Gender Identity and Body Dysphoria
See also: Positive Body ImageThere is a growing understanding that gender is not simply a matter of male/female, and may be much more fluid. However, many people still experience problems and challenges from feeling that they have a ‘different’ gender identity from either others or the sex they were assigned at birth. Gender issues, including gender identity and gender or body dysphoria, can lead to serious mental health problems.
It is important to be clear that whatever issues you are going through concerned with your gender, you are not alone. Many other people have gone through similar issues—and will do in future. The key issue is to find help and support if you need it.
Understanding Gender Identity
Gender identity is defined as how you describe your gender.
You might therefore say that you are a woman, queer, non-binary, transgender, or any number of other descriptors. All these are valid gender identities—as indeed, is any other term you might choose to use.
Defining Some Gender Terms
There are some common terms that are used in defining gender identity. They include:
Cis-gender means that you identify as the gender that matches the sex you were given at birth.
Transgender means that you identify as the opposite gender from your biological sex.
Non-binary, genderqueer and gender fluid or genderfluid are all terms used for people whose chosen gender is not either male or female (that is, does not fall within the gender ‘binary’ of male and female). They may have no gender (agender), embrace all genders (pangender) or choose some other option.
One important consideration is that gender is not the same as sex.
Sex is dictated by genetics and your physical body parts. For example, if you have XX chromosomes, and a vagina, you are a woman; XY chromosomes and a penis means you are a man. Sex is therefore largely fixed. However, there are some people who do not fit neatly into ‘men’ or ‘women’, because they have a chromosomal difference, or a difference in sex development (see box).
Understanding intersex
Intersex is an ‘umbrella term’ used for a wide range of conditions that affect sex development. It is also known as ‘differences in sex development’. These conditions may affect hormones, or physical development of secondary sexual characteristics, or other parts of the body.
There are no precise characteristics that define intersex people, because there are at least 40 conditions covered by the term. These conditions include not having either XX or XY chromosomes, having XXY chromosomes (known as Klinefelter’s Syndrome), androgen insensitivity syndrome and vaginal agenesis.
Estimates suggest that around 1% to 2% of the global population may be intersex. The figure is generally put at 1.7%.
Intersex is NOT a gender identity per se. Intersex people may choose to identify as male, female, non-binary or anything else—just like anyone else.
Pronouns and Gender Identity
Our ‘pronouns’ are simply the words that we ask people to use when describing us or talking about us. If you identify as female, you might choose to use ‘she/her’. However, you might also prefer to use ‘they/them’ instead, perhaps because you feel that gender-neutral pronouns are better.
Unsurprisingly, it is both polite and generally good practice to use people’s correct and chosen pronouns.
There is a growing trend towards identifying pronouns on social media, especially professional platforms like LinkedIn. This is in recognition that this is a matter of personal preference. However, if you don’t wish to disclose your pronouns publicly, that’s also fine. It is entirely up to you.
Gender Identity and ‘Coming Out’
If your gender identify does not match your biological sex, or you are non-binary, you may be concerned about ‘coming out’, or announcing your gender publicly.
You may be concerned that you might be targeted or bullied for being ‘different’. You may also be worried about being discriminated against. Sadly, these fears are not entirely unfounded. Indeed, many people do experience all these things as a result of their gender identity or appearance not matching societal expectations.
It is important to remember that it is entirely your decision whether you ‘come out’, and how widely. You might choose to tell a few friends, or just your family. You might choose your timing—for example, when you are leaving home or already financially independent if you are worried about your family’s reactions.
Understanding Gender or Body Dysphoria
Gender or body dysphoria is defined as a sense of distress and/or discomfort arising because your gender identity does not match your sex assigned at birth.
It is included in the standard diagnostic manual for mental health problems. However, it is important to stress that it is not in itself a mental illness, although it can lead to mental illnesses such as eating disorders, depression or anxiety. Those who experience it often describe a feeling of ‘being stuck in the wrong body’. This is not the same as body dysmorphia (see box) although the words are very similar—and people with gender dysphoria may also develop or experience problems with their body image.
Gender or Body Dysphoria and Body Dysmorphia: What’s the Difference?
There is often confusion about the distinction between gender or body dysphoria, and body dysmorphia. The terms are very similar—but they have quite different meanings.
- Gender or body dysphoria is defined as discomfort or distress arising because your body, and particularly the sex you were assigned at birth, does not fit with your gender identity.
- Body dysmorphia is defined as an obsession with a perceived flaw in your appearance.
The two may therefore be associated, and may often appear in the same person. The perceived flaw for someone with body dysmorphia may be associated with sexual characteristics that do not match their chosen gender.
However, someone with body dysmorphia may fixate on many different elements of their appearance apart from their sex or gender, and someone with gender dysphoria may be entirely happy with their appearance except for the mismatch between gender and sex.
There is more about body dysmorphia, and other problems with body image, in our page on Positive Body Image.
Gender dysphoria is also not related to sexual orientation. People of all sexual orientations (or none) may experience gender dysphoria.
Treating Gender Dysphoria
It is reasonably common for children to want to do things that do not conform with gender norms for their assigned sex.
For example, little girls may want to play with toy cars, and boys with dolls. This does not mean that they will go on to experience gender dysphoria—it simply means that nobody should be stereotyped based on their interests.
It is also common for young adults to question their gender identity, and experiment with different options to see what fits.
In some cases, this may lead to gender dysphoria, and in a few of those cases, this may last into adulthood. They may continue to feel that they want a different body, or to take action that will affect their physical body, such as taking hormones that will alter their physical development.
There has been—and continues to be—considerable controversy about treating gender dysphoria in irreversible ways, such as puberty blockers, cross-sex hormones, or surgery to remove breasts.
Some of the young people so treated have complained that they were allowed to access surgery, or take irreversible hormones when what they needed was time. Some have gone on record as saying that they were simply ‘confused’ about their gender identity or their sexual orientation, and needed time and support to make their own decision. Current treatment is therefore carefully conservative, ensuring that no irreversible decisions are made until the person concerned is over 18 and understands the consequences.
The first step is usually assessment over a long period, perhaps several months.
The next step might be treatment of some sort. This treatment is designed to address the gender dysphoria: the discomfort with a mismatch between sex and gender. There is a perception that the only treatment available is to change biological sex. However, this may not be the answer, and certainly not in every case. Some options may instead help the person concerned to accept their identity, with all that this entails. Possible treatments include family therapy, individual psychotherapy or counselling, long-term monitoring, referrals to mental health services, and hormone treatment. People may also be offered speech and language therapy to help them sound more like their chosen gender.
Getting help
You can find out more about gender dysphoria, and the possible treatments, including their risks, at https://www.nhs.uk/conditions/gender-dysphoria/treatment/.
In Conclusion
Your gender identity is an important part of you.
It should not cause you a problem—but sometimes what you feel about your gender comes into conflict with familial or societal expectations, or your biological sex. When that happens, you may need help, and there is absolutely no shame in reaching out and asking for it from professional services such as healthcare, or from friends or voluntary services.