(last updated September 11, 2019)
Q: What is dysphoria?
A: Dysphoria is a diagnostic term meaning âprofound distress or discomfort.â It is a common symptom of many psychiatric disorders. It's been used this way for over a century (example 1, example 2, example 3). âGender dysphoriaâ refers to dysphoria that occurs as a result of incongruence between a personâs assigned sex and gender identity. To meet the diagnostic criteria for the psychiatric disorder âGender Dysphoriaâ the DSM-V specifically states that the incongruence must cause âsignificant distress or problems functioning.â Sex/gender incongruence that doesnât cause this distress or dysfunction is NOT considered disordered.
Q: I was told that the APA defined gender dysphoria as âconflict between a personâs physical or assigned gender and the gender with which he/she/they identify.â
A: This particular line is a quote from a page on the APA website that was meant to briefly summarize the diagnostic criteria for Gender Dysphoria. It is not the full diagnostic criteria, which is described further down the page. Along with the checklist of traits, the diagnostic criteria for both children and adults include âdistress or inpairment functioningâ as specific necessary condition:
âIn adolescents and adults gender dysphoria diagnosis involves a difference between oneâs experienced/expressed gender and assigned gender, and significant distress or problems functioning [...] In children, gender dysphoria diagnosis involves at least six of the following and an associated significant distress or impairment in function, lasting at least six months.â
Again: that âdistress or problems functioningâ criteria is mandatory; this is why the line meant to summarize gender dysphoria uses the word âconflictâ instead of a more neutral term like âincongruenceâ or even âdifference.â The APAâs endorsed expert opinion on the subject states more explicitly that ânot all transgender people suffer from gender dysphoria.â
According to members of the APA workgroup responsible for writing the Gender Dysphoria diagnostic criteria, the term âdysphoriaâ was chosen based on the logic that âif the new diagnosis would focus more on the dysphoria aspect (e.g., in the name) than does the current one, no separate distress criterion would be necessary, because the distress would be defined as inherent to the diagnosisâ (sci-hub pdf). Note that they ended up keeping the distress criterion in the diagnosis despite the redundancy, presumably because they were afraid that it might not be clear enough that they were referring to distress while using a medical term that literally means âsignificant distress.â
The exact DSM-5 criteria (which I transcribe here) further makes it clear that gender dysphoria requires distress, rather than simply gender incongruence.
Q: Why does it matter how we define dysphoria?
A: Itâs a matter of relevance. When discussing gender dysphoria in the context of the medical model, the relevant definition is the one that gets used within the medical system.
Q: But what if we worked to change the medical definition of gender dysphoria?
A: Iâve see this idea brought up in my notes a few times, and itâs honestly just a terrible idea. The overpathologization of distress responses is a huge concern within psychology, and itâs one of the reasons the medical definition of gender dysphoria is so limited. Extending that definition to include things like âfeeling bad when youâre mistreatedâ is, at best, a step backward.Â
Q: What makes a person transgender, if not dysphoria?
A: An incongruence (mismatch) between their gender identity and their assigned sex category.
Q: How can someone know they're trans without dysphoria?
A: Many non-dysphoric trans people cite "gender euphoria" as their main clue. Others simply describe feeling a strong desire to be a certain gender that differed from their assigned gender.Â
Q: Isn't that just dysphoria?
A: No. As I've already pointed out, dysphoria is a diagnostic term referring specifically to profound distress. While it's certainly common for these other signs of gender incongruence to be accompanied by distress or discomfort, these are not themselves always inherently distressing experiences. The very epicurian idea that gender euphoria is simply a result of gender dysphoria is a false dichotomy based on a zero-sum understanding of pain and pleasure.
Q: Does this mean being transgender is a choice for non-dysphoric trans people?
A: No. While all of us, dysphoric or otherwise, have a choice in what labels we use & which identities we claim, the process through which gender identity is formed is incredibly complex and not incredibly well understood. Non-dysphoric trans people may have less incentive to come out or transition than those of us who do experience dysphoria, but this isn't the same thing as choosing to have a transgender identity.
Q: Why would someone whoâs 100% comfortable with their body transition?
A: First off, most people arenât 100% comfortable with their bodies, and thereâs a wide range of experiences that exist betweenâ complete and total comfortâ and âsignificant distress.â Non-dysphoric trans people seek out medical transition for various reasons, including legal barriers to social transition (eg medical requirements to update ID), feelings of euphoria associated with specific traits, or simply a desire to present in a way that is more congruent with their identities.
Q: But why would non-dysphoric trans people seek out treatment for a condition they donât have? Isnât that like a doctor prescribing chemo drugs to someone without cancer?
A: Many people- cis and trans alike- take HRT for reasons other than treatment of a disorder, including preventive care against future poor health or the potential for quality of life improvements. As of 2016, an estimated 1.67% of adult men under the age of 65 were making insurance claims to cover testosterone supplements, most of whom are cis men; the authors note that men over the age cutoff of the paper were expected to use testosterone supplements at higher rates due to age-related hypogonadism (in this case, the natural, non-disordered decrease in testosterone production cis men experience as they age).
Additionally, doctors actually do prescribe chemo drugs to people without cancer fairly regularly, itâs called âoff-label use.â A common example of this is Methotrexate, a chemotherapy drug which is regularly prescribed to treat noncancerous conditions like rheumatoid arthritis and ectopic pregnancy. Hormonal transition is itself considered an off-label use of HRT, regardless of whether the person transitioning is dysphoricÂ
Q: What sources say that you donât need dysphoria to be transgender?
