Most (some would say all) transgender individuals suffer from gender dysphoria. In short, whenever we are reminded that our body is not like the image in our mind's eye it feels a bit like having a panic attack, being home sick & heart broken at the same time.
The last thing you want to happen is people to actually know that you are transgender, much less misgender you. The transitioning body is not the gender's present in your mind's eye, it is the result of having lived through the wrong puberty. Being made aware of the fact that you are transgender often triggers dysphoria.
Ever heard your voice in a recording and thought "Oh, that's not my voice -- it's just wrong. Must be the recording." and then felt a strong dislike towards that recording? Perhaps a bit of pain or cringe. Well, that's what a lot of transgender individuals experience daily when looking at their own bodies, hearing their own voice, seeing their image in the mirror, looking down at your own hands, etc.
That's a really interesting description, thanks. It seems like a very difficult condition and a constant source of anxiety. I struggle to think this is something anyone would choose for themselves.
It makes me very worried for the three year old I know who's mother insists he/she is transgender. That this shouldn't be a trendy thing - but a serious struggle.
One can choose whether they want to begin a social & hormonal transition but they cannot choose to not have the genetic and biological factors that are at play[1]. I doubt anyone take the decisions lightly. It is a huge burden on your life.
In my case, I have decided to transition after 25 years of successfully living as a male. The burden of not transitioning was compounding with interest and I felt as if waiting any more would result in me being a toxic person both to myself and those surrounding me. Everyone has different factors at play. Personally, I had different hormonal levels than that of a regular male and had some female features as a child (testosterone bulldozes over those during puberty). I have also been told that my body processes estrogen slightly differently than the majority of males.
Three years old is indeed the age where gender identity starts to appear in children. It could be possible that the mother is telling the truth but one cannot say without an actual health professional's advice. It is normal for a child to experience different gender identities at that age since the brain is still forming. Usually the identity begins to solidify around five.
In the case that this identity cause distress in the child (attempting to mutilate themselves, depressive episodes, etc.), they should see a therapist. If there is a diagnostic of gender dysphoria which increase as their body develop, they might choose to use puberty blockers at the start of adolescence to stop the body from going through a puberty that increases this distress. It gives the child and therapist more time to go through those issues. Blockers can be stopped and a regular puberty would occur (with some possible health issue, so you shouldn't prescribe those unless the child is actually suffering). Should the feelings of distress and gender non-conformity still be present, discussion of an actual transition begin around sixteen years old. Children who transition from that path have the chance of not having lived the an extra puberty. It makes their transition easier and makes it less hard for the person to blend in as their actual gender. This avoid a lot of issues which adult transitioner have to struggle with their entire lives and will save on costs (facial feminization surgery, body feminization surgery, voice surgeries, etc.).
>If there is a diagnostic of gender dysphoria which increase as their body develop, they might choose to use puberty blockers at the start of adolescence to stop the body from going through a puberty that increases this distress.
Interesting position that we're in as a society where you can't be trusted to make decisions about almost anything thing until you're 18 but would allow a child and help them stunt/alter their physiological growth process because the they insist this is the correct thing for them.
Right or wrong, mental illness or suffering or natural variance aside, it's an tough problem of doing the right thing for the child.
It may help to think of it as a medical treatment. We don't withhold heart surgery from a child just because they aren't 18 and can't legally consent to it, and likewise we don't withhold treatment for gender dysphoria just because of age.
Note that the diagnostic criteria for this treatment are very strict. It's not gonna accidentally be given to a mere "tomboy".
I used to think like that and then I learned that suicide rate is extremely high among young people with gender dysphoria and these medicines are known to reduce that risk.
> and these medicines are known to reduce that risk
I'd known the first, but I've seen very few sources for actual studies on this. Do you happen to know of any? Even a 5 year study of people transitioning vs people denied the ability to transition would be greatly appreciated. There's a lot of people out there saying that transitioning doesn't lower lifetime suicide risks and I'd love something to push back on that.
So I'm unfortunately unable to access that paper - well, without paying $32 which is a bit steep - but does it have anything on the difference between people who transitioned and ones who did not? That's what matters after all, not the base rates. (Base rates being high tells us we really need to find a treatment, but it doesn't tell us what that treatment might be)
Most studies focus on how safe the therapy is. The questions are will it cause lifelong issues, how does it affect life expectancy, etc. You would need a study that begins before a diagnostic to be able to have any significant data. Any trans person who is denied transition will likely not be available to participate in such an experiment. Those that were denied that do make it to a scientist or expert would instead promptly begin to transition. It would be unethical to deny them transition for a longer period just to see how it goes.
There's a few that focus on how it increase quality of life but I don't know any hard comparaison.
