Understanding
Gender Identity Disorder
(GID)
and
Gender Dysphoria
What
is gender identity?
Gender identity occurs from the
neck up. Biological sex is defined from the neck down.
Our gender is the
self-defined recognition of our selves as either male, female, or some
combination of characteristics from both. Gender is a term which
reflects our "social" self, rather than our biological self.
Our gender does not, in fact, always match our biological markings as
"male" or "female."
What
is gender dysphoria?
Gender dysphoria,
which is also known as 'gender identity disorder' or (GID), is a
medical diagnosis that describes an experience of anxiety, confusion,
and discomfort about the discrepancy between one's biological sex, and
one's self-defined gender identity which does not match their
biological sex.
The first three words
that we often hear upon our entrance to this world are either,
"It's a boy," or "It's a girl." When those
words are spoken, an automatic series of expectations are set in
motion about how we will think, look, dress and act as we grow-up.
The gender dysphoric child, however, will soon discover that what is
expected of him or her is not what feels good or right. This
begins the journey toward self-discovery. Unfortunately, this
journey toward self-discovery is wrought with strong social
influences, expectations, and misinformation. Much like being
dropped in a thick dark forest without a guide, or any clear paths,
the gender dysphoric child must safely navigate his or her way to his
or her true gender, often alone.
Generally, early in
life, a child who is born with mismatched sex and gender, will begin
to feel as if they have been born into the wrong body. Though
there is typically no language, or even understanding of what is
happening, yet a dysphoric child will develop the sense early on that
something is very different about them. The emphasis in our
society on gender-appropriate behavior generally creates varying
degrees of distress for a youngster with gender dysphoria. The
boy who wants to wear pink, and is shamed for this; or the girl who
doesn't want to wear a dress and is made to, may soon develop the
belief that how he or she feels is "wrong," or
"bad." This feeling of shame often serves as the
foundation on which the rest of one's gender then develops.
Gender confusion, and
conflict may ebb and flow over the years, with some periods of time
being more difficult than others. Eventually, however, it will
begin to permeate every aspect of life, causing increasing amounts of
distress, confusion, and anxiety for the gender incongruent person.
The degree of
dysphoria varies from mild to extreme. For some, dysphoria
simply creates mild feelings of belonging to the opposite sex, and may
cause people to dress as the opposite sex once in a while (called
cross-dressing). For others, anxiety about being 'in the
wrong body' can be the major driving force in their lives, leading
them to seek gender reassignment, commonly known as a sex-change or
(known as transsexualism). Others may simply question the rigidity of
gender roles, and seek to establish a 'transgender' identity with out
any particular motivation to alter their bodies.
For diagnostic
purposes, the mental health community relies on a manual commonly
referred to as the DSM-IV, to classify someone as having Gender
Identity Dysphoria (GID). The primary criteria for this
diagnosis is a strong and persistent cross-gender identification.
This means the person wants to be, or is insistent they already
belong to, the opposite sex. A person must be persistently
uncomfortable in their current gender role, and feel that it's not
congruent with their physical self. This diagnosis will not fit
if a person is motivated to transition for the purposes of
experiencing a cultural advantage of the other sex. Likewise, the
diagnosis is not appropriate for someone with 'intersex'
conditions. There has to be evidence of clinically significant
distress, or damage to important aspects of the person's life to
diagnose gender identity disorder.
Gender dysphoria is an
overwhelming and widely misunderstood condition that causes
significant distress for those experiencing these conflicts. It
is common for gender dysphoric men and women to develop anxiety and
depression. The longer these issues go un-addressed, the more
severe the conflicts can become. Many people make choices to
affirm their biological sex by over-compensating for their gender
identification with the other sex. Men may go to extremes to
prove their masculinity, including marriage and fatherhood, and
biological women may also go to extremes to prove their
femininity.
Transsexualism
Transsexualism can be
defined as an incongruence between the biological sexual
differentiation and the gender identity. In a nutshell, a man or
woman who experiences the feeling that they have the mind of one
gender and the body of another. The intensity of conflict for a
transsexual is such that relief can only be experienced by changing
their body to match their mind.
