DJ was recently diagnosed with something the therapist called “gender dysphoria.” DJ has very little idea what this means. The therapist talked about how someone like DJ with gender dysphoria typically feels extremely upset inside about the gender they were assigned at birth. They might not feel like they identify with their assigned gender, and this causes pain inside.
- We will start by covering gender dysphoria definition and gender dysphoria symptoms.
- Then, we will explore some gender dysphoria causes explanations that researchers have put forward.
- Finally, we will delve into the gender dysphoria treatments available.
Gender Dysphoria Definition
Gender is not the same as sex. Gender usually describes how a person acts and identifies and does not refer to their biological sex. However, the facets of gender – masculine or feminine –typically apply to the male or female sex. Masculinity is associated with being male, and femininity with being female.
Problems with gender and sex arise when the two don’t align properly.
Gender dysphoria is a psychological condition defined by the distress produced by a person’s belief that their biological sex does not correspond to their psychological sex (gender identity).
Gender dysphoria was formerly known as gender identity disorder (GID), which was changed after the DSM was updated to be more inclusive in terminology.
Gender Dysphoria Symptoms
Like all disorders, gender dysphoria has specific characteristics by which professionals can tell if a person has it. Some gender dysphoria symptoms are as follows:
- Strong and negative feelings about one’s birth sex.
- Feeling that one’s birth sex does not match the gender one identifies with (this is called a gender identity).
- Desire to have the primary and secondary sex characteristics of the sex you want to identify with (while avoiding or not having the primary and secondary sex characteristics of your birth sex).
- Symptoms of depression related to their birth sex.
Gender Dysphoria Causes: Biological Structures
Brain gender theory states that differences in brain structures and incompatibility with biological sex cause gender dysphoria. This is usually found in sexually dimorphic brain regions.
Dimorphic brain regions are structures of the brain that are genetically different in males and females.
Zhou et al. (1995) studied the bed nucleus of the stria terminalis (BSTc), a brain area that plays a role in sexual function. This area is typically 40% larger in males than females. In the post-mortem study, six male-to-female transgender participants had a BSTc size equivalent to typical females.
They concluded that this might be due to the interaction between the brain and sex hormones during the developmental period.
Kruizjer et al. (2000) also found similar neurons in the BSTc of male-to-female transgender as in females.
Hare et al. (2009) examined the genetic components of transsexualism and suggested a particular gene is associated with lower levels of masculinity and the resulting feminisation. They identified an androgen receptor gene (AR) and found that allele repeats of AR were longer in male/female transgender than in non-transsexual males.
The accumulation of these findings suggests a neurobiological basis for gender identity issues.
Gender Dysphoria Causes: Genes
Psychological research on atypical gender development has shown genetic factors influence gender dysphoria.
Coolidge et al. (2002) examined 157 twin pairs (96 MZ and 61 DZ) for signs of GID using the DSM-4 clinical diagnostic criteria. GID was detected in 2.3% of the pairs, and 62% of these cases were associated with genetic variance GID.
This finding suggests a strong genetic component to GID.
Heylens et al. (2012) compared 23 MZ and 21 DZ twins in which one of the pairs was diagnosed with GID. They found 39% (9) of the MZ twins had genetic concordance for GID compared to the DZ twins who did not. These data suggest a genetic component to GID.
Concordance in twins indicates the likelihood that twins will develop a particular trait or illness.
A genetic disorder that may cause the onset of GID is androgen insensitivity syndrome (AIS). This syndrome is inherited from the mother. In AIS, a child is born genetically male (with the X-Y chromosome) but resistant to androgens (male hormones). The individual may have female-like features such as breasts.
Although the individual looks like a woman, they still have the genetic makeup of a man; this can lead to confusing feelings about their gender and cause the onset of GID.
Gender Dysphoria Causes: Biological Explanation Evaluation
Evaluating the biological explanation of gender dysphoria:
- Conflicting evidence for the BSTc – Hulshoff Pol et al. (2006) found that transgender hormone therapy affects the magnitude of the BSTc, although the BSTc should be fully formed by age five. Therefore, the observed differences in the BSTc in patients with gender dysphoria may be a consequence rather than a cause of gender dysphoria.
- This approach considers only the nature aspect of the ‘nature versus nurture’ debate. It, therefore, ignores the role of the environment. This explanation can be regarded as reductionist.
A reductionist approach tends to oversimplify complex processes by ignoring factors contributing to the behaviour.
Gender Dysphoria Causes: Psychoanalytic Explanation
Since gender is mainly based on how a person acts and identifies, it is only logical that their social environment influences their gender identity. Psychological components are something we need to consider.
One psychological explanation for atypical gender development comes from psychoanalytic theory.
Ovesey and Person (1973) argued that extreme separation anxiety in childhood, before gender identity is established, causes gender dysphoria. They argued that the child fantasises about symbolically fusing with their mother to alleviate this separation anxiety.
According to their theory, the male child ‘becomes the mother’ and adopts the female gender identity. When interviewed, Stoller (1973) found that men diagnosed with gender dysphoria reported a close mother-son relationship. This likely leads to a stronger female identification and confuses gender identity.
Gender Dysphoria Causes: Cognitive Explanation
Dual-path theory – another psychological explanation for the atypical development of the sexes – stems from the cognitive approach.
Liben and Bigler (2002) proposed expanding sex schema theory to emphasise individual differences in gender identity. They suggest gender can take two paths:
- The ‘normal developmental path’ is when gender develops according to gender schemas and exhibits gender-appropriate attitudes and behaviours.
- The ‘personal path’ describes how a person’s behaviour influences their gender identity rather than society. In this pathway, the person’s behaviour becomes stronger than their gender identity and changes their gender schema.
A boy may grow up wearing dresses and believe that boys and girls can do so. Therefore, his schemas are not sex-typed.
Although the theory uses the terminology ‘normal’, we recognise this term can be considered offensive. By ‘normal’, the theory refers to what is most common.
Gender Dysphoria Causes: Psychological Explanation Evaluation
Evaluation of the social-psychological explanations of gender dysphoria:
- Androcentric research– Ovesey and Person’s explanation of gender dysphoria only considers male transgender individuals. The research does not consider females, so the theory does not completely explain gender dysphoria.
- Psychoanalytic explanations are difficult to measure and test scientifically because they state gender dysphoria occurs unconsciously.
- Descriptive versus explanatory – Liben and Bigler’s cognitive theory of gender dysphoria is descriptive. The theory describes what causes gender dysphoria. However, it does not explain the underlying processes that cause the development of gender dysphoria.
Thus, we cannot establish cause-and-effect relationships from the research.
Gender Dysphoria Tests
There are many online gender dysphoria tests available that can help identify any doubts you may have. The questions generally concern how you feel about the sex you were assigned at birth and the other genders.
It is important to note you should take the results with a pinch of salt; it’s always best to get an expert’s opinion.
Professionals can guide individuals needing help with therapy and other treatment options.
Gender Dysphoria Treatment
The most common treatments for people with gender dysphoria are therapy and hormone therapy. Because gender dysphoria can also occur in children, gender reassignment is usually done later.
Gender non-conforming behaviour is when an individual’s behaviour or ascribed gender role does not conform to societal masculine or feminine gender norms.
Gender Dysphoria Treatment: Hormone Replacement Therapy
Hormone replacement therapy can impact a person’s physical appearance and physiological processes.
For example, people with high testosterone levels may have increased hair growth.
There are two common types of hormone replacement therapy:
Puberty blockers
Cross-sex hormones
Before we learn about the two types of hormone therapy, let’s recap which hormones are associated with which sex.
- Testosterone is the hormone associated with males.
- Progesterone and estrogen are the hormones associated with females.
Puberty blockers prevent children from going through puberty, e.g. a male from developing hair or a female from getting their period.
A goal of this is to prevent further distress from their developing body of the gender they do not identify with until they can go through with gender reassignment procedures.
In contrast, cross-sex hormones involve carefully adding doses of the gender that the individual identifies with into their body. Over time, this may lead the individual to develop characteristics of the gender they wish to identify with, e.g. girls who identify as boys may develop a hoarse or deeper voice.
Gender Dysphoria Treatment: Therapy
Therapy is the most common treatment used for patients with gender dysphoria. Therapy can serve to:
Uncover the causes of gender dysphoria (psychotherapy).
Learn how to cope with gender dysphoria (cognitive behavioural therapy).
Understand how others can help and understand gender dysphoria (couples or family therapy).
Gender Dysphoria - Key takeaways
- Gender dysphoria definition is a psychological condition categorised based on the distress caused by the feeling that one’s birth sex does not match one’s gender identity.
- Gender dysphoria symptoms include depression, feeling that one’s birth sex does not match the gender one identifies with and strong and negative feelings about one’s birth sex.
- Gender dysphoria causes have been linked to brain structure differences and genetics, and researchers have put forward psychoanalytic and cognitive explanations to explain the cause of GID.
- Gender dysphoria treatment commonly involves therapy and hormone replacement therapy.
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