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