Hi Everyone
Addendum
This addendum does not revisit the diagnostic analysis set out in the rebuttal. Its purpose is to clarify matters of language and interpretation that can be easily misread when compressed into summary form. In particular, it distinguishes between how things were experienced at the time and how they may appear in hindsight, and between conscious framing and lived understanding.
Incongruence
The question of incongruence must be addressed as I did not specifically address it in the rebuttal and is analytically mentioned in regards to me rather than in a narrative form.
In DSM V, incongruence refers to a marked and persistent internal conflict between experienced gender and assigned sex that is distressing, psychologically destabilising and clinically meaningful. It is defined by friction. It is experienced as something wrong, intrusive, or intolerable that interferes with psychological or social functioning and demands resolution.
That condition was not present in my life.
At no stage did I experience a persistent internal conflict about my sex. There was no ongoing discomfort that required relief. There was no sense of being trapped in the wrong body. There was no psychological pressure that escalated over time. There was no impairment in social, occupational, or personal functioning attributable to sexed experience.
What existed instead was recognition without distress.
Recognition alone is not incongruence. Awareness that something fits is not the same thing as suffering because something does not. Moments such as thinking "this feels right" when dressed or tucked indicate alignment, not conflict. They were not accompanied by discomfort, urgency, dissatisfaction, or distress. They did not motivate action, dominate attention, or impair functioning.
Incongruence also requires persistence. A condition defined by internal conflict does not disappear for extended periods. Long stretches of ordinary functioning without preoccupation, distress, or escalation are incompatible with the presence of marked incongruence. The absence of symptoms is itself evidence.
It is also essential to distinguish how my life was experienced at the time from how it can feel in hindsight. In hindsight, thinking about aspects of my past body can evoke discomfort or aversion. That reaction exists now. It did not exist then. Retrospective aversion does not constitute incongruence as it was experienced at the time and cannot be projected backwards to create a diagnosis after the fact.
Because there was no persistent conflict, no distress, no impairment and no psychological destabilisation, the condition DSM describes as incongruence did not exist for me. Without incongruence, the diagnostic framework for Gender Dysphoria does not activate.
Threshold 2 Clarification: Clinically Significant Distress or Impairment
Threshold 2 requires clinically significant distress or impairment in social, occupational, or other important areas of functioning. This section clarifies two points that can be misinterpreted when summarised.
First, the description of me sitting in my car before surgery and reflecting seriously on what I was about to do risks overstating that moment. It was not serious in the sense of distress, crisis, or doubt. It was simply a brief awareness of an upcoming medical procedure. It did not involve fear, panic, or reconsideration of my life.
Second, I did not consider going back to my previous life while sitting in the car immediately before surgery.
Thoughts sometimes later described as de-transition occurred earlier and were not connected to surgery. They arose midway through the approximately two year period after February 1989, at a time when I had already developed breasts. These thoughts surfaced briefly because other girls were discussing such issues. When the thought occurred, I considered what that would mean and immediately rejected it. The entire process lasted no more than a minute. It did not recur in any sustained way.
This was not hesitation born of distress. It was momentary consideration triggered by external discussion. It did not impair functioning, alter behaviour, or generate anxiety or doubt.
Clinically significant distress is persistent, intrusive and disruptive. A fleeting thought that is immediately dismissed and does not recur does not meet that standard. Reflection and responsibility are not pathology. They are features of informed consent.
I worked, lived, socialised and functioned throughout this period. There was no impairment. Again, Threshold 2 was not met.
Further Reflection
It is important to be clear about language. I was not analysing what I was doing and I did not know why I did the things I did. I simply did them. There was no internal narrative, no framework, and no attempt to understand myself in abstract terms.
When something did not fit, I dealt with it in a practical way. If I had hair on my face, I got rid of it. Women do not have hair on their face. That was the extent of my reasoning. There was no questioning, no interpretation, and no wider meaning attached to it.
From early childhood through adulthood, I did not think about who or what I was in any reflective or conceptual way. I did not ask questions about identity. I did not analyse my behaviour or search for meaning in it. I simply did things as they arose and moved on.
I was also an innately private person. I did not talk about myself, explain myself, or announce anything to others. This was not avoidance or repression. It was simply how I lived. I did not need to say anything in order to live my life and nothing in my day to day experience required explanation.
This privacy extended even to my own understanding. I did not consciously think "I am female" for many years. There was no need to say it in words. My life functioned without explanation.
Language arrived much later, around 2010, when information became abundant. Language followed experience, not the other way around.
From early childhood there were isolated instances such as looking for female clothing, wearing some of my mother's clothes, wanting to wear a skirt or clothes that the girl who sat near me wore. I preferred not to play boys sports or play with boys toys except Lego and Meccano and looking forward to playing with a girl who visited near where I lived in England until I was about ten. These instances were not distressing and did not persist. They were part of recognition, not conflict.
From early adolescence until my mid teens there was virtually nothing. There was no escalation and no fixation. Later, from my late teens into my twenties, there was occasional wearing of underwear. I did not experience this as a sense that being female fit me better. I simply wanted to be female. That wanting became stronger and stronger later in my twenties. It did not arise from distress and it was not accompanied by internal conflict. It strengthened as desire, not as discomfort.
Two Christmas holidays living as Sarah were not undertaken to relieve suffering. They were experiences of ease. I realised I could not get enough of that life because it felt right, not because my existing life felt unbearable. When my uncle said go and live as a female, it was an epiphany not a rescue.
Between eighteen and thirty I built a career. Not because I was delaying something, but because that was what I was doing at the time. In hindsight it provided independence and stability. At the time it was simply life unfolding.
There were moments that now appear symbolic. I remember thinking that I did not want people to take my photograph. In hindsight this can look like erasure. At the time it felt more like authorship. My life was not finished forming and I did not want it fixed prematurely. I cannot remember if this was related to me wanting to be a girl. The past I once sought to minimise is now clearly part of who I am. That does not negate the earlier instinct. It completes it.
When I changed my life around in February 1989, I did not experience it as a dramatic turning point. I did not experience myself as transitioning because the word was not around at the time. I changed my name, corrected documents and removed facial hair, things many women do. I had surgery to correct a physical condition so that I could function in society as any other woman does. I was not becoming something new. I was aligning my body with how my life already functioned.
Even after changing my life, I did not question what I was doing at the time. There was no ongoing self interrogation and no internal debate. Looking back now, the absence of questioning during that period is striking. At the time, it felt entirely normal. I am examining it now not because it was unresolved then, but because language, knowledge and understanding arrived much later.
In hindsight it can be tempting to call this luck. A more accurate description is that there were no hurdles in my way. I moved forward without resistance. Not because I foresaw the outcome and not because I was compelled, but because my life followed a line that was internally consistent.
I did not analyse my life into coherence. I lived my life and coherence followed.
I could keep analyzing this until the cows come home, but as Forrest Gump would say, "That's all I have to say about that."
Best Wishes Always
Sarah B
Global Moderator
