The Nature of Gender Dysphoria

Considering my particularly unique situation as a person who struggles with gender identity disorder (GID) but who has chosen not to transition (change my sex) I have written this essay to share what I have learned about the condition and concerning my own specific techniques used to cope with it. Before beginning however, it is important that you first understand what it feels like to have GID.

Imagine that you’ve just had a very bad day – one among a long line of bad days. Perhaps the kids have worn you down or your job has leached away all your energy. Maybe you feel extremely depressed or lonely and isolated, or maybe you feel hopelessness seeking to overwhelm you. Now imagine you believed that your bad day, as well as all the bad days preceding it, were brought on by a single cause. Imagine if you believed the majority of your life’s struggles, failures, and disappointments all stemmed from one source. Wouldn’t you do anything to fix it? Wouldn’t you do anything to make the pain go away so you could live a happy, normal life?

For a person struggling with GID, the source of their problems is linked to their gender, or at least that is how it seems. “Oh that I were born the other sex, my life would not be so bad!” is a trite representation of a thought often echoed by the gender dysphoric. One’s sex might seem an odd thing to implicate for life’s shortcomings and tragedies, but for people with GID, this thought is so encompassing it drives us to ends that put us on the very fringe of society – those who would pursue changing their sex.

One would think that changing one’s sex, especially when you are a balding, overweight, male, in his forties would certainly create more problems than it would solve, but to the gender dysphoric, it seems to be the only alternative to a lifetime of continued misery. What is worse, we often are convinced that if we aren’t allowed to pursue sex change, that suicide is the only escape from the pain we feel.

Sex change is an incredibly difficult process with plenty of dangers including the risk of hormone treatments, surgery, loss of income and employment, and the looming potential to suffer violence. These dangers, coupled with the knowledge that one’s status in society will take a plunge and that one will lose or at least severely damage most of one’s personal relationships, makes transition a path only for the boldest or most desperate of gender dysphorics. As such, people who choose to transition normally seek out others like themselves to support one another during this incredibly trying life decision.

As with most outcast groups, the polarization of being with like-minded (or in this case, like-disordered individuals) can be empowering and endow one with a certain resistance to being given any advice from someone who “doesn’t understand you” and enable one to readily reject anyone who doesn’t totally accept him or her while cleaving to members of their in-group. Typically attempts to change the mind of one going through this process only results in further determination by the individual to continue in the path of transition. After all, to the dysphoric, this isn’t about social status, the health of their relationships, or income potential, it transcends all of those things – it is about being oneself; it is about being able to look at the mirror each day and be happy with the person they see; and for many it is about survival.

You might ask, but why change one’s sex? Isn’t there another way to cure one’s gender dysphoria? The reason is simply that no other method appears to work. The transsexual groups are rife with individuals who tried other ways to deal with the pain only to end up right back where they started and usually worse for wear for the effort. Indeed for one who is dysphoric it seems the only true fix is to change one’s body. Any other suggested method is often met with disdain. After all, the transsexual’s mantra is “transition or die.”

It was this way for me once. I was in the prime of my youth, a 19 year old male, trim, fit, and willing to do whatever was necessary to rid myself of my gender dysphoria, to end the source of my life’s problems, and to be accepted as the sex I thought I really was. I considered myself fortunate. Living in the 90’s, information about gender dysphoria, transsexuals, and sex change abounded. Online support groups and group therapy sessions were easy to find. Despite losing the support of many of my friends and family members, I considered them acceptable losses in pursuit of the only thing I believed could end my suffering and ever make me truly happy.

So I transitioned to being a female successfully and did so in about two year’s time. My dysphoria was basically non-existent, and I looked forward to a peaceful life as a bright, young, college-going woman who was ready to take on the world. I would ultimately take another path however. Due to some personal events that occurred in my life as well as some observations I made concerning my own GID, I began to wonder if it were possible to live life successfully as a male without transition.

Doing this placed me into a position to learn more about GID, more about why it affects me, how it operates, and most importantly, how to combat it without retreating into escapist activities or going back to transition. Not all of this understanding happened at once, it has taken many bumps and bruises along the way, and I have been tested many times even right to the brink of my ability to cope, but I am stronger for it and have a great deal to share now.

It is important to make note that all information detailed further applies only to my own understanding of GID. Some of the things I have written will fit for some dysphorics while others may feel my experiences to be completely foreign. Understand one thing though. With an identity issue, self-justification is of paramount importance. Challenging a person’s identity regardless of whether it is real or perceived is walking into dangerous territory for any individual. This goes doubly so for dealing with a person with an actual identity disorder like GID. Blanketly applying that which I have written to another person with GID is fraught with the possibility of alienating the person you are trying to understand. As such, take this for what it is worth, the experience of one person and what he has learned about his own gender dysphoria.

GID operates very similarly to a phobia. Just as phobias have triggers and are negatively reinforced by responding to them, so too is gender dysphoria. For an example take arachnophobia. This is an irrational and overwhelming fear of spiders. For the arachnophobe, interaction with a spider or spider like creature serves as the trigger which provokes the distress. The phobic individual then seeks to relieve the stress by fleeing from (or sometimes squashing) the spider. This behavior only further reinforces (strengthens) the desire to flee from the spider rather than be comfortable in its presence (the desired goal for the phobic individual). Only by being forced repeatedly and consistently to confront the spider and remain in its presence long enough to obtain some relief does one unlearn the connection that relief from the spider only comes by retreating from it.

This example works also with GID. Gender dysphoric feelings often have a trigger. For many dysphoric males, a trigger could be seeing a group of young girls at a restaurant laughing and enjoying “girl” time together. This scene provokes unhappy feelings of envy and sadness in the dysphoric male in that he is reminded of the life he feels he should have had and has been denied.

