The strange world of dysphoria and the joys of transition

No trans person expects you to “get” dysphoria if you don’t have it, but we do expect compassion.

This blog serves in part as a record of the changing emotional-mental landscape of one person.  It is a kind of therapy of sorts.  I am so grateful that anyone reads it, and that some even find relevance in it to their own lives.  My human inadequacies are profound, so I do not offer myself as a model of any kind.  But should these words help us collectively understand that trans people are not monsters, then this is a major victory.

The world reference manual for mental health is something called DSM-5-TR.  While there is always controversy surrounding its pronouncements, it is a generally accepted standard on all aspects of mental health.  There is an enormous global consensus around its conclusions, many of which are tinged with compromise.

This post concerns the concept of dysphoria.  Dysphoria is a feeling of a disconnect between gender and biological sex.  A disconnect from sense of self and physical self.  It is particularly hard for those who do not have it to understand it.  Society also makes it hard to change this for many reasons.  First, there are very, very few people who have gender dysphoria.  The most rigorous estimates place those numbers at between 0.4% and 1% of the total global population.  Given that gender dysphoria takes many forms, ie. the ways to be transgender are as varied and rich as the individuals whom it inflicts.

Gender dysphoria is officially classed as a mental illness.  What is transgender?  People with dysphoria.  It is easy to understand that many transgender people, despite their dysphoria, chafe at the mental illness label.  I do.  I am a competent member of society.  Outwardly and inwardly successful.  Am I mentally ill?  Armed with four independent diagnoses of gender dysphoria, required for treatment, hormones, surgery, insurance, etc. in the past few years, and a lived history of therapy since I was a child which included this, dysphoria has been present for my entire conscious life, and been “worked on” too.

The very few who have gender dysphoria means that there is comparatively little information on our lived experience to turn to.  Very few role models.  Very few people to see in society in positions of success or power who have it, or show it, and who convey positivity around it.  What we do have is a demonisation of my brothers and sisters which is served up with a froth of hate and lack of fact, a needless stoking of fear.  It is hate crime.

And I don’t want to belabour it too much, but when Senator Ted Cruz or others make oblique slurs such as “my pronouns are kiss my ass” he is contributing to public bigotry.  Regardless of the issue this should never be okay.  As I grow in strength, I will stick my neck out further and further to fight back, because it is wrong, and it is cruel.

The second reason gender dysphoria is so hard to understand is the most important.  Gender is something we take for granted.  At least the 99% of people who do not have dysphoria do.  It isn’t a luxury, it is just a given.  If you have never woken up in the morning with a psychic ache about your body having the outward appearance of the wrong sex, then it is really hard to imagine what that might feel like.  Dysphoria, however, is also not a one-off.  It is a general feeling, one that is always there.  That means every damn day.  It means every waking moment.  Yes, the intensity goes up and down, and other thoughts crowd in and out, but it is always there.

All I can say is to imagine waking up every day, every day, and thinking about your body, “this is not me, this is not what I want, this is not who I am, this is wrong, I hate this…” and a thousand variations on the same theme.  I hope that makes sense.  It is very difficult to get one’s head around…and as someone who has lived with it for my entire life, I still find it hard.  Sometimes surreal.

Part of the reason that I love being around beautiful women is that it is very triggering and healing at the same time.  The “am-ness” of a beautiful woman, the natural way she inhabits her skin, is at once inspiration, teaching moment, therapy, guide, but also a reminder of the difference between what it is to be born trans versus cis.  The difference hurts but it is not negative.  It opens the door to feel dysphoria.  I experience it as a bittersweet feeling.  On good days.  Every once in a while, it hurts like nothing I’ve felt…a soul-rending heartache.

But I would also describe gender dysphoria as something delicious.  Just as the Portuguese people have a national music called Fado which has at its core a feeling of pleasure from melancholy, and the French also celebrate these feelings on a national and cultural level, I too find that there is deep pleasure in it.

The human experience is not just cupcakes and rainbows.  What makes us human is what makes us different.  The negative column is just as important as the positive one.  Gender dysphoria sits on both sides of the register.  At once a source of immense pleasure for the richness and complexity and rarity of the feeling, as well as both generally and intensely painful.  The idea that we cannot rely on gender as the anchor for who we are, is one that would be challenging even in the most indulgent and tolerant societies.  But living in a world that often reviles us, most definitely doesn’t understand us, seeks to politicise us, fetishize us, sexualise us, makes it much worse.

