Weltschmerz

Every straight girl in earshot who “isn’t homophobic”:

TW: ED mention

Diagnostic criteria don’t usually change so drastically that a person is going to go from having a disorder to not having one. If the criteria change that drastically it’s generally because the old symptoms fall into another category.

For instance, ADHD and ADD being merged into one diagnosis, or the same happening with Asperger’s and Autism Spectrum Disorder. No one who had those stopped having a disorder because the name changed, and treatment that helped was still valid treatment.

Another example is Binge Eating Disorder being added to the DSM in 2013. Before it was added to the DSM, people with the disorder were classified as Bullemic, and the treatment for that helped them somewhat, but they were put into their own more specialized category because their particular cluster of symptoms needed more specialized treatment.

I could write a lot about this, but honestly, you’re deflecting here whether you realize it or not. Gender dysphoria is an incredibly inclusive diagnosis as it is. If a person feels they don’t identify with their gender assigned at birth and has a desire to change it, they fit the criteria. Right now “gender dysphoria” is the label we use for people who need access to hormone replacement therapy and gender confirmation surgeries (note that I said access and not that it’s required).

If, in the future, the label is split into other labels that doesn’t change that you’re trans. It just means they decided the difference is vast enough to warrant a different approach between, say, gender dysphorics with severe distress and without. This does not mean they would stop you from transitioning, transition is already the treatment for your symptoms and that’s incredibly unlikely to change, it mostly means therapy may be approached differently and specific doctors would be able to specialize in one disorder over the other so there would be specialists trained to be better with your specific symptoms.

No doctor is ever going to suddenly tell you you’re not trans as long as you (at least) don’t identify with your gender assigned at birth and do want to change it. If eventually there’s a diagnosis other than gender dysphoria for those symptoms, then in that eventuality there will be two diagnostic labels for people who are trans.

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

TW: slight mention of csa

I assume you’re talking about the case of people dissociating from their assigned gender because of (usually sexual) trauma, because that’s the only case right now where a doctor will avoid a diagnosis of gender dysphoria until after therapy. 

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

Being (that’s their name if that’s not clear) is a good example of this if you want to look them up, they’re very open about their trauma and why they transitioned and detransitioned. 

If a doctor wants to explore a person’s trauma or just really talk things out before letting a person transition, it’s to protect them from permanently changing their body in a way that will cause them distress. Brains do a lot of harmful things to protect themselves, I say this as someone with a personality disorder (essentially someone who has a brain that’s stuck on doing harmful things to protect itself), and I say that without any judgement or malice. 

But let’s take a look at dysphoria anyway: Despite having dysphoria, I did not meet the diagnostic criteria. That doesn’t mean I didn’t have it, it means the diagnostic criteria are not sufficient to account for all dysphoric people.

Despite meeting the diagnostic criteria, the people in your example do not have gender dysphoria. That means the diagnostic criteria are not sufficient to exclude all non-dysphoric people.

When it comes to a single patient it could very well be human error on the doctor’s part for all I know, it could be bias, it could be a trauma exclusion. I don’t know your case. I’ve had a licensed medical doctor tell me I have a soul and have to go to church to keep it healthy, I’ve had another tell me I had to go to his church specifically to buy some holistic medicine that would cure autism and I’ve had a therapist who actually seemed angry when I told her I was trans and then proceeded to ignore it for weeks until I dropped her.

Doctors are people and sometimes doctors forgo science in favor of their own agenda. If your doctor didn’t properly diagnose you I’m sorry, you might want a second opinion.

Also, what people in my example supposedly don’t have dysphoria? What people are even in my example? I was paraphrasing the DSM when I listed symptoms, the symptoms I defined are straight from the DSM.

Do you wish to change your gender? Do you want to be seen/treated as the other gender? Have those feelings persisted for six months? You have dysphoria as defined by the DSM, as seen below:

A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics

A strong desire to be rid of one’s primary and/or secondary sex characteristics

A strong desire for the primary and/or secondary sex characteristics of the other gender

A strong desire to be of the other gender

A strong desire to be treated as the other gender

A strong conviction that one has the typical feelings and reactions of the other gender

Other than wanting to be the other gender and wanting to be validated as and treated like the other gender, how does anyone know they’re trans? What is trans other than wanting to be the other gender and wanting to be seen as the other gender?

The current definition of gender dysphoria is in line with what someone would be feeling to label themself trans. The current definition of gender dysphoria is required to be trans, because how and why would you be trans if you want to be and be seen and treated as you assigned gender?

The label they use for the disorder you have might change, yes, I went over this. As of right now, the label we use for someone who doesn’t identify as their assigned gender, wants to change it and have that change be validated by other people, and feels this way for at least six months, is gender dysphoria. If the label for that changes then the label changes, so what? If you no longer fit the diagnosis, if they make a more accurate map for trans people having less debilitating dysphoria, there will be two things that can define being trans. I don’t see why anyone would be resistant to this.

And I literally did not meet those criteria before starting HRT. I didn’t have a strong desire to be or be treated as another gender. I didn’t have a strong desire to anything. My dysphoria alienated me from my emotions to the point that I didn’t qualify for a dysphoria diagnosis.

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

^^Your example. These people meet the diagnostic criteria for Gender Dysphoria. They have a strong desire to be another gender and to be treated as another gender. Many of them have a desire to be rid of their secondary sexual characteristics.

Why did you want to transition, risking all the awful things that can happen on HRT, if you didn’t have a strong desire to do so? You apparently had a strong enough desire to risk your health, and a strong enough desire to go on HRT under informed consent even after a doctor failed to diagnose you. 

Did you just decide “I guess I’ll undergo this life-threatening treatment that I don’t really feel I need” with no motivation at all? I really doubt that you did. Maybe your doctor wasn’t taking into account that a “strong desire” for you wouldn’t have presented the same as a strong desire would for someone with a healthy emotional range.

I learned that other people whose depression was like mine got on HRT and felt better, and despite not having any strong desires one way or another, I’ve always kind of liked the idea of transition. So I figured I’d try hormones for a bit, see if I like them.

And they cured my depression.

I know trans men are in a pretty similar situation with increased risk for serious health conditions (blood clots, heart attack, etc), except we can also get organ atrophy and have internal organs become septic. It just happened recently to Buck Angel and he almost died. HRT is risky to dangerous depending on your anatomy.

Also, for afab people, HRT causes more pronounced permanent changes. I remember someone saying estrogen causes gentle changes while testosterone does damage that can’t be undone and that seems pretty accurate to me. Afab people who start HRT and get dysphoric are going to be stuck with some of the changes for life.

I point out the differences in a trans guy going on T from your experience because for you it may have been less dangerous/permanent but for others it might not be.

“Sufficient criteria wouldn’t have corollaries” is purely opinion and I can’t really argue opinion. Psychology is incredibly complicated, and ideally there would just be simple boxes to check but people aren’t that simple.

More research needs to be done on this, I can agree with that, but I still believe there needs to be medical gatekeeping because HRT is dangerous and kids and young adults keep demonstrating that they will harm themselves with this treatment if it’s freely available to everyone.

Here’s the thing: if we agree that more research needs to be done on how gender dysphoria presents in some cases because some dysphoric people aren’t able to meet the diagnostic criteria, then you’ve already agreed with my point. The diagnostic criteria for a disorder are not definitive of that disorder. The map is not the territory.

