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What Is Gender Dysphoria & How Does It Affect People Who Are — And Are Not — Transgender

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what is gender dysphoria? Why This Mental Health Diagnosis Does Not Mean Transgender Is A Mental Illness
Self, Health And Wellness

Science agrees — transgender people are not mentally ill.

When people see or hear the diagnosis "gender dysphoria", they assume this means that a transgender person is mentally ill or "crazy" in some way. This couldn’t be further from the truth. Being transgender is not a mental illness. 

So, what is gender dysphoria?

Gender dysphoria is a diagnosis related to how a person feels about the gender they were assigned at birth. 

According to The American Psychiatric Association:

"Gender dysphoria involves a conflict between a person's physical or assigned gender and the gender with which he/she/they identify. People with gender dysphoria may be very uncomfortable with the gender they were assigned, sometimes described as being uncomfortable with their body (particularly developments during puberty) or being uncomfortable with the expected roles of their assigned gender."

While gender dysphoria is not a mental illness, per se, having the diagnosis available for patients provides a category so that the person can gain access to the services he or she needs to resolve the dysphoria and become comfortable with their gender.

In other words, when you have a diagnosis, your insurance is more likely to help you receive necessary medical or psychological services in order to live a happy, healthy life. For some people, this may mean transitioning so that their outward appearance or anatomy matches their gender. 

RELATED: I'm A Transgender Man And I'm Worthy Of The Same Love I Had Before I Transitioned

What is gender?

The first thing to know is that gender is not the same as your biological sex —  though many of us identify as the gender that matches our biological sex.  

There are generally two biological sexes: male and female. Some people are also born intersex which means they were born with anatomy that doesn’t fit what's typical for male or female bodies. Some people have both male and female aspects of their genitals, for example. 

Gender is a social construct —​ not a biological fact.

Gender is how we feel and see ourselves. For many years, male and female were the only genders recognized. Now, we know that gender falls on a spectrum and that even people who are happy with their assigned gender at birth matching their biological sex can move along the spectrum at different parts in their lives. 

For example, I am a biological female and I see my gender as being a woman and I have always identified as a woman (or a girl). However, at some points in my life, I have felt very feminine and at others, I have felt much more masculine.  

RELATED: What My Transgender Brother Taught Me About Being A Woman

Who is diagnosed with gender dysphoria?

People who identify as transgender are the people who are most likely to be identified as gender dysphoric. They often feel they were born into the wrong body. 

But it's crucial to understand that, according to The American Psychiatric Association, not all transgender people have gender dysphoria

Other trans or genderqueer people may choose to stay in the body they were born into. This does not make them any less valid as a trans or genderqueer person. It's just a personal preference. 

Some cisgender and other non-trans people may also be diagnosed with gender dysphoria. 

Gender can also be fluid, and there are many different types of gender identities that aren't strictly transgender within the LGBTQIA+ spectrum. 

For instance, some people are "genderfluid" and identify as female sometimes and male at other times. They do not see themselves as transgender, necessarily, because the way they identify moves along the spectrum between male and female.   

Some people feel they are neither male nor female, while others feel they are both male and female. Some of these people use the label "genderqueer" to refer to themselves. Within the medical and psychological communities, these people are often called gender non-conforming. This term also includes people who are transgender and genderfluid.

RELATED: 5 Things You Don't Know About Transgender People (But You Should)

Are people with gender dysmorphia mentally ill?

People who have gender dysphoria feel very strongly that their gender does not match their biology, but this is not a mental illness. The dysphoria diagnosis is simply a description of the distress this mismatch causes. 

Many people choose to do things to get their bodies to conform more to their identified gender. Some of them choose to go through surgical and/or hormonal processes to aid in matching their anatomy with their gender. Surgery to change a person's anatomy to match their gender is often called "gender confirmation" or "gender affirming" surgery

One of the main reasons for the diagnosis is the access it gives people to appropriate health care, especially in the United States where a diagnosis is necessary for insurance coverage. 

When someone experiences this dysphoria, it causes stress, anxiety, and depression. In some cases, people feel suicidal as a result of the mismatch between gender and biology. Experiencing gender dysmorphia is serious and may require treatment, but the person's gender identity itself is not the problem. 

Gender is one of the central features of self-image and self-understanding and it impacts intensely on how we relate to others. So feeling like your gender is out of place or not representative to who you are can be very stressful.

Feeling as though your body is wrong is an awful feeling, distressing on so many levels. When others mislabel a person’s gender, it is jarring and the person feels invisible and not understood. It impacts on every aspect of life. 

People who have gender dysphoria have higher rates of substance abuse, depression, suicide attempts, eating disorders and anxiety. These people may need treatment, and they deserve to receive the support that can help them resolve their dysphoria. 

RELATED: 8 Unexpected Confessions Of A Transgender Man

What are the signs of gender dysphoria?

People often are aware that their body doesn’t correspond to the gender they feel when they are quite young. Children who have gender dysphoria will consistently tell people that they really are the opposite biological sex. They will tell people that when they grow up they will become the other sex. 

Many talk about removing the genitalia that doesn’t match their gender. They will reject clothing, toys, and activities associated with their biological sex. They will often have friends of the gender they see themselves as. They will often insist on urinating as the opposite gender so girls who identify as boys will urinate standing up.

Tweens and teenagers may become very distressed by the biological changes that come when they hit puberty. This is often a time that suicide risk increases. They often express disgust at their genitals and secondary sex characteristics. 

So biological girls who are developing breasts but identify as boys may do anything to flatten their breasts. Some will seek surgery. They will often dress as the gender they identify as rather than according to biological sex.

As gender fluidity exists, it is important to support children and adolescents where they are at any given time and not assume where they will end up when they reach adulthood. 

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The goal of any talking therapy or counseling is to support the person, not to try to change their gender identification. There is nothing wrong with their gender identification. 

Some people who identify as transgender do not have dysphoria related to this identification. They don’t feel upset that they are identifying as the gender opposite their biological sex. In this case, a diagnosis would not be appropriate. There must be distress about the mismatch between biology and gender in order to gain a diagnosis.

What do you do if someone you love is gender dysphoric? 

If it is a child, be supportive. Don’t contradict the child’s view of themselves. Don’t try to change the child to be the gender of their biological sex. If you find this difficult to manage, get some therapy or coaching to sort your emotional issues and to support you in how best to support the child.  

Call the person by the pronouns they wish to be used. Some choose to simply use ‘he’ or ‘she’. Others who are gender fluid are more comfortable with ‘they’. Others use new pronouns like ‘zi’. Help the person to gain the support that they need.  

If you believe you have gender dysphoria, what can you do? 

There are a lot of places to get help. Make sure to approach specialist clinics, doctors, and mental health professionals so that you will be supported and not told that you have a mental illness or told that you need to change to be as your biological gender.

Make sure that you come out to people who are not going to judge you or damn you. Educate yourself on all of your medical, surgical and psychological options. 


RELATED: Exactly What To Do If Your Kid Comes Out As Transgender


Dr. Lori Beth Bisbey is a sex & intimacy coach and psychologist who works with individuals, couples and polyamorous groups, parents, children, and families. She hosts two podcasts: The A to Z of Sex and Sex Spoken Here every week. Her discovery sessions are available to anyone, regardless of location.