It can be difficult to find clear information about gender dysphoria online, so we compiled answers to some questions you may have about the topic. This text should serve as an introduction for readers who hope to engage with the literature discussing gender, but who know very little about the issues to begin with.
What is gender dysphoria?
Gender dysphoria is a condition in which a person feels as though their sex at birth is mismatched with the gender they identify most with. According to the Diagnostic and Statistical Manual for Mental Disorders (DSM-5), 0.005–0.014% of biological males suffer from gender dysphoria and 0.002–0.003% of biological females do so, although this is changing due to recent surges in gender dysphoria diagnoses. There is no doubt about the existence of gender dysphoria as a legitimate condition that can be alleviated by going through a series of medical processes known as “transitioning”, in which an individual’s body is made to look and feel more similar to that of the gender they identify with. The causes of gender dysphoria are still unclear.
What does “transitioning” mean?
Transitioning can take several different forms and does not always involve surgery or irreversible procedures. The two types of transitions are social and medical.
What is the difference between a medical transition and a social transition?
Social transitioning is when a person chooses to present themselves as a member of the opposite sex. This may be through aesthetic changes such as clothing and hairstyles and could also include going by a different name and pronouns. Steps taken to socially transition are generally reversible. A medical transition is characterised by the use of medical interventions such as puberty blockers, hormone treatment and surgery. Some types of medical transitions, such as puberty blockers, are reversible, whereas surgery is generally permanent.
What is the difference between “sex” and “gender”?
Although the words “sex” and “gender” are often used interchangeably, they refer to different concepts. “Sex” is assigned at birth and describes the difference between men, who have XY chromosomes, and women, who have XX chromosomes. “Gender”, on the other hand, is broadly defined as the social elements of what it means to be a man or woman. This concept of gender as malleable and shaped by environmental factors was developed in the 1960s and 70s. The field of Gender Theory, which has become popularised since that period, generally posits that masculinity and femininity are socially constructed. Some gender academics even propose that sex is socially constructed. This field is not without criticism. Studies have shown that men and women are different in many ways including psychological traits, hormone levels and many observable traits. In addition to this, there is evidence that babies of just three months old prefer toys associated with their sex. This is also observable in rhesus monkeys, who preferred playing with toys associated with their sex, thereby casting doubt on the idea that these traits are solely developed through socialisation.
What does it feel like to suffer from gender dysphoria?
Children suffering from gender dysphoria can exhibit a number of symptoms including refusing toys designed for their sex, urinating in the position of the opposite sex and repeatedly stating they are really of the opposite sex. In teenagers and adults, gender dysphoria can cause deep disgust of one’s own genitals and the strong belief that their real gender is not the same as their biological sex. This is often accompanied by feelings of isolation and depression.
What’s the difference between the terms “gender dysphoria”, “transgender” and “gender non-conforming”?
As described above, “gender dysphoria” is a condition in which an individual feels that they do not identify with their sex. A “transgender” person is someone whose gender identity is different to their sex. A “gender non-conforming” person is someone whose appearance or behaviour does not align with what one might expect from a member of their sex.
What about parents of children who are questioning their gender?
One can only imagine how difficult it must be for people struggling with gender dysphoria. It must also be challenging for parents and family members of these individuals to respond to the revelation that a child does not identify as their biological sex. On top of the difficulty parents might face in understanding their children’s desire to change gender, parents can face even more challenges from those around them. Social media shaming and excessively PC school policies are just two challenges faced by parents who question their child regarding issues of gender.
Is gender dysphoria permanent?
Around 80% of gender non-conforming children grow up to be cisgender (i.e. identifying as the same gender they were born as). However, when gender dysphoria persists through puberty, it is usually permanent. Some research has shown that adults with gender dysphoria can have brain structures that are somewhere in between male and female brain structures.
Does body image and mental health play a role?
One study on teenage girls in the US found that 50% of 13-year olds felt unhappy with their bodies, growing to 80% by the time the girls reached the age of 17. Adolescence is a difficult time for young people. Being uncomfortable in their own bodies is perfectly normal.