Trans suicide levels are 100x higher than they are for the equivalent age and development group among the cis population.  100x.  The dysphoria itself explains only a part of that.  The social context explains the bulk.

Would I “need” to have a sex change had I grown up in a society and home which tolerated alternative gender expression?  Would I have felt the need to commit to alternative definition of my body had the third sex been a reality in my milieu?  I don’t know.  Possibly.  What I do know is that changing sex won’t change me from non-binary.  It might have had I transitioned when I should have, at the age of 11, when it was really present and acute for me.  The appropriate age and treatment for trans children is beyond the scope of this post.

[Our default position in society should be that a child can indicate the path of their heart.  That a child’s parent’s will be primarily focussed on what is best for their child.  That doctors and mental health professionals will do the same.  That the path chosen will be made easier by a tolerant and rigorously un-bigoted school and work life.  The reality is that this stuff is hard, and we are human, and we are dealing with issues that nobody is born equipped to deal with.  What we don’t need is for a nanny state to interfere, for politicians to legislate what is right and wrong.]

The WPATH guidelines, similarly controversial to the DSM-5-TR, as global standards for transgender healthcare provide a roadmap for transition, for both the individual and the array of mental health and other practitioners to engage with supporting a trans person.  Endocrinologists, nurses, doctors, etc.  Trans people often bridle at the standards as it is not an informed-consent model.  We are competent adults able to make decisions about our own bodies on our own.  WPATH does not allow for that.  It is described as gatekeeping.

I don’t like it, but I accept it as a price to pay for society to accept me as trans.  To reassure.  ‘Yes, this is not just something which is the outfit of the day, the flavour of the week.  There are professionals involved at every step of the way.  Real, highly qualified professionals.  And yes, you have to live it, to live ‘out’ in order to be it’.  Many people don’t understand that.  On my own journey, I have been required to provide official assessments of gender dysphoria to various care providers.  Both of my surgeons have asked for three, as well as a letter from my endocrinologist.  They also require a year of genital electrolysis to prepare the site, and at least one year of living fully out in my gender.  I am okay with all of this, but I realise that this is a luxury.

For most trans people this initial period of transition is the most difficult.  It can be dangerous.  The only times in my entire life that I have ever been physically grabbed in an aggressive manner, or had things thrown at me, were in recent years because I am trans.  Never in my life before.  But I am outwardly strong: white, tall, well-dressed, posh looking, professionally successful.  I can guarantee that I am the only transgender person I have ever seen in the First Class British Airways lounge at London Heathrow.  Or in first or business class on an international flight.  In fact, I can’t think of any trans people I have ever even seen on a plane.

Trans people are overwhelmingly poor.  Many live in precarious situations.  Silent discrimination is real and rampant, so we are also under-represented in the labour force…it is hard for trans people to find a job.  Like women before us, we are relegated to areas of the economy where our trans-ness is less threatening.  Retail.  Sex work (and yes, an alarmingly high number of trans people turn to sex work out of desperation.  Never mind that I consider sex work an aspirational profession—or at least one which can be).  This is in part the tragedy of the TERF…but a woman who doesn’t realise that trans people are her natural allies in the quest for equality is hopelessly misguided and self-harming.  Same for all minority groups.  And sad to say, it is the pale-male-stale group which I have left which is the source of patriarchal toxicity which drives our common social structure.

The third reason gender dysphoria is so hard to understand is that our social structure is founded on patriarchy.  Either you are a man or you are ‘not man’, and ‘not man’ is lesser.  What kind of person in their right mind would give up the keys to the patriarchy?  All that privilege.  And yes, I can feel it draining away from me.  Fear about the future and my ability to make a living is now present for me in ways that were never the case before.  That very fear held me back from transitioning in the first place.  That’s the story for a trans woman.

