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submitted 6 days ago by dandelion to c/asklemmy@lemmy.ml

Politeness norms seem to keep a lot of folks from discussing or asking their trans friends questions they have, I figured at the very least I could help try to fill the gap. Lemmy has a decent trans population who might be able to provide their perspectives, as well.

Mostly I'm interested in what people are holding back.

The questions I've been asked IRL:

  • why / how did you pick your name?
  • how long have you known?
  • how long before you are done transitioning?
  • how long do you have to be on HRT?
  • is transgender like being transracial?
  • what do the surgeries involve?

For the most part, though, I get silence - people don't want to talk about it, or are afraid to. A lot of times the anxiety is in not knowing how to behave or what would be offensive or not. Some people have been relieved when they learned all they needed to do is see me as my gender, since that became very simple and easy for them.

If there are trans people you know IRL, do you feel you can talk to them about it? Not everyone is as open about it as I am, and questions can be feel rude, so I understand why people would feel hesitant to talk to me, but even when I open the door, people rarely take the opportunity.

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[-] dandelion 10 points 5 days ago

The current science points to gender dysphoria being caused by the brain developing as one sex while the body develops as another.

If you ask whether someone is primarily their brain or their body, I think most would say identity resides in the brain and subsequent mind. In that sense, gender dysphoria is a genetic and hormonal disorder, basically a condition of yes, having the "wrong body" for the brain they developed as a fetus. This glosses over a lot of details and sex is complicated, but that's the rough sketch. The condition arises from the brain and the mind, and in that sense can be labelled a mental illness, but that would ignore a lot of context and evidence we have about what is going on.

It is with this understanding and with the guidance of substantial empirical evidence that transition and gender-affirming care are recommended - it is the only treatment that alleviates symptoms (conversion therapy, for example, increases risk of suicide), but also these are treatments with a very high success to failure ratio. Gender affirming surgeries have lower regret rates than practically any other surgery, much lower than knee replacement surgeries, for example.

So we deal with gender dysphoria differently than we deal with other mental illnesses because of what we know about the condition. We know that people with body dysmorphia like anorexics feel distress about their body and might seek surgery to "fix" their bodies, but we don't have the large body of evidence that those surgeries improve patient outcomes, relieve symptoms, or are low risk. So we treat anorexia differently than gender dysphoria, because they have different causes and require different treatments.

So gender dysphoria could be classed as a mental illness in a way, but it's important not to be confused by this and think it's a fabrication or that people with gender dysphoria could just think their way out of their condition - it's biological and not able to be solved with therapy or anti-depressants. Trans people respond really well to living as their gender (go figure!), and we see the same with cis people who are raised as the wrong gender (like in the case of David Reimer). We also see that cis people who are forced to take cross-sex hormones, like when homosexuals were given criminal punishments of estrogen treatments in the UK as in the case of Alan Turing, that those people become gender dysphoric in the same way. Gender dysphoria is not just for trans people, forcing cis people to be on the wrong hormones make them depressed too - are cis people just mentally ill when they have symptoms from being forced to live and medically transition to the other sex? It's not different for trans people.

[-] christian@lemmy.ml 5 points 5 days ago* (last edited 5 days ago)

We also see that cis people who are forced to take cross-sex hormones, like when homosexuals were given criminal punishments of estrogen treatments in the UK as in the case of Alan Turing, that those people become gender dysphoric in the same way. Gender dysphoria is not just for trans people, forcing cis people to be on the wrong hormones make them depressed too - are cis people just mentally ill when they have symptoms from being forced to live and medically transition to the other sex? It’s not different for trans people.

What I was getting at with saying I wouldn't be comfortable switching now, but I would have been fine born into it is there there's a shock that would come with a change from what you've lived, and that being cisgendered wouldn't negate that shock, it would be miserable, but I don't feel an attachment in the sense that I feel glad I was born a man. That's what I meant when saying if I had been born a woman I wouldn't be happy with the idea of changing to be a man.

So gender dysphoria could be classed as a mental illness in a way, but it’s important not to be confused by this and think it’s a fabrication or that people with gender dysphoria could just think their way out of their condition - it’s biological and not able to be solved with therapy or anti-depressants. Trans people respond really well to living as their gender (go figure!), and we see the same with cis people who are raised as the wrong gender (like in the case of David Reimer).

