Some of the discussion that's been going on in the topic Would the SOC be any better if run by post-op trans-people ? has got me thinking about the terms used in the SoC/WPATH, and wanting to explore some of this more. I know, I know - it's not like we don't already have umpty-billion topics in which the terminology-wars are continually waged, but I think I may be coming at this from a different angle, so I'm going to have a go at putting my thoughts on "paper" and see what people make of this (and I'm hoping this will clear things up for me too).

I don't want this to become in any way a this-person-vs-that-person topic. I'm just going to try to say what I think, and assume others will think differently (that's pretty much a given!) Anyway, here goes.

For me, this stems particularly from a discussion about whether "transsexuality" is a condition that has a cure, and whether dysphoria is a condition. I think there's something off-beam about how the terms are used in the official definition - including specifically how the term "dysphoria" itself is applied. By off-beam, I mean inconsistent and inappropriate.

In the US, at least, someone described as transsexual by the SoC is specifically someone who wishes to change their anatomical sex characteristics to match their experience of their sex - which is different from the sex they currently anatomically present as (or something like that - I'm not quoting, I'm just summing up what I've read). So let's go with that rough definition for the moment, and perhaps include the broader transgender aspect later on. The healthcare system has decided for the moment to call this (and other experiences) "gender dysphoria", and to label this as a condition. This is partly to move on from calling it a "disorder", but also presumably so that there is still a way to include it in their clinical framework and provide healthcare and support for people whom this fits (and to decide whom it does fit, and who has other issues that just look similar to this).

The problem for me is one of perceptions. As I see it, being transsexual (as defined above) isn't a "condition", it's simply a fact of some people's lives (our culture, being so obsessed with sexual and gender "norms", has yet to catch up with what a lot of more "primitive" cultures hve always been hip to). They have a body that is one sex anatomically, but they experience themselves as being the other sex. This is not in itself a condition (let alone a medical or mental health condition), it's just an experience.

And I don't think "dysphoria" is a condition either. Dysphoria literally means "finding it hard to bear", and implies very simply and directly that something about your current state makes you unhappy in a way that is not easy to live with. So effectively, and for the convenience of having a label to support/treat people under, the healthcare system is forced to call this unhappiness a condition. But to me, dysphoria in this context is not a condition, it's a response to an experience (that's being called a condition!) - that of being in a body that doesn't fit one's sense of sex. For some people, this unhappiness is genuinely debilitating, and can only be addressed by changing their anatomy. And evidence indicates that it's a very individual thing, at what point along the line of possible changes an individual finds themselves no longer unhappy, or finds themselves happy enough to stay put where they are on that line.

In the broader context of transgender, I guess you could say it's a response of unhappiness at not being able to present in the way that one feels fits one's experience of gender - which may or may not include discomfort with one's anatomical sexual characteristics, or it may be more subtle than or different from that, it may be in the cultural rather than the anatomical arena (i.e. how one presents in terms of behaviour and clothing and appearance, and feels able to express one's natural self in that way) or it may cover all of that at once. And the trigger for the dysphoric element is just as often the cultural pressure not to simply be oneself. If we could just get on with it, there'd be no tension.

At this point I want to remind myself (and anyone who's got this far!) that I'm not trying to make definitive definitions of terms, I'm saying what they mean to me, and what they appear to mean to the healthcare system. Bear with me, I know this is all a bit clumsy.

Personally, I would come under the US-stylie definition of "transsexual" because I wish to change my anatomical characteristics to be as in line as possible with the sex I experience myself as - I have a male body, and I want it to be female, and it's mostly the genitalia that I'm concerned about. but I don't think "gender dysphoria" describes my experience at all well. for a start, I think that phrase is a misnomer in any case because when the terminology is trying to make a distinction between sex and gender, it's counter-intuitive to call this experience gender dysphoria, when it should be called something more like "sex dysphoria". But better yet, it should be called something like "sex dislocation". Whuffo? Well in my case at least, I certainly don't have "gender dysphoria". I'm very happy with my gender, at last - it's just that my anatomy doesn't match it, and never fully can. I was very unhappy about that for decades while I thought I couldn't do anything to address it, but I no longer feel that.

