Dysphoria hits me in all of the ways mentioned to some degree or another.
I've been on HRT for about ten years and lasered off my beard, so I took care of several major triggers, but I'm not full time. I'm more of a 20is looking 40 year old due to the HRT and lack of facial hair.
When I see my wife or woman dressed in my style of clothes or my dream hair and makeup, dysphoria hits me.
I hate the unexpected erection, because I freak out wondering what my hormone levels are, if my T is too high, or Estrogen too low, and I'm still months away from my next doctor appointment and lab work. Yikes!
Also, the desire for transgender friends sort of weighs on me, because it's a little odd hanging out with the guys, because I don't relate very well, and I can't really hang out with the girls, because I'm married, not out, and it's probably not socially acceptable.
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