Overcoming ‘Gender Dysphoria’

Artwork by Nicole Jones.
Artwork by Nicole Jones.
Artwork by Nicole Jones.

The pairing of these two words, “gender” and “dysphoria”, is an insidious and anti-feminist one. Gender, a hierarchical construct understood by feminists as oppressive, is inherently distressing. Women and girls, especially, are absolutely right to feel uncomfortable with gender. It has never been something that women should strive to feel at ease within. Perhaps this is why referrals for girls to the Tavistock’s Gender Identity Development Service (GIDS) have increased by 5,337% in under a decade.

In 2013, the term “gender dysphoria” was added to the DSM-5, replacing “gender identity disorder” in the editions before. In this edition, the term “gender” all but replaces “sex”, which is said to be “assigned”. Similarly, in the ICD-11, the World Health Organisation (WHO) removed references to “disorder” and reclassified “gender incongruence” as relating to sexual health, rather than mental illness.

Such revisions are in part due to pressure from lobby groups to de-medicalise transition and are part of a larger trend that has resulted in policy capture and a push for new legislation in many countries. Through subtle linguistic changes, over time, the reality of transition as relating to the body has been obscured and sanitised. Many are not told of the risks and are left without the appropriate follow up care. Some even realise transition that it is impossible to actually change sex. Threshold changes have created an increasingly broad category in which many will find themselves and over-diagnosis and over-treatment can only be expected to follow. This is unsurprising, given the lucrative market surrounding transition. The unfortunate irony at the heart of the “de-medicalisation” of transgenderism is an increasingly medical approach in which non-conformity is deemed treatable through surgical and hormonal interventions.

When looking at these figures from the Tavistock, I feel relieved that my feminist consciousness gave me the ability to understand my body image issues before any doctor could make a referral. “Gender dysphoria” was not yet in the vocabulary of teenagers; however, the climate that preceded this “rise in acceptance” for transgender youth was a homophobic one. There were no ‘out’ lesbians at my secondary school and only one transgender person, who, coincidentally, was the only openly same-sex attracted person we were aware of at the time. The rest of us were assumed, and assumed ourselves to be, straight. Many detransitioners state that they never even considered the possibility of being a lesbian and considered themselves as heterosexual men. For myself and many young women, a relationship with another woman was a completely unknown possibility. Media representation of lesbians usually depicts thin, feminine and conventionally attractive women that resemble a male fantasy rather than any female reality. Besides, most of us had never even heard of the .

As a child, I was fortunate enough to be allowed to dress and play how I wanted. My mother was a teacher at a secondary school at the time and was once stopped by some pupils, who asked: “why do you let your kid dress like that?” She responded that she let me dress how I liked. Unfortunately, many children live in homes where they are not allowed the haircuts, clothing and toys that they like. This may be an outright refusal, or it may be through subtle discouragement or comments when they fail to conform. Over time, the child starts to develop a sense of profound wrongness. It is for these children that transgender identification runs the deepest. As Susie Orbach writes in Bodies:

Women with dysphoria struggle to escape this stinging sense of not being right. When we dress femininely, or are forced by family and peers, we feel as if we are lying to ourselves. But the clothes we want to wear look ‘wrong’ on us. Conditioned from childhood to associate femaleness with femininity, we feel like failed women. This is only compounded when reaching puberty.

As a late developer, I came to identify so wholly with my prepubescent, almost sexless body, that I began to associate it with a forgone liberty. Suddenly, I had to “dress for my figure”. The more visibly female I became, the less freedoms I enjoyed. Attempting to play the part, as a pre-teen, I began stuffing my padded bra (sometimes even wearing two) but soon realised I did not enjoy femininity or male attention. At the age of sixteen, I came very close to buying a binder, prevented only due to a lack of funds. In the meantime, I would wrap thin scarves tightly around my breasts until they were flat. The breasts that weren’t enough for femininity became superfluous in the pursuit of neutrality. I developed an eat/throw up routine that I sincerely saw as the path to my “authentic self”. The real me was thin and androgynous and the body that had betrayed me was just a falsehood. I understood my femaleness not only as excessive but contrary to who I really was.