This is where it gets potentially contentious. I don't see my transsexuality as being something curable, I see it as a disability. It's a disability that I can manage, and that can to some extent be addressed with surgery and pharmaceuticals. A "cure" for me would be waking up one day in an actual female body, having lived my life in it as a female. Since that's out (until I get reborn ), I'm content to be aiming to have a body that much more closely resembles that, and I'll just have to deal with the rest of it as best I can, emotionally. And I'm confident that I can do this.

But I don't feel that I'm being treated for dysphoria - I'm being treated to overcome a disability to which I have dysphoric responses from time to time. This is familiar territory for me, as I've been missing some muscles since birth, and I've gone from feeling distressed, angry and sickened by this as a teen, to being completely at ease with it now (well, it does stop me from playing b->-bleeped-<-ipes, but that's the only unfulfilled longing that it's the direct cause of ).

So long as the healthcare system regards transsexuality/transgender experience as a psychological/emotional phenomenon, rather than as a straightforward state of being, it's inevitable that it will be labelled and responded to inappropriately, to some degree. And I'm resigned to having to put up with fielding the healthcare system's assumptions about what's going on for me and how to respond to it. But I don't have to agree with it.

Phew. Having written all this, I'm really not sure if any of it is relevant to anyone but me - but it's done me some good getting it out there.

So enough about me. I'm interested to know what dysphoria means to others, or whether you have any responses to what I've written about my experience and perceptions. (and of course, TL;DR is an acceptable response .)

Very well said, Padma.

In particular two points you raise ring a bell with me:

"This is where it gets potentially contentious. I don't see my transsexuality as being something curable, I see it as a disability. It's a disability that I can manage, and that can to some extent be addressed with surgery and pharmaceuticals. A "cure" for me would be waking up one day in an actual female body, having lived my life in it as a female."

"So long as the healthcare system regards transsexuality/transgender experience as a psychological/emotional phenomenon, rather than as a straightforward state of being, it's inevitable that it will be labelled and responded to inappropriately, to some degree."

Was talking to a psychiatric nurse (an ex of mine) today and she was going on about the upcoming DSM-V and how there are patients detained on her ward on diagnoses (sp?) that will no longer be present in the upcoming version. So overnight, just like what happened with homosexuality, there will be another miracle mass cure... She also mentioned GID and the pressure from a section the trans community in the US for it to be retained for medical insurance purposes and how although the British NHS diagnoses using DSM-IV it happily prints leaflets stating that Gender Dysphoria is not a psychiatric disorder.

A right mess.

Honestly, I think at the moment, there's a "cure war" between "put them in a psyche ward!" and "give them a transition." As of right now, if I'm not mistaken, Medicare will pay to put a suicidal Trans into a ward, but will not pay for their transition. I would hope that if being Trans is distanced from mental disorders, that it will turn into a biological or hormonal disorder, which really sounds more like the need for a biological, physical, or hormonal cure. However, I would like to see it stated that this disorder is something that is hardwired, not curable, in the brain at birth, just like homosexuality.

One curve-ball in the FFS and Hormonal part of transitioning is that almost every feature that MTF's usually get FFS and Hormones to get rid of are actually documented craniofacial deformities and skin diseases (though inverse-discrimination against men causes most normal doctors not to label it as such for male patients, only for females.) Things like humped noses, baldness, extremely prominent brow ridges, acne-type skin, butt-chins, ect ect are all things that are left over from humans' "ape days" and are all a result of an androgen over-production that also causes early prostate cancer.

It's proven that the most long-living, mentally happy, and physically healthy human beings output hormone levels that overall are very equilateral between male and female. If more science could be applied to this, more people would have the medical excuse to at least achieve an androgynous appearance, for every child to be put on hormone reducers or whatever; I'd rather see more children be given the automatic and required freedom to choose their own sex, than to see half the Trans boys uncontrollably grow to be Conan The Barbarian.

So I at least think that Medicare should pay to give children and adults regular hormone checks, and pay to at least "reduce" the level of androgens in any given person if the levels are too high, especially if the person expresses discomfort with the appearance. I'd like to see hormonal transition be paid for by the government, even if it has to be labeled as "curing an androgen over-production." Before any of this happens though, the right terms need to be applied in all the official documents, and more equality should be reached. If half the straight men/gay men out there knew what androgens were, trust me, they'd want this service too! Hardly any man in this age wants to look like Shrek.

