Imagine going into surgery for an appendectomy.  When you come back to consciousness after surgery, you realize that something is different: you have been mistakenly given gender confirmation surgery.

How do you feel?  If you are not upset about it, maybe you decide to identify and express yourself as this new gender.  If you are disturbed by this gender reassignment, feeling like your true gender does not match this new gender, we call this “gender dysphoria.”

If you imagine feeling this gender dysphoria, what do you do?   Maybe you just continue to identify with and express yourself as your true gender.  You continue to dress and act the way that has always felt natural, and you ask people to call you by a name that matches your true gender.  You may worry about being viewed as a “freak” or about people referring to you by the wrong pronouns.  People may tell you to “get over it” or to dress and act more “ladylike” or “manly” so you can fit in with your new body.  Even if you are able to disguise your reassignment and “pass” as your true gender, your employer may insist on using the wrong pronouns, the wrong name, you may be told to use a restroom of the reassigned gender or feel unsafe using the restroom of your true gender. Or maybe you worry about getting found out and discriminated against when a bouncer, policeman, or potential employer checks your identification.  Maybe your significant other is concerned about how this reassignment affects their sexual orientation, even though you are both the same people in the same relationship.  If you originally considered yourself heterosexual, people may now consider you homosexual, or vice versa, even though you are still attracted to the same people.

Maybe you decide to get the doctor to immediately reverse the surgery.  You may be told that, although surgery on your chest (“top surgery”) will be fairly straightforward, genital surgery (“bottom surgery”) may be a bit more complicated.  Numerous possible side effects are listed.

Maybe you decide to stick to the regular hormone injections, to keep your body and brain feeling and looking more like your true gender, but decide to avoid surgery or try only “top” surgery to avoid the genital surgery complications.  Would you be willing to continue living with genitals that don’t match your gender?  How and when do you let potential love interests know?

Hopefully, this thought exercise can give you some sense of what it is like to be transgender, or someone who identifies as or expresses a gender identity that is different from the gender assigned to them at birth.  If you identify as or express the same gender identity that was assigned to you at birth, you are considered cisgender.  Transgender people frequently experience gender dysphoria as early as age four, and far too many experience severe disturbance and even suicide because of the disconnect between their “true” gender and the one assigned to them.

People with gender dysphoria are currently diagnosed in the DSM-IV-TR as Gender Identity Disorder (GID), even though the currently recommended “treatment” for the disorder is to change the body, rather than changing the mind.  GID can therefore be viewed more accurately as a type of birth defect, rather than a mental illness.  In fact, the American Psychiatric Association is currently debating whether the GID diagnosis should be eliminated from the forthcoming DSM-V, in favor of a condition of “gender dysphoria”.  The problem is that diagnosis of GID is still required for many insurance companies to cover hormone and surgical treatment, and a doctor may require this diagnosis to cooperate with legal identification changes.

As you can tell from the thought exercise, gender identity has nothing to do with who you are attracted to.  Frequently, female-to-male (FTM) transgender individuals are attracted to men, and identify as male.  Likewise, male-to-female (MTF) transgender individuals may be attracted to females.  This is the case with cisgender individuals as well: some people are attracted to males, some people are attracted to females, some are attracted to both, neither, or individuals who don’t fit neatly into one of the traditional gender categories.  Gender identity does not indicate sexual orientation.

Although gender dysphoria may be incredibly painful, it is very possible to live a fulfilling, happy, well-adjusted life as a transgender person.  Many of my transgender clients have worked through their initial fears, societal barriers, and shame, and are respected members of their families, circles of friends, and work teams.  Living a life as their true gender, they are now feeling a sense of freedom, acceptance and authenticity that they only dreamed of in the past.

This is not necessarily the best choice for everyone with gender dysphoria, though, as each person and their circumstances are different.  It can be very helpful to work through your feelings, goals, and circumstances with a therapist/counselor who is experienced in working with people struggling with or questioning their gender identity.

If you are cisgender, hopefully you can understand a little bit more what it is like to have gender dysphoria.  Respectful treatment of those struggling or who have struggled with gender dysphoria can be immensely important.  Remembering the preferred name, pronoun, and gender of your friend/family member/co-worker can mean a lot, and help them feel the sense of legitimacy and authenticity of their true gender that you may take for granted.

Rose Hickman Smith is a psychotherapist in private practice in Marina del Rey and virtually throughout California. She can be reached through the “Contact Me” link on this website.