Gender dysphoria: types, causes, symptoms and treatment

Cases of gender dysphoria are tested quite often. People complain about this pathology, confident that nature “made a mistake” in determining his physiological gender. People who actually suffer from this pathology are deeply unhappy. The realization of one's desires in accordance with one's perceived gender is in most cases condemned by society. This causes problems with socialization, creating a family, and self-determination. Confirmed gender dysphoria is quite rare.

Regardless of the imaginary confidence in the presence of a “mistake” of nature or the presence of a real diagnosis, pathology requires treatment by a psychotherapist. Confirmation of the diagnosis requires a thorough medical examination. An important task for the physician is to determine what the patient is suffering from. Gender dysphoria or homosexuality. Delusions of gender reassignment may occur in schizophrenia.

Biological sex

From a biological point of view, a person belongs to the order of primates of the hominid genus (apes, humans and their extinct ancestors), as a result of which he is a representative of one of three types of sex:

1. Female - consists of two X chromosomes.
2. Male - consists of two different chromosomes, types X and Y.
3. Intersex, i.e. chromosomes deviated from the norm and including characteristics of both sexes indicated above. They are also called hermaphrodites.

Everyone knows what distinguishes man as a biological being from his younger relatives:

• presence of consciousness, thinking and speech;
• labor (production of tools);
• the need for spiritual and moral development.

However, homo sapiens is not only a biological, but also a social subject, capable of going against the iron laws of nature.

Social gender

Despite the biological origin, a person exists within a society in which he develops according to a certain model of behavior and is perceived by society accordingly - as a man or a woman. Such a system is called a social role. It is formed in the process of personality education and includes psychological differences between two characteristics.

A person occupying a certain social status is somehow seen as a representative of a particular gender. However, it is no longer biological, but social. In modern terminology, the concept of gender is used for such a situation.

In psychology

From the point of view of psychologists, dysphoria is a negative emotion, manifested by low mood with gloominess, irritability and anger. In a state of dysphoria, a person is impatient and unrestrained; even a slight irritant can cause a violent reaction of anger and aggression. Like any negative emotion, it arises from a situation that is subjectively assessed as undesirable or unpleasant. Anyone can experience dysphoria, but those who are tired or sick often experience it, while those who are rested and healthy rarely experience it.

Gender education

As mentioned earlier, a person develops according to a certain model of behavior and this model determines his biological sex. But there are exceptions in which gender does not correspond to the sex assigned at birth. This phenomenon is called transgenderism.

More specifically:

• transgenderism is a discrepancy between gender identity and biological sex;
• gender identity - self-perception as a representative of one gender or another;
• People who struggle with gender identity are called transgender.

Transgenderness is still considered a diagnosis and is included in the International Classification of Diseases, 10th edition (ICD-10). The diagnosis can be found in block F64.0 - “Gender identity disorders. Transsexualism." This term was introduced by the German doctor M. Hirschfeld back in 1923.

Are there effective treatments?

Of course, methods of helping people suffering from gender identity issues are just beginning to be developed. First of all, such patients need the help of a psychologist or psychotherapist. Classes with a specialist help people understand the peculiarities of their personality and come to terms with them. In addition, patients with gender dysphoria often simply cannot adapt to society, as they suffer from a lack of understanding on the part of loved ones, acquaintances and even strangers. These problems can also be resolved through therapy sessions. Of course, these are not all correction methods for people diagnosed with gender dysphoria - treatment can be more radical.

In some cases, special procedures are used to help a person change their sexual characteristics. For example, with the help of hormonal drugs you can change the physiological characteristics of the body, making a man look like a woman and vice versa. Naturally, the most effective remedy is considered to be a surgical procedure for gender reassignment, which, alas, is not suitable for every person with similar problems.

Dysphoria: its general definition

Dysphoria (Greek dysphoreo - irritation) is a painful-negative emotional state in which a person is in a low and irritable mood. Dysphoria is observed in a number of diseases.

List of the most common ones:

• schizophrenia;
• epilepsy;
• withdrawal syndrome;
• anxiety disorder;
• rheumatism;
• post-traumatic disorder;
• hypoglycemia;
• traumatic and vascular lesions of the brain;
• abnormal hormonal levels;
• premenstrual condition;
• personality disorders;
• transgenderism.

As well as situations in which there is a likelihood of stress.

Etiology

Emotional swings can have two poles:

• positive - when the mood rises sharply (unreasonable joy, delight, increased gaiety);
• negative - a sharp decline, to the point of irritation or increased anger.

Euphoria and dysphoria are two sides of the same coin. The first term means a positive mood swing, the second - a negative one. Both types require timely treatment, since strong emotional swings lead to rash actions that can be dangerous to the patient’s life.