Do you think you would still be trans if your emotional issues had been treated successfully before you had been allowed to transition? Essentially, I’m wondering if you think you had dysphoria that wasn’t presenting due to the emotional numbness. I’m honestly just curious, this isn’t some kind of gotcha.

Unrelated to the original post, but teaching children and young adults that you don’t need dysphoria to be trans is still going to be harmful to them. It encourages the thinking that trauma, sexism, peer pressure, escapism etc are valid reasons to transition because they don’t need to actually feel like or want to be the other sex.

I honestly do not believe all or even most tucutes are anomalies.

I don’t know what my experiences would have been if my depression and depersonalization had been treated independent of my dysphoria. I don’t even know if such a thing is possible. I do know that I came to conclusion I wasn’t a man well before ever identifyng my dysphoria. The category “men” just wasn’t the right place to put myself.

Teaching people that you don’t need dysphoria to be trans doesn’t encourage people to take hormones or get surgeries they’ll regret. Teaching people that being trans requires medical transition does that. Delineating between transness and dysphoria helps this problem.

I’ve never said being trans requires medical transition. I said in one of the first posts in this conversation that it isn’t required, and I personally am not going through every possible surgery I could (in my case I just feel even the best results are unsatisfactory) so there’s obviously no reason I’d say everyone else has to.

My stance is that being trans requires dysphoria as defined by the DSM, which is something you have even if it wasn’t diagnosable because of a comorbid condition until after you started transitioning.

I understand the point that you’re trying to make by explaining it couldn’t be diagnosed, as far as any professional knew you didn’t have it. The thing is, you do have it, and I don’t have any reason to believe you didn’t have it before you transitioned despite a potentially botched diagnosis.

Adults already can do whatever they want with their bodies, that’s why we have informed consent. Teenagers can’t, but if they’re really determined then they’ll fall under a dysphoria diagnosis unless there’s something excluding them from that in which case it’s better they get therapy first. The system is working as intended, saving as many people from harming themselves as possible while still making it fairly easy to access treatment, the biggest hurdle being time if the patient isn’t already an adult.

I don’t feel that false positives are better than false negatives, but as I said it’s impossible to debate opinion. Maybe in the case of MTFs it’s less permanent, but I imagine people would be very unhappy if trans men had more gatekeeping to get through than trans women, so both need to be treated similarly. I have no opinion on whether trans women should have easier access to transition than trans men, but I know trans men are in immediate danger from transitioning and can’t just go back to the way things were by stopping treatment.

It’s not that it’s comorbid, it’s that that’s how my dysphoria presents. Even now, when it flair’s up it does so as depression and depersonalization. I can just identify the cause now.

If a system working as intended prevents people like me from treating our dysphoria, you aren’t selling me on the system.

Equally, your opinion on whether young people should be afforded the right to harm themselves in pursuit of happiness is also an opinion. Whether the right to bodily autonomy extends to children at all (I believe it does) or extends to people harming themselves (here I believe people need to be well informed, and I don’t believe children can consent to things that are harmful to them) has always been debated. It’s a grey area, there is no correct answer here, there’s no obvious correct moral stance.

Again, when talking about adults, informed consent exists so adults are not part of this part of the discussion. If an adult wants to transition without dysphoria and regrets it, that’s their choice.

Not all adults have access to informed consent healthcare, and transmeds as a group are not making it any easier.

People not having access to informed consent doesn’t mean the system is inherently flawed in my opinion, it means there needs to be more access to informed consent clinics. I definitely understand that, when I turned 18 the closest informed consent clinic was hundreds of miles away and only dealt with trans women on top of that.

“According to the book” is debatable. No one is told to just ask the patient questions and accept their answers as gospel, there are plenty of things that would almost never be diagnosed if they did that. The DSM isn’t a checklist that you go over with the patient, if it were people could just go online and self dx everything with 100% accuracy. I know therapists do this because they’ve done it to me and it’s incredibly lazy and inaccurate. You had dysphoria, if they had asked the right questions they would have been able to help you identify that over time.

TW: ED mention

Diagnostic criteria don’t usually change so drastically that a person is going to go from having a disorder to not having one. If the criteria change that drastically it’s generally because the old symptoms fall into another category.

For instance, ADHD and ADD being merged into one diagnosis, or the same happening with Asperger’s and Autism Spectrum Disorder. No one who had those stopped having a disorder because the name changed, and treatment that helped was still valid treatment.

Another example is Binge Eating Disorder being added to the DSM in 2013. Before it was added to the DSM, people with the disorder were classified as Bullemic, and the treatment for that helped them somewhat, but they were put into their own more specialized category because their particular cluster of symptoms needed more specialized treatment.

I could write a lot about this, but honestly, you’re deflecting here whether you realize it or not. Gender dysphoria is an incredibly inclusive diagnosis as it is. If a person feels they don’t identify with their gender assigned at birth and has a desire to change it, they fit the criteria. Right now “gender dysphoria” is the label we use for people who need access to hormone replacement therapy and gender confirmation surgeries (note that I said access and not that it’s required).

If, in the future, the label is split into other labels that doesn’t change that you’re trans. It just means they decided the difference is vast enough to warrant a different approach between, say, gender dysphorics with severe distress and without. This does not mean they would stop you from transitioning, transition is already the treatment for your symptoms and that’s incredibly unlikely to change, it mostly means therapy may be approached differently and specific doctors would be able to specialize in one disorder over the other so there would be specialists trained to be better with your specific symptoms.

No doctor is ever going to suddenly tell you you’re not trans as long as you (at least) don’t identify with your gender assigned at birth and do want to change it. If eventually there’s a diagnosis other than gender dysphoria for those symptoms, then in that eventuality there will be two diagnostic labels for people who are trans.

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

TW: slight mention of csa

I assume you’re talking about the case of people dissociating from their assigned gender because of (usually sexual) trauma, because that’s the only case right now where a doctor will avoid a diagnosis of gender dysphoria until after therapy. 

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

Being (that’s their name if that’s not clear) is a good example of this if you want to look them up, they’re very open about their trauma and why they transitioned and detransitioned. 

If a doctor wants to explore a person’s trauma or just really talk things out before letting a person transition, it’s to protect them from permanently changing their body in a way that will cause them distress. Brains do a lot of harmful things to protect themselves, I say this as someone with a personality disorder (essentially someone who has a brain that’s stuck on doing harmful things to protect itself), and I say that without any judgement or malice. 

But let’s take a look at dysphoria anyway: Despite having dysphoria, I did not meet the diagnostic criteria. That doesn’t mean I didn’t have it, it means the diagnostic criteria are not sufficient to account for all dysphoric people.

Despite meeting the diagnostic criteria, the people in your example do not have gender dysphoria. That means the diagnostic criteria are not sufficient to exclude all non-dysphoric people.

When it comes to a single patient it could very well be human error on the doctor’s part for all I know, it could be bias, it could be a trauma exclusion. I don’t know your case. I’ve had a licensed medical doctor tell me I have a soul and have to go to church to keep it healthy, I’ve had another tell me I had to go to his church specifically to buy some holistic medicine that would cure autism and I’ve had a therapist who actually seemed angry when I told her I was trans and then proceeded to ignore it for weeks until I dropped her.

Doctors are people and sometimes doctors forgo science in favor of their own agenda. If your doctor didn’t properly diagnose you I’m sorry, you might want a second opinion.

Also, what people in my example supposedly don’t have dysphoria? What people are even in my example? I was paraphrasing the DSM when I listed symptoms, the symptoms I defined are straight from the DSM.