And whether men wish to admit it or not, there must be something deeply fear-inspiring about a member of the tribe walking out and committing the most outrageous symbolic and physical act possible to underline that we are ‘not man’: cutting off our genitals.  Okay, I like to think of it as up-cycling, but the window dressing does not take away from the fact that cock and balls sit at the heart of male power, male sense of self and sexuality, and here we are throwing it away.  And doing so in spectacular fashion.  This is no walk in the park.  We don’t get to push a button and wake up with a different anatomy.  Nope.  We spend a fortune, undergo deep pelvic surgery, and make a lifelong commitment to caring for our neo-vaginas with quasi-religious fervour (I don’t know what else to call dilation).  One year recovery time.

The path of a trans man is much easier to understand, and at least with clothes on, is much easier to execute in terms of “passing” at any age.  Breast removal is no laughing matter.  Creating a penis is no laughing matter, and thus far, we have not created a penis which is fully functional.  I am sure it will come one day.  But you can also understand that many natal females who are trans have an element of aspiration.  There might be frustration at being denied the keys to the patriarchy, a sense of frustration and anger at the unfairness.  But giving up womanhood is surely no less a commitment than giving up manhood is.

The patriarchy demands the binary.  If you are ‘not man’ then you must be sexual object of man.  Usually this means woman.  The pressure to become the opposite gender as a trans person is enormous.  I have “chosen” non-binary because that is what is accessible to me.  I would love to choose woman, but I cannot.  Too much of my lived experience has been male.  Had I transitioned as a child as I should have, then my sense of identity might have evolved in a way that allowed for this.  But it did not.  Even after a sex change, however, I will still be a they-them, non-binary, individual.  A non-binary trans woman.

That means that my existence, my sense of identity is refusing to conform to the binary, to the patriarchal system.  That means that my existence is an affront to those people who cling to the patriarchal structures and systems.  Just being out, is therefore, a colossal act of defiance, of rebellion.

When I think back on how afraid I was to just go out dressed in female-gendered clothes, I hardly recognise me.  But the day that I decided to just step into it coincided with a self-realisation that I am female enough, that I am non-binary, that I am transgender, and wearing what I want is a part of that.  I still make plenty of wardrobe mistakes.  I am overly fond of very short skirts and rather revealing clothes.  My children tell me, as does my soon-to-be-ex-wife, that this is a manifestation of ‘teen girl brain’.  Chemically, that is where my body is right now.  And that is affecting my fashion choices, my worldview, my behaviour.  And it is fun.

The fourth reason that we cannot have adult conversations and live-and-let-live about trans people is that cis people sexualise us.  The conflation of sex and gender is wilfully violent.  There are two words for a reason.  The silly idea that sex and gender are the same thing are only not ridiculed out of existence because of our small numbers.  In addition to the 1% of the populace that is transgender, approximately 1.5% are intersex (people born with characteristics of both sexes, or a genetic variation away from XX or XY).  Going around and saying that sex and gender are the same thing is to deny our existence.

Our natural resistance to this social violence against us is to seem to lend tacit acceptance to the idea that it is okay to be violent towards us.  Our refusal to go along with the idea that sex and gender are the same thing is a finger in the eye to the patriarchy.  That we should choose inequality over conformity is proof enough.  And why and how do members of the cis population endorse this violence?  By sexualising us.

To conflate sex and gender is already a form of sexualisation on the lines of hetero-normative practice.  The number of times I have heard or felt that my transition to female body means I like or want men is absurd.  As if to say that the only reason a ‘man’ would transition to ‘female’ would be to subject themselves to the male gaze.  Gross.

Many trans people end up turning to trans partners in the end, because it is not always just men who sexualise us, though this is most typical.  I can certainly note that many of the women who have displayed interest in me as I have transitioned is a reflection of some level of fetishization of my trans-ness.  I am a safe ‘walk on the wild side’.  I might not mind it if it wasn’t so ephemeral, but we all want to be loved for our humanity, not for our genitals.

The other aspect of this fourth reason is that gender dysphoria has nothing to do with sexuality.  The gay community is as equally troubled by trans people as cis people are.  In other words, most people don’t understand that being transgender has nothing to do with who want to sleep with.  I know that the popular perception is that a man who becomes a woman and goes from straight to straight (man loves woman, then trans-woman loves man), and that the fact of gender transition and/or sex change are regarded as what brough this partner orientation about, I would content that this is not the case.