I don't disagree with what Padma has said. I personally do not like the idea of gender dysphoria, myself. I don't like the idea of gender being a primary focus. I feel like transsexuality has more to do with body sex and brain sex incongruence. Gender is a third concept, a personal and social construct that relates to a broad and vague area of self-expression. Consider now that gender role and gender identity are concepts developed by John Money, the pedophilic "researcher" who ineffectively tried to prove that you can simply raise a boy as a girl and he would never know the difference, and it becomes clear that gender is an out of place concept in the context of transsexuality.

QuoteSo long as the healthcare system regards transsexuality/transgender experience as a psychological/emotional phenomenon, rather than as a straightforward state of being, it's inevitable that it will be labelled and responded to inappropriately, to some degree. And I'm resigned to having to put up with fielding the healthcare system's assumptions about what's going on for me and how to respond to it. But I don't have to agree with it.

I think we would benefit from removing transsexuality/transgender from the realm of psychology and into the realm of neurology, which more and more research is backing up. It is still a medical condition, but one of mismatched neurological sex and anatomical sex, and having less to do with the vague and out of place notion of gender.

I don't personally believe the self is "brain-driven", so I don't particularly want to see trans issues relegated to the neurological in-basket either. I think consciousness and personality is much more mysterious than that - I have no idea why some people experience themselves as a different sex from their apparent biology, but I suspect at least some of the reasons are not reducible to medically discernable "anomalies". This is part of the problem - if the medical community can't "see" something in their own terms (and find it a place in their menu-driven allopathology) they're inclined to assume it doesn't exist. Hence the need for a way to have transsexuality "recognised medically" even though the means for recognition may well be a total (but convenient) fabrication. Transsexuality just is, for some people.

In my opinion .

The 'just is' is how I perceive 'it' personally. This is probably wildly incorrect as an analogy but it feels at a level similar to the autonomic nervous system in that it's there functioning at a semi unconscious level all the time only to rear its head in cases of physical incompatibility such as ours.

One of the reasons it appears to be this way is the manner in which we grow conscious of this anomaly existing in early childhood through observation and interaction with others. Only then do we realise 'something ain't right here' - 'why am I different from the other little kids out there?'. Until then I just felt I was me and probably everyone else was the same as me.

That's dysphoria both in the social and gender sense of the word which perhaps could indicate that GID is a social construct dependent on the norms that surround us. Who knows, that last sentence was more than a bit "seghe mentali" as they say in Italian. Google if you wish

Quote from: RhinoP on September 22, 2011, 01:01:23 PM
I would hope that if being Trans is distanced from mental disorders, that it will turn into a biological or hormonal disorder, which really sounds more like the need for a biological, physical, or hormonal cure. However, I would like to see it stated that this disorder is something that is hardwired, not curable, in the brain at birth, just like homosexuality.

Interesting. Here in Finland we can apply for a special reimbursement  that is 100 % of the reference price, minus a copayment of 3,00 euros for each medicine purchased (valid only for estrogen, not anti androgens), normally after 1 year on HRT. We enter in the category "121 - Severe hypofunction of sexual glands". So somewhere in the world seems that Trans__ are indeed turning into a hormonal disorder, although this is possible only after the diagnosis made by a psychiatrist stating you are trans (in other words, SoC still applies...)

That's very positive, MissF. Good to see Finland is being more open minded than elsewhere.

Quote from: Sunnynight on September 22, 2011, 01:41:04 PM
I think we would benefit from removing transsexuality/transgender from the realm of psychology and into the realm of neurology, which more and more research is backing up. It is still a medical condition, but one of mismatched neurological sex and anatomical sex, and having less to do with the vague and out of place notion of gender.