"The present study suggests a positive effect of hormone therapy on transsexuals' QoL after accounting for confounding factors." [1]
"evidence suggests that sex reassignment that includes hormonal interventions in individuals with GID likely improves gender dysphoria, psychological functioning and comorbidities, sexual function and overall quality of life" [2]
"Psychological evaluation has shown that sex reassignment increases the well-being of transsexuals, but it should not be considered as a cure-all; it is rehabilitative relieving gender dysphoria, but some transsexual subjects may still experience other problems (e.g. comorbid psychiatric problems, social isolation, troubled relationships, prejudice, and discrimination)." [3]
"A clinical protocol of a multidisciplinary team with mental health professionals, physicians, and surgeons, including puberty suppression, followed by cross-sex hormones and gender reassignment surgery, provides gender dysphoric youth who seek gender reassignment from early puberty on, the opportunity to develop into well-functioning young adults." [4]
"Using data draw from the follow-up literature covering the last 30 years, and the author's clinical data on 295 men and women after SRS, an estimation of the number of patients who regretted the operations is made. Among female-to-male transsexuals after SRS, i.e., in men, no regrets were reported in the author's sample, and in the literature they amount to less than 1%. Among male-to- female transsexuals after SRS, i.e., in women, regrets are reported in 1-1.5%. Poor differential diagnosis, failure to carry out the real-life- test, and poor surgical results seem to be the main reasons behind the regrets reported in the literature." [5]
> Interesting position that we're in as a society where you can't be trusted to make decisions about almost anything thing until you're 18 but would allow a child and help them stunt/alter their physiological growth process because the they insist this is the correct thing for them.
This seem to be written from the point of view that children improvise their gender identity to get attention, or that gender transition isn't the method used to alleviate the serious mental health issue that is gender dysphoria. It is a lifelong source of anguish and suffering if not treated correctly.
Children have a quite clear idea of their gender and gender dysphoria is usually serious enough so that a professional won't confuse it from something else.
"A total of 55 young transgender adults [...] who had received puberty suppression during adolescence were assessed 3 times: before the start of puberty suppression, when cross-sex hormones were introduced and and at least 1 year after gender reassignment surgery [...] After gender reassignment, in young adulthood, the GD was alleviated and psychological functioning had steadily improved. Well-being was similar to or better than same-age young adults from the general population. Improvements in psychological functioning were positively correlated with postsurgical subjective well-being." [1]
"On both more-controllable self-report measures and less- controllable implicit measures, our group of transgenderchildren showed a clear indication that they thought of themselves in terms of their expressed gender. Their responses were indistinguishable from those of the two cisgender control groups, when matched by gender identity. [...] In summary, our findings refute the assumption that trans- gender children are simply confused by the questions at hand, delayed, pretending, or being oppositional." [2]
"While they may not have had language for it at the time, 59% knew that their gender identity did not match their body before the age of 10, and 80% had this knowledge by the age of 14." [3]
The differential diagnosis of gender dysphoria makes it quite clear that GD is not to be confused with other similar issues which won't require an hormone replacement therapy (body dysmorphia, the transvestism paraphilia, borderline personality disorder and psychosis, Asperger's syndrome possible obsessive preoccupations with gender, etc.).
It is not the child which request how the therapy will go but the health professional. Blockers are used because they are relatively safe and reversible without serious sequelae. When compared to a the lifetime of issues that would happen in the person's life should they go through an extra puberty are considered worth the risk.
>This seem to be written from the point of view that children improvise their gender identity to get attention, or that gender transition isn't the method used to alleviate the serious mental health issue that is gender dysphoria. It is a lifelong source of anguish and suffering if not treated correctly.
Well, two things to that. No, not really. I'm absolutely in agreement that gender dysphoria is real, and causes great suffering. Absolutely.
As to "get attention"... I have a 13yo niece that did exactly this for two months. She was "transgender" and asked people to call her by a different name and pronoun, seemingly dead serious to even her parents - now, you and I probably agree this is just a teenage girl seeking attention on a hot button topic and doesn't have much weight here. But - let's not pretend that someone else might be more committed. To your expected point, this is what a shrink would determine to be the case and we can move past it.
I guess the question I have is how is Gender Dysphoria different from Body Dysphoria?
If you are proposing to treat Gender Dsyphoria in children by giving them drugs to stop the natural development process. Why would anyone treating anorexia with daily supplements to keep them at a dangerously low weight but alive be different?
There is no answer to that because we just flat out don't understand gender dysphoria yet, imo. Phsycology has a replication crisis, so posting phsyc journals and trans blogs isn't doing much for me.
That's not to say I'm an enemy. I just don't agree that we should make changes to the body because of something we don't understand in the mind.