Transitioning one's
gender role typically involves a regimen of Hormone Replacement
Therapy (HRT), which may or may not be followed by Sexual Reassignment
Surgery (SRS) depending on how a person defines their own gender.
Some men and women are able to find relief for their
gender-incongruence by changing their physical self enough to be
perceived by the world in the gender that is most true for them,
regardless of the genitals they have. Others, despite the
private nature of what one's genitals are, feel persistently
uncomfortable until their entire physical self, genitals and all,
match their gender identification.
How
common is gender dysphoria?
There
are no studies, currently, that reflect an accurate representation of
the percentage of people who experience gender dysphoria.
Because of the highly-stigmatized, often shame-based nature of this
condition, it is common for those with gender issues to censor and
conceal their feelings, thus compromising our ability to know how many
people are experiencing this pain.
What
are the causes?
The quick answer is,
we just don't know.
We do know that
transsexuals have normal male (XY) or female (XX) chromosomes for
their sex. There are no identifiable physical characteristics
for gender dysphoria, and there is no 'test' for the condition.
Hermaphrodites and others with ambiguous sexual characteristics at
birth are not transsexuals, and don't necessarily experience gender
dysphoria.
One theory is that
changes in the brain before birth cause certain parts of it to develop
the opposite pattern to their sex. Significant proportions of male
transsexuals have abnormally low levels of HY antigen. HY assists in
the masculinising effect of the Y chromosome in men. Work done in the
Netherlands also suggests that the problem arises in the hypothalamus
in the brain. This is involved in the early development of sexual
differences within the brain, and controls the production of sex
hormones throughout life.
What
do you look for when diagnosing Gender Identity Disorder (GID)?
There are two
components of Gender Identity Disorder, both of which must be present
to make the diagnosis.
1) There must be evidence
of a strong and persistent gross-gender identification,
which is the desire to be, or the insistence that one is of the
other sex (Criteria A). This cross-gender identification must not
merely be a desire for any perceived cultural advantages of being
the other sex.
2) There must also
be evidence of persistent discomfort about one’s assigned
sex or a sense of inappropriateness in the gender role of that sex
(Criteria B).
The diagnosis is not
made if the individual has a concurrent physical intersex condition
(e.g., androgen insensitivity syndrome or congenital adrenal
hyperplasia) (Criteria C). To make the diagnosis, there must be evidence
of clinically significant distress or impairment in social,
occupational, or other important areas of functioning (Criteria
D).
What
is common to see from a person with GID throughout their development?
...Childhood
During childhood, boys will
typically show an obvious interest in traditionally feminine
activities. They may prefer dressing in girls' or women's clothes. A
boy who openly admits wanting to be a girl is likely to be teased,
redirected, or told that's not "right," and that he
"shouldn't" want to be a girl. He is expected to
grow out of it quickly. In boys, there is also often an assertion
that his penis or testes are disgusting or will disappear or
assertion that it would be better not to have a penis, or aversion
toward rough-and-tumble play and rejection of male stereotypical
toys, games, and activities.
Traditionally,
a young girl who wants to be a boy and expresses this is less likely
to invite such criticism. She may be labeled as a tomboy, but is
still expected to grow out of it. In
girls, rejection of urinating in a sitting position, assertion that
she has or will grow a penis, or assertion that she does not want to
grow breasts or menstruate, or marked aversion toward normative
feminine clothing.
Many children do
grow out of gender dysphoria. Only a small number of children
continue to feel the same way in later adolescence. Some families
are better than others at accepting their children's behavior. Some
children live openly in their chosen gender role, but have to endure
the taunts of their peers as well as pressure from their parents.
Others cope by hiding their feelings and learning to play the gender
role assigned to them, meanwhile going deeper into a private world
of cross-gender fantasy and desire.
...Adolescence
With puberty, hormones start to trigger body
changes which often ignite greater stress for gender incongruent men
not wanting to develop a deeper voice and greater muscle mass, or
incongruent women not wanting to start their menstrual cycle or grow
breasts.