I agree with this^


Also, the original post is pretty interesting. I hadn't really thought about it all before, but after reading I have to agree with Padma on most points, particularly:
"And I don't think "dysphoria" is a condition either. Dysphoria literally means "finding it hard to bear", and implies very simply and directly that something about your current state makes you unhappy in a way that is not easy to live with. So effectively, and for the convenience of having a label to support/treat people under, the healthcare system is forced to call this unhappiness a condition. But to me, dysphoria in this context is not a condition, it's a response to an experience (that's being called a condition!) - that of being in a body that doesn't fit one's sense of sex. For some people, this unhappiness is genuinely debilitating, and can only be addressed by changing their anatomy. And evidence indicates that it's a very individual thing, at what point along the line of possible changes an individual finds themselves no longer unhappy, or finds themselves happy enough to stay put where they are on that line. "

My mother asked me yesterday what dysphoria means. I basically said that it was the opposite of euphoria and gave an account fairly similar to that above.

I don't have dysphoria regarding my gender... I have issues because of societal attitudes about my gender. My gender isn't a medical condition, it is simply who I am. There have been people like me throughout human history.

Z

Sigh... I always feel off-balance with this kind of stuff. I know that I need my body to conform as best it can to a traditionally female shape (because failure to do so makes me psychotically miserable) and I need it to be perceived as female (because otherwise I feel invisible and deceitful) and estrogen is slowly giving me back the sanity that testosterone tried to snuff out (I was diagnosed with BPD on testosterone... which apparently I don't seem to have anymore). But when it comes to gender... I dunno. I don't feel like a woman or a girl or anything. I don't feel gender. I can understand the concept theoretically, I know what the definitions are, but when it comes down to it... there is nothing there. I assume I am a girl, I call myself a girl, because I am female and that is generally how our society divides it up: female-girl, male-boy. The definition of "gender identity" as one's "deeply-felt innate sense of gender" just makes me giggle.

On the upside I also couldn't care less about the lack. I don't like how gender obsessed my world is, I'd rather it was stripped away from everything and people were left free to be as they will. It's kind of revolting that we go so far as to gender things like colours.

So ya, sign me up for sex dysphoria, cause gender just doesn't do it for me.

Quote from: Sunnynight on September 22, 2011, 01:41:04 PM
I think we would benefit from removing transsexuality/transgender from the realm of psychology and into the realm of neurology, which more and more research is backing up. It is still a medical condition, but one of mismatched neurological sex and anatomical sex, and having less to do with the vague and out of place notion of gender.

That's how I see it - as far as I'm concerned my brain has a big "F" stamped on it until proven otherwise. Sorry, Padma, but I don't have a spirit it seems, just flesh.

Yay! Diversity!

Regardless of how I personally experience all this, I'm very glad that the healthcare system is making the shift away from trying to "cure" people of their transness (i.e. seeing it as a disorder) and trying to help people respond to it instead.

Myself, I have a fairly loose relationship with gender. My "self" tells me my body should always have been female, and I'm doing something to address that, to the extent it's possible. But as far as gender goes, I experience myself as pretty damn androgynous, if a label is needed there. The only person that really needs to make sense to is me, because I need to be myself, and express that self in a happy, healthy way. I don't need others to feel the same way, or to "understand" what I'm experiencing or going through, I just need them to be willing to accept it as so. I've been lucky so far in my interactions with the healthcare system - or maybe not just lucky, I've been feeling confident in my understanding of myself, and that communicates itself, and makes it easier for people to accept what I tell them and how I present myself.

I'm 6'3" with big feet, and I'm asymmetrical - when my breasts grow, they'll likely be quite uneven because I'm missing one pectoral muscle. So it's a good thing I don't aspire to be Jennifer Aniston! I'm just gradually feeling out how I am happy dressing and looking. My behaviour isn't changing much, because I'm me. I have noticed that my walk has changed a little - it's like I was holding something tight in my pelvis (to hide it), and now I've let it go. But I don't feel the need to become anyone but me. And I'm happy for it to remain a bit of a mystery who that will turn out to be! I'm starting on hormones in the next few days, so who knows?

Has to be a problem with society, surely? If there isn't general acceptance out there that will worsen any dysphoria and make one more conscious of being outside the norm. Bit like being the only person of an ethnic minority in a town. That's a weird feeling too and something society reminds one of constantly although it can be fun too.