(Note: this list is not intended to be exhaustive)
A: The American Psychiatric Association explicitly says that dysphoria is not necessary â Not all transgender people suffer from gender dysphoria and that distinction is important to keep in mind. Gender dysphoria and/or coming out as transgender can occur at any age.âÂ
The World Health Organization's ICD-10 acknowledges the existence of non-dysphoric trans people with its description of "transsexualism" as "usually accompanied by a sense of discomfort... or inappropriateness."
The American Psychological Association:Â âA psychological state is considered a mental disorder only if it causes significant distress or disability. Many transgender people do not experience their gender as distressing or disabling, which implies that identifying as transgender does not constitute a mental disorder.â
The American Academy of Pediatrics describes gender dysphoria as a potential consequence of being trans:Â â Some youths experience gender dysphoria when the incongruence between assigned sex at birth and asserted gender identity becomes so distressing that it impairs the youth in school, relationships and overall functioning... However, there is no evidence that risk for mental illness is inherently due to a gender-diverse identity.â
The Canadian Paediatric Society provides this definition of Gender Dysphoria: âDescribes the level of discomfort or suffering associated with the conflict that can exist between a person's assigned sex at birth and their true gender. Some transgender children experience no distress about their bodies, but others may be very uncomfortable with their assigned sex, especially at the start of puberty when their body starts to change.â
The World Medical Association cites the APA definition of dysphoria:Â âThe WMA asserts that gender incongruence is not in itself a mental disorder; however it can lead to discomfort or distress, which is referred to as gender dysphoria (DSM-5).â
WPATH states that "the criteria currently listed for [Gender Dysphoria] are descriptive of many people who experience dissonance between their sex as assigned at birth and their gender identity... The DSM-5 descriptive criteria for gender dysphoria were developed to aid in diagnosis and treatment to alleviate the clinically significant distress and impairment that is frequently, though not universally, associated with transsexual and transgender conditionsâ (emphasis added).Â
Q: I was told the American Psychiatric Association isn't trustworthy, so why do you use it as a source?
A: I've written a big post here analyzing criticism of the APA (and particularly, their handling of trans identities); the short version is that the APA has been very heavily criticised in the past for supporting many of the same positions truscum advocate in favour of today. While the APA & DSM aren't perfect, they aren't exactly the mess truscum claim they are either.
Q: What about brain scan research? Doesn't that prove dysphoria is required?
A: No. Brain sex research in interesting, but the results are nowhere near as clear-cut as many people believe. Yes, there's been studies that have observed similarities between the brains of dysphoric binary trans people and cisgender people who share their identities. This is correlational research that can't be used to infer causation without further evidence, and researchers still aren't sure what exactly it means. There's also the problem of attempting to apply a body of research to non-dysphoric trans people that includes few, if any, results from non-dysphoric trans participants.
Q: How can someone transition without a dysphoria diagnosis?
A: Depending on where you are, there may be clinics in your area that operate on an informed consent model of transition. Unlike the traditional gatekeeper model of transition, informed consent models allow anyone who is competent to make their own medical decisions to receive transition care. Note that this does not mean that they block (or should block) mentally ill people from transitioning, even those with delusional disorders; instead, this is about ensuring that a transitioning person is capable of understanding the changes to their body that transition care would lead to, and minimizing the risk of a crisis during a dangerous situation.
Q: What about John Money/David Reimer? Is this evidence that gender is not actually a construct?
A: John Money was a conversion therapy advocate who believed that he could force a child to identify with the gender of his choosing, and that there was no point in someone identifying as male without a functioning penis. Nothing about this disproves the idea that our genders are constructed, though it does demonstrate that the process of gender construction is beyond human control, at least on an individual level. Some of the terms Money coined may still be in use, but his claims about being able to force children to identify as a specific gender are pretty thoroughly rejected outside of the conversion therapy crowd. Additionally, bringing up the fact that certain terms were coined by Money without recognizing that those terms are currently used in a context that otherwise rejects his views is often used as an attempt to poison the well.
Q: What does "radscum" mean?
A: it's an old term for the category of rad/fem than includes what we now call "TE/RFs" and "SW/ERFs." It was still commonly used when the term "truscum" was coined to refer to post-HBS transmedicalism. In the communities I was active in, the term "truscum" caught on specifically because of how it reflected the relationship between the two groups (transmeds and radscum have a long history of co-operation, regardless of how any individual truscum today feels about that).
Q: Is it true that the person who coined the word âtucuteâ was a cis woman pretending to be trans?
A: No, itâs not.
Q: Why did you remove my response with sources from the replies of your post?
A: I didnât.
Q: Will you promo my discourse blog?
A: Sorry, no.
Q:Â Will you promo my fundraiser?Â
A: Please add a link to this post as a reblog or comment instead of messaging me.
About the mod:
Q: what are your pronouns?
A: Ey/em (like âtheyâ without the âth-â)
Q: Why do you call yourself "transsexual"?
A: I've been using the term transsexual for myself for roughly a decade, and I refuse to give it up because some kids decided they own that word now.
Q: Do you ID as queer?
A: That's one of the labels I use, yes.
Q: What other identity labels do you use?
A: I'm being intentionally vague about certain aspects of my ID on this blog because it's interesting to watch what assumptions truscum make, but in general I'm neither straight nor cis & I use a variety of labels depending on the context I'm speaking in and the information I'm trying to communicate to my audience.
Q: How old are you?
A: Over 30 (which is part of the reason why I stick to responding to people who interact with me first instead of seeking out bad posts to argue against)
