Jennifer George

I find it shocking how ill-informed some trans girls are about their transition. I’m one of those people who researches everything to death. Before I accepted myself, I was obsessed with trans-ness and learned all I could about the science, medicine and history of trans people. Now that I am transitioning myself, I obsessively research the various options, medicines, and procedures that are available to me. I like being well informed.

I attend a bi-monthly support group for trans folks. It runs the gamut from questioning to fully transitioned and it is filled with some of the most supportive and lovely people. However, it also has some people who really should know more than they do.

One example was a girl who had been on oral estrogen for a few years and was approved for bottom surgery, yet, when the topic arose, was unaware that estrogen was also available as an injection, a patch, a topical, and sublingual. She really had no idea.

Another surprising, but not as egregious example was when a girl asked what dysphoria and dysmorphia were and what the difference was. I can understand this, but dysphoria is such a key word for our community, I was surprised.

So, I thought I could at least provide some explanation of those terms.

Dysphoria is a general sense of unease about one’s self and/or one’s life. It can arise in many contexts, but for us it is gender dysphoria. You don’t feel right about your gender. You look in the mirror and what you see doesn’t match what you feel. Your body seems wrong. You don’t feel comfortable in your own skin.

Dysphoria can range from mild to extreme. There has been recent debate online about whether you need to suffer from dysphoria to be trans. I’m not a gatekeeper and won’t tell someone who says they don’t feel dysphoric that they are not trans, but I suspect that they do feel it on some level. But, it is possible to be transgender and not feel any dysphoria about it.

Dysphoria is what people are feeling when they say they were born in the wrong body. Or that they “hate” a particular body part and wish it was gone or replaced with the corresponding part from the other sex. It can drive some to physically harm themselves, and others can feel so ambivalent that they never seek corrective surgery.

Dysphoria is the symptom that treatment is based on. In the past, “gender identity disorder” was a diagnosis, and medicine sought to treat that disorder. It laid the “blame” on the person’s gender. It labeled it as a mental disorder and stigmatized the whole community.

The presence of gender variance is not the issue. In fact, gender variance is considered a normal variance of human development. It is the distress that it causes that is the issue. Psychologists use the term ego-dystonic, which means “thoughts and behaviors (dreams, compulsions, desires, etc.) that are conflicting or dissonant with the needs and goals of the ego, or further, in conflict with a person's ideal self-image.”

Medicine now uses the term “gender dysphoria”, describing the symptom that needs to be relieved rather than the underlying “disorder”. Treatment is now designed to relieve that symptom, usually through affirmation of the person’s desired gender. So, hormone replacement therapy, social transition, name change, gender change, gender confirming surgery, all help the patient suffer less from the dysphoria.

Dysmorphia, on the other hand, is a feeling that a body part is distorted in some way, despite scientific evidence. It is a mental illness involving obsessive focus on a perceived flaw in appearance.

Often it is described in the case of a person with anorexia nervosa who, despite being thin, sees themselves as fat.

In men, it tends to manifest itself as an obsession that their body is too small or not muscular enough, and they work out constantly to try to become more “manly”.

Dysmorphia, in many ways is the more debilitating and difficult condition to treat and manage, since it is not based on a realistic view. A person with dysmorphia may be mere skin and bones, but they see themselves as fat, clearly a false perception. A person with dysphoria may see a man’s genitals, but feels they should be female. They are not denying the truth that they have male genitals, but they believe they are the wrong ones. Dysphoria can be relieved through affirmations, medications and surgery. Dysmorphia is a more difficult condition to relieve, and may require a lifetime of therapy and medications.

So, friends, I urge you all to learn more about yourselves and your feelings. If you are Trans, get involved in your treatment. Learn about the process and the history of Trans people. Look into the social and political issues surrounding Trans issues and be proactive with your doctors, get involved politically and in support groups. We are a group currently under attack and the more of us who are involved, the better.