Do you wish to change your gender? Do you want to be seen/treated as the other gender? Have those feelings persisted for six months? You have dysphoria as defined by the DSM, as seen below:

A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics

A strong desire to be rid of one’s primary and/or secondary sex characteristics

A strong desire for the primary and/or secondary sex characteristics of the other gender

A strong desire to be of the other gender

A strong desire to be treated as the other gender

A strong conviction that one has the typical feelings and reactions of the other gender

Other than wanting to be the other gender and wanting to be validated as and treated like the other gender, how does anyone know they’re trans? What is trans other than wanting to be the other gender and wanting to be seen as the other gender?

The current definition of gender dysphoria is in line with what someone would be feeling to label themself trans. The current definition of gender dysphoria is required to be trans, because how and why would you be trans if you want to be and be seen and treated as you assigned gender?

The label they use for the disorder you have might change, yes, I went over this. As of right now, the label we use for someone who doesn’t identify as their assigned gender, wants to change it and have that change be validated by other people, and feels this way for at least six months, is gender dysphoria. If the label for that changes then the label changes, so what? If you no longer fit the diagnosis, if they make a more accurate map for trans people having less debilitating dysphoria, there will be two things that can define being trans. I don’t see why anyone would be resistant to this.

And I literally did not meet those criteria before starting HRT. I didn’t have a strong desire to be or be treated as another gender. I didn’t have a strong desire to anything. My dysphoria alienated me from my emotions to the point that I didn’t qualify for a dysphoria diagnosis.

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

^^Your example. These people meet the diagnostic criteria for Gender Dysphoria. They have a strong desire to be another gender and to be treated as another gender. Many of them have a desire to be rid of their secondary sexual characteristics.

Why did you want to transition, risking all the awful things that can happen on HRT, if you didn’t have a strong desire to do so? You apparently had a strong enough desire to risk your health, and a strong enough desire to go on HRT under informed consent even after a doctor failed to diagnose you. 

Did you just decide “I guess I’ll undergo this life-threatening treatment that I don’t really feel I need” with no motivation at all? I really doubt that you did. Maybe your doctor wasn’t taking into account that a “strong desire” for you wouldn’t have presented the same as a strong desire would for someone with a healthy emotional range.

I learned that other people whose depression was like mine got on HRT and felt better, and despite not having any strong desires one way or another, I’ve always kind of liked the idea of transition. So I figured I’d try hormones for a bit, see if I like them.

And they cured my depression.

I know trans men are in a pretty similar situation with increased risk for serious health conditions (blood clots, heart attack, etc), except we can also get organ atrophy and have internal organs become septic. It just happened recently to Buck Angel and he almost died. HRT is risky to dangerous depending on your anatomy.

Also, for afab people, HRT causes more pronounced permanent changes. I remember someone saying estrogen causes gentle changes while testosterone does damage that can’t be undone and that seems pretty accurate to me. Afab people who start HRT and get dysphoric are going to be stuck with some of the changes for life.

I point out the differences in a trans guy going on T from your experience because for you it may have been less dangerous/permanent but for others it might not be.

“Sufficient criteria wouldn’t have corollaries” is purely opinion and I can’t really argue opinion. Psychology is incredibly complicated, and ideally there would just be simple boxes to check but people aren’t that simple.

More research needs to be done on this, I can agree with that, but I still believe there needs to be medical gatekeeping because HRT is dangerous and kids and young adults keep demonstrating that they will harm themselves with this treatment if it’s freely available to everyone.

Here’s the thing: if we agree that more research needs to be done on how gender dysphoria presents in some cases because some dysphoric people aren’t able to meet the diagnostic criteria, then you’ve already agreed with my point. The diagnostic criteria for a disorder are not definitive of that disorder. The map is not the territory.

Do you think you would still be trans if your emotional issues had been treated successfully before you had been allowed to transition? Essentially, I’m wondering if you think you had dysphoria that wasn’t presenting due to the emotional numbness. I’m honestly just curious, this isn’t some kind of gotcha.

Unrelated to the original post, but teaching children and young adults that you don’t need dysphoria to be trans is still going to be harmful to them. It encourages the thinking that trauma, sexism, peer pressure, escapism etc are valid reasons to transition because they don’t need to actually feel like or want to be the other sex.

I honestly do not believe all or even most tucutes are anomalies.

I don’t know what my experiences would have been if my depression and depersonalization had been treated independent of my dysphoria. I don’t even know if such a thing is possible. I do know that I came to conclusion I wasn’t a man well before ever identifyng my dysphoria. The category “men” just wasn’t the right place to put myself.

Teaching people that you don’t need dysphoria to be trans doesn’t encourage people to take hormones or get surgeries they’ll regret. Teaching people that being trans requires medical transition does that. Delineating between transness and dysphoria helps this problem.

I’ve never said being trans requires medical transition. I said in one of the first posts in this conversation that it isn’t required, and I personally am not going through every possible surgery I could (in my case I just feel even the best results are unsatisfactory) so there’s obviously no reason I’d say everyone else has to.

My stance is that being trans requires dysphoria as defined by the DSM, which is something you have even if it wasn’t diagnosable because of a comorbid condition until after you started transitioning.

I understand the point that you’re trying to make by explaining it couldn’t be diagnosed, as far as any professional knew you didn’t have it. The thing is, you do have it, and I don’t have any reason to believe you didn’t have it before you transitioned despite a potentially botched diagnosis.

Adults already can do whatever they want with their bodies, that’s why we have informed consent. Teenagers can’t, but if they’re really determined then they’ll fall under a dysphoria diagnosis unless there’s something excluding them from that in which case it’s better they get therapy first. The system is working as intended, saving as many people from harming themselves as possible while still making it fairly easy to access treatment, the biggest hurdle being time if the patient isn’t already an adult.

I don’t feel that false positives are better than false negatives, but as I said it’s impossible to debate opinion. Maybe in the case of MTFs it’s less permanent, but I imagine people would be very unhappy if trans men had more gatekeeping to get through than trans women, so both need to be treated similarly. I have no opinion on whether trans women should have easier access to transition than trans men, but I know trans men are in immediate danger from transitioning and can’t just go back to the way things were by stopping treatment.

It’s not that it’s comorbid, it’s that that’s how my dysphoria presents. Even now, when it flair’s up it does so as depression and depersonalization. I can just identify the cause now.

If a system working as intended prevents people like me from treating our dysphoria, you aren’t selling me on the system.

Equally, your opinion on whether young people should be afforded the right to harm themselves in pursuit of happiness is also an opinion. Whether the right to bodily autonomy extends to children at all (I believe it does) or extends to people harming themselves (here I believe people need to be well informed, and I don’t believe children can consent to things that are harmful to them) has always been debated. It’s a grey area, there is no correct answer here, there’s no obvious correct moral stance.

Again, when talking about adults, informed consent exists so adults are not part of this part of the discussion. If an adult wants to transition without dysphoria and regrets it, that’s their choice.

TW: ED mention

Diagnostic criteria don’t usually change so drastically that a person is going to go from having a disorder to not having one. If the criteria change that drastically it’s generally because the old symptoms fall into another category.

For instance, ADHD and ADD being merged into one diagnosis, or the same happening with Asperger’s and Autism Spectrum Disorder. No one who had those stopped having a disorder because the name changed, and treatment that helped was still valid treatment.

