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A whole bunch of proofreading (#113)

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* intro proofreeding pass

* what is gender proofreading pass

> (more about that in the Causes of Gender Dysphoria section)
Is it possible to make this link to the section?

* history of gender dysphoria proofreading pass

* disclaimer proofreading pass

* gender euphoria proofreading pass

Would it be worth linking to [the Wikipedia article for Plato's cave allegory](https://en.wikipedia.org/wiki/Allegory_of_the_cave)?

* physical dysphoria proofreading pass

* biochemical dysphoria proofreading pass

* social dysphoria proofreading pass

I'm assuming the forgotten adjective in "surprisingly phenomenon" was something like "common", so please correct it if it's wrong

* societal dysphoria proofreading pass

> [...] (beyond the discomfort that women experience, as this includes genuine attention, not just unwanted attention).
Recommend rewording this, as it seems to imply that the discomfort women experience is what includes genuine attention rather than the discomfort AFAB trans people experience

* sexual dysphoria proofreading pass

* presentational dysphoria proofreading pass

* existential dysphoria proofreading pass

> Sometimes existential dysphoria can manifest existentially
strongly recommend rewording for redundancy reasons

* managed dysphoria proofreading pass

* impostor syndrome proofreading pass

> ***[YES, YOU ARE TRANS ENOUGH](https://www.amazon.com/Yes-You-Are-Trans-Enough/dp/1785923153/)***
do we really have to support Jeff Bezos?

* Update am-i-trans.md

"it’s nearly impossible avoid listening to oneself over others." has been reworded as "it’s nearly impossible to avoid listening to others over oneself." as the former seems contradictory to the rest of the paragraph, but I may be missing something, so please correct me if it's wrong

I also suggest rewording "I thought being dysphoric all the time was normal human behavior" so as to not imply that dysphoria is a behavior and therefore a choice

Also could use confirmation that "If you want to be a girl and you’ve always thought of yourself as a guy, then you will probably be happier living as a girl." is worded correctly

* Clinical Diagnoses proofreading pass

Some of these changes are to bring the wording somewhat closer to the text of the DSM-5 without making it too binary-centric

* missed one

* Treating Gender Dysphoria proofreading pass

"A newly developing area of bottom surgery is in AMAB non-binary operations which attempt to perform vaginoplasty *without* the removal of the penis. This particular surgery is extremely experimental and has been performed less than a dozen times in the United States, but the outlook for the future is good."
Highly recommend a source on this (admittedly mostly because it interests me personally and I couldn't find anything about it when I looked it up)

* Causes of Gender Dysphoria proofreading pass

* Chromosomes proofreading pass

* forgot some

* Hormones proofreading pass

* Androgenic Second Puberty proofreading pass

* Estrogenic Second Puberty proofreading pass

Removed dead link to https://youtu.be/OROoZzoVwfk?t=12

* Conclusion proofreading pass

* Patch 8 (#1)

* Small fixes and updates for the Portuguese translation (#124)

* fix(es): syntax error that prevented compilation

* feat(pt): add main text translation

* feat(pt): add tweets translation

* feat(pt): add PDF generation to GitHub workflow

* fix(pt): add misisng translations and formatting fixes

* fix(css): link fragment overlap with page header

* fix(css): add font Inter before Gothic A1

The Gothic A1 font lacks a few characters necessary for writing Portuguese, namely: á, í, ó, ú, ã, õ, and their upper case versions.

* fix(pt): remove 'Glossário' entry from _menu.hbs

* fix(build): slugify.js

* fix(pt): various typos and a few missing translations.

* chore: add .vscode to .gitignore

* pt: update index.md to match the current English version

* pt: minor fixes for que-e-genero.md

* pt: small fixes for historia.md

* pt: replace "gendrar" with "generizar"

* pt: more small fixes

* Hirschfield -> Hirschfeld

---------

Co-authored-by: G Queiroz <gabrieljvnq@gmail.com>

* Patch 5 (#2)

* Small fixes and updates for the Portuguese translation (#124)

* fix(es): syntax error that prevented compilation

* feat(pt): add main text translation

* feat(pt): add tweets translation

* feat(pt): add PDF generation to GitHub workflow

* fix(pt): add misisng translations and formatting fixes

* fix(css): link fragment overlap with page header

* fix(css): add font Inter before Gothic A1

The Gothic A1 font lacks a few characters necessary for writing Portuguese, namely: á, í, ó, ú, ã, õ, and their upper case versions.

* fix(pt): remove 'Glossário' entry from _menu.hbs

* fix(build): slugify.js

* fix(pt): various typos and a few missing translations.

* chore: add .vscode to .gitignore

* pt: update index.md to match the current English version

* pt: minor fixes for que-e-genero.md

* pt: small fixes for historia.md

* pt: replace "gendrar" with "generizar"

* pt: more small fixes

* Hirschfield -> Hirschfeld

---------

Co-authored-by: G Queiroz <gabrieljvnq@gmail.com>

* Patch 4 (#3)

* Small fixes and updates for the Portuguese translation (#124)

* fix(es): syntax error that prevented compilation

* feat(pt): add main text translation

* feat(pt): add tweets translation

* feat(pt): add PDF generation to GitHub workflow

* fix(pt): add misisng translations and formatting fixes

* fix(css): link fragment overlap with page header

* fix(css): add font Inter before Gothic A1

The Gothic A1 font lacks a few characters necessary for writing Portuguese, namely: á, í, ó, ú, ã, õ, and their upper case versions.

* fix(pt): remove 'Glossário' entry from _menu.hbs

* fix(build): slugify.js

* fix(pt): various typos and a few missing translations.

* chore: add .vscode to .gitignore

* pt: update index.md to match the current English version

* pt: minor fixes for que-e-genero.md

* pt: small fixes for historia.md

* pt: replace "gendrar" with "generizar"

* pt: more small fixes

* Hirschfield -> Hirschfeld

---------

Co-authored-by: G Queiroz <gabrieljvnq@gmail.com>

* Patch 3 (#4)

* Small fixes and updates for the Portuguese translation (#124)

* fix(es): syntax error that prevented compilation

* feat(pt): add main text translation

* feat(pt): add tweets translation

* feat(pt): add PDF generation to GitHub workflow

* fix(pt): add misisng translations and formatting fixes

* fix(css): link fragment overlap with page header

* fix(css): add font Inter before Gothic A1

The Gothic A1 font lacks a few characters necessary for writing Portuguese, namely: á, í, ó, ú, ã, õ, and their upper case versions.

* fix(pt): remove 'Glossário' entry from _menu.hbs

* fix(build): slugify.js

* fix(pt): various typos and a few missing translations.

* chore: add .vscode to .gitignore

* pt: update index.md to match the current English version

* pt: minor fixes for que-e-genero.md

* pt: small fixes for historia.md

* pt: replace "gendrar" with "generizar"

* pt: more small fixes

* Hirschfield -> Hirschfeld

---------

Co-authored-by: G Queiroz <gabrieljvnq@gmail.com>

* Patch 6 (#5)

* Small fixes and updates for the Portuguese translation (#124)

* fix(es): syntax error that prevented compilation

* feat(pt): add main text translation

* feat(pt): add tweets translation

* feat(pt): add PDF generation to GitHub workflow

* fix(pt): add misisng translations and formatting fixes

* fix(css): link fragment overlap with page header

* fix(css): add font Inter before Gothic A1

The Gothic A1 font lacks a few characters necessary for writing Portuguese, namely: á, í, ó, ú, ã, õ, and their upper case versions.

* fix(pt): remove 'Glossário' entry from _menu.hbs

* fix(build): slugify.js

* fix(pt): various typos and a few missing translations.

* chore: add .vscode to .gitignore

* pt: update index.md to match the current English version

* pt: minor fixes for que-e-genero.md

* pt: small fixes for historia.md

* pt: replace "gendrar" with "generizar"

* pt: more small fixes

* Hirschfield -> Hirschfeld

---------

Co-authored-by: G Queiroz <gabrieljvnq@gmail.com>

* Patch 7 (#6)

* Small fixes and updates for the Portuguese translation (#124)

* fix(es): syntax error that prevented compilation

* feat(pt): add main text translation

* feat(pt): add tweets translation

* feat(pt): add PDF generation to GitHub workflow

* fix(pt): add misisng translations and formatting fixes

* fix(css): link fragment overlap with page header

* fix(css): add font Inter before Gothic A1

The Gothic A1 font lacks a few characters necessary for writing Portuguese, namely: á, í, ó, ú, ã, õ, and their upper case versions.

* fix(pt): remove 'Glossário' entry from _menu.hbs

* fix(build): slugify.js

* fix(pt): various typos and a few missing translations.

* chore: add .vscode to .gitignore

* pt: update index.md to match the current English version

* pt: minor fixes for que-e-genero.md

* pt: small fixes for historia.md

* pt: replace "gendrar" with "generizar"

* pt: more small fixes

* Hirschfield -> Hirschfeld

---------

Co-authored-by: G Queiroz <gabrieljvnq@gmail.com>

* Link directly to book publisher's page instead of Amazon

---------

Co-authored-by: G Queiroz <gabrieljvnq@gmail.com>
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public/_index-copy.md
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@ -6,7 +6,7 @@
In cultures worldwide, for as long as human civilization has existed, [there have been people](https://en.wikipedia.org/wiki/Transgender_history) whose experience of their gender identity do not align with the anglo-european concepts of binary sex based on genital structure. The Gala, a middle gender priest class of the Sumerian empire, existed over 4,500 years ago. The Indigenous cultures of North America recognized [a third gender](https://en.wikipedia.org/wiki/Third_gender) far before European colonialism, and still do to this day. Tribal [cultures all across Africa](https://medium.com/@janelane_62637/the-splendor-of-gender-non-conformity-in-africa-f894ff5706e1) recognize numerous gender identities, which [Europeans tried to wipe out](https://daily.jstor.org/the-deviant-african-genders-that-colonialism-condemned/). Human beings have long lived with identities, norms, and degrees of conformity to those norms which differ from the so-called "traditional" idea of gender in westernized culture today.
In spite of this, however, the modern western understanding of the transgender experience has only existed for approximately 130 years. Even the word "transgender" only dates back to 1965, when John Oliven proposed it as a more accurate alternative to David Cauldwell's term "transsexual" (coined in 1949), which itself replaced Magnus Hirschfield's term "transvestite" (1910).
In spite of this, however, the modern western understanding of the transgender experience has only existed for approximately 130 years. Even the word "transgender" only dates back to 1965, when John Oliven proposed it as a more accurate alternative to David Cauldwell's term "transsexual" (coined in 1949), which itself replaced Magnus Hirschfeld's term "transvestite" (1910).
Being transgender can mean that a person born with a penis is actually a girl, that a person born with a vulva is actually a boy, or that a person with any genital configuration may not wholly fit either side of that spectrum and is non-binary.

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@ -1,4 +1,4 @@
<div class="disclaimer"><div>
<strong>The Gender Dysphoria Bible is a Living Document</strong>
<p>The contents of this site will change over time as new additions and revisions are made to further expand upon the full breadth of Gender Dysphoria. In its current iteration it is severely lacking in non-binary, agender &amp; genderfluid specific dysphoria, as well as Third Gender and Two-Spirit narratives. The GDB is an open source and publicly funded project, <a href="/contributing/">contributions are extremely welcome</a>.</p>
<p>The contents of this site will change over time as new additions and revisions are made to further expand upon the full breadth of gender dysphoria. In its current iteration it is severely lacking in dysphoria specific to non-binary, agender, &amp; genderfluid people, as well as third gender and two-spirit narratives. The GDB is an open source and publicly funded project; <a href="/contributing/">contributions are extremely welcome</a>.</p>
</div></div>

