It is important to understand that Transsexualism, Gender Identity Disorder (GID) and Gender Dysphoria (GD) are in fact the same thing; I will use GID and GD as interchangeable in this article. In the Diagnostic and Statistical Manual (DSM) of Mental Disorders, prepared by the American Psychiatric Association, the terms GID and GD apply to the same condition, depending on which edition of the DSM you look in.
Up to the fourth edition, DSM4, the term appears as Gender Identity Disorder and in DSM5 it appears as Gender Dysphoria . There is a note in DSM5, which confirms that the name was changed to Gender Dysphoria because the word “Disorder” was seen as having negative connotations and was stigmatising to people suffering from the condition. It was not changed because it was no longer considered a mental disorder — as most trans-activists will tell you. GD still appears in the DSM5 which is the DSM of “Mental Disorders”. I make no comment here about the act of or reasons for distorting or hiding the truth with wordplay to protect people’s feelings!
As someone who has suffered with Gender Identity Disorder my entire life I can assure the reader that it is in fact a mental disorder. I was born with a perfectly functional male body in all other respects, but from early childhood my innate behaviours and sense of myself were completely at odds with that fact. The causes of this disorder may well be physiological in some patients and psychological in others and we will discuss that later in this article. The disorder though, is one which with proper medical and or psychiatric care can be managed and so allow the sufferers to live full and happy inclusive lives.
There are all kinds of self-penned pseudo explanations of Gender Dysphoria circulating on the internet, on social media sites by “transgender” people the vast majority of which are incorrect, misinformed or down right spurious. These explanations confuse general discontent or unhappiness with one’s physical appearance, bodily functions or social roles with actual GD and, while these things can contribute to and exacerbate the anxiety caused by GD they are not themselves Gender Dysphoria .
What It Isn’t
Depending upon its severity a dissatisfaction with part or parts of one’s appearance, i.e. being too tall/short, nose too big, lips too thin, jaw too strong, too muscular, not muscular enough, breasts too small or too big are common complaints amongst many of the general population and are little more than mild body dysmorphia.
Where body dysmorphia is so strong it begins to effect a person’s moods or demeanour so much so that they seek surgery to change or as they see it correct, what they perceive to be a defect it still does not mean that this is Gender Dysphoria . Even where the perceived defect is considered a trait of the opposite sex or natal sex it is not GD. A woman with a strong jaw line or nose who seeks surgery to reshape it does not have GD and neither does a man with a receding hairline who seeks scalp surgery. Those who do suffer GID often develop body dysmorphia for their primary sex organs and secondary sex characteristics, but those feelings of discomfort arise from the Gender Identity Disorder; they are not themselves GD. Body dysmorphia does not turn into Gender Identity Disorder; in other words, you don’t become transsexual because you don’t like your penis or flat chest, it is always, always the other way around.
In natal females, it is also very common for them to be uncomfortable, around the time of puberty, as their reproductive systems become active alongside the changes to their body shape, which attracts attention from the opposite sex. It is very easy for young women, especially lesbians or classic “tomboys” to confuse these feelings as being Gender Identity Disorder. They are not, and far too many young lesbian girls are being misled by their peers into believing they are “trans” and embarking on opposite sex hormone regimes and surgeries as a result of this misinformation, which they will doubtless later live to regret. In this article we will look only at Gender Identity Disorder in genetic males, I will leave GID in females to somebody who has sufficient experience of it and those who suffer it and so is better qualified.
HSTS and AGPs
There are two distinct types of transsexual, Homosexual Transsexual (HSTS) and non-homosexual transsexual or Autogynephile (AGP). The differences are best classified in the work of Dr Ray Blanchard as explained here http://rodfleming.com/transvestite-autogynephiles-transsexual/ . Both experience Gender Identity Disorder but in distinct and different ways.
These are usually able to fit into the masculine role expected of their birth sex and most but not all of them only seek transition later in life, having lived for years often decades as successful men, marrying women and having fathered and raised children. They are in almost every case sexually attracted to females and tend to develop an almost idol worship syndrome for women, which they at some point, usually during puberty, conceptualise into a female persona of their own.