Another example is Binge Eating Disorder being added to the DSM in 2013. Before it was added to the DSM, people with the disorder were classified as Bullemic, and the treatment for that helped them somewhat, but they were put into their own more specialized category because their particular cluster of symptoms needed more specialized treatment.

I could write a lot about this, but honestly, you’re deflecting here whether you realize it or not. Gender dysphoria is an incredibly inclusive diagnosis as it is. If a person feels they don’t identify with their gender assigned at birth and has a desire to change it, they fit the criteria. Right now “gender dysphoria” is the label we use for people who need access to hormone replacement therapy and gender confirmation surgeries (note that I said access and not that it’s required).

If, in the future, the label is split into other labels that doesn’t change that you’re trans. It just means they decided the difference is vast enough to warrant a different approach between, say, gender dysphorics with severe distress and without. This does not mean they would stop you from transitioning, transition is already the treatment for your symptoms and that’s incredibly unlikely to change, it mostly means therapy may be approached differently and specific doctors would be able to specialize in one disorder over the other so there would be specialists trained to be better with your specific symptoms.

No doctor is ever going to suddenly tell you you’re not trans as long as you (at least) don’t identify with your gender assigned at birth and do want to change it. If eventually there’s a diagnosis other than gender dysphoria for those symptoms, then in that eventuality there will be two diagnostic labels for people who are trans.

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

TW: slight mention of csa

I assume you’re talking about the case of people dissociating from their assigned gender because of (usually sexual) trauma, because that’s the only case right now where a doctor will avoid a diagnosis of gender dysphoria until after therapy. 

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

Being (that’s their name if that’s not clear) is a good example of this if you want to look them up, they’re very open about their trauma and why they transitioned and detransitioned. 

If a doctor wants to explore a person’s trauma or just really talk things out before letting a person transition, it’s to protect them from permanently changing their body in a way that will cause them distress. Brains do a lot of harmful things to protect themselves, I say this as someone with a personality disorder (essentially someone who has a brain that’s stuck on doing harmful things to protect itself), and I say that without any judgement or malice. 

But let’s take a look at dysphoria anyway: Despite having dysphoria, I did not meet the diagnostic criteria. That doesn’t mean I didn’t have it, it means the diagnostic criteria are not sufficient to account for all dysphoric people.

Despite meeting the diagnostic criteria, the people in your example do not have gender dysphoria. That means the diagnostic criteria are not sufficient to exclude all non-dysphoric people.

When it comes to a single patient it could very well be human error on the doctor’s part for all I know, it could be bias, it could be a trauma exclusion. I don’t know your case. I’ve had a licensed medical doctor tell me I have a soul and have to go to church to keep it healthy, I’ve had another tell me I had to go to his church specifically to buy some holistic medicine that would cure autism and I’ve had a therapist who actually seemed angry when I told her I was trans and then proceeded to ignore it for weeks until I dropped her.

Doctors are people and sometimes doctors forgo science in favor of their own agenda. If your doctor didn’t properly diagnose you I’m sorry, you might want a second opinion.

Also, what people in my example supposedly don’t have dysphoria? What people are even in my example? I was paraphrasing the DSM when I listed symptoms, the symptoms I defined are straight from the DSM.

Do you wish to change your gender? Do you want to be seen/treated as the other gender? Have those feelings persisted for six months? You have dysphoria as defined by the DSM, as seen below:

A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics

A strong desire to be rid of one’s primary and/or secondary sex characteristics

A strong desire for the primary and/or secondary sex characteristics of the other gender

A strong desire to be of the other gender

A strong desire to be treated as the other gender

A strong conviction that one has the typical feelings and reactions of the other gender

Other than wanting to be the other gender and wanting to be validated as and treated like the other gender, how does anyone know they’re trans? What is trans other than wanting to be the other gender and wanting to be seen as the other gender?

The current definition of gender dysphoria is in line with what someone would be feeling to label themself trans. The current definition of gender dysphoria is required to be trans, because how and why would you be trans if you want to be and be seen and treated as you assigned gender?

The label they use for the disorder you have might change, yes, I went over this. As of right now, the label we use for someone who doesn’t identify as their assigned gender, wants to change it and have that change be validated by other people, and feels this way for at least six months, is gender dysphoria. If the label for that changes then the label changes, so what? If you no longer fit the diagnosis, if they make a more accurate map for trans people having less debilitating dysphoria, there will be two things that can define being trans. I don’t see why anyone would be resistant to this.

And I literally did not meet those criteria before starting HRT. I didn’t have a strong desire to be or be treated as another gender. I didn’t have a strong desire to anything. My dysphoria alienated me from my emotions to the point that I didn’t qualify for a dysphoria diagnosis.

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

^^Your example. These people meet the diagnostic criteria for Gender Dysphoria. They have a strong desire to be another gender and to be treated as another gender. Many of them have a desire to be rid of their secondary sexual characteristics.

Why did you want to transition, risking all the awful things that can happen on HRT, if you didn’t have a strong desire to do so? You apparently had a strong enough desire to risk your health, and a strong enough desire to go on HRT under informed consent even after a doctor failed to diagnose you. 

Did you just decide “I guess I’ll undergo this life-threatening treatment that I don’t really feel I need” with no motivation at all? I really doubt that you did. Maybe your doctor wasn’t taking into account that a “strong desire” for you wouldn’t have presented the same as a strong desire would for someone with a healthy emotional range.

I learned that other people whose depression was like mine got on HRT and felt better, and despite not having any strong desires one way or another, I’ve always kind of liked the idea of transition. So I figured I’d try hormones for a bit, see if I like them.

And they cured my depression.

I know trans men are in a pretty similar situation with increased risk for serious health conditions (blood clots, heart attack, etc), except we can also get organ atrophy and have internal organs become septic. It just happened recently to Buck Angel and he almost died. HRT is risky to dangerous depending on your anatomy.

Also, for afab people, HRT causes more pronounced permanent changes. I remember someone saying estrogen causes gentle changes while testosterone does damage that can’t be undone and that seems pretty accurate to me. Afab people who start HRT and get dysphoric are going to be stuck with some of the changes for life.

I point out the differences in a trans guy going on T from your experience because for you it may have been less dangerous/permanent but for others it might not be.

“Sufficient criteria wouldn’t have corollaries” is purely opinion and I can’t really argue opinion. Psychology is incredibly complicated, and ideally there would just be simple boxes to check but people aren’t that simple.

More research needs to be done on this, I can agree with that, but I still believe there needs to be medical gatekeeping because HRT is dangerous and kids and young adults keep demonstrating that they will harm themselves with this treatment if it’s freely available to everyone.

Here’s the thing: if we agree that more research needs to be done on how gender dysphoria presents in some cases because some dysphoric people aren’t able to meet the diagnostic criteria, then you’ve already agreed with my point. The diagnostic criteria for a disorder are not definitive of that disorder. The map is not the territory.

Do you think you would still be trans if your emotional issues had been treated successfully before you had been allowed to transition? Essentially, I’m wondering if you think you had dysphoria that wasn’t presenting due to the emotional numbness. I’m honestly just curious, this isn’t some kind of gotcha.

Unrelated to the original post, but teaching children and young adults that you don’t need dysphoria to be trans is still going to be harmful to them. It encourages the thinking that trauma, sexism, peer pressure, escapism etc are valid reasons to transition because they don’t need to actually feel like or want to be the other sex.

I honestly do not believe all or even most tucutes are anomalies.