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@ -17,11 +17,11 @@ preBody: '_disclaimer'
# Am I Trans?
Long before I started questioning my gender, I had this idle fantasy where one of my best lady friends would walk up to me and say, “give it up, you’re not fooling anyone.”
Long before I started questioning my gender, I had this idle fantasy where one of my best lady friends would walk up to me and say, “Give it up. You’re not fooling anyone.”
If you’d confronted me about this fantasy at the time, I couldn’t have told you what, exactly, I meant by “you’re not fooling anyone.” Deep down I knew that it was probably related to gender, but my lips wouldn’t have been able to form those words. All I knew was that I was pretending to be someone I was not, in some vague, passive, and ephemeral way.
Once I self-accepted as a trans woman and started the long process of coming out , all I wanted was for someone to tell me that they already knew. “I’m so happy you figured it out,” I wanted them to gush. “I’ve known the truth for years. It was so obvious. I don’t know anyone could have ever thought that you were a boy. I’m so happy that you’ll finally get to live as your true self now.”
Once I self-accepted as a trans woman and started the long process of coming out, all I wanted was for someone to tell me that they already knew. “I’m so happy you figured it out,” I wanted them to gush. “I’ve known the truth for years. It was so obvious. I don’t know how anyone could have ever thought that you were a boy. I’m so happy that you’ll finally get to live as your true self now.”
Nobody ever said this to me, though. My coming-out process was successful, and most of my friends were supportive, but I never got the external validation that I craved. My friends and family accepted me as trans because I told them I was trans. They hadn’t noticed that I’d spent the past two decades wearing the ill-fitting costume of a man who barely existed.
@ -29,13 +29,13 @@ Nobody ever said this to me, though. My coming-out process was successful, and m
My good friend Lily coined the phrase **“Egg Prime Directive”** to describe the fact that trans people have an unspoken agreement not to tell people who are questioning their gender whether or not they are trans.
When someone is just told they are trans, then that opens ground for denial, it activates defense mechanisms built by internalized transphobia, and has a high probability of pushing them further into the closet, if not make them outright transphobic. Even when it doesn’t, it leaves ground for their own subconscious to reject their dysphoria, claiming that they were just manipulated or deceived.
The much more affective strategy is to talk about your own experiences with dysphoria so that they see the common grounds and come to their own conclusion about their gender. The code doesn’t forbid helping them to explore their gender, it forbids assigning a gender to them.
Or to put it more succinctly, you cannot be told what the matrix is, you can only be shown.
When someone is just told they are trans, that opens ground for denial; it activates defense mechanisms built by internalized transphobia, and it has a high probability of pushing them further into the closet, if not making them outright transphobic. Even when it doesn’t, it leaves ground for their own subconscious to reject their dysphoria, claiming that they were just manipulated or deceived.
The much more effective strategy is to talk about your own experiences with dysphoria so that they see the common grounds and come to their own conclusion about their gender. The code doesn’t forbid helping them to explore their gender; it forbids assigning a gender to them.
Or, to put it more succinctly, you cannot be told what the Matrix is; you can only be shown.
I’m sure there are some trans people out there who don’t follow the Egg Prime Directive, but I haven’t met them. It’s one of the only things that seems to unify the whole trans community, myself included. Even though I wanted my own external validation more than anything, I now see that true acceptance could have only come from within. The only person who can tell you that you are trans is yourself.
The paradox is that most closeted trans people are absolutely terrible at trusting their inner voice. When you spend your whole life with a nagging disconnect between how the world sees you and how you see yourself, it becomes easier to rely on other people to tell you “who you really are.” Even if you know deep down that all the people in your life are missing some fundamental fact about your identity, it’s nearly impossible avoid listening to oneself over others.
The paradox is that most closeted trans people are absolutely terrible at trusting their inner voice. When you spend your whole life with a nagging disconnect between how the world sees you and how you see yourself, it becomes easier to rely on other people to tell you “who you really are.” Even if you know deep down that all the people in your life are missing some fundamental fact about your identity, it’s nearly impossible to avoid listening to others over oneself.
My goal today, then, is to give you some of the information and mental framing that helped me self-accept. I can’t tell you whether or not you are transgender, but I can point you down a path that you might be able to travel down yourself. I can’t provide the answers, but I can try to give you the right questions.
@ -46,19 +46,19 @@ My goal today, then, is to give you some of the information and mental framing t
<div class="card-body">
æææ
It is never safe to simply tell someone that they are transgender when they haven't asked themselves, even when you are 100% certain that they are. You can educate them on Gender Dysphoria, you can show them parallels between their feelings and your feelings, but you *cannot* simply say to a person "You are transgender".
It is never safe to simply tell someone that they are transgender when they haven't asked themselves, even when you are 100% certain that they are. You can educate them on gender dysphoria and you can show them parallels between their feelings and your feelings, but you *cannot* simply say to a person, "You are transgender".
Why? Because most of the time they won't believe you.
Internalized transphobia has indoctrinated us all to believe that its impossible that we are trans, or that being trans is something negative and reviled. Pressures from within a persons family or from their upbringing can make it extremely hard to accept themselves.
Internalized transphobia has indoctrinated us all to believe that it's impossible that we are trans, or that being trans is something negative and reviled. Pressures from within a person's family or from their upbringing can make it extremely hard to accept themselves.
Trying to tell someone who isn't already questioning that you think they're transgender triggers a self defense mechanism, their subconscious actively tries to reject the statement, and there is a high probability that the suggestion will not only push them further into the closet, it can make them hostile towards you for making it. Many transphobes show clear evidence of fighting their own struggles with gender, and there is no shortage of trans people who [have a history of being transphobic](https://curvyandtrans.tumblr.com/post/661595258598113280/interview-with-an-ex-radfem) out of self preservation.
Trying to tell someone who isn't already questioning that you think they're transgender triggers a self-defense mechanism; their subconscious actively tries to reject the statement, and there is a high probability that the suggestion will not only push them further into the closet, but can even make them hostile towards you for making it. Many transphobes show clear evidence of fighting their own struggles with gender, and there is no shortage of trans people who [have a history of being transphobic](https://curvyandtrans.tumblr.com/post/661595258598113280/interview-with-an-ex-radfem) out of self-preservation.
Even when the person accepts your declaration, the fact that you told them instead of letting them discover it themselves leaves an opening for their own self-conscious to instill doubt about their dysphoria and believe that the idea was suggestive, or that they were manipulated into believing they were trans. The only safe pathway forward for someone to learn they are trans is to realize it on their own.
Finally, the entire purpose of being trans is self assignment and self actualization. Telling a person that they are trans is surely as coercive an assignment as what was done when they were born. If you want to help them figure themselves out, tell them about your life, tell them how dysphoria works, send them to this site, give them ways to see how what they experience isn't something that cis people live with.
Finally, the entire purpose of being trans is self-assignment and self-actualization. Telling a person that they are trans is surely as coercive an assignment as what was done when they were born. If you want to help them figure themselves out, tell them about your life, tell them how dysphoria works, send them to this site, and give them ways to see how what they experience isn't something that cis people live with.
Unless of course they ask you if you think they're trans... then the prime directive no longer applies.
Unless, of course, they ask you if you think they're trans... then the prime directive no longer applies.
æææ
</div>
@ -66,11 +66,11 @@ Unless of course they ask you if you think they're trans... then the prime direc
</div>
æææ
As always, please understand that I have no professional training in gender therapy . I am simply writing this from my own amateur research and personal experiences —mostly my own journey and conversations I’ve had with other trans women and gender questioners. Keep in mind that I am coming at this from the perspective of a fairly binary trans lady who transitioned in her early thirties, which means that I am still blind to a lot of the trans experience. Things are are different for trans masculine and non-binary people, as well as for many other trans women. This is not meant to be a universal expert guide — it’s just the best I can give you right now.
As always, please understand that I have no professional training in gender therapy. I am simply writing this from my own amateur research and personal experiences — mostly my own journey and conversations I’ve had with other trans women and gender questioners. Keep in mind that I am coming at this from the perspective of a fairly binary trans lady who transitioned in her early thirties, which means that I am still blind to a lot of the trans experience. Things are are different for trans-masculine and non-binary people, as well as for many other trans women. This is not meant to be a universal expert guide — it’s just the best I can give you right now.
### Consider That Most Cis People Don’t Think About Their Gender Very Much
If you’re already at the stage where you are questioning your gender — even if that just means Googling “Am I Trans?” and then slamming your laptop shut before you get a search result —congratulations, you’ve already thought about your gender more than most cis people will in their entire lifetimes.
If you’re already at the stage where you are questioning your gender — even if that just means looking up “Am I Trans?” and then slamming your laptop shut before you get a search result — congratulations, you’ve already thought about your gender more than most cis people will in their entire lifetimes.
I’ve asked many of my cis friends if they’ve ever seriously thought about their gender identity, and nine times out of ten they have not. Cis people don’t constantly wonder what it would be like to be a girl. They haven’t had daydreams about how nice it would be if they woke up in a different body. Their hearts don’t race when they think about body-swap movies. Some of them may have imagined what it would be like to be in a body with a gender other than their assigned gender at birth, but those thought experiments have been brief and purely intellectual.
@ -80,13 +80,13 @@ There’s no *energy* there. Not for them. If you feel a weird kind of *energy*
This was hard for me to believe at first, but cis people actually enjoy their gender! Cis men like being men, and cis women like being women. They don’t secretly wish they had been born a member of the “opposite” gender or a genderless being or anything else, really. As we’ve already established, they don’t think about their gender much at all.
There are complications here, of course. Plenty of cis men find toxic masculinity stifling and awful, choosing to actively reject the problematic social aspects of their gender. Plenty of women are deeply frustrated by misogyny, the patriarchy, and the tyranny of classical gender roles. “Enjoying being man” does not necessarily mean loving having to bottle up your emotions in all non-NFL situations, and “enjoying being a woman” rarely means that you love getting belittled by your male co-workers or being constantly asked, “so, when are you getting married?”
There are complications here, of course. Plenty of cis men find toxic masculinity stifling and awful, choosing to actively reject the problematic social aspects of their gender. Plenty of women are deeply frustrated by misogyny, the patriarchy, and the tyranny of classical gender roles. “Enjoying being a man” does not necessarily mean loving having to bottle up your emotions in all non-NFL situations, and “enjoying being a woman” rarely means that you love getting belittled by your male co-workers or being constantly asked, “So, when are you getting married?”
Once you cut through all of that, though? Cis people still enjoy their genders. They might wish that certain aspects of how their gender is performed in society were different, but they would still choose to keep their assigned genders if swapping were on the table. Unfortunately, a lot of closeted trans people hear cis people complaining about the frustrating and problematic aspects of their gender and assume that everybody has the same low-grade dislike for their gender that they do.
Closeted trans people also assume that “I don’t hate being a man” is the same thing as “I enjoy being a man.” I can’t tell you how many of these questioning ladies tell me some variation of “I can’t be trans because I don’t hate being a man,” and then go on to describe countless little things they dislike about being seen as male, as if their gender were a pair of wet socks that they could never quite find a way to take off.
You might be surprised to hear that I didn’t actively hate being seen as a man before I came out to myself, either . Being seen as a guy wasn’t a constant source of misery for me. It just…was who I was, apparently, so I learned to just kind of live with it. A lot of people believe that you can only be trans if you feel actively hurt by being seen as a man, but that particular feeling won’t usually arrive until after you’ve started to transition and you finally know who you truly are. Before self-acceptance, your relationship with your assigned gender at birth is likely to feel a lot more like disconnection than distress.
You might be surprised to hear that I didn’t actively hate being seen as a man before I came out to myself, either. Being seen as a guy wasn’t a constant source of misery for me. It just… was who I was, apparently, so I learned to just kind of live with it. A lot of people believe that you can only be trans if you feel actively hurt by being seen as a man, but that particular feeling won’t usually arrive until after you’ve started to transition and you finally know who you truly are. Before self-acceptance, your relationship with your assigned gender at birth is likely to feel a lot more like disconnection than distress.
I also can’t tell you how many times I’ve heard closeted trans women say something like, “well, I don’t hate being a man, and men have lots of institutional privilege. I don’t think I’d choose to be a woman, even if I could, because I wouldn’t want to give up my male privilege.” Male privilege is a real thing, of course, but it isn’t a reward that men get for having to endure the eternal discomfort of being men. Men enjoy being men, and they would still enjoy being men without their social privileges. If the only thing you like about masculinity is male privilege, that probably means something.
@ -96,7 +96,7 @@ For years, I thought that I couldn’t be trans because I didn’t experience ge
One thing that kept me from realizing that I was experiencing dysphoria was the same reason that fish don’t know they’re swimming in water — it’s just what my life had always been like, so I thought being dysphoric all the time was normal human behavior. I knew that I was kind of sad and more than a little odd, and I knew that my experiences with masculinity were at least slightly gender non-conforming, but I was dealing with the pain of dysphoria every single day without having any idea what was actually going on. No matter how bad I felt, I could always come up with a good enough explanation that had nothing to do with gender.
The other problem is that gender dysphoria manifests differently in pre-acceptance trans women than it does in post-acceptance trans women. I always thought that gender dysphoria was the distress that you get from looking in the mirror and seeing a boy starting back at you instead of a girl, but that wasn’t a feeling I actually had until I started transitioning. You can’t get distressed about not seeing a girl in the mirror until after you’ve realize you’re a girl!
The other problem is that gender dysphoria manifests differently in pre-acceptance trans women than it does in post-acceptance trans women. I always thought that gender dysphoria was the distress that you get from looking in the mirror and seeing a boy starting back at you instead of a girl, but that wasn’t a feeling I actually had until I started transitioning. You can’t get distressed about not seeing a girl in the mirror until after you’ve realized you’re a girl!
Before that, dysphoria manifests in dozens of other, much subtler ways. [I wrote about my experience with pre-acceptance dysphoria here, in what has become my most popular essay ever.](https://cassielabelle.medium.com/gender-dysphoria-isnt-what-you-think-6fdc7ae3ac85) I highly recommend reading it in full if you are questioning your gender.
@ -114,7 +114,7 @@ The Null HypotheCis poses a simple and effective question: once you take your fi
It really is that simple. Men want to be men, and women want to be women. If you want to be a man, then you‘re a man. If you want to be a woman, then you’re a woman. If you don’t want to be either, or you want to be both, or you want to be a woman sometimes and a man other times, then you’re probably some flavor of genderfluid or non-binary.
“But you can’t just…do that!” I hear you say. But you absolutely can just do that. In fact, this is basically the one and only question you really have to answer for yourself. If you want to be a girl and you’ve always thought of yourself as a guy, then you will probably be happier living as a girl. It’s at least worth taking some steps to see if transitioning will bring you happiness, right?
“But you can’t just… do that!” I hear you say. But you absolutely can just do that. In fact, this is basically the one and only question you really have to answer for yourself. If you want to be a girl and you’ve always thought of yourself as a guy, then you will probably be happier living as a girl. It’s at least worth taking some steps to see if transitioning will bring you happiness, right?
### Consider That Doubting Yourself Does Not Invalidate Your Possible Trans-ness
@ -130,7 +130,7 @@ If you feel all of this stuff, you’re in good company. My therapist even jokes
### Consider That Your Trans Journey Might Not Fit The Accepted, Popular Narrative
Popular culture has basically decided that there’s only one transfeminine story worth telling. It’s the story of a young trans girl who figures out her identity at a very young age. Even in childhood, she gravitates toward dolls and tea parties. She tries on her older sister’s dresses and begs her mom to buy her make-up and jewelry. She basically always looks like a girl, too — feminine facial features, short stature, thin and androgynous. If she doesn’t transition in childhood or adolescence, then she’ll still somehow makes it to adulthood still looking more or less like a woman. She cross-dresses all the time, and might even be a drag queen. She is also probably attracted to men, and might have worked a spell as a sex worker.
Popular culture has basically decided that there’s only one transfeminine story worth telling. It’s the story of a young trans girl who figures out her identity at a very young age. Even in childhood, she gravitates toward dolls and tea parties. She tries on her older sister’s dresses and begs her mom to buy her make-up and jewelry. She basically always looks like a girl, too — feminine facial features, short stature, thin and androgynous. If she doesn’t transition in childhood or adolescence, then she’ll still somehow make it to adulthood still looking more or less like a woman. She crossdresses all the time, and might even be a drag queen. She is also probably attracted to men, and might have worked a spell as a sex worker.
This is a valid and common trans narrative. I know many girls who have experienced some or all of these tropes. There’s a reason why this story is told over and over again, after all.
@ -142,19 +142,19 @@ But girls like us are incredibly common. [This scientific study from 2003](https
I also believe that more trans women like us are coming out now because there’s so much more representation and so many more resources. In 1991, 2001, even 2011, the path to transition was much more difficult, and most people didn’t know any openly trans people. In this world, the only people who chose to transition were those for whom not doing so was just about impossible.
It isn’t just easier to question your gender here in 2021, it’s easier to gain access to trans communities, hormones, and other crucial resources. If I’d been born thirty years earlier, I might not have transitioned at all. If I’d been born thirty years later, I’d probably have transitioned as a teenager. Don’t worry about whether or not you’ve “always known” if this is the first time you’ve ever had the freedom and resources to truly ask yourself this question.
It isn’t just easier to question your gender here in 2021; it’s easier to gain access to trans communities, hormones, and other crucial resources. If I’d been born thirty years earlier, I might not have transitioned at all. If I’d been born thirty years later, I’d probably have transitioned as a teenager. Don’t worry about whether or not you’ve “always known” if this is the first time you’ve ever had the freedom and resources to truly ask yourself this question.
### Consider That The Things Keeping You From Self-Acceptance Might Have Nothing To Do With Your Identity
Whenever I’m talking to a questioning trans women, the conversation eventually turns to the obstacles that she might face if she chooses to transition. “I worry that I’m too tall/large/hairy/ugly to transition” is a pretty common fear. “I worry that my family will disown me/my partner will leave me” is another worry I hear a lot. Other girls are really worried about their career, education, or college situation. Many fear that they simply can’t handle the medical bills for HRT or trans surgeries.
Whenever I’m talking to a questioning trans woman, the conversation eventually turns to the obstacles that she might face if she chooses to transition. “I worry that I’m too tall/large/hairy/ugly to transition” is a pretty common fear. “I worry that my family will disown me/my partner will leave me” is another worry I hear a lot. Other girls are really worried about their career, education, or college situation. Many fear that they simply can’t handle the medical bills for HRT or trans surgeries.
Everyone — everyone — doubts that they have the fortitude to deal with socially transitioning. Coming out to friends, wearing women’s clothing, dealing with transphobia…it’s a terrifying mess, especially for closeted trans women, who usually fell pretty short on resilience as it is. The whole thing can seem chronically overwhelming.
Everyone — everyone — doubts that they have the fortitude to deal with socially transitioning. Coming out to friends, wearing women’s clothing, dealing with transphobia… it’s a terrifying mess, especially for closeted trans women, who usually feel pretty short on resilience as it is. The whole thing can seem chronically overwhelming.
These fears often manifest in the form of self-gatekeeping. “I’m afraid that I will never be a pretty girl” turns into “I can’t be trans, because what if I’m not pretty enough after I transition?” This seems somewhat silly in a vacuum, but pre-acceptance trans girls will sometimes do anything to convince themselves that they aren’t actually trans. I definitely thought that I wasn’t trans because I simply couldn’t imagine actually taking HRT and dressing like a woman every day. That was something that brave people did, not people like me, so I couldn’t be trans!
Why do we do this to ourselves? I think it’s all about self-protection. We know that transition is incredibly difficult, and so we will try literally everything else in the world before we’re even willing to start facing the “am I trans?” question. We develop really strong self-protective voices that push back hard against the truth because then we don’t have to worry about the terror of what comes next.
Here’s the thing, though: even if you are trans, you don’t actually have to do anything about it. While I highly recommend transitioning, it’s definitely possible to self-accept and then just…do nothing. Keep your name, your pronouns, your life as it is. Or you can just change a few things, and enjoy those little pings of gender euphoria where you can.
Here’s the thing, though: even if you are trans, you don’t actually have to do anything about it. While I highly recommend transitioning, it’s definitely possible to self-accept and then just… do nothing. Keep your name, your pronouns, your life as it is. Or you can just change a few things, and enjoy those little pings of gender euphoria where you can.
The important thing to remember is that the truth of your identity is separate from all of the hopes and fears you have about transitioning. If you’re a girl on the inside, it doesn’t matter what you look like. It doesn’t matter what your family thinks of you. It doesn’t matter whether or not you have the means or even the desire to medically transition. Identity is a mental and spiritual thing, separate from all of this. If you’re a girl, you’re a girl.
@ -176,7 +176,7 @@ This makes a lot of sense when you think about it. Sex is one of the few realms
Unfortunately, exploring gender this way can actually make self-acceptance harder for many trans women. While I found this sort of sexual exploration absolutely necessary in my pre-self-acceptance days, it also meant that I was able to write off my intrusive gender thoughts or daydreams as “just a fetish.” I treated them as something hidden and shameful instead of something to investigate further.
This issue is further complicated by the term “autogynephilia,” a bogus transphobic “theory” posited by a crank psychologist named Ray Blanchard. Autogynephilia posits that many people who self-identify as trans women aren’t actually women at all, but are instead creepy men who are turned on by the idea of being a woman or having a vagina. According to Blanchard, their entire transition is just an elaborate fetish game that they’re forcing the the world to participate in.
This issue is further complicated by the term “autogynephilia,” a bogus transphobic “theory” posited by a crank psychologist named Ray Blanchard. Autogynephilia posits that many people who self-identify as trans women aren’t actually women at all, but are instead creepy men who are turned on by the idea of being a woman or having a vagina. According to Blanchard, their entire transition is just an elaborate fetish game that they’re forcing the world to participate in.
I want to be clear, here: autogynephilia is bullshit. [It has been discredited by actual scientists and researchers many, many times.](https://juliaserano.medium.com/making-sense-of-autogynephilia-debates-73d9051e88d3) The entire point of this theory, as far as I can tell, was to try and get cis people to start viewing trans women as male sex predators. Thankfully, most cis people don’t feel this way, and most of them haven’t heard of Blanchard or autogynephilia at all.
@ -212,7 +212,7 @@ Unfortunately, this is pretty much impossible to do, especially before you’ve
To that end, it’s worth keeping in mind that you are not a puzzle to be solved. You do not have to perform an exact taxonomic classification of your own gender. You’re just a human with your own complex set of needs, desires, dreams, goals, fears, triggers, and a whole mess of everything else. You are a contradictory, complex, illogical being who contains vast multitudes.
This is kind of scary, but hopefully it’s also somewhat freeing. There’s no “proper” timeline to your transition. No list of things that you absolutely have to do. You can keep your name, or change it. You can get gender conformation surgery, or you can keep what you’ve got. You can wear dresses every day, or you can leave them all for me. Some trans ladies have been dressing like women since they were old enough to buy clothes, but I didn’t once wear a full femme outfit until I was already three months into HRT. There are no rules. They were all made up by people who have been dead for hundreds of years.
This is kind of scary, but hopefully it’s also somewhat freeing. There’s no “proper” timeline to your transition. No list of things that you absolutely have to do. You can keep your name, or change it. You can get gender confirmation surgery, or you can keep what you’ve got. You can wear dresses every day, or you can leave them all for me. Some trans ladies have been dressing like women since they were old enough to buy clothes, but I didn’t once wear a full femme outfit until I was already three months into HRT. There are no rules. They were all made up by people who have been dead for hundreds of years.
You also don’t have to commit to anything right away. Transition isn’t one giant leap into the abyss — it’s a series of small, willing steps. All of the early steps are easily reversible, and you never have to do anything that you don’t think will help make your life better. If you keep your eyes on your feet, you’ll cross the chasm before you know it.

