Transgender Identities and Gender Dysphoria

Becoming who you are meant to be is the goal of every human being, and is part of the natural process of  the chysallis-like unfolding that lets us know ourselves and be known by a world of others who likewise seek to thrive and give. A common thread of humanistic positive psychology, evolutionary theory and Judeo-Christian (and all) traditional spiritual paths is humanity’s reaching upward toward healthy fulfillment of our gifts and dreams, our callings and integrity.

But when you hide a fundamental aspect of yourself, your growth and development is arrested, and you cannot fully mature. Your efforts are spent protecting and isolating your true self from the very people you hope will love you. You cannot become ‘real’ to anyone, and you spend too much energy trying to earn approval by perfect behavior.  Instead of a generally happy life, yours becomes dysphoric (opposite of ‘euphoric’, Greek for ‘happy’). Gender dysphoria is the clinical term describing “the distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender.”  (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, American Psychiatric Assn, 2013, p. 451)

Below is brief clinical information for yourself or parents and loved ones about gender dysphoria, and how it is treated today, with citations you can find on the Resources page. Following that is my philosophy of care to my transgender clients.

Clinical Information

Ongoing research within the World Professional Association for Transgender Health (WPATH.org), formerly the Harry Benjamin Gender Dysphoria Association, yields theories of genetic and/or in-uterine hormonal factors, explores the impact of cultural and historical formation of identity, and rejects psychodynamic theories of childhood trauma or “bad parenting.”  Treating and resolving any existing trauma does not change true gender dysphoria, though it is essential to emotional health and part of my approach. Some people who identify as gender diverse also have identifiable chromosomal and gonadal issues, called intersex conditions that produce atypical gender development. (see Resource page)  Most people who identify as transgender do not have intersex conditions.

Therapy for gender dysphoric people includes assessment of their sense of personal identity, psychological health and daily management of life tasks in order to rule out other factors that interfere with a true diagnosis of gender dysphoria. Therapy should also be holistic in resolving mental health problems that can affect all people: depression and bipolar disorder and anxiety disorders for example. The Standards of Care urge the client and therapist to be sure these problems are well-managed before medical transition (hormones or surgery).

In my practice, I use a broad interpretation of ‘informed consent’ to help clients do their due diligence about how to decide for or against medical and social transition of their bodies and social identity to match their interior gender identity. Gender is not binary, “Barbie” or “G.I. Joe.” Gender identity has nuance and range. Behavioral modification and “reparative therapy” have been shown to lead to denial and further isolation and attempts to live a false life. In many cases, suicide results from attempts to change one’s gender identity. Untreated gender dysphoria manifests in ongoing anxiety, including social avoidance, and depression. Estimates of suicide attempts by gender dysphoric people are about 40 per cent (compared to 4-6% of non-transgender, or “cisgender” people). According to WPATH, regrets after surgery are “extremely rare”: 1-1.5% of male-to-female patients and fewer than 1% of female-to-male patients and satisfaction rates of 87% and 97%, respectively. (p. 8)