure can. Lots of people are. In fact, plenty of (cis) people wish they were taller, shorter, whatever. Humans are great at being dissatisfied with their bodies.
So do I get insecure that I am shorter than most my teammates? Sometimes, of course! The average height on my team is probably 6 feet tall. But you know what? The shortest guy on the team is not me, and he happens to be one of the fastest swimmers. So I know that my body is capable of performing. I know my body keeps me alive and happy. I know that I have put years and years of work into this body and discounting it because it is “too short” is kind of ridiculous and most definitely a HUGE disservice, disrespect, and disregard to all the work that went into it. All the person that it holds, that it keeps. This is not to say that you cannot feel bad or sad about being short. You can! I do, too! It is to say: You are more than your height, and you being short and wishing you were tall is a normal human experience.
I am terrified I will never be who I want to be who I need to be. It hurts to be stuck the way I am. I know that once I am old enough I can finally be in the body that I was meant to have, but what is happening I feel like I can never be who I am.
The idea that you’re not who you need to be is very complicated. Often times, trans people limit themselves by saying they can’t possibly “be themselves” until they get surgery or are on hormones for a while. That is not true. You are who you are, no matter the presentation. Inside of your skin, in the core of your being. You are exactly you. Nothing can change that. Do not wait for your body to look or sound a certain way to deem it worthy.
This is not to invalidate the need or desire for physical change. I get that. I, too, felt those pressures. I guess my point is that you are more than how your body looks. Don’t stop yourself from being you just because your body doesn’t quite look the way you feel it should. The physicality will come. Be patient and intentional. But in the meantime, don’t discredit who you are. You are still you.
My hip/thigh dysphoria is really bad. What exercises can I do to make them smaller?
My first thing I wanna say is that I don’t think you can ever really target just one part of your body with working out to make it look a certain way. It doesn’t work exactly that way biophysically, but more than that, I think that’s not the healthiest way to think about your body. The motivation to work out should be to treat your body with kindness. To move it because it feels good. To feel the endorphins. Do the kind of movement you like. Don’t do something you hate. Enjoy it. There’s a million ways to move your body. Find something you enjoy.
Additionally, I would challenge yourself on your thoughts about your hips and legs. All bodies are different! There are plenty of cisgender guys with larger (“feminine”) hips and thick thighs, and those don’t make them any less of men.
I guess my point is, in my opinion the work you should do is with your thoughts — and not with your body. Be kind to yourself in how you think about your body. Your body is not wrong!