...Early
adulthood
In adulthood,, the
disturbance is manifested by symptoms such as preoccupation with
getting rid of primary and secondary sex characteristics (e.g.,
request for hormones, surgery, or other procedures to physically
alter sexual characteristics to simulate the other sex) or belief
that he or she was born the wrong sex.
Most people who have grown up
with gender dysphoria show less openly cross-gender behavior as time
goes on, because of their parent's interventions or pressure from
their peers. By early adulthood, nearly 75 percent boys who
had a childhood history of gender dysphoria may think of themselves
as homosexual or bisexual. They no longer have feelings of belonging
to the wrong gender.
The remaining 25 percent or
so, however, continue to experience gender dysphoria into adulthood.
They may try to rid themselves of their ever-increasing gender
anxiety in various ways. They may get married and have children, in
the hope that this will help, or simply to hide their feelings from
others. Some seek professional help, often to ask for gender
reassignment.
...Later
adulthood
Years of trying to overcome a deep-rooted
desire and coping with anxiety can lead to depression. For some, the
pressure is so great that they attempt suicide. Many re-assess their
lifestyle when they come to later life. Some seek professional help;
others start cross-dressing more frequently, in private.
How are
gender and sexual orientation related?
Gender identity is the way in
which a person defines their sense of self as male or female.
Sexual orientation is unrelated, except that it is defined by the
gender toward whom we find ourselves attracted both emotionally and
physically. People with gender dysphoria can be homosexual,
bisexual or heterosexual. Typically the direction of one's
attractions toward males or females, remains consistent despite
changes in ones gender role. So if a man is married to a woman
(pre-transition), it is likely that after transition she will wish to
remain married, or will at least remain attracted to women even if she
now lives as one. It does appear common, however, for those who
have transitioned to experiment with relationships that serve to
affirm their gender.
Transvestite
A transvestite, or transvestic
fetishist, will dress as a member of the opposite sex and will often
get sexual excitement from it. Transvestism
is quite different from transsexualism and other forms of gender
dysphoria. Transvestites don't feel that they belong to the opposite
sex or alienated from their own bodies or sexual organs.
What do you
look for in diagnosing Tranvestic Fetishism?
-
Over a period of
at least 6 months, in a heterosexual male, recurrent, intense
sexually arousing fantasies, sexual urges, or behaviors
involving cross-dressing.
-
The fantasies,
sexual urges, or behaviors cause clinically significant distress
or impairment in social, occupational, or other important areas
of functioning.
What is
gender reassignment?
Gender reassignment is a
several year process that starts with an inner conflict that is
unrelenting. Once the transgender person acknowledges this
conflict and makes the decision to deal with it, he or she typically
starts counseling. Typically within three months of counseling
with a skilled gender therapist, a trans man or woman will initate HRT
(hormone replacement therapy) to begin reshaping their body and
initiating a long-overdue ender-appropriate puberty. Eventually
a real life test (RLT) will be initiated and this is an opportunity to
live for an entire year in the preferred gender role. For those
seeking Sex Reassignment Surgery (SRS), this year is required prior to
surgery.
Some people reassign their
genders without ever having surgery. It is difficult, however,
to transfer your identity on legal documents such as birth
certificates, drivers licenses, and social security cards if you do
not have a letter from a surgeon stating your gender has been
reassigned. Although people's
chromosomes and reproductive identity can't be altered, long-term
hormone treatment and surgery should allow them the physical
appearance and some of the sexual functions of the opposite sex.
However, after surgery, they will lose the ability to have children.
Gender reassignment is not the
best solution for everyone. There are many steps to move a person
closer to their authentic gender without requiring sugery. For
others, though, it's essential to live peacefully.
What
does male to female gender reassignment involve?
For a biological male wanting
to affirm his female gender, it is necessary to first start a regimen
of estrogen (hormone replacement therapy or HRT). This will move
the affirmed female into something akin to puberty, whereby she will
experience fat redistribution, softer skin, some mood changes with
increased emotional sensitivity, breast development, and it will also
cause the penis to atrophy and not perform as well, if at all, as
usual.
