I guess this is a complicated question because everybody is different. Our life experiences are different and what works for one person isn’t necessarily going to work for someone else. I totally recognise that my experiences are unique to me and that my experiences have shaped my view of the world.
I think I need to break the question up a bit in order to answer it fully:
1) What is gender dysphoria?
According to the NHS(1) “Adults with gender dysphoria can feel trapped inside a body that doesn’t match their gender identity. They may feel so unhappy about conforming to societal expectations
that they live according to their anatomical sex, rather than the gender
they feel themselves to be. They may also have a strong desire to change or get rid of physical
signs of their biological sex, such as facial hair or breasts.“
The DSM V is likely to change the definition of gender dysphoria (which in fact replaces gender identity disorder) in an attempt to destigmatise it. Notes on the DSM 5 from the APA (2) state “
For a person to be diagnosed with gender dysphoria, there must be a marked difference between the individual’s expressed/experienced gender and the gender others would assign him or her, and it must continue for at least six months. In children, the desire to be of the other gender must be present and verbalized. This condition causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
So gender dysphoria is an acute discomfort with the social role, and the physical manifestation of a sexed body which conflicts with somebody’s sense of themself as a man or a woman. This distress is significant enough to impair the person’s ability to function in society.
2) What causes dysphoria?
This is the million dollar question and whilst there are a number of scientific studies, they often conflict, or are statistically inconclusive.
There are probably many possible things that can combine and contribute to gender dysphoria. 12 potential causes are listed here http://www.patheos.com/blogs/catholicauthenticity/2015/07/12-causes-of-gender-dysphoria/.
Some believe that the cause is biological, perhaps brain differences, perhaps caused by exposure to hormones in utero(3)(4).
Others believe that the cause is nurture rather than nature and is rooted in attachment theory(5).
In some ways this doesn’t matter, because gender dysphoria exists regardless of it’s cause and those of us with it deserve to be treated like worthy human beings and whether it is nature or nurture shouldn’t impact on our right to not be discriminated against. However, it does matter, because the likelihood of sucess of any given form of treatment will vary depending on whether the cause is physiological or psychological. Put simply, if the cause is physiological then medical treatment is more likely to be beneficial, whereas if the cause is psychological then talking therapy may be more beneficial. I should really stress at this point that by talking therapy I do not mean conversion therapy. I’m talking about giving people the tools to accept themselves and build a high level of self esteem and resilience. I’m not talking about persuading people to adopt heteronormative gender roles.
3) What is gender anyway?
Actually, this is probably the billion dollar question as I believe that this question is at the heart of discourse and disagreement between some members of the trans community and some members of the feminist community.
Some people believe that gender is innate. That we all have an internal sense of ourselves as either male or female or both or neither and that this gender identity links to our behaviours that we associate with males and females.
Others believe that there are no innate differences between male and female behaviour and that gender is a system of learned behaviours that are imposed on males and females.
Ironically, the goals of trans people and radical feminists have huge overlaps. We all want society to relax and let people express themselves in the way that feels natural to them without having to meet some stereotype. We all want that people with penises don’t have to have short hair and be tough and like football. They can if they like, but it should be just as acceptable for people with penises to like long hair and make-up and be nurturing and have other likes and traits that our society typically associates with people with uteruses. We all want that people with uteruses don’t have to like dresses and makeup and being submissive and love babies and kittens. They can if they like, but people with uteruses should also be able to like short hair and car engines and football and beer.
The difference is that trans people believe “I identify as X therefore I AM X even though my body is Y” whereas radical feminists (as far as my understanding goes) believe that “My personality is X and my body is Y and that’s fine”.
In my case that means that trans people say that ‘I identify as a woman so I AM a woman’ whereas radical feminists say that ‘I identify with things our society associates with women and it’s fine for men to do that’.
4) What are the options for treatment?
The goals of treatment are to relieve the sense of distress associated with living in a prescribed gender role that the individual does not identify with. To reduce the likelihood of comorbid psychological conditions such as depression, anxiety, self harm and suicidal thought. To reduce the impairment to social, occupational and other function.
