Education

What is Gender Dysphoria?

Firstly, what GD is not.   Though cultures sometimes unfairly pick favorites, differences in personality and expression are a normal part of being human. Biological sex is also innately human. Like other mammals, we reproduce by combining male and female genes. So, "male" and "female" are words for these biological reproductive categories, nothing more. Though there are some traits which tend to be more male or female, on average, not everyone is average. It would sadden us if any girl felt like less of a girl just because she likes trucks, sports or short hair; or for a boy to wonder if he's not really a boy at all just because he likes dolls, the colour pink or dancing. Sex stereotypes are not Gender Dysphoria.​

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Though there’s still a lot we don’t yet know about GD, it has been studied for decades. Leading psychologists and researchers in the field have identified several different types:

 

The most common types

Homosexual GD (Early Onset):

  • Starts in early childhood

  • Occurs in both boys and girls

  • Children show signs of gender non-conformity from a young age

  • Most kids with this type of GD become adult gay or lesbian people and stop having GD, but a small percentage of gay and lesbian people continue to experience GD into adulthood.

 

Autogynephilia (Late Onset):

  • Seen only in natal boys

  • Onset can seem sudden, usually in adolescence

  • Is a kind of heterosexual inversion in which one is attracted to the idea of oneself as female and feels uncomfortable as male. This should not be understood as a mere fetish. That is overly simplistic and degrading.

Uncommon/Rare types

 

Autohomoerotic GD

  • Natal females only, who are attracted to males

  • Aren’t typically gender non-conforming in childhood

  • Attracted to the idea of becoming gay men

  • Is not the same as autogynephilia because they are attracted to men, not themselves as men

 

GD related to having a Disorder of Sex Development

  • Not all people with DSDs have GD, but a small percentage do

  • Especially common in those with Ovotesticular DSD and Congenital Adrenal Hyperplasia

  • Gender non-conformity seen in childhood

  • Developmental and treatment pathway for this type of GD is different than other types of GD

GD Related to Psychosis

  • A person may believe they are the opposite sex as a psychotic delusion

  • Very uncommon

  • Treatment would be the same as for any other psychotic symptoms

 

 

Other (recent developments)

 

Rapid Onset Gender Dysphoria

ROGD is not a formal diagnostic term but a name of a phenomenon studied by Dr Lisa Littman, based on parent reports. Further studies are needed to understand this better, but many leading researchers and clinicians who work with trans youth are seeing a shift in who’s coming to gender clinics. Some traits reported include:

  • Mostly natal girls, but seen in both boys and girls

  • Often no signs of gender non-conformity in childhood

  • First appears in adolescence, quite suddenly

  • Often very intelligent and sensitive youth

  • May have conditions that make them more vulnerable (e.g. Borderline Personality Disorder, Autism or ADHD - all of which impact social skills, emotions and processing)

  • Worsening mental health and behaviour after coming out as trans

  • Firm and intense focus on gender ideology and subculture

What's it like to have Gender Dysphoria?

Most people in our network have Homosexual (Early Onset) GD and identified as gay or lesbian before deciding to medically transition.

As kids we were “tomboys” or “girly boys” and often wished we could be the opposite sex, or believed we were the opposite sex in some way, perhaps believing we had the brain of one sex and the body of the other sex,  or that “God made a mistake.”

Some of us felt distress and shame about these thoughts and feelings, and others didn’t.

Our founder, Aaron Kimberly describes his experience this way:

For as long as I can remember I always thought that I should have been born a boy. That was very confusing for me. It’s not that I thought that being a girl was bad. But when I looked at boys and looked at girls, I just kept putting myself in the boy category. Most of my friends were boys, and many people in my town thought that I was a boy. I got signed up onto the boys’ baseball team by accident one year, because I looked and acted so much like what people expect of boys. 

My GD seemed to be mostly a thought process. I think it’s linked to how we are able to group things together, like cats and dogs for example. Most three year-olds can tell the difference between a cat and a dog pretty easily, even though there are different types of cats and dogs. I had no problem with doing that. But for some reason, with boy and girl categories, I kept putting myself in the “boy” category, rather than the “girl” category. I don't know why. GD was like a puzzle I could never solve, which really upset me sometimes. I didn’t tell anyone about it, but I expressed it in other ways. At Halloween I got to choose male costumes like Dracula, Super Man, and Gene Simmons from Kiss. I imagined I’d grow up to be a man some day.

When I was 19 I was diagnosed with an ovotesticluar DSD. Which is rare and probably why I have GD. Or maybe it's related to my sexual orientation. I think all three of those things are related in some way. 

As an adult, I moved to the city and became a part of the lesbian community. That was really helpful, because I met a lot of gay women who were masculine like me and seemed to have the same kinds of thoughts as I had. Gender non-conformity is common in the gay/lesbian community. There are butch lesbians who have GD, but they don’t identify as trans. They’re happy being butch and deal with their GD in other ways (not by transitioning).  I did decide to medically transition – which I’m happy about – but I still feel a connection with the butches. I know we’re the same, except that I chose to take hormones to appear more male, and they didn’t. 

