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What is gender dysphoria?

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Gender dysphoria, sometimes called gender incongruence, is a state of mismatch between the gender one is assigned at birth and the gender they wish to express themselves as.

It is important to note that dysphoria in itself is not a requirement for one to identify as transgender. Not all trans people have dysphoria; a transgender person may become more aware of their dysphoria as time passes, or even as they begin transition; they might also recognise or remember certain feelings that they’ve had in the past as signs of gender incongruence or dysphoria.

What is gender dysphoria?

Dysphoria is best described as a dissonance between self and body. Sometimes, it may be simplified as “a woman trapped in a man’s body” or “a man trapped in a woman’s body.”

It may be unseen in a person’s life, and this is especially true in people who transition later in age.

While gender identities are more likely to be formed in early childhood – with some expressing a wish to be the gender that they are as early as they were three – some trans people may be comfortable with stereotypically gendered clothes and activities as children and teenagers; others may repress their wants as they meet with resistance from society.

Some examples of gender dysphoria may include:

  • Horror or revulsion when looking at or touching one’s external genitals, which trigger a strong desire to remove the offending organ
    • This might manifest as a persistent awareness of body parts that should not be there (like the weight of breasts, or the presence of testicles or a uterus), or awareness of a body part that isn’t there (a phantom vagina or penis)
  • Depersonalisation and derealisation – a sense of detachment from your own thoughts, feelings, or body
  • Feeling out of place while with peers of one’s assigned gender – for instance, AMAB trans people may find it difficult to be vulnerable around other men, something that might become evident when they go through National Service
  • Shame or guilt when one is unable to fit into common gender roles
  • Anger or sadness at being forced to cut one’s hair (for AMAB trans people) or being pressured to keep their hair long or wear makeup (for AFAB trans people)

The above is not an all-encompassing or definitive definition of what dysphoria is like. Dysphoria can often present in varied ways – for some, flinching when someone uses their birth name; for others, feeling a want to be connected to others of their gender, and distress when they can’t do so. Many describe a desire to repress their inner desires because of how society views gender or an inner belief that being transgender is deviant.

Medical authorities and experts recommend transitioning as a treatment for gender dysphoria or incongruence, as it is the only course of action that has proven effective in alleviating gender dysphoria.

What do experts say about gender dysphoria?

Medical experts largely state that transition is medically necessary and the only effective way to deal with dysphoria. Most will medically benefit from some form of transitioning, regardless of whether their dysphoria is clinically significant.

The Singapore Psychological Society states that conversion therapy – the act to impose a specific sexual orientation or gender identity on a person – is ineffective and possibly harmful to some, and exacerbates distress and poor mental health.

It follows the Ministry of Health’s recommendations on conversion therapy, which state that doctors and other healthcare professionals are expected to practice clinical ethics and consider and respect people’s preferences and circumstances (including sexual orientation) when providing care.

The American Psychiatric Association states that transition is medically necessary, while the American Medical Association agrees that delaying treatment for gender dysphoria can aggravate other health issues like depression and stress-related physical illnesses. The UK Royal College of Psychiatrists states that interventions that claim to convert trans people into cis people – or conversion therapy – is without scientific evidence and is unethical.

Multiple studies also find that transition dramatically reduces suicide risk, improving mental health and quality of life.

Is gender dysphoria a mental health disorder?

ICD-11, the list of mental and behavioural disorders compiled by the World Health Organisation, lists gender incongruence as a sexual health condition, a change from its previous edition, which bundled gender incongruence under the umbrella term gender identity disorder and listed it as a mental health condition.

The DSM-V, as compiled by the American Psychiatric Association, articulates explicitly that gender non-conformity in itself is not a mental disorder.

Still, both documents have definitions on gender incongruence and gender dysphoria, for several reasons:

  • Some health systems – including Singapore’s – require a psychiatric evaluation before trans people can obtain gender-affirming care
  • Insurers depend on either the ICD-11 or DSM-V to determine if your hospital bill should be reimbursed

ICD-11 definitions

DSM-V definitions

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