Following HRT, if surgery is
desired, the candidate will have to live for one year in her new
gender, prior to receiving a letter of referral from a gender
specialist. It is common during this time to initiate hair
removal (via laser or electrolysis), undergo facial feminization
surgery, practice feminizing voice, experiment with feminine dress and
make-up as well as hair styles and body language.
After carefully selecting a
surgeon, receiving a letter of support from her therapist, the
affirmed female can have surgery. Though there are different
techniques for this surgery, the most common will form of surgery will
remove the testicles and erectile tissue of the penis in order to
create a vagina lined with the skin of the penis, where the nerves and
blood vessels remain largely intact. Tissue from the scrotum is then
used to create the labia, and the urethra is shortened and
repositioned appropriately.
What
does female to male gender reassignment involve?
For a biological woman wanting
to affirm his male gender, it is necessary to first start a regimen of
testosterone (hormone replacement therapy or HRT). This will
move the affirmed male into something akin to puberty, whereby he will
experience beard growth and muscle development, along with a deeper
voice, changes in his body odor, skin (it's common to get acne), and
even personality. Affirmed men often feel more aggressive on
testosterone, than prior to taking it. On the whole, these changes
can't be reversed later. It is also common for affirmed men to have a
double mastectomy (breast removal) with chest reconstruction. This
makes it much easier for the person to appear as a man in public.
After at least a year of hormone treatment, the ovaries and uterus are
removed (although menstrual cycles tend to cease within the first
couple of months on testosterone.
For many female to male
transsexuals, this is as far as they will go with surgery. Going
further is more complex, very costly and the surgical techniques
available are not as effective for affirmed males as they are for
affirmed females. For those who do continue, phalloplasty (penis
construction) and testicle implants are available. It's also possible
to create a male urethra and to move the clitoris to the head of the
penis.
To research surgeons, click
here.
Other Terms
Cross-dressing
Cross-dressing is simply the behavior
of wearing clothes and styles that have been assigned by a culture or
society for a person of the opposite gender. This behavior does
not indicate that a person is transsexual or that he desires to live
in the role of the other gender. Rather, it is a behavior that
may be motivated by various reasons, including, but not limited to,
transexualism.
Cross-dressing
behaviors that are not the same as Gender Identity Dysphoria include:
-
Drag - is a
special form of entertainment based on cross-dressing
-
Drag-Queen
is a male-bodied person who performs as an exaggeratedly feminine
character, in an elaborate costume. A drag queen will often
imitate famous female film or pop-music stars.
-
Drag
king - is the counterpart of the drag queen — a
female-bodied person who adopts an exaggerated masculine persona
in performance or who imitates a male film or pop-music star.
Androgyny
This
is a term derived from the combination of Greek
words meaning man (andro) and woman (gyny), that can
refer to two concepts regarding the mixing of both male and female genders
or having a lack of gender identification.
Intersexuality
This
is a term used to describe a person whose sex
chromosomes, genitalia
and/or secondary
sex characteristics are determined to be neither exclusively male
nor female.
A person with intersex may have biological characteristics of both the
male and female sexes.
Genderqueer
or (intergender)
This
is a gender
identity of both, neither or some combination of "man"
and/or "woman". In relation to the gender
binary (the view that there are only two genders), genderqueer
people generally identify as more "both/and" or
"neither/nor," rather than "either/or."
Some genderqueer
people see their identity as one of many different genders outside of
man and woman, some see it as a term encompassing all gender
identities outside of the gender binary, some believe it encompasses
binary genders among others, some may identify as a-gender and some
see it as a third
gender in addition to the traditional two. The commonality is that
all genderqueer people reject the notion that there are only two
genders in the world. The term genderqueer is also occasionally used
more broadly as an adjective to refer to people who are in some way
gender-transgressive, and could have any gender identity.
Pansexual
Pansexuality
means being attracted to or open to attraction to people of all
different gender identities, and reflects a non-binary understanding
of gender and its interplay with sexuality. Other associated
terms include: Omnisexual Polysexual and Multisexual