This is what I was trying to get at with the difference between suppression and accommodation, and gender-affirming care being accommodation. But I don't think it's fair to reduce all mental illnesses to being not biological and being "solved with therapy or anti-depressants", I think that is part of the stigma against them. Some of them should be accommodated and not suppressed. Physical treatments are often more helpful than those things, different illnesses need to be addressed in different ways, not treated as a generic umbrella for characteristics society doesn't approve of.

Sorry for not addressing all of it but I'm skeptical that you read what I wrote there because I explicitly spoke in favor of gender-affirming care as the treatment and your response reads to me like I was arguing against it.

[-] dandelion 1 points 9 hours ago* (last edited 9 hours ago)

is there there’s a shock that would come with a change from what you’ve lived, and that being cisgendered wouldn’t negate that shock, it would be miserable, but I don’t feel an attachment in the sense that I feel glad I was born a man.

I'm having a hard time making sense of what you are trying to communicate, particularly about a shock 🤔 You should know it's not uncommon for cis people to not have thought about their gender or to have particular attachments to their assigned gender. Usually people just haven't thought about it and have no awareness of all the ways they are attached to their gender.

Still, most men have some attachments, they usually would say they might be unhappy if their penis and testes were lost in an accident, for example. And most men would probably feel unhappy having to wear dresses and so on. All you have to do is imagine or actually attempt to live as the opposite sex and you'll quickly get a sense of what aspects of your gender are important to you.

That’s what I meant when saying if I had been born a woman I wouldn’t be happy with the idea of changing to be a man.

If you were born a cis woman you would be happy being as a woman, but the question is whether you, as you are now, were born into a woman's body and then given a girl's name, and then expected to have tea parties with your girlfriends and do braiding circles and so on. Your parents would send you to school in dresses and expect someday you would get pregnant and marry a man, and so on. It's really hard for cis people to actually consider what this would be like, I don't really hold this against you, it's genuinely difficult (maybe impossible, that's my current view - lived experience and qualia just can't be transferred).

But I don’t think it’s fair to reduce all mental illnesses to being not biological and being “solved with therapy or anti-depressants”, I think that is part of the stigma against them.

I don't mean to communicate that all mental illnesses are addressed that way, just that some mental illnesses are addressed that way, and as a result a common line of reasoning is that gender dysphoria should be treated that way too. This isn't the argument you're making, but I'm raising it because this is a relevant point in the discussion about gender dysphoria as a mental illness and you're not the only person reading these comments.

Physical treatments are often more helpful than those things, different illnesses need to be addressed in different ways, not treated as a generic umbrella for characteristics society doesn’t approve of.

I agree with this.

Sorry for not addressing all of it but I’m skeptical that you read what I wrote there because I explicitly spoke in favor of gender-affirming care as the treatment and your response reads to me like I was arguing against it.

I did read what you wrote, but people don't always have awareness of their views or the consequences of their views.

I think you might be missing that the trans person you're talking to is sensitive to a conservative anti-trans talking point being raised and argued for, and that merely disclaiming the common conclusion the anti-trans point is designed to reach does not completely address this. I'm not going to answer narrowly by ignoring that larger context, that would be irresponsible.

[-] ada 6 points 5 days ago

What I was getting at with saying I wouldn't be comfortable switching now, but I would have been fine born into

David Reimer was forcefully transitioned as a child, when he was young enough to not remember. It created a lifetime of dysphoria for him, and he transitioned back to his birth gender as soon as he understood what had happened to him, and was able to.

[-] dandelion 1 points 10 hours ago* (last edited 10 hours ago)

I do think a lot of cis people struggle to understand gender dysphoria. Feeling neutral about your gender because you've never had to think about it is not the same as knowledge that you would be totally fine being born into the opposite sex. Regardless, it's not the best way to reason about what trans experience is like, tbh.

[-] traceur301 5 points 5 days ago

It sounds like for you to understand the existence of trans people you probably first need to accept that other people experience gender and sexuality differently than the way you do

[-] christian@lemmy.ml 4 points 5 days ago* (last edited 5 days ago)

Before I do that though, I'm commenting a follow-up to ask you to elaborate on if there's something specific I can introspect on. I'll read and think over the next few days.

