What is Gender Dysphoria?

Firstly, what GD is not.   Though cultures sometimes unfairly pick favorites, differences in personality and expression are a normal part of being human. Biological sex is also innately human. Like other mammals, we reproduce by combining male and female genes. So, "male" and "female" are words for these biological reproductive categories, nothing more. Though there are some traits which tend to be more male or female, on average, not everyone is average. It would sadden us if any girl felt like less of a girl just because she likes trucks, sports or short hair; or for a boy to wonder if he's not really a boy at all just because he likes dolls, the colour pink or dancing. Sex stereotypes are not Gender Dysphoria.​

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Though there’s still a lot we don’t yet know about GD, it has been studied for decades. Leading psychologists and researchers in the field have identified several different types:

1. Childhood Onset GD

 

This type of GD is highly correlated with homosexuality, so it is sometimes called homosexual transsexualism (HSTS). Gender non-conformity (GNC), and some degree of cross-sex identification, is quite common among gay and lesbian people, especially in childhood. The degree to which this dimension of homosexuality is expressed is culturally mediated. Distress (dysphoria) associated with gender non-conformity is most likely due to lack of cultural understanding and support for LGB/non-conformity. Gender-related distress isn't common in places like Samoa where gender-nonconformity is expressed openly. 

 

Key features:

  • Obvious signs of gender-nonconformity from age 3-4

  • Express a strong desire to be the opposite sex, or believe they are in fact the opposite sex

  • Occurs in both boys and girls

  • 60-90% of kids who voice a desire to be the opposite sex, desist by or through adolescence without intervention. The remainder may desire medical interventions as adults.

  • Predictors of persistence: lower socio-economic status, intensity of cross-sex identification, autism

Read: Gender dysphoria is not on thing

2. Autogynephilia (Late Onset)

 

Dr Ray Blanchard, who coined the term Autogynephilia, described it as "a man's propensity to be sexually aroused by the fantasy of being a woman."  It is classified as a paraphilia, which is an erotic target location error. This should not be seen as a mere fetish, because that is overly reductive. AGP, like a sexual orientation, is multidimensional and includes a range of feelings and behaviours including romantic love and  bonding.

Key features:

  • Historically, it was estimated that 75% of trans women have AGP

  • Seen almost exclusively in non-homosexual natal boys/men

  • Not typically gender-non-conforming as children

  • Onset can seem sudden, in adolescence or adulthood

  • Can get progressively worse over time

  • There are subcategories and variations

  • There may be a higher transition regret rate among AGP

Read: The Man Who Would Be Queen by Michael Bailey

Read: Men Trapped in Men's Bodies, by Anne Lawrence

3. Uncommon/Rare Types

 

Autohomoerotic GD

  • Heterosexual/bisexual natal females

  • Aren’t typically gender non-conforming in childhood

  • Attracted to the idea of becoming gay men

  • Is not the same as autogynephilia because they are attracted to men, not themselves as men

 

GD related to having a Disorder of Sex Development

  • Not all people with DSDs have GD, but a small percentage do

  • More common in those with Ovotesticular DSD and Congenital Adrenal Hyperplasia

  • Gender non-conformity seen in childhood

  • Developmental and treatment pathway for this type of GD is different than other types of GD

GD related to psychosis

  • A person may believe they are the opposite sex as a delusion

  • Very uncommon

  • Treatment would be the same as for any other psychosis

4. Rapid Onset Gender Dysphoria (ROGD)

 

ROGD is not a formal diagnostic term but a name of a phenomenon studied by Dr Lisa Littman, based on parent reports. Further studies are needed to understand this better, but many leading researchers and clinicians who work with trans youth are seeing a shift in who’s coming to gender clinics. Some traits reported include:

  • Mostly natal girls, but seen in both boys and girls

  • Often no signs of gender non-conformity in childhood

  • First appears in adolescence, quite suddenly

  • Often very intelligent and sensitive youth

  • May have conditions that make them more vulnerable (e.g. Borderline Personality Disorder, Autism or ADHD - all of which impact social skills, emotions and processing)

  • Worsening mental health and behaviour after coming out as trans

  • Firm and intense focus on gender ideology and subculture

  • Social media and pornography are believed to be contributers

A Deeper Dive

Hear some of the leading researchers talk about different kinds of GD