What is gender dysphoria?
For people experiencing gender dysphoria, there is a significant disconnect between the sex they were assigned at birth and the gender identity they experience.
Though not all people with gender dysphoria experience distress, many do. The discrepancy between their experienced and assigned gender can be overwhelming and uncomfortable.
According to Caitlin Lawrence, a psychotherapist at Main Line Health's Women's Emotional Wellness Center, gender dysphoria occurs in people of all ages, sometimes as young as toddlers all the way into the geriatric years. Though it may seem like gender dysphoria is becoming more common, the medical condition has always existed — the difference is that now more people have the space and safety to explore their gender.
There are many different gender-affirming medications and surgical options to help people experiencing gender dysphoria close the disconnect between their assigned and experienced gender. At Main Line Health, the goal is to help patients experiencing gender dysphoria to access the resources and care they deserve so they can comfortably and confidently embody the gender they know themselves to be.
What does gender dysphoria feel like?
Gender dysphoria is a lived experience in which a person's assigned gender does not align with their experienced gender. Someone, for example, may experience themselves as male or masculine although they were born with breasts and a vagina. People with gender dysphoria may feel like they are not the gender that their body, or paperwork, says they are.
Gender dysphoria symptoms can occur in people of all ages. It's been observed in toddlers along with geriatric patients, says Lawrence. Often, gender dysphoria comes out during adolescence when kids are individualizing and becoming aware of their identity. Gender dysphoria may seem more common now, but it has always existed — now, there is more space and safety for people to acknowledge and explore their gender and seek affirming care. "We see it across the life span into geriatric age," Lawrence says.
In the medical field, since insurance companies require a diagnosis to cover care, gender dysphoria is clinically defined as distress individuals feel that is caused by a discrepancy between a person's experienced gender and their assigned gender. Not all gender-variant individuals experience psychological distress, but in order to access care, a diagnosis is currently required for gender-variant individuals.
"This is a medical condition," says Lawrence. "This is not a pathological disorder of the mind."
How can gender dysphoria cause psychological distress?
As previously stated, gender dysphoria is not a mental illness. Not everyone with gender dysphoria is distressed, according to Lawrence, but many people do find it stressful to feel a strong disconnect between the gender they were assigned and the gender they see in the mirror. For adolescents, developing secondary sex characteristics that don't align with a person's experienced gender can be overwhelming and traumatic.
Nearly 47 percent of gender-variant individuals have considered or attempted suicide. People experiencing gender dysphoria are also more at risk of experiencing discrimination at home or at work, homelessness, a higher rate of sexual transmitted infections, depression, and greater barriers to health care.
Many experience tension in their interpersonal and family relationships and may face rejection, violence, and bullying. There is a lot of stigma surrounding gender variance that can present as a massive barrier to getting care. Transitioning can also be stressful, as there is a lot of societal pressure for all genders on what it might mean to pass as their experienced gender, or be feminine or masculine.
What type of gender-affirming interventions exist?
There are several options for people experiencing symptoms of gender dysphoria, including medications and surgical procedures that can help minimize the discrepancy between the gender people experience themselves as and the gender they were assigned.
Behavioral health: For those who experience psychological distress, mental health professionals can work with patients to help them be comfortable with ambiguity and gender diversity. Mental health professionals can also help patients process and unpack gender incongruence and learn to accept and celebrate who they are.
Puberty blockers: These are given to young people who are prepubescent. According to Lawrence, puberty blockers essentially put a pause button on puberty so people don't develop the characteristics that could put them at high risk for pathological gender dysphoria. "You can put a pause button on it and say, 'Alright, let's let your adolescence ride out a little bit, let's think about it, let's plan and see how you're really feeling and what's coming up for you and what you really want to do,'" Lawrence says.
Affirming hormones: Affirming hormones can be given to people who have already gone through puberty. Gender-affirming hormones are more aligned with the person's experienced gender, explains Lawrence. Affirming hormones retract some secondary characteristics such as chest hair, menses, erections, deepening of the voice, and breast development.
Gender-affirming surgeries: There are many different gender-affirming surgical procedures available. Some people may choose to pursue breast augmentation or chest-masculinizing surgery/subcutaneous mastectomy (breast tissue removal, commonly known as top surgery). There is a vast array of facial feminization surgical procedures, including the reduction of the Adam's apple and reshaping of the nose, cheek bones, jawline and other facial features which develop during male puberty. There are also many procedures which alter genitals to reflect one’s gender expression. Some of the masculinizing procedures include hysterectomy and phalloplasty (in which a phallus is created); feminizing procedures include testicle removal and vaginoplasty, in which a vaginal canal is created and the penis and testicles are removed. Consulting with a surgeon who performs gender-affirming surgeries can help you navigate gender dysphoria and options available to you.
What resources exist for gender dysphoria?
If you or a loved one is experiencing gender dysphoria, Lawrence recommends first finding a primary care doctor that provides affirming care. Look for gender-inclusive signaling on the provider's website or office, such as rainbow flags or gender-inclusive language.
The World Professional Association for Transgender Health is a great resource aiming to educate people about gender diversity and improve access to care for non-conforming individuals.
Lawrence also recommends getting in touch with a local gender clinic or inclusive care facility, such as the Main Line Health locations in Bryn Mawr, Media and Paoli or the newly formed program, Main Line Health Comprehensive Gender Care under the direction of Dr. Katerine Rose. Call and speak to them about how you are exploring your gender and that you wish to speak to someone about it, Lawrence advises. Mental health professionals, such as the Main Line Health Women's Emotional Center, can also provide valuable emotional support and resources related to affirming housing, gender-inclusive health care, finances, and social support.
At Main Line Health King of Prussia, Lawrence offers free monthly support groups for parents of transgender children. For people who are experiencing a disconnect with their gender, the goal is to get them "involved in a medical and behavioral health intervention so we can get them resources they need," Lawrence says.