One last edit:

Logging off is because I know this is an issue I have. Right now I don't have much to be proud of other than my character, so in a moment I'm bad at listening and taking in criticisms that might suggest bigotry, because it feels like an attack on my identity. I'm aware that in reality I should be listening and not fighting, it just takes me an unreasonable amount of time and I act like a jackass until I've processed. Hence, logging out to introspect. Better late than never.

[-] christian@lemmy.ml 4 points 5 days ago* (last edited 5 days ago)

I'll introspect on that. It generally takes me time to digest. I'm embarrassed here. But I do agree that gender-affirming care is the correct treatment. I read your response like I was not explicit about being in favor of it.

I think I should log off and mull on it because right now I'm just being an asshole. I'm a very slow learner and it generally takes a few days after I argue vehemently against something for it to sink in that I was wrong. I interpreted the first response like you thought I was arguing it should be addressed in a way other than gender-affirming care and responded like that was an attack, which is really shitty of me and pretty embarrassing.

[-] christian@lemmy.ml 2 points 5 days ago* (last edited 5 days ago)

Took some time to reflect, I communicated my question quite poorly and that is on me but I'm gonna try to ask it in a better way.

I feel somewhat strongly that trans-affirming care is the only appropriate approach to treating being trans. I have the impression that as a trans person you feel this is wholly incompatible with my sense that it is a mental health issue. I'd like to explicitly ask why my two beliefs are contradictory.

I'm asking because I am just in the past year or so suffering with severe physical and mental illnesses, and when I try to picture what the trans experience is like, I find that what I am imagining aligns very closely with my mental illnesses and not closely at all with my physical illnesses. I was extremely reluctant to accept that I have a mental illness because of both societal stigma and because in my situation, no one in their right mind would choose to treat my mental illnesses with therapy and pills when a change in living conditions would actually help enormously more, which seemed analogous to treating being trans.

That is what's made me feel my two beliefs aren't contradictory - I hadn't understand how deeply I had internalized stigma against the mentally ill until I was asked to apply it to myself. I am imagining that other people would resist identifying as having mental illness in the same way I was. I picture the trans experience as emotional anguish with all physical threats as consequences of that emotional anguish. One where, also like many cases of mental illness, physical treatments are the correct option. But I don't understand a way to liken it to my experiences with physical illness, so maybe it would be helpful to understand the physical danger and physical suffering explicitly.

I think there are extremely few situations where a mental illness should be treated as something to correct rather than accommodate without the patient being fully on board with thinking of it as something that needs to be corrected. In many cases, the only reason a patient would be fully on board is societal stigma and designed inaccessibility of accommodations, which is the impression I have of the trans experience as well. That's the reason I don't think of options other than trans-affirming care as okay.

I reacted badly because of recently surfaced mental health issues (blehhh) where I obsess over my character and respond to perceived character attacks as an attack on my identity even though I should just be listening. Your response seemed to focus on why I should agree with gender-affirming care and I read that as a character attack, rather than considering that you don't see it as even possible to believe being trans is a mental health issue that should only be addressed by gender-affirming care. I was being overly wordy to try to be clear that I'm trying to understand how your experience compares with mine, and look, we're back again.

Also I tend to read comments like that as a disgust and a need to distance from the mentally ill, and that's something I very much need to work on because I know it's not the intention at all. It stung more than usual in this case because I was looking to build camaraderie and tried my best to clarify that I don't want mental illness to be an attack and that I am in favor of gender-affirming care.

This time I promise I will have the good sense to wait at least a few hours in responding to something that makes me feel bigoted. I apologize for being hurtful earlier and I'm hoping this one is less so.

tl;dr - The core stumbling block for me is this one - when I try to picture what the trans experience is like, I find that what I am imagining aligns very closely with my mental illnesses and not closely at all with my physical illnesses. I've elaborated way too much on why that is. I need to hear what I have imagined incorrectly, what I have overlooked.

[-] dandelion 1 points 9 hours ago* (last edited 37 minutes ago)

Hm, you've said a lot, so there is a lot to cover. I've been very busy traveling and haven't been able to respond to comments like this, so apologies for the delay, the reasons for the delay were on my end.

First, I am hearing you disclose that you are struggling mentally, but it's a bit ambiguous what you are struggling with. I hear you saying that you are sensitive to feeling criticized or attacked, and sensitive to having disgust or stigma as a reaction to your mental illness.