Society can be prejudiced, some societies are worse than others on that regard as are religions. Probably harder to be trans in the bible belt in the US than in that tribe in Sulawesi with five genders. The big three monotheistic religions take a hard line on sexuality and gender and most of us posting here are influenced by one or more them in daily life whatever our personal faith maybe.

Should we consider our situation as something to be cured or as an affliction? Politically I find that totally unacceptable but my being pulls me the other way. Difficult to reconcile.

I think this is why I like thinking of it as a disability. It's just something I was born with, I can work with it, I can improve my relationship with it, I can get help functioning as I would if I didn't have it, and I have to deal with people's prejudices towards disability. I'm used to all that already, and it seems to fit my experience of coming to terms with my transness too. 'Affliction" creeps me out because it's very biblical-sounding, and implies someone doing the afflicting.

You're right, best not to go down the biblical plague style route nor follow our lot's straight on the barbecue tendency

Disability doesn't sound totally correct either, disabled people suffer prejudice and exclusion which is unjustified. Maybe we need something more politically correct as in 'vertically challenged'...

Anyone think there's too much negativity about the whole issue, it's reflected in the language we use to describe it. Examining our situation carefully I just don't see it as that negative. Is it really any worse than being like everyone else? We get to do and see things they can never experience and the same is true the other way around. Perhaps dysphoria if there is any lies there in our lack of understanding in the gift we have been born with and for some of us our failure to make the most of it.

If we are honest surely some of us must admit there have been times when being the way we are has taken us halfway to paradise. Despite the many bad and hard times I wouldn't want it otherwise.

I would prefer it if the medical community labelled our condition as a birth defect, when we have gender reasignment all we're doing is having our birth defect corrected to bring our body & mind into alignment.

Just my 2 pence worth

I don't have a negative connotation in my mind when I think of myself as having a disability. It's just a fact of life - I can't do everything that most people born a woman can do (just like I can't play b->-bleeped-<-ipes because of my missing muscles). There's stuff I can do about some of that, which is mostly in the realm of improved appearance and some limited functionality improvements. I'm happy with what's available to me, and can get on with life - in the same way that I'm happy I can drum and sing, and that makes up for the b->-bleeped-<-ipes! I'm not going to be the me I would have been if I'd grown up as a woman, and so I'll just get to be the me I am, which is good enough.

Then loaded on top of what's actually happening is the socially-constructed pesudo-problem, inasmuch as society says: you're either this, this, or "abnormal" and then treats you accordingly. But we know it's normal for a certain percentage of people to be the way we are, it's just a sliding social mindset that decides what states of being are on which side of the imposed diversity-abnormality border, which changes its positions over the decades. Tiresome.

I don't think of disability in a negative way as doctors have often said that because of the severity of my ecxema I could be classed as having a disability, i've never bothered filling out the forms to be classified as disabled as it wouldn't make any difference to my life & would be a pain in the rear.

I agree that the classification confusion over our condition is tiresome but what can you do apart from shrug your shoulders & get on with life?

QuoteWell, you said you liked diversity and wanted to hear a variety of experiences... going to regret that soon probably.

Nope, no regrets so far...

I do want to make the point that I would never say "just" a state of being in such a way as to belittle the experience. It's a huge deal for most people - and one of the reasons why it's such a huge deal in a negative sense is because it's an experience that's not considered normal and acceptable in our society, so there's no default supportive framework for our responding to our experience positively - we're pretty much stuck having to find that on our own, swimming upstream against public distaste/discomfort and an imposed certainty that there's something fundamentally wrong with us for feeling the way we do.

I'm sorry the experience has been so painful for you, and I can relate to the strength of feeling you've had. In my case, my gender issues were overshadowed by my abuse issues until the last year or so, and all my struggle with suicidal and self-destructive tendencies were gathered around that. I do feel fortunate (and grateful to myself) that I was able to get myself to the point where it was safe to fully engage with my desire and need for transition because it was actually finally possible to do something about it without completely self-destructing now.

And that's just my story, and it's bound to be different from the next person's. It's clear from spending time on Susan's just what a broad range of experiences people have had that are all roughly fit under this umbrella we're sort of under together - and just how different people's experience of dysphoria is too. So I'm glad you've told your version of it here as well. I feel very passionate about my transition, and the need for it to happen and happen now, and the reason I don't feel more dysphoric is partly because it *is* happening now, and I'm making it happen - and partly because I'm making it happen on the back of a huge victory won against self-negating tendencies that stretch way beyond my sense of sex/gender, so I'm riding on a kind of wave of confidence in my ability to do stuff to look after myself, at last.

