Gender Dysphoria

Gender Dysphoria Definition

Gender is not the same as sex. Gender usually describes how a person acts and identifies and does not refer to their biological sex. However, the facets of gender – masculine or feminine –typically apply to the male or female sex. Masculinity is associated with being male, and femininity with being female.

Problems with gender and sex arise when the two don’t align properly.

Gender Dysphoria Symptoms

Like all disorders, gender dysphoria has specific characteristics by which professionals can tell if a person has it. Some gender dysphoria symptoms are as follows:

• Strong and negative feelings about one’s birth sex.
• Feeling that one’s birth sex does not match the gender one identifies with (this is called a gender identity).
• Desire to have the primary and secondary sex characteristics of the sex you want to identify with (while avoiding or not having the primary and secondary sex characteristics of your birth sex).
• Symptoms of depression related to their birth sex.

Gender Dysphoria Causes: Biological Structures

Brain gender theory states that differences in brain structures and incompatibility with biological sex cause gender dysphoria. This is usually found in sexually dimorphic brain regions.

Zhou et al. (1995) studied the bed nucleus of the stria terminalis (BSTc), a brain area that plays a role in sexual function. This area is typically 40% larger in males than females. In the post-mortem study, six male-to-female transgender participants had a BSTc size equivalent to typical females.

Kruizjer et al. (2000) also found similar neurons in the BSTc of male-to-female transgender as in females.

Hare et al. (2009) examined the genetic components of transsexualism and suggested a particular gene is associated with lower levels of masculinity and the resulting feminisation. They identified an androgen receptor gene (AR) and found that allele repeats of AR were longer in male/female transgender than in non-transsexual males.

Gender Dysphoria Causes: Genes

Psychological research on atypical gender development has shown genetic factors influence gender dysphoria.

Coolidge et al. (2002) examined 157 twin pairs (96 MZ and 61 DZ) for signs of GID using the DSM-4 clinical diagnostic criteria. GID was detected in 2.3% of the pairs, and 62% of these cases were associated with genetic variance GID.

Heylens et al. (2012) compared 23 MZ and 21 DZ twins in which one of the pairs was diagnosed with GID. They found 39% (9) of the MZ twins had genetic concordance for GID compared to the DZ twins who did not. These data suggest a genetic component to GID.

A genetic disorder that may cause the onset of GID is androgen insensitivity syndrome (AIS). This syndrome is inherited from the mother. In AIS, a child is born genetically male (with the X-Y chromosome) but resistant to androgens (male hormones). The individual may have female-like features such as breasts.

Gender Dysphoria Causes: Biological Explanation Evaluation

Evaluating the biological explanation of gender dysphoria:

• Conflicting evidence for the BSTc – Hulshoff Pol et al. (2006) found that transgender hormone therapy affects the magnitude of the BSTc, although the BSTc should be fully formed by age five. Therefore, the observed differences in the BSTc in patients with gender dysphoria may be a consequence rather than a cause of gender dysphoria.

• This approach considers only the nature aspect of the ‘nature versus nurture’ debate. It, therefore, ignores the role of the environment. This explanation can be regarded as reductionist.

Gender Dysphoria Causes: Psychoanalytic Explanation

Since gender is mainly based on how a person acts and identifies, it is only logical that their social environment influences their gender identity. Psychological components are something we need to consider.

One psychological explanation for atypical gender development comes from psychoanalytic theory.

Ovesey and Person (1973) argued that extreme separation anxiety in childhood, before gender identity is established, causes gender dysphoria. They argued that the child fantasises about symbolically fusing with their mother to alleviate this separation anxiety.

According to their theory, the male child ‘becomes the mother’ and adopts the female gender identity. When interviewed, Stoller (1973) found that men diagnosed with gender dysphoria reported a close mother-son relationship. This likely leads to a stronger female identification and confuses gender identity.

Gender Dysphoria Causes: Cognitive Explanation

Dual-path theory – another psychological explanation for the atypical development of the sexes – stems from the cognitive approach.

Liben and Bigler (2002) proposed expanding sex schema theory to emphasise individual differences in gender identity. They suggest gender can take two paths:

• The ‘normal developmental path’ is when gender develops according to gender schemas and exhibits gender-appropriate attitudes and behaviours.
• The ‘personal path’ describes how a person’s behaviour influences their gender identity rather than society. In this pathway, the person’s behaviour becomes stronger than their gender identity and changes their gender schema.

Gender Dysphoria Causes: Psychological Explanation Evaluation

Evaluation of the social-psychological explanations of gender dysphoria:

• Androcentric research– Ovesey and Person’s explanation of gender dysphoria only considers male transgender individuals. The research does not consider females, so the theory does not completely explain gender dysphoria.

• Psychoanalytic explanations are difficult to measure and test scientifically because they state gender dysphoria occurs unconsciously.

• Descriptive versus explanatory – Liben and Bigler’s cognitive theory of gender dysphoria is descriptive. The theory describes what causes gender dysphoria. However, it does not explain the underlying processes that cause the development of gender dysphoria.

Gender Dysphoria Tests

There are many online gender dysphoria tests available that can help identify any doubts you may have. The questions generally concern how you feel about the sex you were assigned at birth and the other genders.

Professionals can guide individuals needing help with therapy and other treatment options.

Gender Dysphoria Treatment

The most common treatments for people with gender dysphoria are therapy and hormone therapy. Because gender dysphoria can also occur in children, gender reassignment is usually done later.

Gender Dysphoria Treatment: Hormone Replacement Therapy

Hormone replacement therapy can impact a person’s physical appearance and physiological processes.

There are two common types of hormone replacement therapy:

1. Puberty blockers

2. Cross-sex hormones

Before we learn about the two types of hormone therapy, let’s recap which hormones are associated with which sex.

• Testosterone is the hormone associated with males.
• Progesterone and estrogen are the hormones associated with females.

Puberty blockers prevent children from going through puberty, e.g. a male from developing hair or a female from getting their period.

In contrast, cross-sex hormones involve carefully adding doses of the gender that the individual identifies with into their body. Over time, this may lead the individual to develop characteristics of the gender they wish to identify with, e.g. girls who identify as boys may develop a hoarse or deeper voice.

Gender Dysphoria Treatment: Therapy

Therapy is the most common treatment used for patients with gender dysphoria. Therapy can serve to:

• Uncover the causes of gender dysphoria (psychotherapy).

• Learn how to cope with gender dysphoria (cognitive behavioural therapy).

• Understand how others can help and understand gender dysphoria (couples or family therapy).