22
public/en/biochemical-dysphoria.md
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@ -2,7 +2,7 @@
date: "2020-01-26T20:41:55.827Z"
title: "How Gender Dysphoria Manifests: Biochemical Dysphoria"
linkTitle: "Biochemical Dysphoria"
description: "The very real and biological factors of Gender Dysphoria that cause mental disturbance."
description: "The very real and biological factors of gender dysphoria that cause mental disturbance."
preBody: '_disclaimer'
classes:
- gdb
@ -27,9 +27,9 @@ siblings:
# Biochemical Dysphoria
The primary sexual features of the body begin development during the 8th week of human gestation. Typically by week 11 it is possible to determine the genitals of a fetus via ultrasound. The brain, however, forms [between weeks 14 and 24](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989000/#Sec5title). Current prevailing understanding of neurological development suggests that it is during these 10 weeks when the brain will either masculinize or feminize based upon the presence of testosterone in the fetus bloodstream (initiated by the SRY gene on the Y chromosome, or introduced from other sources). This process locks the brain into a pattern of either desiring estrogens or androgens.
The primary sexual features of the body begin development during the eighth week of human gestation. Typically, by week 11, it is possible to determine the genitals of a fetus via ultrasound. The brain, however, forms [between weeks 14 and 24](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989000/#Sec5title). Current prevailing understanding of neurological development suggests that it is during these 10 weeks when the brain will either masculinize or feminize based upon the presence of testosterone in the fetus bloodstream (initiated by the SRY gene on the Y chromosome, or introduced from other sources). This process locks the brain into a pattern of either desiring estrogens or androgens.
If your brain is wired for one gonadal hormones (such as testosterone) and your body produces the other hormone (such as estradiol), this can result in a biochemical malfunction within your brain chemistry. This produces a sort of brain fog, a reduction in mental capacity, and a general state of anxiety and unease. This is the source of the first two symptoms that often alleviate with medical hormonal therapy, Depersonalization and Derealization (DPDR).
If your brain is wired for one kind of gonadal hormones (such as testosterone) and your body produces the other hormone (such as estradiol), this can result in a biochemical malfunction within your brain chemistry. This produces a sort of brain fog: a reduction in mental capacity and a general state of anxiety and unease. This is the source of the first two symptoms that often alleviate with medical hormonal therapy: **depersonalization and derealization (DPDR)**.
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@ -60,7 +60,7 @@ If your brain is wired for one gonadal hormones (such as testosterone) and your
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**Depersonalization** is a disconnect from your own body, an inability to believe that the person you see in the mirror is actually yourself. You feel like you are watching someone else in your body. You may find yourself not caring about what happens to your body, lack of concern with weight changes or improving your fitness because you have no ownership of this fleshy vehicle that transports you around your life.
**Depersonalization** is a disconnect from your own body: an inability to believe that the person you see in the mirror is actually yourself. You feel like you are watching someone else in your body. You may find yourself not caring about what happens to your body, feeling a lack of concern with weight changes or improving your fitness because you have no ownership of this fleshy vehicle that transports you around your life.
Zinnia Jones [gives these descriptions for Depersonalization](https://web.archive.org/web/20190406141617/https://genderanalysis.net/2017/06/depersonalization-in-gender-dysphoria-widespread-and-widely-unrecognized/):
@ -88,7 +88,7 @@ You may be unconcerned with the state of your body, perhaps not even fearing dea
'1215740224325783553'
] tweets=meta.tweets className="oneblock" }}</div> }!}
**Derealization** is a detachment from the world around you, a mental sense that everything you perceive is false.
**Derealization** is a detachment from the world around you: a mental sense that everything you perceive is false.
- Your surroundings seem alien or unfamiliar, even if you've always been there, like someone has swapped out your house for a stage replica.
- Moving through the world feels like you're walking on a treadmill, with the buildings moving around you instead of you through them.
@ -98,11 +98,11 @@ You may be unconcerned with the state of your body, perhaps not even fearing dea
- Distortions of distance and the size and shape of objects
- Feeling like a passive observer in the events of your life
If you found yourself strongly relating to The Matrix or The Truman Show, you might be experiencing derealization. This can also manifest as a feeling of otherworldliness, like you don't belong in this society. You're just walking around waiting for your super powers to appear, or for an owl to fly up with your letter to Hogwarts. As a teen I was obsessed with an episode of The Outer Limits where a boy discovers a spaceship under his house and learns that he and his parents aren't actually human.
If you found yourself strongly relating to *The Matrix* or *The Truman Show*, you might be experiencing derealization. This can also manifest as a feeling of otherworldliness, like you don't belong in this society. You're just walking around waiting for your super powers to appear, or for an owl to fly up with your letter to Hogwarts. As a teen I was obsessed with an episode of *The Outer Limits* where a boy discovers a spaceship under his house and learns that he and his parents aren't actually human.
DPDR sometimes comes with an emotional stunting. You are able to laugh and find humor, but rarely ever genuine joy. Moments of sadness or grief cause you to just go numb, dissociated by the event that caused it. This can also go in the opposite direction, where the person is under so much anxiety that their emotional response is extremely disproportionate to the catalyst, resulting in severe crying or violent outbursts from seemingly small events.
It's important to note that DPDR is not exclusive to Gender Dysphoria. This condition is co-morbid with several other mental health issues, including chronic depression, obsessive compulsive disorder, and borderline personality disorder. DPDR should not be taken as a sign of Gender Dysphoria purely on its own, it's just a big alarm signal that something is very wrong. It's also usually pretty easy to spot externally, once you know how to watch for it. People with DPDR tend to have a mile long stare as they move about in the world; eyes so gloomy and dead that they look like a shell. One of the most common comments on transition timelines is how the eyes gain so much spark.
It's important to note that DPDR is not exclusive to gender dysphoria. This condition is comorbid with several other mental health issues, including chronic depression, obsessive compulsive disorder, and borderline personality disorder. DPDR should not be taken as a sign of gender dysphoria purely on its own; it's just a big alarm signal that something is very wrong. It's also usually pretty easy to spot externally, once you know how to watch for it. People with DPDR tend to have a mile long stare as they move about in the world; eyes so gloomy and dead that they look like a shell. One of the most common comments on transition timelines is how the eyes gain so much spark.
### The Ebb and Flow
@ -110,7 +110,7 @@ The intensity of physical and biochemical dysphoria is highly influenced by othe
- If your blood sugar is out of whack, or you have a thyroid condition, it could cause your dysphoria to spike.
- If you are having dopamine withdrawal because of ceasing stimulants, that can make it worse.
- If you start on an SSRI Antidepressant and start running with more serotonin, that can make it less intense.
- If you start on an SSRI antidepressant and start running with more serotonin, that can make it less intense.
- Transfeminine AMABs (people assigned male at birth) with testicles experience surges in testosterone in relation to attraction and desire, which can make them more dysphoric.
- Transmasculine AFABs (people assigned female at birth) with unsuppressed ovaries experience rises and falls in estrogen and progesterone over the course of their menstrual cycle, making their dysphoria intensify and lessen based on what day of the cycle they are on.
@ -131,12 +131,12 @@ All of this is valid, and just because you feel very dysphoric one day and not d
'1222743749920464896'
] tweets=meta.tweets className="oneblock" }}</div> }!}
Sometimes you will hear naysayers suggesting that taking hormone therapy always improves mental health. I heard this myself when I came out to my mother. "Estrogen makes everyone happier." This is flat out false. When cis people are put on cross hormone therapy it always results in dysphoria. This is one reason why Spironolactone is rarely ever prescribed to men, because the anti-androgen factor causes mental instability. Five to ten percent of cis women suffer from Polycystic Ovarian Syndrome (PCOS), a condition which causes the ovaries to produce testosterone instead of estrogen. Ask any one of them how their mental health has been, and they will give you an ear full.
Sometimes you will hear naysayers suggesting that taking hormone therapy always improves mental health. I heard this myself when I came out to my mother. "Estrogen makes everyone happier." This is flat out false. When cis people are put on cross-hormone therapy it always results in dysphoria. This is one reason why Spironolactone is rarely ever prescribed to men, because the anti-androgen factor causes mental instability. Five to ten percent of cis women suffer from [polycystic ovary syndrome (PCOS)](https://en.wikipedia.org/wiki/Polycystic_ovary_syndrome), a condition which causes the ovaries to produce testosterone instead of estrogen. Ask any one of them how their mental health has been, and they will give you an earful.
One very potent demonstration of this is the tragic case of [David Reimer](https://en.wikipedia.org/wiki/David_Reimer). At seven months of age David and his twin brother were given circumcisions to treat a bad case of phimosis (a skin condition on the foreskin). David's went horribly wrong, and the penis was destroyed. The decision was made to perform vaginoplasty and raise him as a girl, including estrogen therapy at pubescence. By the age of 13 he was deep into suicidal depression and suffering greatly, as no amount of coaching and encouraging can make a boy enjoy being a girl. When his parents informed him of what had happened, he returned to a male presentation, switched to testosterone therapy, and over the course of his teen years had multiple operations in order to transition back to male.
One very potent demonstration of this is the tragic case of [David Reimer](https://en.wikipedia.org/wiki/David_Reimer). At seven months of age David and his twin brother were given circumcisions to treat a bad case of phimosis (a skin condition on the foreskin). David's went horribly wrong, and the penis was destroyed. The decision was made to perform vaginoplasty and raise him as a girl, including estrogen therapy at pubescence. By the age of 13, he was deep into suicidal depression and suffering greatly, as no amount of coaching and encouraging can make a boy enjoy being a girl. When his parents informed him of what had happened, he returned to a male presentation, switched to testosterone therapy, and over the course of his teen years had multiple operations in order to transition back to male.
People know when they're living the wrong gender.
Psychologist John Money oversaw David's case and was largely responsible for the decisions that were made in David's upbringing. Money, seeking to make a name for himself, massively misreported on David's case, calling it a complete success in his reports. The result of this echoes to this day, as Money's reports were used as an example of why performing genital corrective surgeries on intersex infants was an appropriate course of action. Fifty years later there are still doctors who believe that you can just change a child's genitals and raise them as that gender, and it will stick.
Psychologist John Money oversaw David's case and was largely responsible for the decisions that were made in David's upbringing. Money, seeking to make a name for himself, massively misreported on David's case, calling it a complete success in his reports. The result of this echoes to this day, as Money's reports were used as an example of why performing genital corrective surgeries on intersex infants was an appropriate course of action. Fifty years later there are still doctors who believe that you can just change a child's genitals and raise them as that gender and it will stick.
This is the tragedy of the [intersex](https://en.wikipedia.org/wiki/Intersex) community. Roughly one in every 60 births results in some kind of intersex condition (though not all of these are related to genitalia). Often times the "corrective" procedures used on intersex children results in a loss of function and/or sensation. Far too frequently, doctors would opt towards forced female assignment because it was easier to construct a vulva than a penis.