I don’t know what my experiences would have been if my depression and depersonalization had been treated independent of my dysphoria. I don’t even know if such a thing is possible. I do know that I came to conclusion I wasn’t a man well before ever identifyng my dysphoria. The category “men” just wasn’t the right place to put myself.

Teaching people that you don’t need dysphoria to be trans doesn’t encourage people to take hormones or get surgeries they’ll regret. Teaching people that being trans requires medical transition does that. Delineating between transness and dysphoria helps this problem.

I’ve never said being trans requires medical transition. I said in one of the first posts in this conversation that it isn’t required, and I personally am not going through every possible surgery I could (in my case I just feel even the best results are unsatisfactory) so there’s obviously no reason I’d say everyone else has to.

My stance is that being trans requires dysphoria as defined by the DSM, which is something you have even if it wasn’t diagnosable because of a comorbid condition until after you started transitioning.

I understand the point that you’re trying to make by explaining it couldn’t be diagnosed, as far as any professional knew you didn’t have it. The thing is, you do have it, and I don’t have any reason to believe you didn’t have it before you transitioned despite a potentially botched diagnosis.

Adults already can do whatever they want with their bodies, that’s why we have informed consent. Teenagers can’t, but if they’re really determined then they’ll fall under a dysphoria diagnosis unless there’s something excluding them from that in which case it’s better they get therapy first. The system is working as intended, saving as many people from harming themselves as possible while still making it fairly easy to access treatment, the biggest hurdle being time if the patient isn’t already an adult.

I don’t feel that false positives are better than false negatives, but as I said it’s impossible to debate opinion. Maybe in the case of MTFs it’s less permanent, but I imagine people would be very unhappy if trans men had more gatekeeping to get through than trans women, so both need to be treated similarly. I have no opinion on whether trans women should have easier access to transition than trans men, but I know trans men are in immediate danger from transitioning and can’t just go back to the way things were by stopping treatment.

TW: ED mention

Diagnostic criteria don’t usually change so drastically that a person is going to go from having a disorder to not having one. If the criteria change that drastically it’s generally because the old symptoms fall into another category.

For instance, ADHD and ADD being merged into one diagnosis, or the same happening with Asperger’s and Autism Spectrum Disorder. No one who had those stopped having a disorder because the name changed, and treatment that helped was still valid treatment.

Another example is Binge Eating Disorder being added to the DSM in 2013. Before it was added to the DSM, people with the disorder were classified as Bullemic, and the treatment for that helped them somewhat, but they were put into their own more specialized category because their particular cluster of symptoms needed more specialized treatment.

I could write a lot about this, but honestly, you’re deflecting here whether you realize it or not. Gender dysphoria is an incredibly inclusive diagnosis as it is. If a person feels they don’t identify with their gender assigned at birth and has a desire to change it, they fit the criteria. Right now “gender dysphoria” is the label we use for people who need access to hormone replacement therapy and gender confirmation surgeries (note that I said access and not that it’s required).

If, in the future, the label is split into other labels that doesn’t change that you’re trans. It just means they decided the difference is vast enough to warrant a different approach between, say, gender dysphorics with severe distress and without. This does not mean they would stop you from transitioning, transition is already the treatment for your symptoms and that’s incredibly unlikely to change, it mostly means therapy may be approached differently and specific doctors would be able to specialize in one disorder over the other so there would be specialists trained to be better with your specific symptoms.

No doctor is ever going to suddenly tell you you’re not trans as long as you (at least) don’t identify with your gender assigned at birth and do want to change it. If eventually there’s a diagnosis other than gender dysphoria for those symptoms, then in that eventuality there will be two diagnostic labels for people who are trans.

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

TW: slight mention of csa

I assume you’re talking about the case of people dissociating from their assigned gender because of (usually sexual) trauma, because that’s the only case right now where a doctor will avoid a diagnosis of gender dysphoria until after therapy. 

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

Being (that’s their name if that’s not clear) is a good example of this if you want to look them up, they’re very open about their trauma and why they transitioned and detransitioned. 

If a doctor wants to explore a person’s trauma or just really talk things out before letting a person transition, it’s to protect them from permanently changing their body in a way that will cause them distress. Brains do a lot of harmful things to protect themselves, I say this as someone with a personality disorder (essentially someone who has a brain that’s stuck on doing harmful things to protect itself), and I say that without any judgement or malice. 

But let’s take a look at dysphoria anyway: Despite having dysphoria, I did not meet the diagnostic criteria. That doesn’t mean I didn’t have it, it means the diagnostic criteria are not sufficient to account for all dysphoric people.

Despite meeting the diagnostic criteria, the people in your example do not have gender dysphoria. That means the diagnostic criteria are not sufficient to exclude all non-dysphoric people.

When it comes to a single patient it could very well be human error on the doctor’s part for all I know, it could be bias, it could be a trauma exclusion. I don’t know your case. I’ve had a licensed medical doctor tell me I have a soul and have to go to church to keep it healthy, I’ve had another tell me I had to go to his church specifically to buy some holistic medicine that would cure autism and I’ve had a therapist who actually seemed angry when I told her I was trans and then proceeded to ignore it for weeks until I dropped her.

Doctors are people and sometimes doctors forgo science in favor of their own agenda. If your doctor didn’t properly diagnose you I’m sorry, you might want a second opinion.

Also, what people in my example supposedly don’t have dysphoria? What people are even in my example? I was paraphrasing the DSM when I listed symptoms, the symptoms I defined are straight from the DSM.

Do you wish to change your gender? Do you want to be seen/treated as the other gender? Have those feelings persisted for six months? You have dysphoria as defined by the DSM, as seen below:

A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics

A strong desire to be rid of one’s primary and/or secondary sex characteristics

A strong desire for the primary and/or secondary sex characteristics of the other gender

A strong desire to be of the other gender

A strong desire to be treated as the other gender

A strong conviction that one has the typical feelings and reactions of the other gender

Other than wanting to be the other gender and wanting to be validated as and treated like the other gender, how does anyone know they’re trans? What is trans other than wanting to be the other gender and wanting to be seen as the other gender?

The current definition of gender dysphoria is in line with what someone would be feeling to label themself trans. The current definition of gender dysphoria is required to be trans, because how and why would you be trans if you want to be and be seen and treated as you assigned gender?

The label they use for the disorder you have might change, yes, I went over this. As of right now, the label we use for someone who doesn’t identify as their assigned gender, wants to change it and have that change be validated by other people, and feels this way for at least six months, is gender dysphoria. If the label for that changes then the label changes, so what? If you no longer fit the diagnosis, if they make a more accurate map for trans people having less debilitating dysphoria, there will be two things that can define being trans. I don’t see why anyone would be resistant to this.

And I literally did not meet those criteria before starting HRT. I didn’t have a strong desire to be or be treated as another gender. I didn’t have a strong desire to anything. My dysphoria alienated me from my emotions to the point that I didn’t qualify for a dysphoria diagnosis.

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

^^Your example. These people meet the diagnostic criteria for Gender Dysphoria. They have a strong desire to be another gender and to be treated as another gender. Many of them have a desire to be rid of their secondary sexual characteristics.

Why did you want to transition, risking all the awful things that can happen on HRT, if you didn’t have a strong desire to do so? You apparently had a strong enough desire to risk your health, and a strong enough desire to go on HRT under informed consent even after a doctor failed to diagnose you. 