Let me ask you a totally serious question - if tomorrow a pill is released to "fix" gender dsyphoria, it's 100% effective and the person sees their body as their own, hears their voice as their own, etc. Would it be right to treat the symptoms by stopping adolescence or would that be seen as a barbaric / the very wrong thing to do? Would you take that pill or would that in your opinion remove who you are?
My point isn't to suggest there is a fix or will be a pill. It's to understand why gender dysphoria is different than body dysphoria. I suppose there is a great divide in the effects of one are physical and the other are mental. But also we accept that one is a flaw, but are told the other is to be accepted. The extreme of my argument is gay conversion camps which I can assure you is not the case I'm making.
> As to "get attention"... I have a 13yo niece that did exactly this for two months. She was "transgender" and asked people to call her by a different name and pronoun, seemingly dead serious to even her parents
I doubt that a therapist would have written her a letter of recommendation for an endocrinologist to start puberty blockers or HRT. Children can also claim to hear voices and you do not give them medication for schizophrenia without a diagnosis. Adults can start hormone replacement therapy since the enlightened consent path without a therapist since it allows an adult to make the decisions they see as the best for themselves. No therapist would be caught dead risking their entire career to agree with the whims of a child. I went to therapy as an adult and it was only after two years of monthly visits that they wrote me the recommendation letter. I have read the testimonials of children who claimed to be transgender in such a way and they pretty much all saw their quality of life decrease as their treatment advanced[1]. I don't have the source at hand but I've seen claims that desisters are 2% to 5% of the children who take blockers. That's a very small percentage of a small population (0.6%[2]) so I don't believe that we should see transition as a "danger to children". This is also to be expected since blockers are used to create an environment where the child can calmly explore all options and some of those options are not transitioning.
> I guess the question I have is how is Gender Dysphoria different from Body Dysphoria?
Gender Dysphoria is multifaceted and touch more of a person's life than Body Dysmorphia which I assume is your actual question. "Body dysmorphic disorder involves a distressing or impairing preoccupation with an imagined or slight defect in appearance. Individuals do not consider themselves a different gender, but find a part of their body (possibly the genitalia or breasts) to be abnormal and want them removed."[3] Gender Dysphoria is much more pervasive than that in an individual's life.
Body dysphoria is one of the facets of gender dysphoria. It is not different from gender dysphoria because it is part of it. Gender dysphoria may be experienced as body dysphoria, social dysphoria, or both.
"Gender dysphoria involves a conflict between a person's physical or assigned gender and the gender with which [...] they identify. People with gender dysphoria may be very uncomfortable with the gender they were assigned, sometimes described as being uncomfortable with their body [...] or being uncomfortable with the expected roles of their assigned gender."[4]
"Gender dysphoria in adults and children is considered a disorder if the person also experiences significant distress or impairment in major areas of life as a result of the incongruence. Identifying with a gender different from the one that was assigned is no longer considered a mental disorder in itself."[5]
Gender dysphoria will flare up from social encounters. A person who has had all the surgeries done and has the physical body of a model of their identified gender will still suffer if put in the opposite gender's roles.
It can also manifest in relation to a person's inner emotional life. A "boy" identifying as female being told to man up while crying is an example. In my case, I had stumped my emotional life to pretty much nothing and was coldly going through the motions.
> If you are proposing to treat Gender Dsyphoria in children by giving them drugs to stop the natural development process.
Puberty blocker are used when the child shows significant distress with their incoming puberty. Suicidal idealization, self-mutilation, substance-related disorders, etc. They are coupled with therapy and will allow the therapist to explore all possible options with the patient without the stress of a ticking clock.
> Why would anyone treating anorexia with daily supplements to keep them at a dangerously low weight but alive be different?
Identifying with a gender different from the one that was assigned is no longer considered a mental disorder in itself. The patient will likely cease to suffer from the destructive effects of gender dysphoria after transition or at the very least reach a point where the issue is manageable when coupled with therapy should the transition stop at a point where the individual is unable to pass as their transitioned gender.
> There is no answer to that because we just flat out don't understand gender dysphoria yet, imo. Phsycology has a replication crisis, so posting phsyc journals and trans blogs isn't doing much for me.