Earlier this week I was sat in my shrink's office listening to him back-pedal on his promise 2 months ago to give me the go-ahead on HRT this time round, and it made me feel desperate - but then I asserted myself and met his questions with my confidence in why they were not real issues, and he agreed to support me. It's clear that among FTM trans women, I'm a bit atypical, because I experience myself as female in physical sex, and more androgynous in general gender identity, so my presentation isn't driven by a desire to appear feminine, but by a desire to be female in a fairly androgynous/hippy/dykey kind of way - that's who I am, and that's how I feel most myself. It may well take me longer to get "processed" by the system over here, because I'm not going to be doing some of the things they are used to people wanting to do, such as long hair and makeup and more obvious feminine-flag stuff. Or maybe I will, who knows what I'm going to want to be like even a few months from now? For me, the thing that feels absolutely key, and which I care about more than anything else, is the anatomy (specifically the genital anatomy), but I'm not going to spend any time trying to appear as someone I'm not I'm order to get that. If it takes longer (or if I have to win the lottery) because I'm not in pursuit of femme, so be it. If for some reason I don't get to do it at all, then there'll be a real problem. But for the moment, my journey seems to be under way, so I'm feeling good about it.

I suppose in retrospect I'd been wanting to write about all this to say: everyone's experience of the trans-journey seems to be different, and is equally valid, and I'm tired of the positions some people seem to have been assuming of judgment concerning others' experiences here - and feeling sometimes judged in that way myself. So I did want to just say: this is how it is for me, this is how I make sense of my experience, others will doubtless feel different. Which seems to be right so far . There's room for all of us here, and we don't have to feel like we're under the same umbrella, so long as we each do have some umbrella protecting us from the downpour of judgment and dismissal and all that crap.

Quote from: Padma on September 23, 2011, 11:07:41 PM
I do want to make the point that I would never say "just" a state of being in such a way as to belittle the experience.

Sorry, I meant "exclusively," i.e. without corresponding suffering. I really didn't intend "lesser," though now I can see how it can be read that way. Oops! Fixed it.

(I also put my winky back, vandal! )

Quote from: Padma on September 23, 2011, 11:07:41 PM
Earlier this week I was sat in my shrink's office listening to him back-pedal on his promise 2 months ago to give me the go-ahead on HRT this time round, and it made me feel desperate - but then I asserted myself and met his questions with my confidence in why they were not real issues, and he agreed to support me. It's clear that among FTM trans women, I'm a bit atypical, because I experience myself as female in physical sex, and more androgynous in general gender identity, so my presentation isn't driven by a desire to appear feminine, but by a desire to be female in a fairly androgynous/hippy/dykey kind of way - that's who I am, and that's how I feel most myself. It may well take me longer to get "processed" by the system over here, because I'm not going to be doing some of the things they are used to people wanting to do, such as long hair and makeup and more obvious feminine-flag stuff. Or maybe I will, who knows what I'm going to want to be like even a few months from now? For me, the thing that feels absolutely key, and which I care about more than anything else, is the anatomy (specifically the genital anatomy), but I'm not going to spend any time trying to appear as someone I'm not I'm order to get that. If it takes longer (or if I have to win the lottery) because I'm not in pursuit of femme, so be it. If for some reason I don't get to do it at all, then there'll be a real problem. But for the moment, my journey seems to be under way, so I'm feeling good about it.

Glad to see you are sticking to your own self-expression and not forcing yourself into a state you aren't comfortable with. After all the years of not being you, it would be such a waste to end up in another ill-fitting box. And it's nice to know there are other non-femme trans girls around (not that you HAVE to stay that way of course). Feels lonely sometimes.

I dunno why exactly I'm androgynous in gender expression. It just fits me, it's comfortable. Even when I was little I knew it was the kind of girl I was supposed to be. I think the extremes of gender just kind of turn me off... I'm not attracted to very butch or very femme women either. And besides, it makes me look hot.