Did you just decide “I guess I’ll undergo this life-threatening treatment that I don’t really feel I need” with no motivation at all? I really doubt that you did. Maybe your doctor wasn’t taking into account that a “strong desire” for you wouldn’t have presented the same as a strong desire would for someone with a healthy emotional range.

I learned that other people whose depression was like mine got on HRT and felt better, and despite not having any strong desires one way or another, I’ve always kind of liked the idea of transition. So I figured I’d try hormones for a bit, see if I like them.

And they cured my depression.

I know trans men are in a pretty similar situation with increased risk for serious health conditions (blood clots, heart attack, etc), except we can also get organ atrophy and have internal organs become septic. It just happened recently to Buck Angel and he almost died. HRT is risky to dangerous depending on your anatomy.

Also, for afab people, HRT causes more pronounced permanent changes. I remember someone saying estrogen causes gentle changes while testosterone does damage that can’t be undone and that seems pretty accurate to me. Afab people who start HRT and get dysphoric are going to be stuck with some of the changes for life.

I point out the differences in a trans guy going on T from your experience because for you it may have been less dangerous/permanent but for others it might not be.

“Sufficient criteria wouldn’t have corollaries” is purely opinion and I can’t really argue opinion. Psychology is incredibly complicated, and ideally there would just be simple boxes to check but people aren’t that simple.

More research needs to be done on this, I can agree with that, but I still believe there needs to be medical gatekeeping because HRT is dangerous and kids and young adults keep demonstrating that they will harm themselves with this treatment if it’s freely available to everyone.

Here’s the thing: if we agree that more research needs to be done on how gender dysphoria presents in some cases because some dysphoric people aren’t able to meet the diagnostic criteria, then you’ve already agreed with my point. The diagnostic criteria for a disorder are not definitive of that disorder. The map is not the territory.

Do you think you would still be trans if your emotional issues had been treated successfully before you had been allowed to transition? Essentially, I’m wondering if you think you had dysphoria that wasn’t presenting due to the emotional numbness. I’m honestly just curious, this isn’t some kind of gotcha.

Unrelated to the original post, but teaching children and young adults that you don’t need dysphoria to be trans is still going to be harmful to them. It encourages the thinking that trauma, sexism, peer pressure, escapism etc are valid reasons to transition because they don’t need to actually feel like or want to be the other sex.

I honestly do not believe all or even most tucutes are anomalies.

TW: ED mention

Diagnostic criteria don’t usually change so drastically that a person is going to go from having a disorder to not having one. If the criteria change that drastically it’s generally because the old symptoms fall into another category.

For instance, ADHD and ADD being merged into one diagnosis, or the same happening with Asperger’s and Autism Spectrum Disorder. No one who had those stopped having a disorder because the name changed, and treatment that helped was still valid treatment.

Another example is Binge Eating Disorder being added to the DSM in 2013. Before it was added to the DSM, people with the disorder were classified as Bullemic, and the treatment for that helped them somewhat, but they were put into their own more specialized category because their particular cluster of symptoms needed more specialized treatment.

I could write a lot about this, but honestly, you’re deflecting here whether you realize it or not. Gender dysphoria is an incredibly inclusive diagnosis as it is. If a person feels they don’t identify with their gender assigned at birth and has a desire to change it, they fit the criteria. Right now “gender dysphoria” is the label we use for people who need access to hormone replacement therapy and gender confirmation surgeries (note that I said access and not that it’s required).

If, in the future, the label is split into other labels that doesn’t change that you’re trans. It just means they decided the difference is vast enough to warrant a different approach between, say, gender dysphorics with severe distress and without. This does not mean they would stop you from transitioning, transition is already the treatment for your symptoms and that’s incredibly unlikely to change, it mostly means therapy may be approached differently and specific doctors would be able to specialize in one disorder over the other so there would be specialists trained to be better with your specific symptoms.

No doctor is ever going to suddenly tell you you’re not trans as long as you (at least) don’t identify with your gender assigned at birth and do want to change it. If eventually there’s a diagnosis other than gender dysphoria for those symptoms, then in that eventuality there will be two diagnostic labels for people who are trans.

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

TW: slight mention of csa

I assume you’re talking about the case of people dissociating from their assigned gender because of (usually sexual) trauma, because that’s the only case right now where a doctor will avoid a diagnosis of gender dysphoria until after therapy. 

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

Being (that’s their name if that’s not clear) is a good example of this if you want to look them up, they’re very open about their trauma and why they transitioned and detransitioned. 

If a doctor wants to explore a person’s trauma or just really talk things out before letting a person transition, it’s to protect them from permanently changing their body in a way that will cause them distress. Brains do a lot of harmful things to protect themselves, I say this as someone with a personality disorder (essentially someone who has a brain that’s stuck on doing harmful things to protect itself), and I say that without any judgement or malice. 

But let’s take a look at dysphoria anyway: Despite having dysphoria, I did not meet the diagnostic criteria. That doesn’t mean I didn’t have it, it means the diagnostic criteria are not sufficient to account for all dysphoric people.

Despite meeting the diagnostic criteria, the people in your example do not have gender dysphoria. That means the diagnostic criteria are not sufficient to exclude all non-dysphoric people.

When it comes to a single patient it could very well be human error on the doctor’s part for all I know, it could be bias, it could be a trauma exclusion. I don’t know your case. I’ve had a licensed medical doctor tell me I have a soul and have to go to church to keep it healthy, I’ve had another tell me I had to go to his church specifically to buy some holistic medicine that would cure autism and I’ve had a therapist who actually seemed angry when I told her I was trans and then proceeded to ignore it for weeks until I dropped her.

Doctors are people and sometimes doctors forgo science in favor of their own agenda. If your doctor didn’t properly diagnose you I’m sorry, you might want a second opinion.

Also, what people in my example supposedly don’t have dysphoria? What people are even in my example? I was paraphrasing the DSM when I listed symptoms, the symptoms I defined are straight from the DSM.

Do you wish to change your gender? Do you want to be seen/treated as the other gender? Have those feelings persisted for six months? You have dysphoria as defined by the DSM, as seen below:

A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics

A strong desire to be rid of one’s primary and/or secondary sex characteristics

A strong desire for the primary and/or secondary sex characteristics of the other gender

A strong desire to be of the other gender

A strong desire to be treated as the other gender

A strong conviction that one has the typical feelings and reactions of the other gender

Other than wanting to be the other gender and wanting to be validated as and treated like the other gender, how does anyone know they’re trans? What is trans other than wanting to be the other gender and wanting to be seen as the other gender?

The current definition of gender dysphoria is in line with what someone would be feeling to label themself trans. The current definition of gender dysphoria is required to be trans, because how and why would you be trans if you want to be and be seen and treated as you assigned gender?

The label they use for the disorder you have might change, yes, I went over this. As of right now, the label we use for someone who doesn’t identify as their assigned gender, wants to change it and have that change be validated by other people, and feels this way for at least six months, is gender dysphoria. If the label for that changes then the label changes, so what? If you no longer fit the diagnosis, if they make a more accurate map for trans people having less debilitating dysphoria, there will be two things that can define being trans. I don’t see why anyone would be resistant to this.

And I literally did not meet those criteria before starting HRT. I didn’t have a strong desire to be or be treated as another gender. I didn’t have a strong desire to anything. My dysphoria alienated me from my emotions to the point that I didn’t qualify for a dysphoria diagnosis.

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

^^Your example. These people meet the diagnostic criteria for Gender Dysphoria. They have a strong desire to be another gender and to be treated as another gender. Many of them have a desire to be rid of their secondary sexual characteristics.