25
public/en/causes.md
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@ -23,11 +23,11 @@ siblings:
# What is the Cause of Gender Incongruence?
To put it bluntly: We don't know, not firmly. Science and modern psychology has proven that it is **not** caused by nurture; no one *becomes* transgender, gender identity is congenital, solidifying before we even exit the womb. It also appears to sometimes be hereditary; transgender parents have a higher likelihood of having transgender children, and many times they realize this in reverse. The child comes out to the parent, and that helps the parent realize they can come out as well.
To put it bluntly, we don't know (at least not firmly). Science and modern psychology has proven that it is **not** caused by nurture; no one *becomes* transgender, gender identity is congenital, solidifying before we even exit the womb. It also appears to sometimes be hereditary; transgender parents have a higher likelihood of having transgender children, and many times they realize this in reverse. The child comes out to the parent, and that helps the parent realize they can come out as well.
Here is the science that is believed to influence gender identity. This does not mean that it *defines* gender identity, nor does it fully encapsulate one's gender, as so many aspects of gender are cultural and social. None of this is prescriptive of a person's identity, none of it is cast in stone.
If you've seen Jurassic Park then you may remember this scene:
If you've seen Jurassic Park, you may remember this scene:
{!{
{{import '~/img' images.jurassicpark
@ -47,16 +47,15 @@ If you've seen Jurassic Park then you may remember this scene:
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The gonads in human fetuses initially develop in a bi-potential state, meaning they can become either ovaries or testes. The SRY gene on the Y chromosome releases a protein called [Testis Determining Factor](https://en.wikipedia.org/wiki/Testis-determining_factor) (TDF). This protein then starts a chain reaction with SOX9 production (another protein), which causes the gonadal cells to form into the Sertoli and Leydig cells that make up the testes. If TDF is never produced or is interfered with then the gonad cells form into the Theca cells and Follicles which comprise the ovaries.
The gonads in human fetuses initially develop in a bi-potential state, meaning they can become either ovaries or testes. The SRY gene on the Y chromosome releases a protein called [testis-determining factor](https://en.wikipedia.org/wiki/Testis-determining_factor) (TDF). This protein then starts a chain reaction with SOX9 production (another protein), which causes the gonadal cells to form into the Sertoli and Leydig cells that make up the testes. If TDF is never produced or is interfered with, the gonad cells form into the Theca cells and follicles which comprise the ovaries.
Once formed, the testes then begin producing a testosterone surge which typically starts in the eighth week of gestation and continues until the 24th week. This surge, [combined with another hormone from the placenta](https://www.sciencedaily.com/releases/2019/02/190214153053.htm), is responsible for the development of the penis and scrotum. Genitalia formation starts around week nine and becomes identifiable by the 11th week. If the surge does not occur, or the body does not respond to it (such as in the case of androgen insensitivity syndrome) then the genitalia form into the vulva, vagina, and uterus instead.
Once formed, the testes then begin producing a testosterone surge which typically starts in the 8th week of gestation and continues until the 24th week. This surge, [combined with another hormone from the placenta](https://www.sciencedaily.com/releases/2019/02/190214153053.htm), is responsible for the development of the penis and scrotum. Genitalia formation starts around week 9 and becomes identifiable by the 11th week. If the surge does not occur, or the body does not respond to it (such as in the case of Androgen Insensitivity Syndrome) then the genitalia form into the vulva, vagina and uterus instead.
If there is an interference in this process then you can end up with the wrong bits, and this is the result of many intersex conditions. Oftentimes this is a partial development, where the external genitalia only partially form but functional gonads still exist. Sometimes the child comes out with fully functional male or female genitalia, but mismatched gonads. Sometimes the TDF protein fails to release and the fetus grows completely functional female reproductive organs, despite the presence of a Y chromosome.
If there is an interference in this process then you can end up with the wrong bits, and this is the result of many intersex conditions. Often times this is a partial development, where the external genitalia only partially form, but functional gonads still exist. Sometimes the child comes out with fully functional male or female genitalia, but mismatched gonads. Sometimes the TDF protein fails to release and the fetus grows completely functional female reproductive organs, despite the presence of a Y chromosome.
This is known as Swyer syndrome, and an unknown number of women may have this condition. In 2015 [an XY woman with Swyer syndrome who was born without ovaries](https://www.independent.co.uk/news/science/mostly-male-woman-gives-birth-to-twins-in-medical-miracle-10033528.html) successfully carried and gave birth to a child via IVF. Usually, Swyer syndrome results in completely non-functional ovaries, but [in 2008 a woman was found with Swyer syndrome](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2190741/) who had gone through puberty, menstruated normally, and had two unassisted pregnancies. Her condition went undiscovered until her daughter was found to also have it.
This is known as Swyer Syndrome, and an unknown number of women may have this condition. In 2015 [an XY woman with Swyer Syndrome who was born without ovaries](https://www.independent.co.uk/news/science/mostly-male-woman-gives-birth-to-twins-in-medical-miracle-10033528.html) successfully carried and gave birth to a child via IVF. Usually Swyer Syndrome results in completely non-functional ovaries, but [in 2008 a woman was found with Swyer Syndrome](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2190741/) who had gone through puberty, menstruated normally, and had two unassisted pregnancies. Her condition went undiscovered until her daughter was found to also have it.
The fact is, the vast majority of the population has never been tested for genetic karyotype, so we don’t know how common these cases actually are. Where does this come into affect for gender identity? Well, the exact same process that causes the external genitals to differentiate also occurs for the brain.
The fact is, the vast majority of the population has never been tested for genetic karyotype, so we don’t know how common these cases actually are. Where does this come into effect for gender identity? Well, the exact same process that causes the external genitals to differentiate also occurs for the brain.
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@ -74,17 +73,17 @@ The fact is, the vast majority of the population has never been tested for genet
#### Brain Split
The prenatal brain doesn't really start to develop until between week 12 and 24. The cerebral cortex, the thin outer layer of the brain that contains most of what we think of as consciousness, grows substantially during those periods of time. Prior to that, the structure present is more like a scaffolding, the basic parts of the nervous system necessary for bodily function. The primary sulci (the wrinkles in the cerebral cortex that allow for more surface area) [start to form at week 14](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989000/#Sec5title), well after the genitals have developed.
The prenatal brain doesn't really start to develop until between week 12 and 24. The cerebral cortex, the thin outer layer of the brain that contains most of what we think of as consciousness, grows substantially during those periods of time. Prior to that, the structure present is more like a scaffolding — the basic parts of the nervous system necessary for bodily function. The primary sulci (the wrinkles in the cerebral cortex that allow for more surface area) [start to form at week 14](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989000/#Sec5title), well after the genitals have developed.
It [has been confirmed multiple times](https://www.the-scientist.com/features/are-the-brains-of-transgender-people-different-from-those-of-cisgender-people-30027) via MRI studies that there are small but significant differences between cis male and cis female brains, differences which align with the gender identities of trans people in the study. Note, **this does not mean that anyone with those differences will have that gender**, because gender identity isn't that simple, but it provides evidence that there is a clear difference in masculine and feminine brains. [There is also evidence](https://www.pnas.org/content/112/50/15468) that brains can have mosaic combinations of these differences, which may be the case in non-binary people.
It [has been confirmed multiple times](https://www.the-scientist.com/features/are-the-brains-of-transgender-people-different-from-those-of-cisgender-people-30027) via MRI studies that there are small but significant differences between cis male and cis female brains — differences which align with the gender identities of trans people in the study. Note that **this does not mean that anyone with those differences will have that gender**; gender identity isn't that simple, but it provides evidence that there is a clear difference in masculine and feminine brains. [There is also evidence](https://www.pnas.org/content/112/50/15468) that brains can have mosaic combinations of these differences, which may be the case in non-binary people.
A change in the testosterone levels in the fetus after the 11th week can directly impact the masculinization of the cerebral cortex, as well as changes in other parts of the brain structure. This has been examined [over and over again](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4350266/) in studies of female assigned children with CAH (congenital adrenal hyperplasia) and CAIS (complete androgen insensitivity syndrome).
A change in the testosterone levels in the fetus after the 11th week can directly impact the masculinization of the cerebral cortex, as well as changes in other parts of the brain structure. This has been examined [over and over again](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4350266/) in studies of female-assigned children with CAH (congenital adrenal hyperplasia) and CAIS (complete androgen insensitivity syndrome).
<blockquote class="cite"><p>We found a significant relationship between fetal testosterone and sexually differentiated play behavior in both girls and boys.</p>&mdash; <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2778233/">Fetal Testosterone Predicts Sexually Differentiated Childhood Behavior in Girls and in Boys</a></blockquote>
An excess of testosterone in the mother’s body during the second trimester can (and does) cause masculinization of the brain in an externally female fetus, and an interference in testosterone production or uptake can (and does) cause feminization of the brain in an externally male fetus. This interference does not have to be external in origin, either. Any number of genetic traits can cause the brain to respond differently to testosterone.
A fairly large study of transgender individuals released in 2018 [found several key genes](https://academic.oup.com/jcem/article/104/2/390/5104458) which were statistically more likely to be longer among trans women (longer, as in having more repeated fragments). Individually these genes may not have an impact strong enough to cause a malfunction of masculinization, but collectively they absolutely could reduce the ability for the fetal brain to masculinize. These genes are all passed from parent to child, giving credence to a tendency for trans parents to have trans children.
A fairly large study of transgender individuals released in 2018 [found several key genes](https://academic.oup.com/jcem/article/104/2/390/5104458) which were statistically more likely to be longer among trans women (longer as in having more repeated fragments). Individually these genes may not have an impact strong enough to cause a malfunction of masculinization, but collectively they absolutely could reduce the ability for the fetal brain to masculinize. These genes are all passed from parent to child, giving credence to a tendency for trans parents to have trans children.
#### Gender is Biological
@ -92,4 +91,4 @@ Sadly, western society has actively prevented a deeper understanding of gender.
Yet, progress continues, and every few years we learn a little bit more.
What we know for certain is that it is not a psychological condition, it is not something caused by trauma or by any external influence, nothing can make a person transgender. It happens in the womb, and is not something that a person can choose to be, any more than they could choose their race or their eye color. It has nothing to do with sexual orientation, it has nothing to do with kinks or fetishes, and it has nothing to do with social influences from their parents or from their peers. [Transgender children are as firm in their identities as cisgender children are](https://www.forbes.com/sites/dawnstaceyennis/2020/12/29/study-transgender-children-recognize-their-authentic-gender-at-early-age-just-like-other-kids/#20bbb14526bf).
What we know for certain is that it is not a psychological condition. It is not something caused by trauma or by any external influence; nothing can make a person transgender. It happens in the womb, and is not something that a person can choose to be, any more than they could choose their race or their eye color. It has nothing to do with sexual orientation, it has nothing to do with kinks or fetishes, and it has nothing to do with social influences from their parents or from their peers. [Transgender children are as firm in their identities as cisgender children are](https://www.forbes.com/sites/dawnstaceyennis/2020/12/29/study-transgender-children-recognize-their-authentic-gender-at-early-age-just-like-other-kids/#20bbb14526bf).

