Hi EveryoneThe rebuttal I present arises from an earlier piece I wrote in August 2010 and a recent discussion I have had in attempting to examine and ultimately reject the applicability of Gender Identity Disorder from the DSM IV to my own life at the time. That original discussion can be read here so the reader can see the context from which this rebuttal emerges.
For those who think it's okay for TG to be a mental disorderIt must be said this is from my viewpoint and without further ado I present my thoughts:
IntroductionMy position has not changed. I never suffered mental dysphoria, bodily dysphoria or gender identity disorder at any stage of my life. This is not a conclusion reached later and projected backwards. It reflects how I lived before and after changing my life around.
In hindsight thinking about what I once had makes me feel sick or it gives me the shivers. That reaction exists now. It did not exist back then. Retrospective aversion is not the same thing as dysphoria at the time and the two should not be conflated.
I have known VictoriasSecret (recently a new member) for approximately 37 years. Like me she lived her life quietly and successfully without Gender Dysphoria or Gender Identity Disorder. More recently a doctor said to me "there are others like you".
This leads directly to what is known as the White Swan versus Black Swan problem. For centuries in Europe and the UK it was believed that all swans were white because only white swans had ever been observed. That belief was not challenged until black swans were discovered in Australia. The moment a single black swan was observed the universal claim "all swans are white" collapsed. It did not matter how many white swans had been seen before. One genuine counterexample was enough.
The same logic applies here. Diagnostic frameworks were built from people who presented clinically because they were distressed and those people overwhelmingly experienced distress. People like me did not present for psychiatric care because of distress, but because assessment was a procedural requirement of the surgical pathway. If even one person exists who lived successfully without Gender Dysphoria, then dysphoria cannot be a necessary condition. If two such people exist, the claim weakens further. When a doctor can say "there are others like you", the White Swan assumption no longer holds.
When I was around four, five or six years old I remember looking through a pile of clothing knowing I was looking for female clothing and not finding any. There was no distress no confusion and no impairment attached to this memory. There was simply recognition. In hindsight this was the first time I realised that I had always been female even though I did not yet have the language to describe it. When I later mentioned this to my psychiatrist it was dismissed because it did not fit a distress based framework.
I never questioned what I was doing. I simply did it. At the time I had very limited information and there was no internet as we know it today. I was not following a script and I was not absorbing community narratives. I was acting on what made my life coherent.
I never overtly expressed my gender. I did not perform it. I did not announce it. I largely only had to confront sex categories when marking gender boxes. I live in a binary world and I am simply seen as female and have been all my life.
When I changed my life around in February 1989 I was not framed as having a psychiatric disorder. I was described as transsexual. I had three surgery recommendation letters and at least two of those letters explicitly used the word transsexual. My psychiatrist assessed stability and suitability not pathology. His letter to my surgeon reflected judgement and expected outcome not DSM criteria.
This matters because it shows that even at the time real clinical practice did not strictly follow DSM theory. DSM functioned as a bureaucratic wrapper not as the actual decision making engine. Decisions were pragmatic and outcome focused.
What follows is a point by point examination of the DSM V diagnostic criteria for Gender Dysphoria written in plain language and applied directly to my life showing explicitly that I do not meet those conditions and why DSM Gender Dysphoria cannot be treated as a necessary precondition for surgery.
DSM V Gender Dysphoria RebuttalBefore addressing individual criteria, it is important to clearly explain how DSM V structures the diagnosis of Gender Dysphoria, as this structure is not intuitive and is often misunderstood. DSM V does not use a single flat list of equal criteria. Instead, it uses a two stage process consisting of threshold conditions followed by indicators.
For clarity, Thresholds 1 and 2 function as the primary gatekeepers. Threshold 3 only becomes relevant if Threshold 1 is met. Threshold 4 is only evaluated if Thresholds 1 and 2 are met. All four threshold conditions must hold for a DSM V diagnosis of Gender Dysphoria to be made.
I will first address the threshold conditions in order of importance and then the indicators, explicitly stating whether I meet each one.
Even so, for completeness and clarity, I later examine each of the six indicators in this rebuttal. None are met. Therefore, even if the indicator requirements were considered independently, they would still fail.
Threshold 1: Marked incongruence between experienced gender and assigned sexDSM V requires that there be a marked incongruence between experienced gender and assigned sex. DSM describes this as a persistent internal conflict or mismatch that is intense enough to be clinically meaningful.
I did not experience this. There was no prolonged internal conflict and no psychological destabilisation. What existed was knowledge without distress. I lived my life, worked, socialised and functioned. As I have said "I never overtly expressed my gender. I just lived my life".
There were moments of quiet recognition rather than distress before I changed my life around. When fully dressed, the thought that crossed my mind was simply "this feels right". On occasions when I tucked what was there, the same thought occurred "this feels right". These were not moments of discomfort, dissatisfaction or urgency. They were brief recognitions of coherence and ease. They did not motivate action, did not cause distress and did not impair functioning.
Later medical decisions do not retroactively create a prior state of distress. Recognition without discomfort is not incongruence as DSM defines it.
Do I meet this threshold condition: No
Threshold 2: Clinically significant distress or impairmentDSM V requires clinically significant distress or impairment in social, occupational, or other important areas of functioning.
I did not experience this. I worked, lived, socialised and formed relationships. I functioned before and after changing my life. I did not experience distress that impaired my ability to live, work, or relate to others. Just before surgery, sitting in my car, I reflected seriously on what I was about to do. That moment of reflection lasted no more than a minute. I briefly considered going back to my old life and rejected the thought immediately because it did not fit my life.