There’s a very real sense of depersonalisation in which your own body characteristics are felt not as your own but representative of someone else — usually resembling the expectations others have of you. You become obsessed with inscribing value judgements onto inherently meaningless details, which accumulate in your mind to represent the persona you are rejecting. The body becomes a site of moral accountability. You endeavour to become less and less of this person, but it is dysphoria, so the goal posts keep getting pushed back. The body may have changed but the value system remains. Dysphoria sustains itself.

Occasionally, you are reminded of the futility of your efforts. There is only so much that the external can only be disciplined by the internal. Sooner or later, you will be reminded of your powerlessness. For transgender people, this manifests in the desire to determine the speech of others, as the use of “preferred pronouns” communicates to the dysphoric their efforts have not been in vain. The further these efforts are extended, the more they stand to lose, as the very foundations of their personhood have been formed on top of what is, essentially, a lie. Dysphoria, limitless and intangible, can be quantified by external confirmations of its validity, as it is never truly felt by the dysphoric to be enough. Denial has to be maintained. As a consequence, online communities dedicated to documenting the “journey” arise. For people with dysphoria, online videos and blogs serve to maintain and intensify the disorder. Surrounding themselves with others like them, a “safe space” is created in which the invalidating words of the adults in their lives can no longer reach them. Adults that are invested in you becoming the person you have rejected.

Pro-anorexia communities were popular on websites like tumblr, where girls would upload and reblog black and white pictures of thin women, often posing in such a way as to contort the body to give the impression of the desired body shape — tricks you learn quickly. To create or exaggerate a “thigh gap” you could turn your heels turned outward and lean your shoulders forward. “Hip dips” were when your stomach was so concave, your trousers or underwear would stretch from hip bone to hip bone without touching the skin in between, something most could only achieve while lying down. Shoulders can be pushed forward and inwards to enhance collar bones. Within these forums, the appearance of weight loss can come hold almost equal significance to the weight loss itself as a means of psychological relief. Neatly organised into tags, the block button always to hand, the digital world provides the dysphoric a sense of control lacking in the outside world. This imagery would feature alongside tips on how to most effectively starve yourself.

Within the online trans community, the colloquial use of “T” for testosterone is troubling in its resemblance to the personified abbreviations of “Ana” for anorexia and “Mia” for bulimia, often referred to as “my friend”. In these circles, there is a similar unrelenting self-scrutiny, but it is “passing” rather than dieting that is the focus. The disclaimer made by transgender activists, that passing is not integral to trans identity, although well-meaning, is removed from the reality of dysphoria. In popular videos and blogs, women “pre-T” are encouraged to engage in a number of obsessive and self-regulatory behaviours. Striped clothing is said to give the impression of height, while patterned shirts can add width to shoulders and bring attention away from wide hips; an angular haircut that is shorter on both sides is deemed masculine, as are thick, full eyebrows which can be penciled but preferably dyed. Dye can also be used to darken the lower face, to give the impression of five o’clock shadow. Talk slower and deeper, with fewer hand gestures. Walk in larger strides. Pack. The most frequently mentioned, of course, is binding. Many advocates for “safe” binding admit to having personally not followed this advice and report using tape and bandages, wearing binders that were too small or sleeping in them. When your end goal is to be rid of your breasts, it is difficult to care what happens to them in the meantime. Once on testosterone, a popular trend is to record the progression of the voice as it deepens. “T” is repeated, again and again, like the ever thinning pictures women take to record their weight loss.