As they age they continue to feed and get reward from secretly bringing this female persona to life. This causes them a great deal of distress as they hide this out of fear of how this will affect their lives and those around them. This results in years of them indulging this fantasised persona in secret causing them mounting depression until eventually they have a breakdown of sorts and the constructed female character takes over their identity and they come out as trans believing that they were in fact female all along just “trapped in the wrong body”. They do not suddenly wake up one day at 45 and decide to be a woman. This created persona is usually nothing like an actual female but is often an exaggerated caricature of femininity. It is only after this second identity becomes dominant that AGPs usually begin to develop body dysmorphia.
These are almost without exception very feminine in appearance, body type and in their innate behaviours from early childhood. They rarely fit in as boys or young men and avoid gendered pastimes and sports typically associated with their birth sex. They are exclusively sexually attracted to other males to whom they are submissive. They recognise their femininity from an early age and become comfortable with it but realise all too soon that this is incompatible with their lives as males.
The resultant depression this causes is usually compounded by the antagonistic reactions of other males around them. They begin very quickly to disassociate themselves with their physical masculinity and feel like their lives would have been better had they been born female and feeling that they should in fact have been born so. HSTS usually present as transsexual and seek treatment early in life, by their teens or early twenties.
It is usual for HSTS to develop body dysmorphia around the time of puberty. It is more than likely that this type of transsexualism is physiological in nature and MRI studies and genetic studies give indications that HSTS have different brain structures and Androgen Receptor polymorphism than other males. These are not found at all in AGPs . https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402034/
Both types of transsexualism are equally distressing conditions causing considerable suffering to those who experience them.
What is Gender Dysphoria?
In both types of transsexual Gender Dysphoria manifests and is observable as severe anxiety and depression, which arises from the internalised feelings of guilt and profound and pronounced shame, they each feel from the effect that their disassociation with their birth sex has upon them, but in different ways.
AGPs feel guilt and shame for wanting to undertake the societal female role when they, their partner, family and children believe and often need them to be the male component of the family unit. Many will delay announcing their condition until after their children have grown and left home. Once an AGP is “out” they then start to realise the gargantuan (often impossible) task they face in living and being accepted as women in society; this is when the secondary symptoms such as body dysmorphia set in. They often believe themselves to actually be female and are devastated when this cannot be realised physically or socially. Once “out” they can live their constructed persona openly so the GD is effectively removed and it is only the failure to realise their goal of being accepted as female which causes them distress, not the Gender Identity Disorder.
Experience of Gender Identity Disorder
HSTS too feel guilt and extreme shame but for simply being male! This is because the target of their desires, heterosexual males are attracted to and desire females and it is for those partners that they experience the feelings of shame. HSTS usually transition very easily and fit into society as women without experiencing any problems such as those experienced by AGPs. They may well have had Genital Reconstruction Surgery (GRS) to remove the male genitalia and create a vagina, but despite externally appearing female in every sense they are fully aware that they are not so. Sadly this means that while GID is greatly reduced following transition, HSTS will still experience it from time to time.
As a personal experience of Gender Identity Disorder post GRS, I can recount that this only happens very rarely and is a totally internalised experience. I might at some random fleeting occasion contemplate the fact that I am still genetically male and wonder at the totally imagined effect this fact might have on my male partner’s feelings about me. The feelings of crippling shame that this induces can be devastating, it is like trying to breath with somebody standing on your chest. Fortunately after transition these are very short lived and extremely rare relapses.
That “self-generated” anxiety and depression from the disassociation with one’s biological sex is Gender Dysphoria. It comes from within the psyche and not from external factors. Being “upset” because someone misgenders you or “clocks” you; looking in the mirror and not liking the look of a particular feature or body part; or you hating a bodily function are just that, being upset, nothing more. These are not Gender Dysphoria ! Such a person is upset or sad because they cannot have what they want or because somebody has been rude or mean to them; it is not Gender Dysphoria. However those things can lead the person to induce an attack of GD.
Gender Identity Disorder is a very debilitating condition and those who suffer it do deserve sympathy and help in treating it. Suffering it is not a choice and all attempts to treat it other than transitioning tend to fail miserably and perhaps with fatal consequences.
Those who claim to be “transgender” but say they do not suffer Gender Dysphoria are not transsexual at all but are simply making a nonconforming fashion statement for their own reasons.