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date: "2020-01-26T20:41:55.827Z"
title: "Disorders of Sex Development: Gender is not Chromosomal"
linkTitle: "Chromosomes"
description: "DNA is more what you'd call guidelines, than actual rules."
description: "DNA is more what you'd call guidelines than actual rules."
preBody: '_disclaimer'
classes:
- gdb
@ -37,42 +37,44 @@ tweets:
</div>}!}
There are dozens of ways that chromosomes can be much more complex than XX and XY. Referred to as DSDs ([Differences in Sex Development](https://en.wikipedia.org/wiki/Disorders_of_sex_development)), not all of them result in an intersex condition, and many only manifest at the onset of puberty.
There are dozens of ways that chromosomes can be much more complex than XX and XY. Referred to as DSDs ([differences in sex development](https://en.wikipedia.org/wiki/Disorders_of_sex_development)), not all of them result in an intersex condition, and many only manifest at the onset of puberty.
- [De la Chapelle Syndrome](https://en.wikipedia.org/wiki/XX_male_syndrome) (46,XX Male) occurs when the SRY gene from the sperm parent crosses over into a non-Y-bearing sperm during spermatogenesis. When the egg and sperm merge, it results in an XX embryo with an SRY gene, creating a phenotypical male child with two X chromosomes.
- [De la Chapelle syndrome](https://en.wikipedia.org/wiki/XX_male_syndrome) (46,XX Male) occurs when the SRY gene from the sperm parent crosses over into a non-Y-bearing sperm during spermatogenesis. When the egg and sperm merge, it results in an XX embryo with an SRY gene, creating a phenotypically-male child with two X chromosomes.
- [Swyer Syndrome](https://en.wikipedia.org/wiki/Swyer_syndrome) (46,XY Female) produces a phenotypically female child with an XY chromosome. This results from a dozen different genetic conditions, including:
- [Swyer syndrome](https://en.wikipedia.org/wiki/Swyer_syndrome) (46,XY Female) produces a phenotypically-female child with an XY chromosome. This results from a dozen different genetic conditions, including:
- Absence or defect of an SRY gene
- Absence or defect of [DHH](https://en.wikipedia.org/wiki/Desert_hedgehog_(protein)) synthesis
- Absence of the [SF-1](https://en.wikipedia.org/wiki/Steroidogenic_factor_1) protein due to adrenal failure
- Absence of or defect the [CBX2](https://en.wikipedia.org/wiki/CBX2_(gene)) gene, preventing TDF cascade
- [XX Gonadal Dysgenesis](https://en.wikipedia.org/wiki/XX_gonadal_dysgenesis) is very similar to Swyer Syndrome, except occurs in XX children and results in nonfunctional ovaries.
- [XX gonadal dysgenesis](https://en.wikipedia.org/wiki/XX_gonadal_dysgenesis) is very similar to Swyer syndrome, except it occurs in XX children and results in nonfunctional ovaries.
- [Turner Syndrome](https://en.wikipedia.org/wiki/Turner_syndrome) (45,X) produces a phenotypically female child with numerous abnormalities. It occurs when neither an X or Y chromosome crosses over from the sperm.
- [Turner syndrome](https://en.wikipedia.org/wiki/Turner_syndrome) (45,X) produces a phenotypically-female child with numerous abnormalities. It occurs when neither an X or Y chromosome crosses over from the sperm.
- [Klinefelter Syndrome](https://en.wikipedia.org/wiki/Klinefelter_syndrome) (47,XXY) results in a phenotypically male child with more feminine traits. In extremely rare cases [it appears in female assigned children](https://www.ncbi.nlm.nih.gov/pubmed/15755052) as well, resulting in feminized testicles instead of ovaries.
- [Klinefelter syndrome](https://en.wikipedia.org/wiki/Klinefelter_syndrome) (47,XXY) results in a phenotypically-male child with more feminine traits. In extremely rare cases [it appears in female-assigned children](https://www.ncbi.nlm.nih.gov/pubmed/15755052) as well, resulting in feminized testicles instead of ovaries.
- [49,XXXXY Klinefelter Syndrome](https://en.wikipedia.org/wiki/49,XXXXY) is often fatal, but when it isn't, it often results in a sterile child.
- [48,XXXY Klinefelter syndrome](https://en.wikipedia.org/wiki/XXXY_syndrome) has similar results to 47,XXY Klinefelter syndrome, but with more intense health issues.
- [49,XXXXY Klinefelter syndrome](https://en.wikipedia.org/wiki/49,XXXXY) is often fatal, but when it isn't, it often results in a sterile child.
- [Trisomy X](https://en.wikipedia.org/wiki/Triple_X_syndrome) (47,XXX), [Tetrasomy X](https://en.wikipedia.org/wiki/Tetrasomy_X) (48,XXXX), and [Pentasomy X](https://en.wikipedia.org/wiki/49,_XXXXX) (49,XXXXX) all result in a female child, but with progressively more intense health issues.
- [XXYY Syndrome](https://en.wikipedia.org/wiki/XXYY_syndrome) results in male children (due to two SRY genes) which often experience hypogonadism, needing testosterone supplements, but otherwise seeming like a typical male
- [XXYY Syndrome](https://en.wikipedia.org/wiki/XXYY_syndrome) results in male children (due to two SRY genes) who often experience hypogonadism, needing testosterone supplements, but otherwise seeming like a typical male.
- [Mosaicism](https://en.wikipedia.org/wiki/Mosaic_(genetics)) results when some cells in the body have one set of chromosomes and other cells have another due to a mutation of the genome during gestation. This may be XX/XY (resulting in a dual set of genitalia), X/XY (a milder form of Swyer or Turner syndromes) or XX/XXY (a milder form of Klinefelter syndrome).
- [Chimerism](https://en.wikipedia.org/wiki/Chimera_(genetics)) occurs when two fertilized embryos merge together into one zygote, causing half of the child to contain one set of DNA and the other half to contain another. This can result in an otherwise completely typical human being of either male or female phenotype, even capable of producing offspring, but which comes back on a kareotype test as not matching their phenotype based on where the sample was taken on their body. In extremely rare cases this can result in two full sets of reproductive organs.
- [Chimerism](https://en.wikipedia.org/wiki/Chimera_(genetics)) occurs when two fertilized embryos merge together into one zygote, causing half of the child to contain one set of DNA and the other half to contain another. This can result in an otherwise completely typical human being of either male or female phenotype, even capable of producing offspring, but which comes back on a karyotype test as not matching their phenotype based on where the sample was taken on their body. In extremely rare cases this can result in two full sets of reproductive organs.
- [Congenital Adrenal Hyperplasia](https://en.wikipedia.org/wiki/Congenital_adrenal_hyperplasia)(CAH) is masculinization of the female genitals in an XX child due to overactive adrenal glands.
- [Congenital adrenal hyperplasia](https://en.wikipedia.org/wiki/Congenital_adrenal_hyperplasia) (CAH) is masculinization of the female genitals in an XX child due to overactive adrenal glands.
- [Androgen Insensitivity Syndrome](https://en.wikipedia.org/wiki/Androgen_insensitivity_syndrome)(AIS) is a total or partial resistance to all androgens, preventing masculinization of all organs, save for the testicles, in an XY child. AIS subjects typically develop a female gender identity, but some partial cases may be male.
- [Androgen insensitivity syndrome](https://en.wikipedia.org/wiki/Androgen_insensitivity_syndrome) (AIS) is a total or partial resistance to all androgens, preventing masculinization of all organs, save for the testicles, in an XY child. AIS subjects typically develop a female gender identity, but some partial cases may be male.
- [5-alpha-reductase deficiency](https://en.wikipedia.org/wiki/5-alpha-reductase_deficiency)(5ARD) is a failure in the body's ability to metabolize testosterone into dihydrotestosterone (DHT), preventing masculinization of the genitalia until the onset of puberty, when the child suddenly grows a penis.
- [5-alpha-reductase deficiency](https://en.wikipedia.org/wiki/5-alpha-reductase_deficiency) (5ARD) is a failure in the body's ability to metabolize testosterone into dihydrotestosterone (DHT), preventing masculinization of the genitalia until the onset of puberty, when the child suddenly grows a penis.
- [Aromatase Deficiency](https://en.wikipedia.org/wiki/Aromatase_deficiency) causes masculinization of an otherwise female child due to excess levels of testosterone (and can bleed-over into the mother during gestation).
- [Aromatase deficiency](https://en.wikipedia.org/wiki/Aromatase_deficiency) causes masculinization of an otherwise female child due to excess levels of testosterone (and can bleed over into the mother during gestation).
- [Aromatase Excess](https://en.wikipedia.org/wiki/Aromatase_excess_syndrome) causes feminisation in an otherwise male child, as all testosterone is converted into estrogen.
- [Aromatase excess](https://en.wikipedia.org/wiki/Aromatase_excess_syndrome) causes feminisation in an otherwise male child, as all testosterone is converted into estrogen.
{!{ <div class="span34 center print-span2">
{{import '~/tweet' ids=[

15
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What is choice? No, I’m not talking about free will and fate. That is not a subject within the scope of this essay. However, in the context of gender, I do believe it is important to consider the processes that drive us to make decisions.
In the philosophy of decision theory, choice is broken down into two pieces, [preferences and prospects](https://plato.stanford.edu/entries/decision-theory/#WhaPreOvePro). Prospects are the different paths that lay before us, the unresolved potential of any given choice. Preferences are our internal factors that drive us towards one prospect over another. Sometimes these are overtly clear, rational choices that we can describe easily with language. These motivations come from what is coined as the Rational Mind. Just as often, however, these preferences come to us without clear reasoning, stemming from our past experiences, our biochemical driving forces, or instinctual drives that exist below all of that. Sometimes our preference is just a gut feeling, deep inside. Proponents of Mindfulness refer to this as the Emotional Mind.
In the philosophy of decision theory, choice is broken down into two pieces: [preferences and prospects](https://plato.stanford.edu/entries/decision-theory/#WhaPreOvePro). Prospects are the different paths that lay before us — the unresolved potential of any given choice. Preferences are our internal factors that drive us towards one prospect over another. Sometimes these are overtly clear, rational choices that we can describe easily with language. These motivations come from what is coined as the rational mind. Just as often, however, these preferences come to us without clear reasoning, stemming from our past experiences, our biochemical driving forces, or instinctual drives that exist below all of that. Sometimes our preference is just a gut feeling, deep inside. Proponents of mindfulness refer to this as the emotional mind.
Regardless of where a preference originates from, however, it is shaped by its position between two poles. Pleasure and Discomfort. Peace and Dissonance. Euphoria and Dysphoria. Everything we do, every choice we make, comes from either positive or negative responses. When faced with two options, we will select the one we find most beneficial or least harmful to our own internal needs.
Regardless of where a preference originates from, however, it is shaped by its position between two poles. Pleasure and discomfort. Peace and dissonance. Euphoria and dysphoria. Everything we do, every choice we make, comes from either positive or negative responses. When faced with two options, we will select the one we find most beneficial or least harmful to our own internal needs.
What does this have to do with Gender? A person’s gender is not a choice, it comes from somewhere deep inside them at a level of the brain’s function that is not subject to change. There are factors which may result in fluctuation of a persons perception of their gender (as in genderfluid individuals and those with dissociative identities), and a person may change how they describe their gender over time, but no one *chooses* their gender identity. We only choose how to present it to the rest of the world.
What does this have to do with gender? A person’s gender is not a choice; it comes from somewhere deep inside them at a level of the brain’s function that is not subject to change. There are factors which may result in fluctuation of a person's perception of their gender (as in genderfluid individuals and those with dissociative identities), and a person may change how they describe their gender over time, but no one *chooses* their gender identity. We only choose how to present it to the rest of the world.
Those choices, those preferences, are driven by what feels good and what feels bad. A person who chooses to publicly identify as a gender different from the one assigned them at their birth is making that choice based on what feels right to do. A person defending that identity does so based on what feels wrong. We make these choices against the social stigma and discrimination that comes with the transgender label, and indeed a not insignificant number of trans people may choose to go stealth and abandon that label once it is safe to do so. Even among those who are not stealth, many trans people accept the safety of being presumed cisgender, and take no effort to break people of that presumption. That is, again, a choice. Being visibly trans produces a negative experience for them.
Those choices, those preferences, are driven by what feels good and what feels bad. A person who chooses to publicly identify as a gender different from the one assigned to them at their birth is making that choice based on what feels right to do. A person defending that identity does so based on what feels wrong. We make these choices against the social stigma and discrimination that comes with the transgender label, and indeed a not-insignificant number of trans people may choose to go stealth and abandon that label once it is safe to do so. Even among those who are not stealth, many trans people accept the safety of being presumed cisgender, and take no effort to break people of that presumption. That is, again, a choice. Being visibly trans produces a negative experience for them.
There are those who find the notion that Euphoria and Dysphoria are central motivators behind gender variance to be uncomfortable, you could even say they experience dysphoria at the concept of dysphoria. To them ask, if you believe you do not have dysphoria, why did you take on the mantle of the trans label? That *choice* did not happen in a vacuum; even if your motivations stem entirely from happy feelings, ask yourself how you feel when your gender is not respected. How do you feel when others invalidate your identity?
There are those who find the notion that euphoria and dysphoria are central motivators behind gender variance to be uncomfortable; one could even say they experience dysphoria at the concept of dysphoria. To them, ask, if you believe you do not have dysphoria, why did you take on the mantle of the trans label? That *choice* did not happen in a vacuum; even if your motivations stem entirely from happy feelings, ask yourself how you feel when your gender is not respected. How do you feel when others invalidate your identity?
Is it not _a state of unease or generalized dissatisfaction_?
@ -31,9 +31,9 @@ That’s dysphoria, baby.
## We’re here, we’re queer.
Every single year we get new studies that show an increase in the size of the transgender population. As awareness continues to grow, more and more people are realizing what has been wrong with their lives and are coming out of the closet. People who transitioned decades ago are coming out of stealth. GLAAD estimates as much as 3% of the population could be transgender, and I have seen numbers as high as 5% or even 10% from more liberal estimations. The more we come to understand about gender, the more language we gain to describe gender, the more people realize that the rigid Male and Female sexual structure that we have been forced into is false.
Every single year, we get new studies that show an increase in the size of the transgender population. As awareness continues to grow, more and more people are realizing what has been wrong with their lives and are coming out of the closet. People who transitioned decades ago are coming out of stealth. GLAAD estimates as much as 3% of the population could be transgender, and I have seen numbers as high as 5% or even 10% from more liberal estimations. The more we come to understand about gender, the more language we gain to describe gender, the more people realize that the rigid Male and Female sexual structure that we have been forced into is false.
Yet all this change frightens people. It frightens conservatives who see their patriarchal social structures dissolving under the new understanding of gender. It frightens old-school transgender people who transitioned under the Harry Benjamin rules and now see so many people easily obtaining what they had to act and lie and manipulate to achieve. They fear that if anyone can be trans, then the public will stop taking trans people seriously. It frightens the misogynistic trans-exclusionary groups that fight so hard to invalidate transgender rights, because they think if anyone can be a man or a woman, then their status as a man or a woman is harmed.
Yet all this change frightens people. It frightens conservatives who see their patriarchal social structures dissolving under the new understanding of gender. It frightens old-school transgender people who transitioned under the Harry Benjamin rules and now see so many people easily obtaining what they had to act and lie and manipulate to achieve. They fear that if anyone can be trans, the public will stop taking trans people seriously. It frightens the misogynistic or misandristic trans-exclusionary groups that fight so hard to invalidate transgender rights because they think, if anyone can be a man or a woman, their status as a man or a woman is harmed.
There is no such thing as a "Transtrender".
@ -42,4 +42,3 @@ There is no such thing as "Rapid Onset Gender Dysphoria".
There is no such thing as people "transing" kids.
These mentalities have to stop.