One aspect of the whole debate about whether gender dysphoria is a mental illness does have to do with exactly that stigma associated with mental illness, and a reason for that is that homosexuality was also stigmatized and classified as a mental illness. As gay rights were achieved, the stigma and classification of homosexuality as a mental illness was reconsidered.

I would like to hold space for both realities: that classifying something as a mental illness is a way society communicates stigmatized way of thinking about behavior, and also that this stigma can be an inappropriate response to mental illness (even classically stigmatizing mental illnesses, like psychosis).

It is also worth noting that I did notice you said you were in favor of gender affirming care as a treatment of gender dysphoria, even while still thinking of gender dysphoria as a mental illness. To turn this around a little, I wonder if you noticed that I admitted gender dysphoria could be thought of as a mental illness in some sense of what it means to be a mental illness.

I do think you might have missed some of my larger points, which were not primarily trying to convince you that gender affirming care is important or the right way to treat it (which you have already affirmed), but why that is true - this gets to the point about classifying it as a mental illness.

Gender dysphoria is a genetic, hormonal, neural, and physical condition that causes both physical and mental symptoms. It is not just a mental illness because it is also a hormonal disorder, for example. It is more like diabetes or hypothyroidism. You also experience mental symptoms if you are an untreated diabetic, for example. The brain develops a certain way, and the body develops another way, and as a result the dominance of the wrong sex hormones creates problems. As Ada has already pointed out, this is true for a cis person - if you take a cis person and raise them as the opposite sex, they experience the same gender dysphoria.

"Mental illness" is very broad and that gets into problems, though. Some mental illnesses are like gender dysphoria, caused by genetic and physical conditions which can be alleviated medically through various drugs, surgeries, etc. Sometimes the brain just doesn't work for some reason that ends up being more physiology than psychology.

Other mental illnesses are caused by the experiences we have and our psychology. I suffered from an eating disorder at one point as a result of abuse from a family member. I have experienced hyper-vigilance and symptoms of PTSD as a result of abuse as well. Both of those were not caused nor solved through medicine or surgery, the problems were more psychological.

So what is so important about classifying gender dysphoria as a mental illness? Usually this comes up when conservatives wish to dismiss gender dysphoria as a legitimate or valid reason for someone's gender identity to be respected. It's a reason for them to not just stigmatize but dismiss - the conservative might argue it's a mental illness like PTSD (and not a medical condition like diabetes). They then want to argue that social and medical transition is inappropriate and heavy-handed as a treatment, and instead it should be treated with talk therapy (which is conversion therapy), and so on. This is based on nothing more than discomfort and bias about trans people, there is no evidence supporting it (and plenty of evidence for why we shouldn't treat gender dysphoria with conversion therapy - like, it doubles the risk of suicide).

I understand completely that this conservative "argument" is not what you are agreeing with, but you should know that the only reason we are having this discussion is because gender dysphoria has been framed this way by an anti-trans movement that aims to deny trans people their medical care. It's a needless discussion and way to rationalize and wedge people on the trans topic - doctors are not wringing their hands over this or wondering whether it's a mental illness. The doctors and scientists know now that gender identity is biological and genetic, that gender dysphoria is not like PTSD or other mental illnesses like that, and that the treatment is social transition, hormones, and surgeries as appropriate (i.e. as the patient seems to need it, based on the consensus of the patient, their therapist, and doctors).

So why is this so relevant? What does it mean to be a mental illness to you, and why is it so important to determine if it is a mental illness or not?

EDIT: I forgot to mention, one of the problems with thinking of gender dysphoria as just a mental illness is that this is often used to imply the experience of gender identity is delusional when it's not according with the assigned sex at birth. A neurobiologist might argue that the brain is where a person's identity exists in the first place, and if you were to choose between someone being their brain or their body, it is obvious people's identities are in their brains. To this extent, trans women are women because their brains are female - their gender identity is biologically hard-wired, and not a delusion, and thus not a mental illness. The body is what is wrong, so it's what gets changed.

EDIT2: oops, I didn't forget to mention that, it was the first point I made in my initial reply to your comment 😅 We're going in circles now!

[-] felsiq@piefed.zip 1 points 5 days ago

There was something I wanted to say in response to your original question, but I forgot it because I was too impressed with your emotional maturity and self-awareness in your responses

I might edit this or comment again if I remember, but for now I just wanted to say I really admire you for that :)

this post was submitted on 24 Aug 2025
141 points (100.0% liked)

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