Dysphoria and Honesty

This might be the only thing I ever write, but I guess I feel like I have to. So if that’s the case, so be it.

There’s a lot of debate right now about the “T” of the LGBT. Should trans women be allowed to participate in women’s sports? Which bathrooms should trans people use and should we even have segregated bathrooms at all? Which pronouns should be used? What’s the most politically correct language to refer to trans people- transgender, transsexual, separated with a space, add an asterisk? Are the current medical treatments safe and effective?

Why are people trans? When can we say for sure that a person is trans? What is the cause of being trans? Why are there so many more trans people than there were 20 years ago?

People generally don’t like to think too hard about the genitals of others- OR have others think too hard about their own. When we talk about having children, we euphemistically say that we are “trying for a baby”, rather than “intentionally having a lot of unprotected sex for the primary purpose of reproducing (but also because it’s fun)”. Everyone understands what is being implied, but we mentally skim over the sex part because it’s not necessary to dwell on (and it would be rude). We wish the parents-to-be luck and move on.

Unfortunately, the “trans phenomenon” is not nearly as universally understood as childbearing. We’re still in the early stages of really talking about it, figuring out what causes it, whether or not it’s psychological or physiological. I won’t be making any guesses as to the science behind it in this particular post, since it’s not relevant right now. What I want to talk about is the way we discuss the elephant in the room- the primary, most compelling reason that people use to justify physical transition: Sex Dysphoria.

(cue dramatic organ music)

Full disclosure: I was born female, took testosterone for around 1.5 years, and have had a double mastectomy. I changed my name and gender marker on my driver’s license (to male) and (at the time of writing) am in the process of changing my name and gender marker again (to female). I recognized myself as FTM for a period of about 12 years and do not currently think of myself as having a gender identity other than being female. I think of sex dysphoria as a mental health issue- I also have other mental health issues. This is just for context, so that there’s no confusion about my perspective.

Like most trans people, I started by describing myself as a “man trapped in a woman’s body”. I have also described it and/or seen it described as: discomfort with your birth gender, not liking your gendered body, not wanting to be a man/woman, wishing you were a man/woman, not liking the restrictions of your birth sex, male/female brain in a female/male body, similar to phantom limb syndrome, faulty brain map…

You get the idea. It’s all the “trying for a baby” of the trans world. And that’s if you can wring out any kind of rationale other than “I identify as a wo/man, end of discussion”. Rarely does anyone accurately describe sex dysphoria in an honest, unadulterated way that means something understandable to the average layperson. Just so we’re clear, I’m going to attempt to do that here, based off of my own personal experience with it. Here we go:


Sex Dysphoria:

A powerful, persistent desire to have been the opposite sex. In males, the desire for: vagina, vulva, clitoris, uterus, ovaries, production of eggs, etc. In females, the desire for: penis, testicles, scrotum, ejaculation, production of sperm, etc. The patient’s natal sex (and acknowledgements thereof, such as pronouns and gendered clothing) and secondary sex characteristics are distressing insofar as they are evidence of not being the desired sex.

Sex dysphoria is distinct from a fetish (such as crossdressing, autogynephilia, autoandrophilia, etc.) as it is not based on a fascination with the taboo and/or exotic. While sexuality is linked to sex dysphoria, since genitalia cannot be separated from sex, the sex dysphoric are not turned on by the idea of becoming the opposite sex. Rather, it is intensely disturbing to the sex dysphoric that they are not the opposite sex. Thus, imagining themselves as the opposite sex during sexual experiences is meant to reduce the distress they experience.

Sex dysphoria is also distinct from the phenomenon known as “penis/womb envy”. Envy is defined as “a feeling of discontented or resentful longing aroused by someone else’s possessions, qualities, or luck”. Sex dysphoria is not longing for someone else’s genitalia. It is longing for what, to the sex dysphoric, feels like one’s own genitalia. It is not driven by a desire to disparage the opposite sex, but by the desire to participate in the biological functions of the opposite sex, rather than one’s own.


It’s not the cleanest, most concise definition in the world, but it is (I think) understandable by most. I’ve tried to be as transparent as possible and avoid the vague, idealistic language that I see most often when discussing the experience at the heart of the trans debate. Some people might think of it as crude and I understand the desire to clean it up a little before presenting it to the public, which might consist of individuals such as your landlord, your conservative boss, and your 90 year old grandmother. But cleanliness can be confusing if not everyone involved knows what’s being discussed. It’s okay to discuss pregnancy in euphemisms because people understand what “trying for a baby” means. People- including our own medical professionals and legal advocates– DO NOT UNIVERSALLY UNDERSTAND WHAT WE MEAN WHEN WE SAY THAT WE ARE SEX DYSPHORIC. This is a problem. We cannot expect people to have a nuanced, well-reasoned discussion when they don’t even know what they’re talking about.

The truth is that people cannot change sex and I do think there’s been a push to obfuscate that truth for the sake of sex dysphorics’ feelings. Most people don’t understand what exactly happens during physical transition, how many procedures are involved, how hormones affect the body. Most people don’t even understand how natural hormones affect their own bodies. A lot of people still believe in “the surgery” or think that taking testosterone can give a female a penis. Even my doctors struggled to remember which sex I started as and which way I (thought I) was going at times. These people were the ones facilitating my transition. My former therapist is an advocate deeply involved in the trans community. This is not transphobic. It’s a picture of just how poorly understood we are. It’s damning.

It’s immediately gratifying to insist that non-dysphorics use the “correct” pronouns and other capitulations. It shields us from the painful truth, if only for a brief moment. But it doesn’t solve the problem long-term. It doesn’t prevent our midnight ruminations. It doesn’t fix the unease we feel when we remember what’s actually going on between our legs.

Surviving in the world necessitates that we all lie sometimes, but lying to ourselves- our own community- only hurts us in the long run.