Gender Dysphoria, Transition and Detransition: Introducing some key ideas
Sex and gender?
In every day speech sex and gender are sometimes used interchangeably and in some languages there is only one word to describe the two. However, the whole concept of gender dysphoria relies on understanding that there are differences between sex and gender.
Sex refers to a person's biology (i.e. their anatomy; skeleton, musculature, chromosomes, reproductive system and secondary sex characteristics). Note that over 99% of people are biologically either male or female, there is no sex spectrum though some people do have disorders of sexual development (DSDs). The vast majority of people with DSDs are male or female.
Gender refers to the ‘socially constructed’ roles, behaviours, activities, and attributes that a given society considers appropriate for men and women [as defined by their biological sex]. 'Masculine' and 'feminine' are gender categories. Most, maybe all, people have a mix of masculine and feminine traits. Gender changes over time and between cultures.
Gender non-conformity occurs when a person acts or presents differently from how their society expects them to, based on their sex.
Gender Identity - some people believe that we all have an innate ‘gender identity’ – a deep sense or awareness of ourselves as either male, female or somewhere in between – which exists separately to our biological sex and which can, on rare occasions, differ from it. Other people do not believe that a specific gender identity exists that is distinct from other any other aspect of a person’s personality or identity.
What is gender dysphoria?
Gender dysphoria is a diagnostic term used by the psychiatric and medical community to describe the distress experienced when someone feels that their gender identity does not match their biological sex.
People experiencing gender dysphoria report strong, persistent feelings of identification with a gender that differs from their sex, and associated discomfort with their sexed body. For a formal diagnosis to be made at present, the feelings have to cause significant distress or impairment to the person experiencing them.
What does it mean to be transgender?
Transgender is a term that can mean different things to different people. It is generally agreed that trans women are born with a male body but identify as female, trans men are born with a female body but identify as male, and non-binary people identify as neither male or female. People often use the shorter term ‘trans,’ to signify that someone identifies with a gender that is not the same as their biological sex.
Transgender can be understood to mean that i) you are the sex/gender opposite to the sex you were born, ii) you believe yourself to be the sex/gender opposite to that which you were born, or iii) you are living as if your sex/gender is opposite to the sex which you were born. Debates about which of these three ways of understanding the term is the most accurate can be heated and controversial. Some people feel that even having a discussion about what it means to be transgender is undermining the validity of the experience. However, these different beliefs inevitably lead to different ideas for how best to support people to manage gender related distress so discussions are necessary to ensure that people get the best help and advice possible.
What is desistance?
Desistance is when someone who identified as transgender but didn't undertake medical interventions no longer identifies as transgender. Although they may not have to deal with the implications of having undertaken medical interventions people desistance can still be a very emotionally painful, confusing and difficult process.
Detransition and detransitioners
Detransition is when someone who identified as transgender and underwent medical interventions no longer identifies as transgender. There is an enormously wide variation in people's experiences within this group. Some people may be highly distressed by what they have been through and the long term implications, others may see it as something that they had to go through to understand themselves as they currently are.
Some people may have identified as transgender for many years and have undergone medical interventions such as hormones and surgeries that have changed their bodies irreversibly. They may feel that they regret initiating a medical gender transition but they also continue to identify as transgender and/or continue with cross sex hormones.