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# How is Gender Dysphoria Diagnosed?
This section is going to focus on the diagnostic criteria under the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, version five (DSM-5). The reason I'm focusing on this standard is because, well, nobody else has one. The UK's National Health Service basically mirrors the APA's DSM. Other countries have their own local standards, but they're all either very similar, or a lot more outdated.
This section is going to focus on the diagnostic criteria under the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, version five (DSM-5). The reason I'm focusing on this standard is because, well, nobody else has one. The UK's National Health Service basically mirrors the APA's DSM. Other countries have their own local standards, but they're all either very similar or a lot more outdated.
The WPATH SoC describes ways that Gender Dysphoria manifests, but does not define clear diagnostic criteria, instead leaving it up to individual mental health professionals to make their own diagnoses. In general it advocates that if the patient is of sound mind and body and says that they have Gender Dysphoria, then they should be believed. The key piece here is "sound mind and body", it is left to the mental health professional to do the due diligence to ensure that there are no other conditions which may be causing the patient to believe this.
The WPATH SoC describes ways that gender dysphoria manifests, but does not define clear diagnostic criteria, instead leaving it up to individual mental health professionals to make their own diagnoses. In general, it advocates that, if the patient is of sound mind and body and says that they have gender dysphoria, they should be believed. The key piece here is "sound mind and body"; it is left to the mental health professional to do the due diligence to ensure that there are no other conditions which may be causing the patient to believe this.
Or to put it bluntly, WPATH says that if you think you're trans, you're trans. This has been the attitude that the majority of the community has adopted as well. As long as you believe your gender does not match what you were assigned at birth, you are transgender. However, insurance companies aren't so happy with self-diagnoses, so here are the criteria which are defined in DSM-5 for diagnosing someone with Gender Dysphoria.
Or, to put it bluntly, WPATH says that if you think you're trans, you're trans. This has been the attitude that the majority of the community has adopted as well. As long as you believe your gender does not match what you were assigned at birth, you are transgender. However, insurance companies aren't so happy with self-diagnoses, so here are the criteria which are defined in the DSM-5 for diagnosing someone with gender dysphoria.
{!{ <div class="gutter d-md-block d-sm-none"><div class="card"><div class="card-body"><h4 class="card-title">For Your Information</h4> }!}
Diagnosis of Gender Dysphoria in prepubescent children requires the child must have a documented six month history of meeting six of these criteria, as well as demonstrated distress or impairment in function.
Diagnosis of gender dysphoria in prepubescent children requires the child must have a documented six month history of meeting six of these criteria (one of which must be Criterion 1), as well as demonstrated distress or impairment in social, school, or other important areas of functioning.
1. A strong desire to be of the other gender or an insistence that one is the other gender
2. A strong preference for wearing clothes typical of the opposite gender
3. A strong preference for cross-gender roles in make-believe play or fantasy play
4. A strong preference for the toys, games or activities stereotypically used or engaged in by the other gender
5. A strong preference for playmates of the other gender
6. A strong rejection of toys, games and activities typical of one’s assigned gender
7. A strong dislike of one’s sexual anatomy
8. A strong desire for the physical sex characteristics that match one’s experienced gender
1. A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gender different from one's assigned gender).
2. A strong preference for wearing clothes typical of the other gender.
3. A strong preference for cross-gender roles in make-believe play or fantasy play.
4. A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender.
5. A strong preference for playmates of the other gender.
6. A strong rejection of toys, games, and activities typical of one’s assigned gender.
7. A strong dislike of one’s sexual anatomy.
8. A strong desire for the physical sex characteristics that match one’s experienced gender.
{!{ </div></div></div> }!}
**Note** These are the criteria for adolescents and adults. Children have a different set of criteria, which [you can find here](https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria). I have also changed the wording slightly, here, as the official criteria are binary-centric.
**Note** These are the criteria for children. Adolescents and adults have a different set of criteria. Both sets [can also be found here](https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria). I have also changed the wording slightly, here, as the official criteria are binary-centric.
For an adult to be diagnosed with Gender Dysphoria by a licensed mental health professional they must meet two of these six criteria, and have experienced those criteria for longer than six months.
For an adult to be diagnosed with gender dysphoria by a licensed mental health professional, they must meet two of these six criteria and have experienced those criteria for longer than six months.
- **A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics**
@ -58,10 +58,10 @@ For an adult to be diagnosed with Gender Dysphoria by a licensed mental health p
This is pretty self explanatory.
As I said, only two of these conditions need be met for a formal diagnosis. You may notice that only two of these comprise the physical body. It is perfectly valid for a trans person to be experiencing Gender Dysphoria without actually hating any part of their body, or wanting to change any part of their body. Physical Dysphoria is only one fraction of the many ways that lead to being trans.
As I said, only two of these conditions need to be met for a formal diagnosis. You may notice that only two of these comprise the physical body. It is perfectly valid for a trans person to be experiencing gender dysphoria without actually hating any part of their body or wanting to change any part of their body. Physical dysphoria is only one fraction of the many things that lead to being trans.
Now, here is the kicker. If you identify as transgender, meaning that your gender does not align with the binary sex you were assigned at birth, you already meet two of these criteria! You have a strong enough desire to be of another gender that you are identifying that you *are* another gender, and you have a strong conviction of what your gender feels like, and it isn't what you were given at birth.
So, it is literally impossible for a person to identify as trans and not experience gender dysphoria. By the WPATH requirements anyone can identify as trans. Ergo, the statement "you do not have to have dysphoria to be transgender" is a logical paradox.
Then why do we still say it? Because most people don't know what gender dysphoria actually is, and it is easier to repeat the mantra than to explain the nuances and subtleties of how Gender Dysphoria manifests. But hey, look, now you've got a nice article to link to that can help people understand that.
Then why do we still say it? Because most people don't know what gender dysphoria actually is, and it is easier to repeat the mantra than to explain the nuances and subtleties of how gender dysphoria manifests. But hey, look, now you've got a nice article to link to that can help people understand that.

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}!}
Before I can talk about discomfort, I have to talk about relief. Gender Euphoria is itself a sign of Gender Dysphoria. You might be asking yourself, "how can happiness be sadness?" The answer to that is simple.
Before I can talk about discomfort, I have to talk about relief. Gender euphoria is itself a sign of gender dysphoria. You might be asking yourself, "how can happiness be sadness?" The answer to that is simple.
Imagine a person who was born in a cave, who spent their entire life living underground, their only source of illumination being candles and oil lamps. Imagine they've never been above ground, they don't even know the surface exists. Then one day a cave-in happens in a side tunnel, and reveals an opening to the surface. Sunlight pours into the opening, and at first it is blinding and the person runs away in fear. Later they return to the opening, and as the person's eyes adjust they look out through the hole and see a bright and brilliant world full of colors they didn't even know existed.
Imagine a person who was born in a cave, who spent their entire life living underground, with their only source of illumination being candles and oil lamps. Imagine they've never been above ground; they don't even know the surface exists. Then, one day, a cave-in happens in a side tunnel, and reveals an opening to the surface. Sunlight pours into the opening, and at first it is blinding and the person runs away in fear. Later, they return to the opening, and, as the person's eyes adjust, they look out through the hole and see a bright and brilliant world full of colors they didn't even know existed.
That world is scary, it's huge and full of unknowns, so they crawl back into the cave for safety, but that hole is still there, and they see the light every time they pass it. Gradually they peek out more and more frequently, and further and further from the opening. They start to want that light, they find reasons to visit it more often.
That world is scary, huge, and full of unknowns, so they crawl back into the cave for safety, but that hole is still there, and they see the light every time they pass it. Gradually, they peek out more and more frequently, and further and further from the opening. They start to want that light; they find reasons to visit it more often.
Eventually they realize that they don't want to go back into the hole any more. They have to go back, because that is where their family and friends are, but this place is so much better, they want to stay here. Going back into the hole feels wrong, it starts to hurt to be in the dark so much.
Eventually they realize that they don't want to go back into the hole any more. They have to go back, because that is where their family and friends are, but this place is so much better, and they want to stay here. Going back into the hole feels wrong; it starts to hurt to be in the dark so much.
This is what Gender Euphoria is like, it is brief flashes of a light that may be too bright to handle at first, too confusing to understand, but as time goes on you become more accustomed to them and you realize that this is where you belong, and the darkness becomes the dysphoria.
This is what gender euphoria is like: brief flashes of a light that may be too bright to handle at first, too confusing to understand, but as time goes on you become more accustomed to them and you realize that this is where you belong, and the darkness becomes the dysphoria.
{!{ <div class="gutter">{{import '~/tweet' ids=[
'1215716433210105856'
@ -60,7 +60,7 @@ Examples:
- Being gendered correctly
- Being addressed by your chosen name
- Wearing correctly gendered clothing
- Wearing correctly-gendered clothing
- Seeing and feeling changes in your body
- Seeing yourself in the mirror (removal of depersonalization)
- Socializing in a way that conforms with gendered expectations
@ -72,6 +72,6 @@ Examples:
Even just being out in the world as yourself and being seen as yourself can be massively euphoric.
**What euphoria is NOT** is a sexual high, turn on, or fetish. Sometimes euphoria can trigger a sexual response, and there are many factors at play that cause that (feeling good about your body is a turn on, for example), but it is not a source of sexual excitement. Trans people are not "getting off" on presenting or acting like their true selves.
**What euphoria is NOT** is a sexual high, turn-on, or fetish. Sometimes euphoria can trigger a sexual response, and there are many factors at play that cause that (feeling good about your body is a turn-on, for example), but it is not a source of sexual excitement. Trans people are not "getting off" on presenting or acting like their true selves.
That said, many people who have not yet realized they are trans may resort to fetishes and kinks to express their gender and/or relieve their dysphoria. They may maintain some of these kinks through transition. There is no shame in this, how they find sexual fulfillment is their own business. However, these things are *alongside* their gender. A trans person's sense of gender persists indefinitely, it does not go away when they go back to their daily lives.
That said, many people who have not yet realized they are trans may resort to fetishes and kinks to express their gender and/or relieve their dysphoria. They may maintain some of these kinks through transition. There is no shame in this; how they find sexual fulfillment is their own business. However, these things are *alongside* their gender. A trans person's sense of gender persists indefinitely; it does not go away when they go back to their daily lives.

2
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@ -2,7 +2,7 @@
date: "2020-01-26T20:41:55.827Z"
title: "How Gender Dysphoria Manifests: Existential Dysphoria"
linkTitle: "Existential Dysphoria"
description: "I don't regret the things I have done, I regret the things I didn't do when I had the chance."
description: "I don't regret the things I have done; I regret the things I didn't do when I had the chance."
classes:
- gdb
preBody: '_disclaimer'