There are two categories of causes of the disease. In a mentally healthy person, the condition can be provoked by the following factors:

• severe overload of the nervous system, constant stress;
• unhealthy family environment: parental alcoholism, violence;
• problems with circulatory disorders in the vessels of the brain;
• genetic abnormalities;
• influence of alcohol;
• hormonal changes.

In a person with a psychiatric disorder, dysphoria may be a consequence of the following diseases:

• schizophrenia;
• hypoglycemia;
• dysmorphophobia.

If the state of dysphoria recurs frequently, this will be a signal to action for parents.

Types of dysphoria

Dysphoria is divided into:

• postcoital - a state of depression after sexual intercourse;
• premenstrual - a common phenomenon among women;
• gender - the most complex and serious type of all of the above.

Types of gender dysphoria vary in severity. She may be:

• easy (problems mostly only with society);
• medium (incomplete self-acceptance and rejection from the outside);
• severe (lack of internal harmony and hatred from people).

Lack of treatment and its consequences

For many people with normal gender identification, questions about gender reassignment surgery cause genuine bewilderment, and the phenomenon of gender dysphoria itself is perceived as some kind of quirk. In fact, transsexuality is by no means a fad, and gender reassignment is the only possible solution. After all, as already mentioned, the discrepancy between gender and consciousness affects the mental state of a person. For example, denial of the problem, lack of understanding among others and the inability to get rid of one’s own thoughts and desires cause constant emotional discomfort, suffering and pain, which often leads to clinical depression, drug or alcohol addiction, and the development of suicidal tendencies.

Gender dysphoria

In the International Classification of Diseases, 11th revision, block F64 “Gender Identity Disorders” is replaced by “Gender Dysphoria,” thus combining with the previous version of the 10th revision into one general concept.

Experts also propose to remove this term from mental disorders to the department of sexology, which means completely deregistering transsexualism as a diagnosis. In 2020, the 11th revision of the ICD is due to come into force.

Root Causes

According to scientists in the course of research, transgenderism should not be perceived as a purely sociocultural phenomenon.

Because:

• According to a study of the relationship between transsexualism and the structure of the brain, it turned out that gender dysphoria is the result of an altered interaction between the brain and sex hormones.
• Recent diagnostic magnetic resonance imaging showed that the insular (responsible for body perception) lobe of the brain in transsexuals was larger than in men, but smaller than in women. As a result, scientists conclude: physiological differences in the brain are laid down during the period of intrauterine development.
• Naturally occurring hermaphroditism is a gene mutation.

Research and theories on this issue are still ongoing and are very controversial among experts.

Symptoms

The main symptoms of gender dysphoria are clear:

• Unconscious perception of oneself as a person of the opposite sex from early childhood. But it’s worth noting right away that not all transgender people experience this from an early age in their lives. Often awareness comes in adolescence, when the body begins to develop according to one or another sexual physiology.

• Reluctance to live in the gender role assigned to him from birth and expected by society in later life. In childhood, the situation manifests itself in the refusal to wear feminine (if it is a girl) and masculine (if it is a boy) things. The child has an involuntary desire to play with toys uncharacteristic of his biological sex in the company of the same children, to whom he unconsciously identifies himself.

• During puberty, hostility towards one's genitals and changes in the body becomes especially acute. It is during this period that gender dysphoria most often strikes with a nuclear strike. A teenager is unable to control physiological development and change the process in the opposite direction. A young transgender person is not accepted by society the way he identifies and cannot find a place for himself in a society with traditional values. Trans people are subject to both psychological and physical pressure from the outside, which clearly affects their internal state.

The main sign of gender dysphoria is the belief that oneself belongs to a person of the opposite sex and the inconsistency with this in real life.

All of the above points in most cases worsen over time and ultimately lead to death. Transsexuals become unable to withstand both the internal struggle with themselves and the external struggle with a merciless society, and therefore decide on the most desperate way out of the situation - suicide.

To avoid death, the causes of gender dysphoria must be eliminated by providing mandatory assistance - gender reassignment.

Reasons and factors

In addition to existing psychological problems and personality disorders, the following factors provoke a decline in mood:

• sleep disturbances, sleep deficiency;
• chronic stress;
• low self-esteem;
• impaired socialization, identification, including gender;
• exhaustion and burnout of the body and psyche;
• alcohol, other chemical dependence;
• long-term illness;
• chronic pain.

In a broad sense, two groups of factors influence: psychophysiological and external. The last group includes stress, psychological trauma, social pressure, changes in habitual lifestyle, difficult life situations, and fatigue.

Internal changes causing dysphoria:

• disturbances in the functioning of inhibition and excitation reactions;
• hormonal disbalance;
• organic lesions, head injuries.