Just as young women with eating disorders will try to obtain diet supplements, laxatives and exercise equipment without their parents knowledge, transgender people can find ways of purchasing binders and off-label hormones online. The publicly funded LGBT Foundation even provides a “MORF Binder Scheme” in which young women can receive a free binder, packaged in such a way as to not reveal to their parents what’s inside. The UK charity Mermaids recently promoted a feature on their website that allowed young users living at home with family to click a button and quickly be sent to another site. Distrust comes to define the relationships children have with their parents, whose understandable apprehension in accepting the sometimes rapid onset of this new identity, is characterised by online peers and transgender activists as “transphobia”. The parent who has been accepting of the gender non-conforming child in the past, cannot begin to understand this sudden obsession with identity and appearance. The gender conservative parent, however, is likely acting on an unacknowledged homophobia, for the homosexual child is a more direct threat to the nuclear family unit than the transgender. Homophobia camouflaged by the “progressive” veneer of the transgender movement.

Secrecy is one of the hallmarks of dysphoria, as when you finally utter the words that have consumed your conscious thought for so long, they can seem irrational, vulgarised, even petty. The disapproval of your family confirms to you that you and your online peers are the only ones fit for the task of understanding. So you can retreat into yourself, withdraw, refuse to talk about it. The gap between who you are for yourself and who you are for others widens into a chasm. The perceived instigator of the conflict is forced to accommodate the emergence of a strict criteria within their interactions, if they are to be able to interact at all. Family dinners and feminist events can become quite unpleasant.

Many mothers who can relate to their daughter’s unease cannot get through to them. They may stumble with their words, attempting to reassure the child that these feelings will resolve with age, but using the word “phase” and setting off alarm bells. Extreme body hatred, unlike homosexuality, is something one should endeavour to outgrow. The conflation of the two issues is deliberate: transgender campaigners have been advised to piggy back on former liberation struggles, like gay rights, despite the clear differences between the two. Unfortunately, most parents cannot relate to their non-conforming child’s feelings of difference, and so rely entirely on the guidance of professionals. In the US, it’s pretty obvious what these professionals stand to gain from over-diagnosis: lifelong customers. The politicised influence of government-funded lobby groups in the UK have resulted in a climate in which the system is buckling under the pressure of demand. Legislation and policy intended to legitimise this scandal can’t be put in place fast enough — ideally before anyone has a chance to stop and think.

Upon learning of my bulimia, those close to me would attempt to console with “but thin girls are ugly, men like curvy girls!” To me, a closeted gay woman, you can imagine this had the opposite of its intended effect. Heterosexuality and the gendered expectations that came with it were the very things I was trying to escape. For a start, they were “misgendering” me. I was not one of those “curvy girls” men desired: I was a subject, not an object. Yet when googling my dress size, pictures of “plus size” models wearing nothing more than their underwear would appear on screen. If I had searched “lesbian”, I would have been presented with pornography of thin, feminine women with long nails violating each other for a male spectator. As shown in the documentary , heterosexual porn sees petite women classified as “teeny boppers” while women with larger bodies are “MILFs” — roles that relate specifically to their relationship with puberty and reproductive function. Young women learn quickly what it means to be a woman in this world. As Victoria Smith writes:

The overwhelming disconnect between millennial women and second wave radical feminists is in part due to this conception of womanhood as formed in conjunction with the rise of pornography and the dissemination of images throughout the web. These images have permeated our self-conception so deeply, that when rejecting them, we feel as if we have no choice but to reject ourselves. When older women urge us on the necessity of embracing our bodies as women, they are speaking of womanhood as it is known to them. Women who can recall the days of women’s liberation. Women who didn’t spend their teenage years being mocked by boys and discussed by girls who had all been raised on porn. It therefore becomes easy to dismiss their aims as being different to ours. They are asking too much. The body is the domain of the dysphoric, it can be moulded to their liking. Self-acceptance is seen as surrender to hostile outside forces.