Our sexuality, what turns us on, what or who we want to sleep with, may evolve over time, but it is unlikely to go 180° changed.  My endo told me when I first met with her, ‘you may experience a change in sexual orientation’.  What I said to her then was what I still feel.

“I don’t believe that’s possible.  I do accept that for a man coming out as trans, it might be possible for them to now express their preference for men, but I would suggest that this was already there, just not one they were willing to express, either consciously or no’.

What’s happening to my orientation?  I used to like butch women.  I still do.  Only I am liking true demonstrations of performative ultra-femininity in ways that I didn’t before.  Petite women, very feminine women.  I guess this is not surprising given my own moves along the spectrum from male to female…but the orientation remains the same.

The other thing that has happened to me is that my gay male sex fantasy life has completely disappeared.  Through therapy and ex-Mistress I realised that this was a manifestation of shame for feeling aroused when I was sexually molested by men as a child and teen.  My intense ‘coercion’ and ‘first-time’ gay male sex fantasies were all ways of processing real-life experiences.  I am glad they no longer turn me on as they were a reflection of toxicity, and now I can feel that in the past.  

If you are interested in reading some of them, you can find a sampling of them on the Smashwords platform under the pseudonym Will Richards, and ditto for Amazon.  Please note that they are quite aggressive and sordid. This is but one of many pseudonyms I write under, and one of many frequent themes.

The crux of this fourth reason of not being able to have adult conversations about transgender people and how we fit in society lies in the inherent contradiction of sexualising us.  While the conflation of gender and sex as words does that on its own, the reality is that many men, and again, it is almost always men, fetishize us.  And while I would be the first to argue that the things we find erotic offer an opportunity to use the most powerful energetic force we feel as humans, our sexuality, to grow as humans, the magnetic pull of a fetish towards stasis is too great.  Fetishes like to be satisfied.  Again and again.  They turn subject into object.  Are repetitive.  A form of being stuck.  When we cannot have intimacy between two humans as the driving force between the interaction, we are not in a healthy place.  When a trans person is sexualised, this is what is going on—not for the trans person but for the person who is gazing at us, sexualising us.

And the most important part about this is that this is not about us, the trans people, but it is about the sexuality of the individual doing this to us.  In other words, it has nothing to do with us and everything to do with the inner sexual landscape of the person doing it to us.  And we all know that sexual motivation and the erotic is as diverse as humanity.  In other words, how could we possibly understand or unpick this without unpicking the feelings of every single person who sexualises a trans person.  

Surely it is an act of further violence to ask the trans person to explain why we are being sexualised.  Surely the onus for that should lie with the person doing it to us in the first place?  Surely this also applies to society.  When Ted Cruz says intolerant things, or anyone else for that matter, what they are effectively saying is that they are incapable of not sexualizing us.  That they have a pathology.  A problem.  It may be convenient to blame us, but that’s sick.  It’s like saying that a man into bestiality has the right to say it was the animal’s fault…

The victim-blame syndrome is the absolute core of patriarchal privilege.  Deep down any woman knows that.  To have your virtue used to police you, to have comments like ‘she was asking for it dressed like that’ is all part of the same narrative.  This is a part of the lived experience of most women.  When entitled non-women ascribe agency to toxicity, seeking to transfer their own bad behaviour onto others.  Being anti-trans, making arguments about bathroom use and sports are all just forms of bigotry which manifest themselves as self-righteous nonsense.  The issue is cis men, not trans people.  That a cis-man somewhere isn’t scheming to use “trans” as a cover for predatory behaviour is obvious.  That maybe there are also sickos who are trans and who are predators is also obvious.  There are also female sickos.  The sicko is pervasive.  Sad but true.

Conclusion

Phew.  I have yet to meet a trans person who doesn’t want to just disappear.  To be as invisible as a cis person.  To just be accepted as they are.  That adds to the immense pressure on us to ‘pass’.  It comes in the form of daily reminders as people stare at me for inappropriate amounts of time, making me uncomfortable when I pay attention.  That is why I am so grateful for those who go out of their way to gender me correctly, who ask me my pronouns (and yes, it does matter).  And you know what?  With the amount of *shit* we have to put up with, so what if it is hard for someone to use “they” in a sentence when referring to the singular?  Everyone is already on notice.  To refuse to do so is to declare your hand for the patriarchs.