Living in conflict with one of the basic tenets of existence (Am I male or am I female?) is understandably anxiety provoking. This fact leads me to suggest that Gender Identity Disorder as this conflict is described in the DSM IV, is not an appropriate descriptor. I suggest here as I have elsewhere (Vitale, 1997, 2001) that instead the condition be termed Gender Expression Deprivation Anxiety Disorder (GEDAD). After explaining my thinking on gender expression deprivation anxiety, I will describe how this anxiety, if left untreated, is manifested in each of the five developmental stages of life: confusion and rebellion in childhood, false hopes and disappointment in adolescence, hesitant compliance in early adulthood, feelings of self induced entrapment in middle age, and if still untreated, depression and resignation in old age.
I'll be quoting and discussing certain points within.
There is a growing body of evidence that Gender Identity Disorder (GID) as described in the Diagnostic and Statistical Manual IV (DSM IV) (1994) is at least in part, the result of insufficient or inappropriate androgenization of the brain at a critical stage of embryonic development. As a result, the affected individual may be left with somewhere between a partial and a full sense of having a cross-sexed gender identity. Essentially creating a not-male, not-female but otherwise permanent gender variant condition. Even though there apparently are some individuals who fall very close to or dead-center on the gender identity spectrum, most gender variant people can easily identify with being closer to one end of the spectrum then the other...
...Given gender identity permanency and its obvious importance in the ordering of one's life, it is reasonable to consider gender identity as essential existential knowledge, knowledge that can not be unknown or separated out from the whole without radically redefining the whole.
...I believe it is safe to say that gender dysphoria is the single most dominating influence during developmental stages [for severe dysphorics].Research continues to reinforce that gender identity is fix at birth and permanent. I agree that for me, as a severe gender dysphoric, my dysphora was and is the single more dominating influence in my life. For instance, do you know the reason I never drank or got high growing up? The primary reason was I was afraid that during a period of reduced inhibitions, I would reveal to others my true feelings about my sex. Even today, if I'm tired or emotional, it is hard to hold back expressing the REAL struggles and anxieties I have concerning my sex.
The term Gender Identity Disorder implies that one's physiological sex is correct and that one's inner sense of gender is disordered or wrong. It is clear that this is not how gender dysphoric individuals perceive their condition. This is evident both in psychologists' inability to change a person's sense of gender with therapy and the ready preference of many of these individuals to undergo physical sex reassignment.Due to the definition of my condition in the DSM, I tried to convince myself for years that my brain was wrong and my body was correct that the true fix for my condition would be in my brain. I say tried to convince myself because that is not at all how I actually saw it. My brain and heart always told me I was supposed to be female and that ultimately my body was the reason problem.
Having been more diligent than most at trying to treat my condition psychologically, I can attest to the fact that ultimately my internal sense of gender has been unchangeable and has not reduced my desire to be myself.
The majority of the pain I feel comes in two forms, depression and mostly anxiety. When I think on the life I didn't get to have, when others assert my maleness, etc, it is depressing. When I was working to treat myself, I mainly focused on these types of depression triggers. I could not do anything for the anxiety however which seems to be the greatest source of threat. There is anxiety that people will find out me, anxiety that those who know don't accept me, anxiety about living up to societal expectations, anxiety about living the rest of my life as male, etc. I'd say anxiety has been my constant companion my entire life.
Psychological pressure comes from society's strong expectations that one conform to one's assigned gender role. This an obvious tenet. Physiological pressure is less obvious but most likely results from the inability of the individual's body to produce sufficient cross-sex hormones. This becomes evident in the fact that within days or weeks of receiving cross-sex hormones, dysphoric individuals exhibit markedly lower anxiety. This procedure is so reliable that it is the second step in a the triadic treatment plan described in the Harry Benjamin International Gender Dysphoria Association's (HBIGDA) Standards of Care. (W. Meyer, et al.,2001). Hormonal treatment is considered both a verifier of gender dysphoria and a treatment. Further, as treatment continues, the resulting cross-sex feminization or masculinization typically reduces and eventually eliminates the anxiety entirely (W. Meyer, et al.,2001).My pain comes from two sources - both extremely important. Body dysphoria and social dysphoria. Generally to relieve body dysphoria I'll avoid mirrors or other gender defining characteristics or I'll try to feminize myself in some way. Those times when I am not dissatisfied with my body and when I feel I am particularly feminine looking, I feel the greatest relief of the body dysphoria. Relief also came from the use of hormones - it was like it 'fixed' some part of my brain and the body changes were great too. True relief though would come from knowing my body is female.
I cannot escape the social dysphoria however and it by far dominates my conscious mind. Male expectations and societal pressures are a constant source of anxiety, depression, and tears. My partner was called "a boy" the other day because she was playing "boy games" and wasn't interested in "girl things". This upset her greatly. For me, this is an every day, every moment occurrence. Every assertion as to the fact I am male is like a dagger piercing me. People telling me that I'm not really female, that I'm not feminine, that I look male, that I have strong male features, that I wouldn't understand x because I'm male, being excluded from female activities on the basis of my sex, etc. really bother me. Even things as simple and common as using male pronouns and calling me by my male name drive me crazy. I want to cry out, "If you only knew you are talking to a girl!" Growing up male meant I didn't get to grow up in a female social world so I have the disadvantage of not knowing what is it like to actually "be" a girl. It doesn't change the fact that I AM one though.
Since everyone, even an intersexed child, is raised as either a boy or a girl even in the most non-sexist environment (Stein, 1984), a chain of physiological and societal events begins at birth that propel the individual into a predetermined set of behavioral expectations. In a bicameral sexed culture, deviating from those expectations almost invariably results in social conflict. The individual's quality of life, his or her relationship with family, friends, career, legal gender status and the nature of his or her being in the universe, are all at stake.I need, and I mean, NEED to be seen by others as female to relieve the social dysphoria. I have told my partner for years that I just want to come out to everyone everywhere. Make a facebook post or something to clear the air and that this would help me. Repeatedly she has requested I not do that, but the reason I want to so badly is because I feel it will actually relieve my anxiety. It wouldn't be a complete fix though. Even if well meaning people know that I believe I'm female, it doesn't mean they can start seeing me that way or interacting with me that way. Even my best friend who has known me about 25 years says even that is hard for him to see me as female because I still look male. This highlights the need to take steps to look as female as possible. Looking female and not hiding feminine desires and mannerisms would go a long way to facilitating others seeing me as a female. Achieving that without complete transition is a fine line however and one I still don't know how to accomplish.
For individuals with a mild to moderate form of dysphoria, life is tolerable and they rarely make any overt attempt to live outside prescribed social norms. For those with a more extreme dysphoria, mild palliatives such as periodic cross-dressing, although helpful, becomes insufficient. These individuals appear to need to inhabit and live out the cross-sexed identity.
Exactly my previous point... I don't cross dress privately and haven't for very many years because it doesn't really fix anything. It isn't enough to be a boy in girl's clothes, I need to be seen as a girl in girl's clothes.
There is more to be said about this article and more things that describe my experience, but in the interest of keeping this from going too long, I'll end it here. I hope those who read this have a greater appreciation for the real problem created by the dysphoria and that the fix for it is not an easy one.
The whole paper can be read here: