Dysphoria usually refers to a disturbance in mood, accompanied by anxiety, discomfort, and even angry reactions. On the other hand, gender dysphoria, which will be discussed here, is a medical term used to describe the distress of the transgender person, faced with a mismatch between their assigned sex and their gender identity.

Neurobiologist Catherine Vidal affirms that the concept of gender was first of all an object of research in the human and social sciences, for which biological sex is not enough to make a woman or a man. “Or, she indicated in Le Monde in 2013, this concept is now validated by research in neurobiology which demonstrates the extraordinary plasticity of the brain“. And so, “thanks to this plasticity, Homo sapiens can bypass genetic and hormonal determinism«.

What is gender dysphoria?

The term dysphoria, in its original sense, can refer to a mental disorder, characterized by a mood oscillating between sadness and excitement. It is thus a disturbance of mood, which is accompanied by anxiety, discomfort, and even angry reactions: hence a character designated as being atrabilary. This state often proves to be lasting.

Gender dysphoria, a specific medical term used in the American Psychiatric Association (DSM-V) manual, actually describes the distress experienced by a transgender person, that is, having the physical attributes of a person. girl but feeling like a boy, or the other way around. It is the feeling of mismatch between their assigned sex and their gender identity that creates a disruption.

Ann Oakley, British sociologist and feminist, wrote on gender explicitly in 1972. A pioneer, she defined it in “Sex, gender and society” as follows: “The word sex refers to the biological differences between males and females: the visible difference between their genitals and the correlative difference between their reproductive functions. Gender is a question of culture: it refers to the social classification in masculine and feminine«.

Indeed, the prevalence of the number of transgender people varies internationally, due to societal and cultural norms, and differences in definition. In New Zealand, for example, the prevalence is estimated at 1 in 6 people, with a male-to-female ratio of 000: 6.

Two clinical forms of gender dysphoria are now described, differentiated according to their age of onset, appearing in infancy for one, and during the puberty period or later for the other. “Late forms that do not take root during the early stages of the construction of gender identity (often between two and four years old) are the ones that raise the most difficult questions for the medical profession“, Indicates the psychiatrist Thierry Gallarda, intervened during a conference in a French congress of psychiatry.

How to recognize gender dysphoria

Biological sex refers to the reproductive organs, gender identity, the inner feeling of being male or female. It is generally accepted that babies born with the female sex will later see themselves as female, and that babies born with the male sex will develop into men, dressing in this way.

But ultimately, sex and gender tend more, more than on a clear and frank dichotomy of these two categories, to represent a kind of continuum. The variation in how people position themselves on this continuum depends on factors such as stage of development, past and present environment and lived experience, as well as the nature of relationships to self and to others. .

Symptoms of gender dysphoria appear at different stages of development, but become more prominent with the onset of secondary sex characteristics during puberty.

To establish a diagnosis of gender dysphoria, at least two of these criteria established by the DSM-V have been present for at least six months:

• a significant difference between their own gender experience and their secondary sex characteristics;
• a strong desire to get rid of their secondary sex characteristics, or prevent their development;
• desire for secondary sex characteristics of the opposite gender;
• willingness to be treated like the other gender;
• strong belief in having feelings and reactions of the opposite gender.

Risk factors

Men are more affected by gender dysphoria than women: the prevalence estimated by the DSM-V working group shows rates varying between 0,005 and 0,014% for adults born to males, and from 0,002 to 0,003% for people born women. This gender dysphoria often appears and expresses itself in adolescence.

Gender dysphoria, which is therefore more frequent in heterosexual or bisexual biological men (male to female) can be preceded by a more or less lasting phase of cross-dressing, gradually evolving towards a desire to get rid of its secondary sexual characteristics and a compelling desire to live fully under a female gender identity. According to doctor Gallarda, these transsexuals mainly project themselves into lesbian or bisexual sexuality.

Gender dysphoria comes from the concept that biological sex is not enough to make a man or a woman, a concept that has long remained a subject of research limited to the human and social sciences. But as neurobiologist Catherine Vidal underlined in an interview with Le Monde on May 25, 2013, “this concept is now validated by research in neurobiology, which demonstrates the extraordinary plasticity of the brain«.

Previously, it was believed that this brain plasticity was only possible in extreme cases, for example following strokes. In fact, it is at work on a daily basis. Thus asserts Catherine Vidal, “our brain continues to change throughout our life, based on our learning and our lived experiences. Thanks to the plasticity of his brain, Homo sapiens can bypass genetic and hormonal determinism“. And the neurobiologist concludes: “The human being is not a machine programmed by genes and hormones. He has a free will which allows him a freedom of choice in his actions and behaviors. “

A great disarray

A person’s perceived discrepancy between their biological sex and their gender identity is often accompanied by great distress.

A social rejection, a rejection of the family

This distress that grips some transgender people has been studied by a team from the National Institute of Psychiatry in Mexico City. These researchers seem to show that in reality, the distress encountered by some transgender people is not an inherent characteristic of their identity, but is much more due to the experience of social rejection and violence. The rejection of the family would also be the most influential factor in this disarray.

Anguish, disgust, even mutilation

On the other hand, these people’s feelings about their own secondary sex characteristics and those of the opposite gender are very strong. For many, the physical maturation and growth of their discordant sexual characteristics is a strong source of angst, a cause of disgust, which can even lead to mutilation.

Higher prevalence of mental illness

Mental illness is common in the transgender population: the prevalence of depression is double compared to the general population. Investigations should be carried out in each case to see if this is associated with gender dysphoria or related to other problems.

Abus

In addition, abuse, harassment, discrimination, isolation, and suicidal ideation are significantly higher among individuals identified as transgender.

Few sex stories

It is common for young people to report very little or no sexual history.

Being an individual who identifies as transgender is not inherently pathological. Investigations are essential, in particular to know the patients who would like to benefit from hormonal therapies. It is important that the attending physician has a good understanding of gender dysphoria, as they will often be the first point of contact for these patients. More often isolated, they also have higher rates of depression and suicide, so they need to be taken on the right path with kindness.

Because taken care of appropriately, the prognosis of gender dysphoria is generally positive: its treatment allows real improvements. This can include the combination of psychotherapy, management via hormone therapy, and sometimes surgery. These treatments are safe, and effective in the long term. Very few people who have surgically changed genitals have regrets about their decision later in life.

In addition, in the new international classification of diseases, known as ICD-11, which was published in June 2018 and is due to enter into force on January 1, 2022, the World Health Organization has created a new chapter devoted to sexual health. . It covers conditions previously classified elsewhere, such as this gender incongruence, hitherto listed with mental disorders. Thus, gender dysphoria can no longer be considered to be a mental disorder.