Deciding that you’re unhappy with your gender and wanting to change is something which is beginning to be almost commonplace in today’s society and it’s sometimes known as gender dysphoria. In other words a dissatisfaction with the assigned gender because there’s a pull towards the opposite one. It’s all about a conflict between a person’s physical presentation and the gender with which they identify. People with gender dysphoria tend to present as being extremely uncomfortable with their assigned gender, and this becomes a particular problem if this is a young person and they start puberty/have started because this is when the body develops into its adult form and more signs of the birth gender begin to come out – facial hair, breast growth, a deepening voice in males. All of these things are noticeable to the outside world and definitively places them as a male or female.
Q. What’s the difference between being transgender and being transsexual?
A. ‘Transgender’ is a non-medical, umbrella, term to describe someone who has a different gender identity than the one they were born with. This is variously described as:
- Gender expression
- Gender non-conforming
- Genderqueer
- Bigendered
- Agendered
All of the above are being used more and more in today’s world. Someone who is transgender doesn’t usually go onto to have permanent medical treatment or surgery to become their preferred gender.
‘Transsexual’ is a medical term to describe those who do undergo some form of surgical and/or medical processes to re-assign their gender. These processes include breast removal, hormone treatments, construction of a penis and construction of a vagina; they are extensive and complex surgeries. Gender dysphoria can be attributed to some transgender people and some transsexual people, but it isn’t automatically given.
Q. Is there a general age at which people recognise that they’re transgender? Can it happen in later life?
A. It’s important to remember that not all transgender people experience gender dysphoria. It’s a serious condition so this is an important distinction to make. Having transgender feelings is something that can happen at any age, there’s no age limit although children are obviously subject to different treatment because they are not considered to have capacity to make such huge decisions. Their feelings are still respected and recorded and they have regular sessions with a psychologist if needed, but no major decisions are made, nor medical processes undertaken.
However, gender dysphoria in childhood is a diagnosis that is made. And it’s made for those who present with these feelings before puberty. Gender dysphoria in adults and adolescents is something which can be diagnosed at any age. Sadly, those who are diagnosed in later life often report having these feelings a lot earlier, sometimes even in childhood, and having hidden their gender dysphoric feelings from other people for a variety of reasons:
- Being uncomfortable with how they feeling and what it means.
- Being afraid of being judged.
- Being afraid of not being believed/having their feelings played down.
- Not wanting to disturb the ‘status quo’.
This last is a recurring problem for many because by later life they might have a spouse, families, a career to protect and simply not feel that they can make a major decision to change their gender and still fulfil their responsibilities. Again, psychotherapy can be useful in helping people come to terms with how they feel and help them to reconcile themselves with how to move on in whichever direction that takes.
Q. In terms of an emotional state, how does hormone therapy affected the person?
A. For those transitioning they are given either testosterone or oestrogen hormones and they often report an improvement in their gender dysphoric feelings as these feelings become resolved. But there are other things which come into the mix too, as you might expect. A process like this is never going to be a straightforward one and will always take its toll on the body and mind. Especially when things like hormones are being introduced. For example: a MTF (male to female) transitioning person may experience a loss of libido and a FTM (female to male) person may experience an increase in libido. These are all just things to be aware of as they move through the process.
However, much though this treatment will be working to resolve some of their negative feelings, it’s important to bear in mind that new ones might surface too – this is nota simple, straightforward switch. Studies have shown that a FTM person might display hypomania, anxious, psychotic or manic symptoms if they have an underlying psychiatric disorder which commonly includes these symptoms because hormones can act as a trigger. It seems to be associated with higher levels of testosterone in the blood.
As with any extensive treatment, close consultations with your doctor are imperative so they can decide on a definite diagnosis and explain the possible risks involved. In some situations they may decline to start treatment although this is usually subject to review.
Q. If a person has gender dysphoria does it necessarily follow that they will have gender affirming treatments?
A. No. Not everyone does opt for surgical/medical procedures. They consider all of the options and decide what’s best for them. Some choose hormones but not surgery, some choose both and some choose to just present as their preferred gender. Some people can cope with their gender dysphoria diagnosis and feel comfortable with claiming a gender identity without having surgery to reflect this in a physical sense. Or they may opt to only express their feelings in private to avoid potentially negative reactions in public. Online social forums can be a huge help to people experiencing confusing feelings because it can be a safe space where they can express themselves and connect with others going through the same thing. With no access to help or support it can have a disastrous impact on mental health, such as depression, anxiety and even suicidal thoughts.
Q. If a man simply prefers to dress as a woman, but doesn’t identify as female and typically lives as a male, does this mean that they have a psychiatric disorder?
A. No. This is described as transvestitism or sometimes Transvestite Disorder. It doesn’t apply to all those who dress as the opposite sex, even if they do so on a regular basis. The term disorder is actually only applied when the cross-dressing – or thoughts of – are accompanied by sexual arousal.