Indeed, certain mental health problems have been found to correlate with feelings of gender dysphoria. There is anecdotal evidence of young people mistaking body image issues and depression for gender dysphoria.
In 2020, Keira Bell brought a case to the UK High Court. Keira had begun transitioning into a boy when she was a teenager but had changed her mind and de-transitioned. She claimed that she had been given false hope that transitioning would solve all her problems. She said:
I made a brash decision as a teenager, as a lot of teenagers do, trying to find confidence and happiness, except now the rest of my life will be negatively affected. Transition was a very temporary, superficial fix for a very complex identity issue.
Of course, disentangling causality in those who are—or simply believe themselves to be —suffering from gender dysphoria can be tricky. Those who genuinely and persistently believe themselves to be in the wrong body would doubtless be vulnerable to mental health issues and body issues.
What’s the role of sexuality?
Around 75% of boys who are gender-nonconforming grow up to be gay adults. In fact, gender-nonconformity in childhood is one of the best predictors of homosexuality in adulthood.
What treatment is given to children who question their gender?
When a child is thought to have gender dysphoria and is brought to a gender clinic, they will generally be required to see a number of different specialists over the course of a few months. As stated on the NHS website, many interventions involve psychological support rather than medical because gender dysphoria has a tendency to subside during puberty. Children may also be given puberty blockers, designed to pause the physical changes that usually occur during puberty. In the UK, after the age of 16, children may be given cross-sex hormones. These have more permanent effects and involve giving female patients the male hormone (testosterone) and male patients the female hormone (oestrogen). In the US, puberty blockers and hormone therapy can be administered to children under the age of 16 in the majority of states, while in some states treatment for children under 16 is banned. In Arkansas, doctors cannot provide any treatment for gender dysphoria to patients under the age of 18.
Are there any side effects of these treatments?
Puberty blockers do have a number of side-effects, some of which are relatively benign, for example headaches, muscle aches and changes in weight. Other more serious side-effects include lower bone density, changes in mood and delayed growth plate closure. The effects of puberty blockers are thought to be reversible – once a patient stops taking these blockers, puberty will resume, although longer term effects are still unknown and researchers are yet to discover whether puberty blockers affect brain development.
The side-effects of taking cross-sex hormones are still largely unknown. However, the few studies done have suggested that transgender women who were on the hormones had a greater risk of mortality, while transgender men had increased blood pressure and insulin resistance. In addition to this, infertility is a very common side-effect of long-term use of cross-sex hormones.
Although it is not a treatment per-se, chest binders are sometimes used by biological women who wish to give the appearance of a flat chest. It has been shown that the use of chest binders, a tight piece of cloth which is wrapped around the chest, comes with considerable side-effects. 53% of participants experienced back pain and 47% reported shortness of breath as a result of chest binding. Rarer side-effects can include spinal misalignment and rib damage.
Can children give informed consent for gender dysphoria treatments?
Despite the potential for harm, UK gender clinics have found a legal loophole through which pharmacies can administer hormone medication prescribed by doctors in any part of the EU and outside the jurisdiction of UK regulators. This was discovered when a reporter posing as a 15-year-old girl was prescribed testosterone by a gender clinic without parental knowledge. This raises the issue of informed consent. In the UK, children under the age of 16 are unable to consent to sexual intercourse, while those under 18 cannot marry, drink alcohol or vote in elections. These age limits are put in place because adolescents are not deemed to be capable of assessing decisions in the same way that a fully developed adult would. This is because the frontal cortex, the brain’s decision-making powerhouse, is not fully developed. While an adult should be well within their rights to transition if they decide to, a child may not be capable of making a decision that has such life-altering consequences, infertility being one of them.
Science has a long way to go in researching the causes and treatments of gender dysphoria, so open and honest dialogue about these issues will be increasingly important as we move forward. We can do this by learning the facts, keeping an open mind and treating everyone with dignity.
After studying Architecture at the University of Nottingham, Laura Walker-Beaven worked in fundraising and international development. She is currently studying a masters in Human Rights, during which she has become increasingly concerned about the impact of Critical Social Justice on universities.