Gender dysphoria is the distress or discomfort one experiences because there is incongruence between their assigned sex/gender and their gender identity.
Society often defines gender as being “male or female”, which is mainly influenced by cultural and social factors. But this only encompasses the gender binary which is a concept that people are categorized exclusively as either male or female, often basing gender on their anatomical sex. This often excludes identities that don’t exist in the gender binary.
The gender you are or identify with may be the same as or different from your assigned sex/gender. Assigned gender/sex is determined at birth often based on the appearance of the genitalia of an infant. If an infant has a penis, they’re assigned male at birth and raised and socialised as a boy. On the other hand, if an infant has a vulva, they’re assigned female at birth and raised and socialised as a girl. The sex that is assigned to an infant at birth is meant to correspond to the child’s gender identity.
Gender Identity is how an individual internally identify themselves as male or female or any other gender outside the binary. Gender identity may or may not correspond with assigned sex. Some are assigned female at birth and identify as male. While others are assigned male and identify as female. Some have a different sense of their gender identity that exists beyond being/ expressing as male or female, this is can be described as gender diverse or trans.
Most Individuals with gender dysphoria strongly feel the need to seek medical intervention that will allow their bodies to align with their gender identity. This desire may become stronger during puberty. Although not all individuals will experience distress as a result of such incongruence, many are distressed if the desired physical interventions by means of hormones and/or surgery are not available.
When one is unable to seek help while dealing with gender dysphoria
Some individuals with gender dysphoria are often distressed by the incongruence between their physical body and which in turn leads to anxiety, depression, self-harm and some may become suicidal.
Gender Dysphoria in Children
Children are diagnosed with gender dysphoria if they experienced distress for a period of at least six months and a few of the following (APA, 2022) :
A strong desire to be of the other gender or an insistence that one is the other gender, or some alternative gender different from one’s assigned gender.
Those assigned female as their gender, have a strong preference for wearing clothes that are traditionally viewed as masculine and they may also resist wearing feminine clothing. And those assigned male as their gender, have a strong preference for wearing feminine clothing.
Some show a strong desire to play with toys, and games and participate in activities that are stereotypically associated with the other gender
They have strong rejection for toys, games and activities that are stereotypically used by the other gender.
They have a strong preference for having playmates of the other gender.
Some may develop or show a strong dislike of their sexual anatomy.
They have a strong desire to have their primary and secondary sex characteristics match their experienced gender.
They experience significant distress in their day-to-day lives, especially in their social environment such as in school which in turn affects how they function.
Primary sex characterisitics are present during birth and comprise of internal and external reproductive organs. Secondary sex characteristics are those that emerge during and throughout puberty.
From the age of 4, children are able to think and sometimes their behaviour and personal interests may be linked to gender roles that are traditionally associated with a certain gender. For example, a girl may play with toys such as trucks, cars that are typical to the male gender. However, this does not always mean that their gender identity is different from their assigned gender. Allowing children to explore diverse gender expressions plays a vital role in their development. It maybe confusing to parents or a family whose child’s expressed/ affirmed gender is different from their assigned one but it is important to love and support them as they grow up. As they grow up, for some children this may disappear but those with gender dysphoria this continues through to the onset of puberty into adulthood.
Gender Dysphoria in Adolescents and Adults
In most children, Gender dysphoria disappears before or early in puberty. However in some of them,the distress may intensify as they become adolescents.
When physical visible signs of puberty develop, boys(assigned gender) may start shaving their legs when they notice hair growth. They may bind their genitals to make them less visible. Individuals who are assigned female at birth may walk on a stoop, wear loose clothes or even bind their breasts to make them less visible. Those living in accepting environments may openly express their strong desire to be treated, dress partially or completely, adopt the first name or have a hairstyle typical to their expressed gender.
Adults may adopt behaviours and start dressing as their expressed and affirmed gender.
Some often feel uncomfortable being identified or socializing as members of their assigned gender.
Some may develop a strong desire to be of a different gender and be treated as such and may feel or respond as their expressed gender without seeking any medical interventions to alter their bodies.
They may choose to find other ways to solve the distress by living fully or partially in their desired gender role or adopt a role that is neither conventionally male or female.