I knew surgery was irreversible and I accepted that fully. I understood that if I ever changed my mind later, I alone would be responsible and would have to live with the consequences. I accepted that responsibility. I never changed my mind and I have never regretted what I did. Reflection, responsibility and informed consent are not signs of pathology. They are signs of agency.
Do I meet this threshold condition: No.
Threshold 3: Duration of at least six monthsDSM V requires that the marked incongruence described above must be present for at least six months.
Because I did not experience marked incongruence at all, this duration requirement is never triggered. Duration cannot apply to something that did not exist. There was no six month period, or any period, of the kind of incongruence DSM is describing.
Do I meet this threshold condition: No, because it is never triggered.
Threshold 4: At least two indicators must be presentDSM V requires that at least two of the listed indicators must be present. These indicators are the specific descriptive features that DSM lists under Gender Dysphoria. However, this requirement only matters after the threshold conditions of marked incongruence and duration are met.
Do I meet this threshold condition: No, because this requirement is only evaluated after the preceding thresholds are met and they are not.
Indicator 1: Marked incongruence between experienced gender and primary or secondary sex characteristicsDSM V frames this indicator as a distressing awareness that one's physical sex characteristics are incongruent with one's experienced gender. This did not occur for me. I was not distressed by my body in a persistent or clinically significant way. I lived my life, worked, socialised and functioned and as I have said "I never overtly expressed my gender. I just lived my life".
There were moments of quiet recognition rather than distress, before I changed my life around. When fully dressed, the thought that crossed my mind was simply "this feels right". On occasions when I tucked what was there, the same thought occurred "this feels right". These were not moments of discomfort, dissatisfaction, or urgency. They were brief recognitions of coherence and ease. They did not motivate action, did not cause distress and did not impair functioning.
Later medical decisions do not retroactively create a prior state of distress. Recognition without discomfort is not incongruence as DSM defines it.
Conclusion for this indicator: I do not meet it.
Indicator 2: Strong desire to be rid of primary or secondary sex characteristicsDSM V describes this as a persistent and distressing desire to remove or suppress one's sex characteristics because of perceived incongruence. My experience does not match this description. I have said "I wanted to grow breasts but knew realistically that was not going to happen", "I did not like shaving but had a moustache before changing my life around" and "I did not want my voice to change but knew realistically that it was going to happen". Each of these thoughts occupied no more than a minute or so of my time. They were fleeting and non dominant. They did not dominate my mental life and they did not impair functioning. Fleeting thoughts are not dysphoria. DSM requires persistence and clinical significance.
Conclusion for this indicator: I do not meet it.
Indicator 3: Strong desire for the primary or secondary sex characteristics of the other genderDSM V frames this as a persistent distress driven longing for the sex characteristics of another gender. My experience was not distress driven. As I have said "I had to have long hair. I just loved it". Enjoyment preference and liking something are not distress. Wanting something is not the same thing as suffering without it.
These preferences were never experienced as a need or a lack and their absence did not produce distress or impairment.
Conclusion for this indicator: I do not meet it.
Indicator 4: Strong desire to be of the other genderDSM V frames this as a persistent identity claim accompanied by distress or discomfort with one's assigned sex. This does not describe my life. I have stated "I never overtly expressed my gender" and that I "largely only had to confront sex categories when marking gender boxes". I did not experience my life as an identity struggle. I did not insist or assert. I simply lived.
Conclusion for this indicator: I do not meet it.
Indicator 5: Strong desire to be treated as the other genderDSM V frames this indicator as a distress driven desire to be recognised affirmed or treated as the other gender by others. This does not describe my life.
I have always been an extremely private person. I do not tell people about my medical history or about having changed my life around and I think very carefully before telling any doctor and only do so when it is absolutely necessary. This is a matter of privacy and safety not identity.
I did not seek recognition validation or affirmation from others. I did not need to explain myself or assert anything. I simply lived my life and was treated as the sex I live as. Not disclosing personal medical history does not mean that I am something other than female. It means that my history is private and irrelevant to how I live.
There was no distress driven need to be treated as anything through declaration or disclosure. There was no social impairment and no compulsion to be recognised.
Conclusion for this indicator: I do not meet it.
Indicator 6: Strong conviction that one has the typical feelings and reactions of the other genderDSM V frames this as a psychologically significant conviction linked to dysphoria. My childhood memory shows something else. I remember "looking for female clothing and not finding any". There was no distress no confusion and no impairment. There was recognition without language. Understanding came decades later. Experience came first.
Conclusion for this indicator: I do not meet it.
ConclusionThis rebuttal does not argue that Gender Dysphoria does not exist. It demonstrates something narrower and stronger. "DSM Gender Dysphoria cannot be treated as a necessary precondition for surgery".
I did not meet the diagnostic criteria for thresholds or indicators. I did not have the disorder. I still had capacity agency and informed consent. I made an irreversible decision knowingly. I accepted responsibility. I benefited. I never regretted it.
If people like me exist if VictoriasSecret exists and if a doctor can say "there are others like you" then dysphoria is not required. The DSM category may describe a subset of experiences but it does not define legitimacy.
Once Black Swans exist the claim for necessity, fails.
The final thought on this is, "Oh me, Oh my, but I had surgery".
Best Wishes AlwaysSarah BGlobal Moderator@VictoriasSecret