The disorder caused by organic lesions is accompanied by headache, nausea, and increased sensitivity. A person reacts violently to acceptable stimuli: light, street noise. The reaction manifests itself even externally: itching, burning of the skin.

Dysphoria is the result of the cumulative influence of factors. Therefore, often the reason after which the disorder manifested itself seems inappropriate to the strength of the consequences. The "overflowing cup" effect. This makes diagnosis difficult, but the situation is even more confused by the fact that the mood returns to normal just as unexpectedly. Often without medical assistance.

Therapy

Research by American scientists confirms that transgenderism in itself is not a diagnosis and is not related to sexual orientation. However, treatment is necessary, and the cause of the terrible consequences can be eliminated in the following ways:

• psychotherapy;
• hormone therapy;
• surgical intervention.

It is worth noting: not all transgender people decide to undergo a full course of therapy. Each situation is considered purely individual, and satisfaction with one’s condition can occur at different stages of gender correction.

To receive help and a certificate with a diagnosis of “F64.0 Transsexualism,” the patient must undergo a psychiatric commission. It is carried out with the aim of making an accurate diagnosis (according to the still valid ICD-10). Doctors evaluate the emotional state in order to exclude mental disorders that can provoke false transsexualism. An example of this would be dissociative disorder, in other words, split personality disorder.

After receiving the certificate, the transgender person has several options for further actions:

1. Lifelong use of hormone replacement therapy (HRT).

For women who want to bring their social gender into harmony with their biological gender, courses of taking male hormones are prescribed. Most often, testosterone is administered intramuscularly into the body. For such cases, there is a definition in medicine - FtM (Female to Male), which translated means “from woman to man.”

For men planning to reunite women's spiritual health with physical health, they are prescribed the hormone estrogen. In medical circles, patients are called MtF (Male to Female) - “from man to woman.”

2. Surgical intervention to correct sexual characteristics to the desired type.

FtM removes the mammary glands and shapes the breasts according to the male type, removes the ovaries, appendages and uterus. Finally, phalloplasty is performed - the creation of a male genital organ.

MtF perform cosmetic procedures to soften facial features (optional), and also enlarge breasts and shape female genitalia (vaginoplasty).

In addition to the medical problem, the problem is also solved from the legal side: all documents are drawn up anew with a change in the “gender” column and a new name.

Does everyone need gender reassignment surgery?

Quite often, the only way to improve a person’s life is gender reassignment surgery. With this type of surgery, women undergo removal of the uterus, and male genital organs are reproduced from the patient’s own tissues and special implants. Men, on the contrary, are spared the external genitalia, forming a female vagina from their own tissues.

Of course, before going to the surgeon’s table, the patient undergoes a lot of research, since doctors must first make sure whether gender dysphoria really occurs and whether the person can cope with the consequences of the operation. For example, there are some standard requirements for patients. To begin with, it is worth noting that they all must be adults. In addition, a person wishing to change gender must undergo a series of psychological tests, which make it possible to determine the absence of mental illness.

Gender reassignment helps a person create balance between the different facets of their personality. In turn, this gives the patient a feeling of wholeness, happiness and harmony.

Benjamin Gender Identity Scale

The gender dysphoria test is associated with the name of the American doctor Harry Benjamin. He was the first to try to classify forms of gender-variant behavior. His attempt was to create a scale of 6 categories:

1. Pseudo-transvestism.
2. Fetishistic transvestism.
3. True transvestism.
4. Non-op transsexualism.
5. Nuclear transsexualism with moderate gender dysphoria.
6. Nuclear transsexualism with a severe degree of disorder.

However, current views do not correspond to the vision of a specialist. Sexual orientation is not considered as a criterion for distinguishing between transsexuality and transvestism.

Until now, there is confusion in these concepts, which should be dispelled.

Transvestism is a psychological phenomenon in which there is a desire to transform into a person of the opposite sex by dressing up and acquiring accessories characteristic of that sex.

Transvestism is not always the same as transsexualism. It is men who most often represent this phenomenon, and they have no desire to adjust their biological sex. When a person does not feel discomfort with his body and satisfies sexual needs with the help of dressing, we are not talking about gender dysphoria.

The most effective way of testing is to make an appointment with a psychotherapist who will help you sort out your identity if any doubts arise.

Symptoms

In a state of dysphoria, a person looks gloomy, tense and wary. When communicating, such people are rude, prone to petty touchiness and picky. Characterized by increased sensitivity to sound, smell, bright light, and touch. There are almost always somatic manifestations in the form of increased heart rate, breathing, impaired muscle tone (convulsions, twitching, tics) and vegetative symptoms. With severe dysphoria, aggressive behavior towards oneself (self-cutting, self-harm) or towards others (insults, threats, beatings, etc.) is possible.