Why did you want to transition, risking all the awful things that can happen on HRT, if you didn’t have a strong desire to do so? You apparently had a strong enough desire to risk your health, and a strong enough desire to go on HRT under informed consent even after a doctor failed to diagnose you. 

Did you just decide “I guess I’ll undergo this life-threatening treatment that I don’t really feel I need” with no motivation at all? I really doubt that you did. Maybe your doctor wasn’t taking into account that a “strong desire” for you wouldn’t have presented the same as a strong desire would for someone with a healthy emotional range.

I learned that other people whose depression was like mine got on HRT and felt better, and despite not having any strong desires one way or another, I’ve always kind of liked the idea of transition. So I figured I’d try hormones for a bit, see if I like them.

And they cured my depression.

I know trans men are in a pretty similar situation with increased risk for serious health conditions (blood clots, heart attack, etc), except we can also get organ atrophy and have internal organs become septic. It just happened recently to Buck Angel and he almost died. HRT is risky to dangerous depending on your anatomy.

Also, for afab people, HRT causes more pronounced permanent changes. I remember someone saying estrogen causes gentle changes while testosterone does damage that can’t be undone and that seems pretty accurate to me. Afab people who start HRT and get dysphoric are going to be stuck with some of the changes for life.

I point out the differences in a trans guy going on T from your experience because for you it may have been less dangerous/permanent but for others it might not be.

“Sufficient criteria wouldn’t have corollaries” is purely opinion and I can’t really argue opinion. Psychology is incredibly complicated, and ideally there would just be simple boxes to check but people aren’t that simple.

More research needs to be done on this, I can agree with that, but I still believe there needs to be medical gatekeeping because HRT is dangerous and kids and young adults keep demonstrating that they will harm themselves with this treatment if it’s freely available to everyone.

TW: ED mention

Diagnostic criteria don’t usually change so drastically that a person is going to go from having a disorder to not having one. If the criteria change that drastically it’s generally because the old symptoms fall into another category.

For instance, ADHD and ADD being merged into one diagnosis, or the same happening with Asperger’s and Autism Spectrum Disorder. No one who had those stopped having a disorder because the name changed, and treatment that helped was still valid treatment.

Another example is Binge Eating Disorder being added to the DSM in 2013. Before it was added to the DSM, people with the disorder were classified as Bullemic, and the treatment for that helped them somewhat, but they were put into their own more specialized category because their particular cluster of symptoms needed more specialized treatment.

I could write a lot about this, but honestly, you’re deflecting here whether you realize it or not. Gender dysphoria is an incredibly inclusive diagnosis as it is. If a person feels they don’t identify with their gender assigned at birth and has a desire to change it, they fit the criteria. Right now “gender dysphoria” is the label we use for people who need access to hormone replacement therapy and gender confirmation surgeries (note that I said access and not that it’s required).

If, in the future, the label is split into other labels that doesn’t change that you’re trans. It just means they decided the difference is vast enough to warrant a different approach between, say, gender dysphorics with severe distress and without. This does not mean they would stop you from transitioning, transition is already the treatment for your symptoms and that’s incredibly unlikely to change, it mostly means therapy may be approached differently and specific doctors would be able to specialize in one disorder over the other so there would be specialists trained to be better with your specific symptoms.

No doctor is ever going to suddenly tell you you’re not trans as long as you (at least) don’t identify with your gender assigned at birth and do want to change it. If eventually there’s a diagnosis other than gender dysphoria for those symptoms, then in that eventuality there will be two diagnostic labels for people who are trans.

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

TW: slight mention of csa

I assume you’re talking about the case of people dissociating from their assigned gender because of (usually sexual) trauma, because that’s the only case right now where a doctor will avoid a diagnosis of gender dysphoria until after therapy. 

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

Being (that’s their name if that’s not clear) is a good example of this if you want to look them up, they’re very open about their trauma and why they transitioned and detransitioned. 

If a doctor wants to explore a person’s trauma or just really talk things out before letting a person transition, it’s to protect them from permanently changing their body in a way that will cause them distress. Brains do a lot of harmful things to protect themselves, I say this as someone with a personality disorder (essentially someone who has a brain that’s stuck on doing harmful things to protect itself), and I say that without any judgement or malice. 

But let’s take a look at dysphoria anyway: Despite having dysphoria, I did not meet the diagnostic criteria. That doesn’t mean I didn’t have it, it means the diagnostic criteria are not sufficient to account for all dysphoric people.

Despite meeting the diagnostic criteria, the people in your example do not have gender dysphoria. That means the diagnostic criteria are not sufficient to exclude all non-dysphoric people.

When it comes to a single patient it could very well be human error on the doctor’s part for all I know, it could be bias, it could be a trauma exclusion. I don’t know your case. I’ve had a licensed medical doctor tell me I have a soul and have to go to church to keep it healthy, I’ve had another tell me I had to go to his church specifically to buy some holistic medicine that would cure autism and I’ve had a therapist who actually seemed angry when I told her I was trans and then proceeded to ignore it for weeks until I dropped her.

Doctors are people and sometimes doctors forgo science in favor of their own agenda. If your doctor didn’t properly diagnose you I’m sorry, you might want a second opinion.

Also, what people in my example supposedly don’t have dysphoria? What people are even in my example? I was paraphrasing the DSM when I listed symptoms, the symptoms I defined are straight from the DSM.

Do you wish to change your gender? Do you want to be seen/treated as the other gender? Have those feelings persisted for six months? You have dysphoria as defined by the DSM, as seen below:

A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics

A strong desire to be rid of one’s primary and/or secondary sex characteristics

A strong desire for the primary and/or secondary sex characteristics of the other gender

A strong desire to be of the other gender

A strong desire to be treated as the other gender

A strong conviction that one has the typical feelings and reactions of the other gender

Other than wanting to be the other gender and wanting to be validated as and treated like the other gender, how does anyone know they’re trans? What is trans other than wanting to be the other gender and wanting to be seen as the other gender?

The current definition of gender dysphoria is in line with what someone would be feeling to label themself trans. The current definition of gender dysphoria is required to be trans, because how and why would you be trans if you want to be and be seen and treated as you assigned gender?

The label they use for the disorder you have might change, yes, I went over this. As of right now, the label we use for someone who doesn’t identify as their assigned gender, wants to change it and have that change be validated by other people, and feels this way for at least six months, is gender dysphoria. If the label for that changes then the label changes, so what? If you no longer fit the diagnosis, if they make a more accurate map for trans people having less debilitating dysphoria, there will be two things that can define being trans. I don’t see why anyone would be resistant to this.

And I literally did not meet those criteria before starting HRT. I didn’t have a strong desire to be or be treated as another gender. I didn’t have a strong desire to anything. My dysphoria alienated me from my emotions to the point that I didn’t qualify for a dysphoria diagnosis.

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

^^Your example. These people meet the diagnostic criteria for Gender Dysphoria. They have a strong desire to be another gender and to be treated as another gender. Many of them have a desire to be rid of their secondary sexual characteristics.

Why did you want to transition, risking all the awful things that can happen on HRT, if you didn’t have a strong desire to do so? You apparently had a strong enough desire to risk your health, and a strong enough desire to go on HRT under informed consent even after a doctor failed to diagnose you. 