20
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@ -17,7 +17,7 @@ siblings:
In 1948, noted sexologist Dr. Alfred Kinsey (yes, [*that* Kinsey](https://en.wikipedia.org/wiki/Alfred_Kinsey)) was contacted by a woman whose male child adamantly insisted that they were in fact a girl, and that something had gone very wrong. The mother, rather than trying to suppress her daughter, wished to help her become who she knew herself to be. Kinsey reached out to a German endocrinologist named [Dr. Harry Benjamin](https://en.wikipedia.org/wiki/Harry_Benjamin) to see if he could help the child. Dr. Benjamin then developed a protocol of estrogen therapy for the teen, and worked with the family to find surgical help.
Benjamin then went on to refine his protocol and treated thousands of patients with similar feelings over the course of his career. He refused to take payment for his work, instead taking satisfaction from the relief he granted these patients, and using their treatment to further his understanding of the condition. He coined a term for this feeling of incongruence in 1973: Gender Dysphoria. Unfortunately, this term would not be used in the United States until 2013, with the American Psychiatric Association opting for the term Gender Identity Disorder instead.
Benjamin then went on to refine his protocol and treated thousands of patients with similar feelings over the course of his career. He refused to take payment for his work, instead taking satisfaction from the relief he granted these patients, and using their treatment to further his understanding of the condition. He coined a term for this feeling of incongruence in 1973: **gender dysphoria**. Unfortunately, this term would not be used in the United States until 2013, with the American Psychiatric Association opting for the term "gender identity disorder" instead.
{!{
<div class="gutter print-inline">
@ -28,11 +28,11 @@ Benjamin then went on to refine his protocol and treated thousands of patients w
</div>
}!}
If you are a trans person reading this, you may have heard the name Harry Benjamin before, but probably not in a favorable context. In 1979 his name was used (with permission) in the forming of the Harry Benjamin International Gender Dysphoria Association (HBIGDA), which released a Standards of Care (SoC) for transgender people. This SoC came to be known as the Harry Benjamin Rules, and were infamously limiting in regards to how Gender Dysphoria could be diagnosed. Patients were placed within a six tier scale based upon their level of misery and sexual dysfunction. If you did not land at Tier 5 or higher, classified as a "True Transsexual", you were usually rejected for treatment.
If you are a trans person reading this, you may have heard the name Harry Benjamin before, but probably not in a favorable context. In 1979 his name was used (with permission) in the forming of the Harry Benjamin International Gender Dysphoria Association (HBIGDA), which released a Standards of Care (SoC) for transgender people. This SoC came to be known as the Harry Benjamin Rules, and were infamously limiting in regards to how gender dysphoria could be diagnosed. Patients were placed within a six tier scale based upon their level of misery and sexual dysfunction. If you did not land at Tier 5 or higher, classified as a "True Transsexual", you were usually rejected for treatment.
The problem was, Tier 5 and 6 required that you had to be exclusively attracted to your own birth sex. Transition *had* to be making you straight, not gay, and bisexuals were not allowed. You also had to be experiencing severe distress with your body and genitals, and already be living as your true gender without treatment. Many trans people got around these limitations through community coaching and performative presentations, but for many people (myself included) it was believed that if you did not fit all the criteria, then you were not trans enough to transition.
The problem was that Tiers 5 and 6 required that you had to be exclusively attracted to your own birth sex. Transition *had* to be making you straight, not gay, and bisexuals were not allowed. You also had to be experiencing severe distress with your body and genitals and already be living as your true gender without treatment. Many trans people got around these limitations through community coaching and performative presentations, but for many people (myself included) it was believed that, if you did not fit all the criteria, you were not trans enough to transition.
In 2011 the HBIGDA reorganized itself to respond to mounting pressures in trans understanding and acceptance, taking on the new name World Professional Association for Transgender Health (WPATH). Under guidance by actual transgender people (a first for the organization), WPATH then proceeded to release an entirely new Standards of Care (SoC, version 7, the first in ten years) which abandoned the Benjamin Scale, focusing on specific individual symptoms and disconnecting gender from sexuality entirely. Two years later, in 2013, the American Psychiatric Association changed their diagnostic criteria to match the WPATH SoC in their Diagnostic and Statistical Manual of Mental Disorders (DSM) version 5, replacing Gender Identity Disorder with Gender Dysphoria. With this change, medical transition became available to all trans people in the United States.
In 2011, the HBIGDA reorganized itself to respond to mounting pressures in trans understanding and acceptance, taking on the new name World Professional Association for Transgender Health (WPATH). Under guidance by actual transgender people (a first for the organization), WPATH then proceeded to release an entirely new Standards of Care (SoC, version 7, the first in ten years) which abandoned the Benjamin Scale, focusing on specific individual symptoms and disconnecting gender from sexuality entirely. Two years later, in 2013, the American Psychiatric Association changed their diagnostic criteria to match the WPATH SoC in their Diagnostic and Statistical Manual of Mental Disorders (DSM) version 5, replacing Gender Identity Disorder with Gender Dysphoria. With this change, medical transition became available to all trans people in the United States.
This is why trans presence across the world has suddenly exploded in the last decade. With easier access comes larger numbers, with larger numbers comes more visibility, with more visibility comes more awareness, and with more awareness comes more people accessing treatment. [A study conducted in 2014](https://williamsinstitute.law.ucla.edu/wp-content/uploads/TransAgeReport.pdf) showed 0.6% of adults and 0.7% of youth in the United States identified as transgender, [a study conducted in 2016](https://www.cdc.gov/mmwr/volumes/68/wr/mm6803a3.htm) showed 1.8% of high school age students identified as transgender, and [a survey conducted by GLAAD in 2017](https://www.glaad.org/files/aa/2017_GLAAD_Accelerating_Acceptance.pdf) showed a whopping 12% of respondents 18 to 34 did not identify as cisgender.
@ -50,9 +50,9 @@ Transgender people are coming out of the woodwork; we are everywhere.
</div>
}!}
There is a common misconception among both cisgender and transgender people that Gender Dysphoria refers exclusively to a physical discomfort with ones own body. However, this belief that body discomfort is central to Gender Dysphoria is in fact a misconception, and is not even a majority component of a Gender Dysphoria diagnosis. Gender Dysphoria crosses a large number of all aspects of life, including how you interact with others, how others interact with you, how you dress, how you behave, how you fit into society, how you perceive the world around you, and yes, how you relate to your own body. Consequently, proponents of the WPATH SoC 7 and the DSM-5 have taken to a habit of saying that you do not have to have dysphoria to be transgender. This statement is often repeated like a mantra, as it informs people who do not feel significant body discomfort that they may also be transgender.
There is a common misconception among both cisgender and transgender people that gender dysphoria refers exclusively to a physical discomfort with ones own body. However, this belief that body discomfort is central to gender dysphoria is in fact a misconception, and is not even a majority component of a gender dysphoria diagnosis. Gender dysphoria crosses a large number of all aspects of life, including how you interact with others, how others interact with you, how you dress, how you behave, how you fit into society, how you perceive the world around you, and, yes, how you relate to your own body. Consequently, proponents of the WPATH SoC 7 and the DSM-5 have taken to a habit of saying that you do not have to have dysphoria to be transgender. This statement is often repeated like a mantra, as it informs people who do not feel significant body discomfort that they may also be transgender.
In principle, Gender Dysphoria is a feeling of wrongness intrinsic to the self. There is no logical backing to this wrongness, there is nothing which explains it, you can not describe why you feel this way, it is just there. Things in your existence are incorrect, and even knowing which things *are* incorrect can be hard to properly identify.
In principle, gender dysphoria is a feeling of wrongness intrinsic to the self. There is no logical backing to this wrongness; there is nothing which explains it, and you can not describe why you feel this way; it is just there. Things in your existence are incorrect, and even knowing which things *are* incorrect can be hard to properly identify.
The way I used to describe it is like wearing an adult's glove when you are a child. You can put your hand into the glove, and your fingers feed into the digits of the glove, but your dexterity with the glove is severely hindered. You might be able to pick something up, but you can not manipulate it like an adult could. Things just aren't quite right.
@ -66,16 +66,16 @@ Evey Winters described it this way [in her Dysphoria post](https://eveywinters.c
>
> It is knowing that something is wrong and not being able to do a damn thing about it.
Gender Dysphoria is, at its core, simply emotional reactions to the brain knowing that something does not fit. This incongruence is so deep inside the brain's subsystems that there is no obvious message of what the problem is. The only way we have to identify it is via the emotions that it triggers. Our consciousness receives either positive (euphoria) or negative (dysphoria) feedback according to how well our current environment aligns with our internal sense of self. Part of transition is learning to recognize those signals.
Gender dysphoria is, at its core, simply emotional reactions to the brain knowing that something does not fit. This incongruence is so deep inside the brain's subsystems that there is no obvious message of what the problem is. The only way we have to identify it is via the emotions that it triggers. Our consciousness receives either positive (euphoria) or negative (dysphoria) feedback according to how well our current environment aligns with our internal sense of self. Part of transition is learning to recognize those signals.
Cisgender people receive them as well, but since the signals usually align with their environment, they take them for granted. There have been a few notable occasions, however, when a cisgender person has been [put into a situation](https://www.teenvogue.com/story/maisie-williams-arya-stark-game-of-thrones-affected-her-body-image) where they experience gender dysphoria. Attempts to raise cisgender children [as the opposite sex](https://www.nytimes.com/2004/05/12/us/david-reimer-38-subject-of-the-john-joan-case.html) (Content warning: suicide) have always met with failure when the child inevitably declares themselves differently.
These impulses of euphoria and dysphoria, arousal and aversion, they all manifest in many different ways, some obvious, some much more subtle. Dysphoria changes over time as well, taking on new shapes as one moves from pre-awareness into understanding and through transition. The goal of this book is to break down these manifestations into their distinct categories and describe them so that others may learn to recognize them.
These impulses of euphoria and dysphoria, arousal and aversion — they all manifest in many different ways: some obvious, some much more subtle. Dysphoria changes over time as well, taking on new shapes as one moves from pre-awareness into understanding and through transition. The goal of this book is to break down these manifestations into their distinct categories and describe them so that others may learn to recognize them.
However, first I must stress something very important, so important that I am putting it into big bold letters:
**EVERY SINGLE TRANS PERSON EXPERIENCES A DIFFERENT SET OF DYSPHORIA SOURCES AND INTENSITIES**
There is no one single trans experience, there is no standard set of feelings and discomforts, there *is no one true trans narrative*. Every trans person experiences dysphoria in their own way to their own degree, and what bothers one person may not bother another.
There is no one single trans experience; there is no standard set of feelings and discomforts; there *is no one true trans narrative*. Every trans person experiences dysphoria in their own way to their own degree, and what bothers one person may not bother another.
Ok, that disclaimer out of the way, let's get to the meat and potatoes.
Okay, with that disclaimer out of the way, let's get to the meat and potatoes.