The feelings of gender dysphoria begin to come on very strongly as the dysphoric’s mind leaps into a cycle blaming one depressive attribute after another on the fact that he is male while at the same time romanticizing the idea that being female would bring relief from such pains. Just as with the arachnophobic, the relief from the trigger seems to come from escaping the problem. The arachnophobic flees the scene while the dysphoric fantasizes about being the other sex reinforcing the idea that his sex is the source of his woes while being the other sex would alleviate them.

It is important to note that triggers are not limited to external events. For most people with gender dysphoria their own bodies – even their reflection in a mirror can be a great source of discomfort. In addition to this body dysmorphia, triggers can also include statements or impressions held or made by others. The female gender dysphoric doesn’t want to hear how “pretty” or “feminine” she is no more than the male gender dysphoric wants to be compared to other males. Sometimes even the act of referring to the dysphoric by a gender-specific title like Mister or Miss is enough to provoke a rage of dysphoric feelings in the individual.

Unfortunately for gender dysphorics, there is rarely ever only one trigger and to make matters worse, one trigger can take on a life of its own. To use my example, what may start as a trigger related to girls laughing in a restaurant may be generalized to include seeing a girl at a restaurant then eventually generalize to such a degree that even the sight of a restaurant provokes unwanted dysphoric feelings. It isn’t hard to see how for the dysphoric, even living every day life can become debilitating.

In order to alleviate these dysphoric feelings provoked by these triggers, most people with GID take steps to assume, at least in private, the life of the other sex. They may find relief dressing as the other sex, fantasizing about being the other sex, interacting with others anonymously – such as in an internet chat room – as a person of the other sex, or by engaging materials that allow them to escape from their current sex. This is a vicious cycle however. Since doing cross-gender activities relieves the dysphoria, the individual becomes reliant upon them to stave off depression.

Unfortunately, merely “pretending” to be the other sex is not “being” the other sex and can lead to greater and greater efforts to live life as the other sex. In a cruel irony, even these acts of relief can become their own source of gender dysphoria. For example the male dysphoric who looks at himself in the mirror dressed to the nines realizes he is still only a male in female clothing and not the girl he’d always hoped to be which, in turn, further provokes his gender dysphoria.
This cycle, if left to itself, can only intensify dysphoric feelings until eventually they can become unbearable for the individual leaving them desperately seeking relief but running out of ways to cope. Eventually, this cycle and the depression it brings leads to only one unavoidable conclusion, “transition or die.”

So how does one break the cycle? It isn’t easy, but I have found that the first task in doing it is identifying one’s triggers. For individuals who have been severely dysphoric for several years, it may be hard to pinpoint what their triggers are because they have generalized so much. It may seem to them that everything provokes their dysphoria. Still it is important to identify at least some triggers and work on them one at a time. Once identified, normally avoidance of the trigger can serve to offer some relief. If seeing a women’s clothing store sets off your dysphoric feelings, then stay out of the mall for the time being. The dysphoric needs the opportunity to not be so consumed with their dysphoria so as to allow them to really tackle what triggers it.

Once a trigger has been identified and a level of self-sustainability has been maintained, it is time to work to neutralize it. Neutralization refers to the action of taking a stimulus that provokes GID and turning it into one that doesn’t. The way this is done is similar to how phobias are dealt with. When in the presence of the triggering stimulus, gender dysphoric feelings will certainly manifest, but instead of finding relief from them by escaping or avoiding the thoughts, instead begin to focus on something else entirely. In other words, pair the stimulus with a new response. For me, it involved telling the people I was with that I was feeling gender dysphoric, what was provoking it, and that I needed help to keep from getting depressed. Those with me would then take the time to talk it over with me or would seek to entertain me. Eventually, the triggering stimulus began to be paired with pleasant experiences of understanding from others and merriment rather than alienation, depression, and self loathing.

Of course, one cannot always be with others in the presence of a trigger. When alone and in the presence of a trigger where gender dysphoric feelings were manifesting, I forced myself to think about all the good things about my male life. In other words, all the stuff I would have to give up or leave behind were I to become a female. This focus on what I had (the benefits of my current male life) instead of what I didn’t (the benefits of having a female life) became the backbone to my coping strategy and my number one defense against gender dysphoric feelings. In fact, in the presence of some triggers, I automatically begin to feel grateful for the things I have in my life – completely the opposite of the feelings once inspired by the same stimulus.

Can this be done alone? I do not believe so – it would have been much, much harder without the caring understanding and open ears from my church, friends, and family who helped me – especially during the darkest times when in the grip of crushing depression brought on by dysphoria. That being said, if you are reading this know that you too can be a great ally to one suffering with GID. Having someone willing to listen to them, their struggles, and their thoughts, as alien as they might seem to you, can become one of the greatest weapons the dysphoric has in his or her arsenal against the debilitating effects of the disorder. The more time you take to learn about the feelings of the dysphoric individual, the less alone they will feel. Their feelings must not be in any way belittled or it may encourage the dysphoric to alienate themselves further. I know this from personal experience as some attempted to help me by making light of my feelings and it only provoked me to avoid future interactions with them.

While the causes of GID are yet unknown and treatment of it is severely limited, it is not necessarily a sentence to a life of misery. Regardless of the choice of the dysphoric to transition to the other sex or not, they can benefit from learning to break their dysphoric associations by identifying and systematically neutralizing their triggering stimuli. While this might not bring complete peace from gender dysphoria, it can go a long way to providing the relief the dysphoric needs in order to make decisions about how to deal with their GID long term while not engulfed in pain from their condition.