Did you just decide “I guess I’ll undergo this life-threatening treatment that I don’t really feel I need” with no motivation at all? I really doubt that you did. Maybe your doctor wasn’t taking into account that a “strong desire” for you wouldn’t have presented the same as a strong desire would for someone with a healthy emotional range.

TW: ED mention

Diagnostic criteria don’t usually change so drastically that a person is going to go from having a disorder to not having one. If the criteria change that drastically it’s generally because the old symptoms fall into another category.

For instance, ADHD and ADD being merged into one diagnosis, or the same happening with Asperger’s and Autism Spectrum Disorder. No one who had those stopped having a disorder because the name changed, and treatment that helped was still valid treatment.

Another example is Binge Eating Disorder being added to the DSM in 2013. Before it was added to the DSM, people with the disorder were classified as Bullemic, and the treatment for that helped them somewhat, but they were put into their own more specialized category because their particular cluster of symptoms needed more specialized treatment.

I could write a lot about this, but honestly, you’re deflecting here whether you realize it or not. Gender dysphoria is an incredibly inclusive diagnosis as it is. If a person feels they don’t identify with their gender assigned at birth and has a desire to change it, they fit the criteria. Right now “gender dysphoria” is the label we use for people who need access to hormone replacement therapy and gender confirmation surgeries (note that I said access and not that it’s required).

If, in the future, the label is split into other labels that doesn’t change that you’re trans. It just means they decided the difference is vast enough to warrant a different approach between, say, gender dysphorics with severe distress and without. This does not mean they would stop you from transitioning, transition is already the treatment for your symptoms and that’s incredibly unlikely to change, it mostly means therapy may be approached differently and specific doctors would be able to specialize in one disorder over the other so there would be specialists trained to be better with your specific symptoms.

No doctor is ever going to suddenly tell you you’re not trans as long as you (at least) don’t identify with your gender assigned at birth and do want to change it. If eventually there’s a diagnosis other than gender dysphoria for those symptoms, then in that eventuality there will be two diagnostic labels for people who are trans.

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

TW: slight mention of csa

I assume you’re talking about the case of people dissociating from their assigned gender because of (usually sexual) trauma, because that’s the only case right now where a doctor will avoid a diagnosis of gender dysphoria until after therapy. 

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

Being (that’s their name if that’s not clear) is a good example of this if you want to look them up, they’re very open about their trauma and why they transitioned and detransitioned. 

If a doctor wants to explore a person’s trauma or just really talk things out before letting a person transition, it’s to protect them from permanently changing their body in a way that will cause them distress. Brains do a lot of harmful things to protect themselves, I say this as someone with a personality disorder (essentially someone who has a brain that’s stuck on doing harmful things to protect itself), and I say that without any judgement or malice. 

But let’s take a look at dysphoria anyway: Despite having dysphoria, I did not meet the diagnostic criteria. That doesn’t mean I didn’t have it, it means the diagnostic criteria are not sufficient to account for all dysphoric people.

Despite meeting the diagnostic criteria, the people in your example do not have gender dysphoria. That means the diagnostic criteria are not sufficient to exclude all non-dysphoric people.

When it comes to a single patient it could very well be human error on the doctor’s part for all I know, it could be bias, it could be a trauma exclusion. I don’t know your case. I’ve had a licensed medical doctor tell me I have a soul and have to go to church to keep it healthy, I’ve had another tell me I had to go to his church specifically to buy some holistic medicine that would cure autism and I’ve had a therapist who actually seemed angry when I told her I was trans and then proceeded to ignore it for weeks until I dropped her.

Doctors are people and sometimes doctors forgo science in favor of their own agenda. If your doctor didn’t properly diagnose you I’m sorry, you might want a second opinion.

Also, what people in my example supposedly don’t have dysphoria? What people are even in my example? I was paraphrasing the DSM when I listed symptoms, the symptoms I defined are straight from the DSM.

Do you wish to change your gender? Do you want to be seen/treated as the other gender? Have those feelings persisted for six months? You have dysphoria as defined by the DSM, as seen below:

A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics

A strong desire to be rid of one’s primary and/or secondary sex characteristics

A strong desire for the primary and/or secondary sex characteristics of the other gender

A strong desire to be of the other gender

A strong desire to be treated as the other gender

A strong conviction that one has the typical feelings and reactions of the other gender

Other than wanting to be the other gender and wanting to be validated as and treated like the other gender, how does anyone know they’re trans? What is trans other than wanting to be the other gender and wanting to be seen as the other gender?

The current definition of gender dysphoria is in line with what someone would be feeling to label themself trans. The current definition of gender dysphoria is required to be trans, because how and why would you be trans if you want to be and be seen and treated as you assigned gender?

The label they use for the disorder you have might change, yes, I went over this. As of right now, the label we use for someone who doesn’t identify as their assigned gender, wants to change it and have that change be validated by other people, and feels this way for at least six months, is gender dysphoria. If the label for that changes then the label changes, so what? If you no longer fit the diagnosis, if they make a more accurate map for trans people having less debilitating dysphoria, there will be two things that can define being trans. I don’t see why anyone would be resistant to this.

TW: ED mention

Diagnostic criteria don’t usually change so drastically that a person is going to go from having a disorder to not having one. If the criteria change that drastically it’s generally because the old symptoms fall into another category.

For instance, ADHD and ADD being merged into one diagnosis, or the same happening with Asperger’s and Autism Spectrum Disorder. No one who had those stopped having a disorder because the name changed, and treatment that helped was still valid treatment.

Another example is Binge Eating Disorder being added to the DSM in 2013. Before it was added to the DSM, people with the disorder were classified as Bullemic, and the treatment for that helped them somewhat, but they were put into their own more specialized category because their particular cluster of symptoms needed more specialized treatment.

I could write a lot about this, but honestly, you’re deflecting here whether you realize it or not. Gender dysphoria is an incredibly inclusive diagnosis as it is. If a person feels they don’t identify with their gender assigned at birth and has a desire to change it, they fit the criteria. Right now “gender dysphoria” is the label we use for people who need access to hormone replacement therapy and gender confirmation surgeries (note that I said access and not that it’s required).

If, in the future, the label is split into other labels that doesn’t change that you’re trans. It just means they decided the difference is vast enough to warrant a different approach between, say, gender dysphorics with severe distress and without. This does not mean they would stop you from transitioning, transition is already the treatment for your symptoms and that’s incredibly unlikely to change, it mostly means therapy may be approached differently and specific doctors would be able to specialize in one disorder over the other so there would be specialists trained to be better with your specific symptoms.

No doctor is ever going to suddenly tell you you’re not trans as long as you (at least) don’t identify with your gender assigned at birth and do want to change it. If eventually there’s a diagnosis other than gender dysphoria for those symptoms, then in that eventuality there will be two diagnostic labels for people who are trans.

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

TW: slight mention of csa

I assume you’re talking about the case of people dissociating from their assigned gender because of (usually sexual) trauma, because that’s the only case right now where a doctor will avoid a diagnosis of gender dysphoria until after therapy. 

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

Being (that’s their name if that’s not clear) is a good example of this if you want to look them up, they’re very open about their trauma and why they transitioned and detransitioned. 

If a doctor wants to explore a person’s trauma or just really talk things out before letting a person transition, it’s to protect them from permanently changing their body in a way that will cause them distress. Brains do a lot of harmful things to protect themselves, I say this as someone with a personality disorder (essentially someone who has a brain that’s stuck on doing harmful things to protect itself), and I say that without any judgement or malice.