According to the most recent Diagnostic and Statistic manual of Mental Health Disorders, Gender Identity disorder(GID) is no longer classified as such. GID has now been replaced with Gender Dysphoria(GD). We now can diagnose our clients in a much more accurate and less stigmatizing way. Gender Dysphoria is an intense and persistent feeling of incongruence between one’s internalized sense of gender and our biological sex. This is represented on a spectrum ranging from mild to moderate to severe. Many individuals experiencing mild gender dysphoria find ways to express that part of their identity that do not involve gender role transition.  However, those experiencing severe GD are often only able to find peace and congruence upon addressing and living their authentic selves. Identity is not something we can (or should) change, so the treatment plans often focus on ways in which we can change the physical body to match the internalized sense of gender.

There are a few options for addressing this intense Dysphoric feeling. The first step is often Hormone Replacement Therapy(HRT).  HRT can have tremendous feminizing/masculinizing effects on the physical body(depending on age, genetics, etc.). However, one thing that we do know is that Testosterone is a very powerful substance. For those MtF (Male to Female) clients who are transitioning at a later age, the effects of Testosterone have already set in and often will be unchanged via hormone use. This is particularly evident in male/female facial structures. Hormones will often result in secondary sexual characteristics (though sometimes underdeveloped…ie: small breast size for mtf).

In Western society, there is a huge amount of emphasis put on one’s body image. We can see this every time we pick up a magazine or go to the gym. An intense and often exaggerated sense of disgust with one’s physical body is known as Body Dysmorphia. I feel that in the Trans-identified individual, this is only amplified. Besides not feeling like the body one has fits for them, there are some major safety concerns that often intensify this feeling. ‘Passing’ becomes of utmost priority. This can often lead to Trans-identified individuals seeking out more procedures than we may feel are necessary.

Long after the 2-3 year hormone replacement process, many mtf may continue to struggle with seeing the female in the mirror they have so desired for most of their lives. It is more important for us as healthcare providers to explore how changing one’s body might affect them. In our society, plastic surgery often comes with mixed reactions. Many people feel the need to let people know they do not ‘need’ any procedures. This however, can be a catch 22. By telling someone who is Trans-identified that they don’t need any procedures and that they are fine the way they are can possibly undermine or deny the individual’s core belief about their physical selves; no matter how good-intentioned it may have been.

So in conclusion, i hope that healthcare providers will take into account the effects of Body Dysmorphia on the Trans-identified individual. It is not our place to tell people they should or should not physically alter themselves.  Instead, we should be focusing more on the thoughts, concerns, and beliefs that have become so ingrained in their psyche. Many clients will pull for approval, but this is a time for staying very client-centered and not interjecting our personal biases based on our lived experiences.

Cameron Duvall, MS
MFT registered intern (IMF#65656)
30 N. San Pedro Rd, Suite 160
San Rafael, California 94903
(415) 968-9591