Assuming you meant Trans PULSE project as the "trans blog", possibly because their site is hosted on WordPress? "The Trans PULSE Project is a community-based research (CBR) project that is investigating the impact of social exclusion and discrimination on the health of trans people in Ontario, Canada." See their team's credentials here: http://transpulseproject.ca/about-us/meet-the-team/
If you choose to ignore current research from scientific journal there isn't much I can do to convince you. The literature is not very much exhaustive because this is a relatively new field of study. The "Institut für Sexualwissenschaft" studied the topic back in 1919 and coined the term transsexualism but the Nazi Party launched its purge in 1933, destroyed the research and sent the founders to concentration camps. Source say that around 20,000 books and journals, and 5,000 images, were destroyed. After that, most of the studies were done from the point of view that identifying with a gender different from the one assigned at birth was a disease of the mind. Transgender individuals were mixed up with transvestism and cross-dressers and were seen as fetishist. The research was on how to cure those "poor depraved souls". It is only recently that transgender individuals were recognized as sane individuals.
> I just don't agree that we should make changes to the body because of something we don't understand in the mind.
We may not understand the root cause with certitude but we know that transition raise the quality of life of patients. There has been many studies on the topic and health professionals will collaborate with them based on their experience in the field. I have never seen a study claiming the opposite other than the cases where misdiagnosis are used as if the non transgender patient was transgender and the wording written in such a way as to push a transphobic agenda.
It would be unethical not to attempt to treat a segment of the population that has rates of suicide attempts as high as 40%[6] simply because the exact cause of their issue is undetermined.
All I can do is claim from my anecdotal experience on the topic that my quality of life augmented, my substance-abuse issues stopped, my suicidal idealization and self-mutilation issues ceased and the heavy veil of negativity that was pervasive through my entire life dissipated once my testosterone levels dropped and my estrogen levels raised to cis female levels. It even cured my lifelong addiction to nails biting in the first week of hormonal therapy.
> Let me ask you a totally serious question - if tomorrow a pill is released to "fix" gender dsyphoria, it's 100% effective and the person sees their body as their own, hears their voice as their own, etc. Would it be right to treat the symptoms by stopping adolescence or would that be seen as a barbaric / the very wrong thing to do? Would you take that pill or would that in your opinion remove who you are?
I'm not quite certain what you mean here with "as their own". In the case of a trans person, that would be their identifying gender. Assuming you meant a pill that fully transition you, this is actually a question that is often asked at the beginning of therapy. All the trans individuals I've talked to would take that pill.
If you meant a pill that magically cures gender dysphoria while keeping the person in the body of the gender they do not identify with, then you do not understand the crux of the issue. According to your description, a "male to female" person would perceive their body as a female's and hear their voice as a female's. This might solve the issue if they lived in a vacuum or alone in the wilderness but we live in a society. Everyone else around them would expect male gender's roles from them and their dysphoria would be at its worst. Some transgender individuals I've talked with are already in that very situation, where their own perception tells them "you are looking at a female" but everyone around them sees a male.
Should you mean a pill that rewrites your entire brain, habits, joys and manners along with sexual orientation then I'd say no without any speck of hesitation. The question is often asked to transgender individuals and I've seen many an online poll asking the same thing and most if not all ended up with a strong majority of no's. From my point of view, it is alike to electroshock therapy and frontal cortex ablation straight out of the 1950's. The only persons I've seen answer yes to that are those with abusive families and transphobic environment. They would rather delete their entire life and start over than live through the hate and violence.
Identifying with a gender different from the one that was assigned is not a mental disorder. There is nothing to be cured since it is not a disease. If we lived in a world where body transfer existed, in one where nanobots could rebuild our bodies from the inside or in one where genetic engineering was so evolved that you could change someone's chromosomes this would be a non-issue. Anyone born in a body they do not identify with would simply switch to the right one and the concept of "transgender" would not exist. Gender Dysphoria would not exist either since the new body would be indiscernible from a cis person's eliminating body related dysphoria and nobody would push gender roles or be transphobic which would eliminate sources of social related dysphoria.
I do not transition to be pretty nor I do not transition to become someone else. It is not exciting to transition but rather a chore. The reason I transition is to be myself without filters. To stop fabricating and improvising my life according to gender roles that are not natural to me. My entire life up to this point has been an exhausting constant imitation and mimicry of behaviors that does not come intuitively to me. Now I can simply stop thinking about anything, be my unadulterated self and fit one of society's box without effort -- that of a woman. In the same way that living your life as your current gender does not cause you any distress, exhaustion or ask any effort out of you.
[6] James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality.
The last thing you want to happen is people to actually know that you are transgender, much less misgender you. The transitioning body is not the gender's present in your mind's eye, it is the result of having lived through the wrong puberty. Being made aware of the fact that you are transgender often triggers dysphoria.
Ever heard your voice in a recording and thought "Oh, that's not my voice -- it's just wrong. Must be the recording." and then felt a strong dislike towards that recording? Perhaps a bit of pain or cringe. Well, that's what a lot of transgender individuals experience daily when looking at their own bodies, hearing their own voice, seeing their image in the mirror, looking down at your own hands, etc.