Hear some of the leading researchers talk about different kinds of GD

A Deeper Dive

Ahmadabadi et all. The role of parent-child relationship, attachment styles, and family performance in the formation of gender dysphoria. Fundamentals of Mental Health, 2018 Jan-Feb

American College of Pediatricians - June 2017 - Gender Dysphoria in Children,

Bailey, M. The Man Who Would Be Queen The Science of Gender-Bending and Transsexualism (2003). 

Berenbaum SA. Evidence needed to understand gender identity: Commentary on Turban & Ehrensaft (2018). J Child Psychol Psychiatry. 2018 Dec;59(12):1244-1247. doi: 10.1111/jcpp.12997. PMID: 30450644.

Bradley, S.J.B. & Zucker, Kenneth. (1990). Gender Identity Disorder and Psychosexual Problems in Children and Adolescents. Canadian journal of psychiatry. Revue canadienne de psychiatrie. 35. 477-86. 10.1177/070674379003500603. 

Burke, S, Manzouri M, Savic, I. Structural connections in the brain in relation to gender identity and sexual orientation. Scientific Reports. 2017. 7:17954 | DOI:10.1038/s41598-017-17352-

 

Butler, C., & Hutchinson, A. (2020). Debate: The pressing need for research and services for gender desisters/detransitioners. Child & Adolescent Mental Health, 25(1), 45–47. https://doi.org/10.1111/camh.12361

Cantor, J. New MRI Studies Support the Blanchard Typology of Male-to-Female Transsexualism. Arch Sex Behav (2011) 40:863–864

Coolidge, Frederick & Thede, Linda & Young, Susan. (2002). The Heritability of Gender Identity Disorder in a Child and Adolescent Twin Sample. Behavior genetics. 32. 251-7. 10.1023/A:1019724712983. 

Dragowski et all. Childhood Gender Identity... Disorder? Developmental, Cultural, and Diagnostic Concerns. Journal of Counseling & Development • Summer 2011 • Volume 89

Guillamon A, Junque C, Gómez-Gil E. A Review of the Status of Brain Structure Research in Transsexualism. Arch Sex Behav. 2016;45(7):1615-1648. doi:10.1007/s10508-016-0768-5

Kaltiala, Riittakerttu & Bergman, Hannah & Työläjärvi, Marja & Frisen, Louise. (2018). Gender dysphoria in adolescence: current perspectives. Adolescent Health, Medicine and Therapeutics. Volume 9. 31-41. 10.2147/AHMT.S135432. 

Kozlowska K, McClure G, Chudleigh C, et al. Australian children and adolescents with gender dysphoria: Clinical presentations and challenges experienced by a multidisciplinary team and gender service. Human Systems. April 2021. doi:10.1177/26344041211010777

Lawrence, A.  A Validation of Blanchard’s Typology: Comment on Nuttbrock et al. (2010). Arch Sex Behav (2010) 39:1011–1015

Littman L (2018) Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLoS ONE 13(8): e0202330. https://doi.org/10.1371/journal.pone.0202330

Littman, L. The Use of Methodologies in Littman (2018) Is Consistent with the Use of Methodologies in Other Studies Contributing to the Field of Gender Dysphoria Research: Response to Restar (2019). Archives of Sexual Behavior (2020) 49:67–77

Pablo Expósito-Campos (2021): A Typology of Gender Detransition and Its Implications for Healthcare Providers, Journal of Sex & Marital Therapy, DOI: 10.1080/0092623X.2020.1869126

Roselli CE. Neurobiology of gender identity and sexual orientation. J Neuroendocrinol. 2018;30:e12562. https://doi.org/10.1111/jne.12562

Scarpa, MG., Lesma, A., Di Grazia, M. et al. Ovotesticular differences of sex development: male or female? Case series. Ital J Pediatr 45, 66 (2019). https://doi.org/10.1186/s13052-019-0660-8

 

Singh Devita, Bradley Susan J., Zucker Kenneth J. A Follow-Up Study of Boys With Gender Identity Disorder. Frontiers in Psychiatry  (2021)

Steensma. Letter: JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT PSYCHIATRY (2015)

Steensma TD, Biemond R, de Boer F, Cohen-Kettenis PT. Desisting and persisting gender dysphoria after childhood: a qualitative follow-up study. Clin Child Psychol Psychiatry. 2011 Oct;16(4):499-516. doi: 10.1177/1359104510378303. Epub 2011 Jan 7. PMID: 21216800.

Zucker, K. Debate: Different strokes for different folks, Child and Adolescent Mental Health. 2019

Zucker (2018) The myth of persistence: Response to “A critical commentary on follow-up studies and ‘desistance’ theories about transgender and gender non-conforming children” by Temple Newhook et al. (2018), International Journal of Transgenderism, 19:2, 231-245, DOI: 10.1080/15532739.2018.1468293

Other

GD Resource for Providers - Dr Malone

Dr Kenneth Zucker - Recent Publications