Some adults may seek hormone treatment (sometimes without medical prescription and supervision) and gender reassignment surgery. Others are satisfied with either hormone treatment or surgery alone.
What options are available for those with Gender Dysphoria?
These are different ways individuals may ease their Gender Dysphoria.
Psychotherapy : Finding a comfortable gender role is, first and foremost, a psychosocial process. Psychotherapy can be very vital in assisting trans, intersex and gender diverse individuals in the following ways:
Defining and exploring their gender identity and role.
Addressing the impact of stigma, discrimination and violence on their mental health care,development and wellbeing.
Help with the coming-out process which for some transgender individuals may involve changing their gender role expression and the use of medical interventions.
Peer support group meetings to meet other individuals with gender dysphoria.
Health professionals assist trans, intersex and gender diverse individuals with affirming their gender identity, exploring different options for expression of that identity, and making decisions about medical treatment options for alleviating gender dysphoria.
These options include:
Gender-affirming surgeries/procedures – Some individuals may choose to have gender-affirming surgeries/procedures to bring their physical looks more in line with their feelings.
Voice training to help you alter your voice to sound more typical of your gender Identity
Gender-affirming hormone therapy (GAHT)can be of help in two ways: –
Puberty blockers– medication to delay the onset of puberty.
Using Gender-affirming hormones such as oestrogen or testosterone.
Note: However the type of hormonal treatment being administered depends on whether the person has gone through puberty or not and their age. Children and individuals who are not of legal age require consent from their guardians or legal authority to go on hormones.
Involves legally changing one’s name and gender marker on official documents such as school certificates, birth certificates, national identification documents, and driving licenses to reflect their gender identity.
Making changes in their Gender expression and roles. This may involve living and presenting in a Gender role that is the same as their Gender Identity.
Chest Binding – a common practice among trans masculine individuals, is the process of compressing your chest (breast) tissue to create the appearance of a flattened chest. Using a variety of materials and methods such as sports bra, layering several sports bras or shirts, chest binders and athletic compression shirts.
Breast Padding– a common practice among trans feminine individuals, is the process of using undergarments to create the appearance of larger breasts, hips or buttocks.
Packing -is wearing padding or a phallic object in the front of the pants or underwear to give the appearance of having a penis and male bulge.It is commonly practiced by trans men.
Tucking– is the practice of hiding the penis and testes so they are not visible in tight clothing. There are many ways to tuck, such as pushing the penis and testes between your legs and then pulling on a pair of panties, to tuck the testes inside of you.
Use of make-up
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The American Medical Association and the American Psychiatric Association have recognised gender dysphoria as a medical condition but not a disorder. Further, the degree of dysphoria varies, meaning the psychological distress varies as well. Yet because gender dysphoria can lead to severe health issues like depression, anxiety, and suicidal ideation, the recommended course of treatment is living as a trans person, including the use of mental health support and maybe the options of gender-affirming hormone therapy (GAHT) and procedures.
Refers to the initial assignment as female or male that occurs at birth based on the external genitalia. In some cases, the doctors may check the gonadal tissue or chromosomes to help “determine” the infant’s gender, but the infant is assigned male or female based on biological features. The guardians /parents then raise the kid under specific gender roles and presentation based on this.
Describes how an individual internally understands and identifies themselves as male or female or any other gender outside the binary. It can correspond to an individual’s assigned sex at birth or it can differ from it. For those people whose gender identity conforms to their assigned sex at birth e.g a person assigned male at birth will usually have a masculine gender identity that is expressed by taking a male role and physical expression
This is the idea that gender only exists in two forms and that people can either be male or female. However, this is not true, since there are gender identities that are diverse and exist out of these binaries.
A sense of distress that may arise when a person’s physical sex and/or sex characteristics is inconsistent with the person’s sense of who they really are or with their experienced gender.
This can be felt physically. For example, for some trans men having breasts, not having facial hair, having a vulva and being shorter may cause them to feel that the society perceives them as female which is contrary to their gender identity. It can also be felt socially. For example, people may see their breasts and assume that the person is a woman. Some may hear their low voice and assume that they are a man.