This is where “gender identity” comes in to pick up the pieces. “Identity” as a rhetoric, proposes an individualised, rather than collective, experience of gender. It provides dysphoric individuals with the very thing they’re seeking: control. Lesbian and bisexual women, whose understanding of their sexuality is formed within the context of a heterosexual patriarchy, are able refashion their bodies and narratives, psychologically immunised by their non-binary or gender fluid identity. The children bullied by their families and peers for their non-conformity are offered a chance to exchange their feelings of powerlessness. Feminist criticisms of this binary thinking are painted as attempts to enforce the binary, no matter how gender non-conforming the speaker might be. The dysphoric assumes the dissenting voice advocates for their feelings of powerlessness, for whenever they dissent within their own mind, powerless they become. When the body becomes vilified, those who speak in its defence ally themselves with this enemy.

There is a power in diagnosis in that the child witnesses an adult tell their parent that there is a “reason” and what follows is permission. This permission, however, is conditional. The parents rush out to buy their “son” the clothes that she has wanted for years. The child is suddenly able to wear trousers at school but they must socially transition. Someone finally stands up to the bully, not to tell them that girls can play football, but to reassure them the girl who wants to play is a boy. People start speaking to you with respect. The extent of your family’s disapproval becomes clear after transition when they explain how they “always knew” that something was wrong, different, or that you were “actually” a boy. There is very little motivation to go back. Detransitioners may have to face “disappointing” their loved ones, once again, perhaps even more profoundly this time. The perceived success of transition is something feminists recognise to be an individual solution to a collective problem, summarised by Rebecca Reilly-Cooper: “the solution is not to try to slip through the bars of the cage while leaving the rest of the cage intact, and the rest of womankind trapped within it.”

I have no doubt puberty blockers would have eased my distress on having entered into a female puberty, just as I had no doubt that throwing up after my meals would make me feel better. When throwing up, I would have tears down my cheeks. I had learnt, from blogs and my own experience, what not to eat, what was painful to have come back up. What is difficult for others to understand, is that however horrible this was, it was so much easier to endure than the mindset that came before, temporarily postponed until the next meal. Women who wear binders have similar accounts of physical pain as ranking secondary to psychological pain, as do most self harmers. When feminists speak of young women “mutilating” their bodies, it falls on deaf ears. The problem isn’t that young women don’t understand what they’re doing when they opt for a double mastectomy, it’s that, like when I was puking, it’s the alternative that feels like the disfigurement.

This is the mind of the dysphoric. It is then the responsibility of family, friends and society to intervene in this self harm. To minimise and prevent with the aim of eventually restoring a sense of ease within the body. Gender conservatives do not want their non-conforming or gay children to feel at ease within their bodies. They would rather, through medical intervention, make themselves feel at ease ideologically. Almost tragically, society shares with the dysphoric the mindset that justifies harm as a necessary evil. Yet studies have shown that suicidal ideation, suicide attempts and depression increase sexual reassignment. There are growing numbers of detransitioners coming forward with their accounts of medical malpractice. It’s increasingly evident that medical transition is the false promise that keeps women suspended in decades of agony.

I don’t have the solution to overcoming gender dysphoria. I still press my breasts flat against my chest when looking in the mirror. When I put on weight, it is a terrifying reminder of my femaleness. When I run up stairs, I have to hold my chest, because the feeling is unbearable. It has taken me a long time to be able to listen to audio recordings of my voice. All I know, is that despite all this, it does get better. Less all-encompassing. Discovering my sexuality and realising that female bodies were cause for celebration, not contempt, has lifted me from the majority of my despair. I have discovered that I’m a competent endurance runner and cyclist — something I never would have known if I’d bought that binder at sixteen. What helped my dysphoria was doing things that encouraged me to feel my body rather than just witness to it. Binders, like the corset, encourage women to be passive and rob them of the opportunity to discover how capable their bodies are. To rephrase Germaine Greer: if she never takes off her binder, how will she ever know how far she could walk or how fast she could run?

Artist and writer based in Edinburgh. To support my writing: paypal.me/satiricole

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