Potential treatments include:
- Social role transition
- Hormone treatment
- Surgical treatment
- Psychological treatment
- Conversion therapy
I believe that conversion therapy is, for the most part, dangerous, damaging and counter productive and largely unsuccessful in the long term. This is a way of forcing people to adhere to social roles that they simply do not identify with. Gender dysphoria is not something that goes away no matter how much you try to suppress it.
I believe that any successful treatment has to centre around allowing and encouraging somebody to express themselves in the way that they feel comfortable with and to remove the stigma associated with that, and to build somebodies self acceptance and self worth.
The first four treatments listed above are all geared towards achieving these goals.
5) What are the impacts of different treatment methods?
Social role transition
I think that this is really important, although what it means can be interpreted differently by different observers. Essentially it is the freedom for somebody to live and express themselves in a way that they feel comfortable with, and perhaps more importantly to not have to adhere to a social role that causes them significant distress. Some observers may see this as men living in a role that we typically associate with women and that that is OK because the social roles are socially constructed and artificial in any case. Others may see this is someone who is actually a woman (despite being male bodied) being able to live in their true gender. Others may see it as abnormal and wrong, even perverted. The need to feel worthy and valuable can not be underestimated and the impact of others is what ultimately drives an individual’s sense of worth.
Because we live in a society where others have a wide variety of views, it’s important for a trans person (as it is for anyone) to not feel that they are constantly under scrutiny and being judged by others. There are two ways to achieve this which go hand in hand.Firstly to change society so that trans people are accepted and not ridiculed, and secondly to go as unnoticed as possible.
No matter how much I accept myself, I still live in a real world where the majority of people have strict expectations of how men and women are meant to be and can be quite vocal in expressing these beliefs and ridiculing those who don’t conform to their expectations. This is a strain so life is much easier if you can go unnoticed. Hormones and hair removal really help with this, People probably look at me and suspect that I’m trans, but as long as there is an element of doubt, people wouldn’t dare to say anything in case they offend somebody who is actually a woman. So it’s not about being ‘stealth’, just being confusing enough to be able to get on with your life. Of course, the stares can hurt too so the more you ‘pass’ the easier life is.
If we could change society to accept trans people as just part of the norm, then the need for hormones would probably be less, but in our current society they certainly make life much more tolerable.
I think that this is an area for the individual and I’m hugely conflicted about it. I’m going to pass on this one as it deserves a lot more thought and a dedicated blog.
I think that this is really, really important and sadly very lacking in current treatment approaches. Self acceptance is the most important thing in my opinion. The current trend in any kind of therapeutic support seems to rely on the “you are valid and worthy because you are actually a woman/man” and this is why any challenge to this, no matter how well meaning, is dangerous and damaging because it attacks the very foundations of self worth that a trans persion has been given. The response is a fight or flight response because it is an attack on somebody’s validity. My concern is that this approach is of huge short term benefit but has long term repercussions. In order for this approach to be successful in achieving the therapeutic goals outlined earlier, it requires everyone to buy into and support this belief. However, it’s unrealistic to expect that we can change the views of everybody in society and this leaves an individual vulnerable when they encounter anybody who challenges this belief.
An alternative approach is to view gender roles as socially constructed and to say “you are valid as you are because the views of society that make you feel bad about being who you are are artificial social constructs. You are OK whatever and however you are. You don’t need to believe that you are actually female/male in order for you to be a valid and worthy person living the life that you feel comfortable with.” Whilst this view is unpopular, I believe that it is a more stable way of supporting somebody who is trans as it is not reliant on cognitive dissonance and the buy in of all of society. I also believe that this type of support may, for some but not all, reduce the need for surgical intervention.
I think that in a different society where gender is accepted by all as a social construct, it may be possible for some people to relieve gender dysphoria without hormones or surgery. I think that transition is largely required though and no attempt to force somebody to live long term in a social role that causes them distress can be relieved through therapy alone. In our current society hormones and hair removal are extremely beneficial in reducing impairment in social and occupational function and minimising the exposure to discrimination and hate.
I personally think that being critical about gender whilst supporting transition provides a more stable psychological foundation than telling somebody that they are actually the other sex.