67
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@ -15,77 +15,74 @@ classes:
# How Hormones Work
As we described in the [Causes of Gender Dysphoria](/en/causes) section, every human's DNA contains the genetic instructions for both male and female bodies, and which set of instructions gets used is controlled by what hormones your gonads produce. That differentiation occurs entirely based on whether you happen to have an SRY gene which, in the 6-8th week of gestation, kicks off a chain reaction that produces testes instead of ovaries. From that point on, every sexual attribute of the human body (primary and secondary) is a result of the hormones that those gonads produce.
As we described in the [Causes of Gender Dysphoria](/en/causes) section, every human's DNA contains the genetic instructions for both male and female bodies, and which set of instructions gets used is controlled by what hormones your gonads produce. That differentiation occurs entirely based on whether you happen to have an SRY gene which, between the sixth and eighth weeks of gestation, kicks off a chain reaction that produces testes instead of ovaries. From that point on, every sexual attribute of the human body (primary and secondary) is a result of the hormones that those gonads produce.
If they produce estrogens (primarily Estradiol) then the genitals form into a vulva, vagina and uterus. If they produce androgens (primarily Testosterone) then the genitals form into a penis and scrotum, shifting the [Skene's gland](https://en.wikipedia.org/wiki/Skene%27s_gland) downward and enlarging it into a prostate. Differentiation ends here until the onset of puberty, 9-10 years later, and we all know what puberty does.
So how does this work? Why do the cells differentiate like this? Well, before we can explain that, first we have to explain the concept of a **Receptor**.
If they produce estrogens (primarily estradiol), the genitals form into a vulva, vagina, and uterus. If they produce androgens (primarily testosterone), the genitals form into a penis and scrotum, shifting the [Skene's gland](https://en.wikipedia.org/wiki/Skene%27s_gland) downward and enlarging it into a prostate. Differentiation ends here until the onset of puberty, nine to ten years later, and we all know what puberty does.
So how does this work? Why do the cells differentiate like this? Well, before we can explain that, first we have to explain the concept of a **receptor**.
## Hormone Receptors
In simplest terms, a receptor is like the keyed lock ignition on a car (do new car’s still have keyed ignitions?). Every cell in the body has a set of locks which activate different functions within that cell. They’re like switches which signal to the cell that it should activate a different part of its genetic sequence. Each receptor can only accept certain chemical compounds, much like how a lock can only accept certain keys, and different chemicals have different capabilities at turning the key. Some can completely start the car, while others only turn it to Accessory Mode.
In simplest terms, a receptor is like the keyed lock ignition on a car (do new cars still have keyed ignitions?). Every cell in the body has a set of locks which activate different functions within that cell. They’re like switches which signal to the cell that it should activate a different part of its genetic sequence. Each receptor can only accept certain chemical compounds, much like how a lock can only accept certain keys, and different chemicals have different capabilities at turning the key. Some can completely start the car, while others only turn it to Accessory Mode.
The ability for a chemical to fit into a receptor is called **Relational Binding Affinity**, and is measured as percentage of how likely a chemical will bind to a receptor compared to another. So, for example, if Hormone B binds only 10% of the time in relation to Hormone A, then it is said to have a 10% binding affinity. Similarly, the ability for a chemical to turn the key is called *Transactivational Ability*. Compounds which fit into a receptor but don’t do anything are called *Antagonists*, compounds which are able to turn the key are called **Agonists**. If it can only turn the key a tiny bit, it’s called a **Partial Agonist**.
The ability for a chemical to fit into a receptor is called **relational binding affinity**, and is measured as a percentage of how likely a chemical will bind to a receptor compared to another. So, for example, if hormone B binds only 10% of the time in relation to hormone A, then it is said to have a 10% binding affinity. Similarly, the ability for a chemical to turn the key is called *transactivational ability*. Compounds which fit into a receptor but don’t do anything are called *antagonists*; compounds which are able to turn the key are called **agonists**. If it can only turn the key a tiny bit, it’s called a **partial agonist**.
You can think of antagonists like bouncers at a club. They stand in the doorway and prevent anything else from getting through, but don’t enter the club themselves. Most antagonists are referred to as **blockers**. This is different from an **inhibitor**, which is a compound that slows down a chemical reaction, or an *activator*, which speeds up a reaction. In receptors, an inhibitor lowers the ability of the receptor, causing it to respond less effectively to things that bind to the receptor, and an activator increases the ability of the receptor, making it respond stronger, like a booster.
In some cases a hormone can function as an inhibitor or an activator for a different hormone by slowing down or increasing behavior in a cell. For example, progesterone increase cell activity, making cells respond more effectively to estrogens and androgens, and testosterone increases the transaction ability of dopamine receptors, so less dopamine is needed in the brain for the same effect.
In some cases, a hormone can function as an inhibitor or an activator for a different hormone by slowing down or increasing behavior in a cell. For example, progesterone increases cell activity, making cells respond more effectively to estrogens and androgens, and testosterone increases the transactivational ability of dopamine receptors, so less dopamine is needed in the brain for the same effect.
## Whats in a Hormone
## What's in a Hormone
There are four main kinds of hormones:
- [Amino Acids](https://en.wikipedia.org/wiki/Amino_acid) such as Melatonin which controls sleep, or Thyroxine which regulates the metabolism.
- [Peptides](https://en.wikipedia.org/wiki/Peptide_hormone), like Oxytocin and Insulin, which are collections of Amino Acids.
- [Eicosanoids](https://en.wikipedia.org/wiki/Eicosanoid) that are formed from lipids and fatty acids and predominantly affect the immune system
- [Steroids](https://en.wikipedia.org/wiki/Steroid) are signaling molecules produced by various internal organs in order to pass messages to other organs within the body.
- [Amino acids](https://en.wikipedia.org/wiki/Amino_acid) such as melatonin (which controls sleep) or thyroxine (which regulates metabolism).
- [Peptides](https://en.wikipedia.org/wiki/Peptide_hormone) like oxytocin and insulin, which are collections of amino acids.
- [Eicosanoids](https://en.wikipedia.org/wiki/Eicosanoid) that are formed from lipids and fatty acids and predominantly affect the immune system.
- [Steroids](https://en.wikipedia.org/wiki/Steroid), which signaling molecules produced by various internal organs in order to pass messages to other organs within the body.
{!{ <div class="gutter print-span3">{{import '~/img' images.steroidogenesis
className="card"
link="https://en.wikipedia.org/wiki/File:Steroidogenesis.svg"
external=1
alt="Chart of steroid metabolism flow"
caption="All steroids are formed from cholesterols (top left) and are derived from other steroids. Progestins form into Androgens which form into Estrogens. This is a one-way exchange, and does not reverse, so don't believe it when someone tells you that too much estrogen will turn it into testosterone."
caption="All steroids are formed from cholesterols (top left) and are derived from other steroids. Progestogens form into androgens which form into estrogens. This is a one-way exchange, and does not reverse, so don't believe it when someone tells you that too much estrogen will turn it into testosterone."
}}</div> }!}
For the purposes of transition, this last category is what we care about the most, as all of the sex hormones are steroids. They fall into seven main categories:
- [Androgens](https://en.wikipedia.org/wiki/Androgen)
- [Estrogens](https://en.wikipedia.org/wiki/Estrogen)
- [Progestagins](https://en.wikipedia.org/wiki/Progestogen)
- [Progestogens](https://en.wikipedia.org/wiki/Progestogen)
- [Glucocorticoids](https://en.wikipedia.org/wiki/Glucocorticoid)
- [Mineralcorticoids](https://en.wikipedia.org/wiki/Mineralocorticoid)
- [Mineralocorticoids](https://en.wikipedia.org/wiki/Mineralocorticoid)
- [Neurosteroids](https://en.wikipedia.org/wiki/Steroid)
- [Aminosteroids](https://en.wikipedia.org/wiki/Aminosteroid)
The first three of these are what we care about most when it comes to Hormone Therapy. Note: All human beings, regardless of phenotype, have some of every one of these hormones in their bodies. The ratios are what affect body shape.
The first three of these are what we care about most when it comes to hormone therapy. Note: All human beings, regardless of phenotype, have some of every one of these hormones in their bodies. The ratios are what affect body shape.
### Androgens
There are nearly a dozen different androgens, but the ones we care about the most are [Testosterone](https://en.wikipedia.org/wiki/Testosterone) and [Dihydrotestosterone](https://en.wikipedia.org/wiki/Dihydrotestosterone).
There are nearly a dozen different androgens, but the ones we care about the most are [testosterone](https://en.wikipedia.org/wiki/Testosterone) and [dihydrotestosterone](https://en.wikipedia.org/wiki/Dihydrotestosterone).
Testosterone is the primary masculinizing hormone for the human body and is produced in the adrenal glands, the testes, and in the ovaries (where it is immediately converted into estrone and estradiol). It tells both muscle and bone cells to grow and in higher concentrations encourages larger muscle mass and thicker skeletal structure. This also means that Testosterone is critical for bone health, as it affects calcium distribution within the skeletal structure. Thus, severe depletion of testosterone can result in osteoperosis and fragile bones. Testosterone also plays a major role in sex drive and libido, encouraging mating behavior within the cerebral cortex.
Dihydrotestosterone (DHT), which is converted from Testosterone in the prostate, skin and liver, plays a major role in the development of the male genitalia during puberty by inducing random erections, and the growth of facial and body hair. Paradoxically, DHT is also what causes male pattern baldness, as it chokes off blood circulation to the follicles on the top of the scalp (sorry, trans guys, it's a double edged sword). DHT binds to androgen receptors ten times more strongly than testosterone, which is why it is critical to eliminate it for feminizing transition.
Testosterone is the primary masculinizing hormone for the human body and is produced in the adrenal glands, the testes, and in the ovaries (where it is immediately converted into estrone and estradiol). It tells both muscle and bone cells to grow and, in higher concentrations, encourages larger muscle mass and thicker skeletal structure. This also means that testosterone is critical for bone health, as it affects calcium distribution within the skeletal structure. Thus, severe depletion of testosterone can result in osteoporosis and fragile bones. Testosterone also plays a major role in sex drive and libido, encouraging mating behavior within the cerebral cortex.
Dihydrotestosterone (DHT), which is converted from testosterone in the prostate, skin, and liver, plays a major role in the development of the male genitalia during puberty by inducing random erections, and the growth of facial and body hair. Paradoxically, DHT is also what causes male pattern baldness, as it chokes off blood circulation to the follicles on the top of the scalp (sorry, trans guys, it's a double-edged sword). DHT binds to androgen receptors ten times more strongly than testosterone, which is why it is critical to eliminate it for feminizing transition.
### Estrogens
There are four estrogens: [Estradiol](https://en.wikipedia.org/wiki/Estradiol), [Estrone](https://en.wikipedia.org/wiki/Estrone), Estriol and Estetrol. The latter two are only produced during pregnancy and are important for fetal health, but have no bearing on transition.
There are four estrogens: [estradiol](https://en.wikipedia.org/wiki/Estradiol), [estrone](https://en.wikipedia.org/wiki/Estrone), estriol and estetrol. The latter two are only produced during pregnancy and are important for fetal health, but have no bearing on transition.
Estradiol is the Feminizing hormone, as it is the primary signaling hormone for growth in the mammary glands (breast tissue), and because it encourages fat deposits in the thighs, hips, butt, chest and arms, while discouraging fat deposits in the abdomen, thus producing a curvier figure. Estradiol also promote increased collagen production, resulting in softer skin and more flexible tendons & ligaments.
Estradiol is the feminizing hormone, as it is the primary signaling hormone for growth in the mammary glands (breast tissue), and because it encourages fat deposits in the thighs, hips, butt, chest, and arms, while discouraging fat deposits in the abdomen, thus producing a curvier figure. Estradiol also promotes increased collagen production, resulting in softer skin and more flexible tendons & ligaments.
Estrone's role in the body has been something of a puzzle in medical research, as it has significantly lower binding affinity compared to estradiol (0.6%) and very low transactivational ability (4%). The hormone doesn't appear to *do* anything, it just sits in the blood stream. However it has a unique ability to convert to and from Estradiol via an enzyme group called [17β-HSD](https://en.wikipedia.org/wiki/17%CE%B2-Hydroxysteroid_dehydrogenase), making it ideally suited to function like an estrogen battery within the body.
Estrone's role in the body has been something of a puzzle in medical research, as it has significantly lower binding affinity compared to estradiol (0.6%) and very low transactivational ability (4%). The hormone doesn't appear to *do* anything; it just sits in the bloodstream. However, it has a unique ability to convert to and from estradiol via an enzyme group called [17β-HSD](https://en.wikipedia.org/wiki/17%CE%B2-Hydroxysteroid_dehydrogenase), making it ideally suited to function like an estrogen battery within the body.
New research is starting to suggest that the body may regulate total estradiol levels by releasing HSD17B1 to turn estradiol into estrone, and releasing HSD17B2 to convert it back, however this is very early study. Both enzymes are produced in breast tissue, and may play a role in the presence of cyclical period-like symptoms in estrogenic individuals who do not have ovaries, such as trans women.
New research is starting to suggest that the body may regulate total estradiol levels by releasing HSD17B1 to turn estradiol into estrone, and releasing HSD17B2 to convert it back, but this is a very early study. Both enzymes are produced in breast tissue, and may play a role in the presence of cyclical period-like symptoms in estrogenic individuals who do not have ovaries, such as trans women.
{!{ <div class="gutter"><div class="card"><div class="card-body"><h4 class="card-title">For Your Information</h4> }!}
**Why aren't AFAB trans people prescribed estrogen blockers alongside testosterone?**
There are two separate sources for estrogens within the female reproductive system. Ovaries contains thousands of follicles, cell structures which produce eggs. The pituitary gland produces luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which encourages the follicles to grow into luteal cells. Theca cells within the follicle produce testosterone, and granulosa cells produce the enzyme [aromatase](https://en.wikipedia.org/wiki/Aromatase), which converts that testosterone into estradiol. This is the first source of estrogen, but it is not the largest source.
There are two separate sources for estrogens within the female reproductive system. Ovaries contain thousands of follicles: cell structures which produce eggs. The pituitary gland produces luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which encourages the follicles to grow into luteal cells. Theca cells within the follicle produce testosterone, and granulosa cells produce the enzyme [aromatase](https://en.wikipedia.org/wiki/Aromatase), which converts that testosterone into estradiol. This is the first source of estrogen, but it is not the largest source.
Note: This is why PCOS causes ovaries to produce testosterone; the ovarian cysts disrupt the aromatase production, so the testosterone does not get converted.
@ -97,24 +94,24 @@ Taking testosterone causes the hypothalamus to deactivate the genes that initiat
{!{ </div></div></div> }!}
### Progestagins
### Progestogens
The primary progestogin is [progesterone](https://en.wikipedia.org/wiki/Progesterone), which plays numerous roles in the body and has been found to be [an important component for feminizing hormone therapy](https://academic.oup.com/jcem/article/104/4/1181/5270376).
The primary progestogen is [progesterone](https://en.wikipedia.org/wiki/Progesterone), which plays numerous roles in the body and has been found to be [an important component for feminizing hormone therapy](https://academic.oup.com/jcem/article/104/4/1181/5270376).
One of the largest roles that the progestogin receptor plays is in the regulation of gonadal function (ovaries and testies). The hypothalamus is positively *littered* with progestogin receptors and responds strongly to their activation, downregulating the production of [GnRH](https://en.wikipedia.org/wiki/Gonadotropin-releasing_hormone), which then reduces the production of [luteinizing hormone](https://en.wikipedia.org/wiki/Luteinizing_hormone) by the pituitary gland.
One of the largest roles that the progestogen receptor plays is in the regulation of gonadal function (ovaries and testes). The hypothalamus is positively *littered* with progestogen receptors and responds strongly to their activation, downregulating the production of [GnRH](https://en.wikipedia.org/wiki/Gonadotropin-releasing_hormone), which then reduces the production of [luteinizing hormone](https://en.wikipedia.org/wiki/Luteinizing_hormone) by the pituitary gland.
LH is what tells the ovaries and testes to produce estrogen and androgens. LH and its sibling hormone [FSH](https://en.wikipedia.org/wiki/Follicle-stimulating_hormone) both play central roles in ovulation, which is another large source of estrogen in ovary-havers. Thus, synthetic progestins, chemicals that fit into progestogin receptors, are often included in birth control in order to prevent ovulation. In AMABs, progestogins are a useful tool for blocking testosterone production.
LH is what tells the ovaries and testes to produce estrogen and androgens. LH and its sibling hormone [FSH](https://en.wikipedia.org/wiki/Follicle-stimulating_hormone) both play central roles in ovulation, which is another large source of estrogen in ovary-havers. Thus, synthetic progestogens (chemicals that fit into progestogen receptors) are often included in birth control in order to prevent ovulation. In AMABs, progestogens are a useful tool for blocking testosterone production.
Another type of cell that is full of progestogin receptors is mammary tissue. Progesterone plays a major role in the growth and maturation of milk ducts within breast tissue. While little formal research has been conducted into progesterone's effect on breast development, anecdotally it has been seen widely across the transfem community to provide significant improvements in breast fullness. Progesterone has also been demonstrated to increase blood flow to breast tissue, and encourages fat deposits in the breasts, both of which increase breast size.
Another type of cell that is full of progestogen receptors is mammary tissue. Progesterone plays a major role in the growth and maturation of milk ducts within breast tissue. While little formal research has been conducted into progesterone's effect on breast development, anecdotally it has been seen widely across the transfem community to provide significant improvements in breast fullness. Progesterone has also been demonstrated to increase blood flow to breast tissue, and encourages fat deposits in the breasts, both of which increase breast size.
Additionally, progesterone promotes better sleep, improves cardiovascular health, increases ketogenesis (reducing triglycerides), increases metabolic function, and has been found to reduce breast cancer risk.
### Mineralcorticoids
### Mineralocorticoids
Mineralcorticoids play no role in transition, but they are worth mentioning because of one major hormone: [Aldosterone](https://en.wikipedia.org/wiki/Aldosterone).
Mineralocorticoids play no role in transition, but they are worth mentioning because of one major hormone: [aldosterone](https://en.wikipedia.org/wiki/Aldosterone).
Aldosterone is what instructs the kidneys to *stop* extracting water from the blood stream. It is produced by the adrenal glands in order to regulate body hydration. Why is this significant?
Aldosterone is what instructs the kidneys to *stop* extracting water from the bloodstream. It is produced by the adrenal glands in order to regulate body hydration. Why is this significant?
Because one drug that is very commonly used in trans hormone therapy is an extremely powerful aldosterone antagonist... Spironolactone. Spiro binds to mineralcorticoid receptors more strongly than aldosterone does, but does not activate the receptor. It just clogs it, preventing the kidneys from receiving the signal to stop extracting water.
Because one drug that is very commonly used in trans hormone therapy is an extremely powerful aldosterone antagonist: spironolactone. Spiro binds to mineralocorticoid receptors more strongly than aldosterone does, but does not activate the receptor. It just clogs it, preventing the kidneys from receiving the signal to stop extracting water.
This is why spiro makes people pee so much.

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> [Impostor syndrome](https://en.wikipedia.org/wiki/Impostor_syndrome) (also known as impostor phenomenon, impostorism, fraud syndrome or the impostor experience) is a psychological pattern in which an individual doubts their accomplishments and has a persistent internalized fear of being exposed as a "fraud".
> [Impostor syndrome](https://en.wikipedia.org/wiki/Impostor_syndrome) (also known as impostor phenomenon, impostorism, fraud syndrome, or the impostor experience) is a psychological pattern in which an individual doubts their accomplishments and has a persistent internalized fear of being exposed as a "fraud".
Society in general is very good about making trans people doubt themselves. We receive tons and tons of subliminal messages through out our lives saying that being trans isn't normal and that anyone who is has to be exceptionally special. Cis media's obsession with the "born in the wrong body" narrative has led to a lot of false information being internalized by trans youth. Many, *many* trans kids grow up thinking they aren't actually trans because they don't *know* that they are a different gender, they just wish they were. Many non-binary children grow up knowing something is wrong, but not believing they're trans because they don't feel like a binary trans person.
Society in general is very good about making trans people doubt themselves. We receive tons and tons of subliminal messages through out our lives saying that being trans isn't normal and that anyone who is has to be exceptionally special. Cis media's obsession with the "born in the wrong body" narrative has led to a lot of false information being internalized by trans youth. Many, *many* trans kids grow up thinking they aren't actually trans because they don't *know* that they are a different gender but simply *wish* they were. Many non-binary children grow up knowing something is wrong, but not believing they're trans because they don't feel like a binary trans person.
On top of this, messages saying that trans people hate their bodies or hate their genitalia have polluted the awareness landscape, so that many people who either do not experience physical dysphoria (or simply think theirs isn't very strong) go around believing they aren't "trans enough".
***[YES, YOU ARE TRANS ENOUGH](https://www.amazon.com/Yes-You-Are-Trans-Enough/dp/1785923153/)***
***[YES, YOU ARE TRANS ENOUGH](https://us.jkp.com/products/yes-you-are-trans-enough)***
{!{ <div class="gutter">{{import '~/tweet' ids=[
'1221970265862811650'
@ -42,9 +42,9 @@ On top of this, messages saying that trans people hate their bodies or hate thei
On top of this, the constant messaging from transphobic media that trans people are not actually their true genders and are simply trying to trick people into believing otherwise gets internalized like a virus. This creates a lot of self doubt about the authenticity of one's gender, especially in the face of so many gender stereotypes. Seeing oneself fail to meet those stereotypes can make it very easy to convince yourself that you do not live up to your own gender (note: cis men and women get this too, far too often).
Furthermore, due to a history of transphobic abuse, many trans people suffer from damaged self-esteems, and often already have difficulty with self doubts. Gender Dysphoria also causes depression, which further contributes to and reinforces those doubts. This all leads into a massive cluster of self invalidation that can lead someone to struggle over and over again to accept their own gender identity.
Furthermore, due to a history of transphobic abuse, many trans people suffer from damaged self-esteems, and often already have difficulty with self-doubt. Gender dysphoria also causes depression, which further contributes to and reinforces those doubts. This all leads into a massive cluster of self-invalidation that can lead someone to struggle over and over again to accept their own gender identity.
But here's the thing... only trans people are worried about if they are actually transgender! A cisgender person does not have this obsession with their identity, they think about it, they process it, they move on. If you keep returning to these thoughts over and over again, this is your brain telling you that you took a wrong turn.
But here's the thing... only trans people are worried about if they are actually transgender! A cisgender person does not have this obsession with their identity: they think about it, they process it, they move on. If you keep returning to these thoughts over and over again, this is your brain telling you that you took a wrong turn.
The world is *full* of influences put in place to fill us with doubt and keep us from breaking outside of the established social order. These are some of the systems and ideologies that seek to invalidate trans people and keep us from self-actualizing.
@ -59,7 +59,7 @@ The world is *full* of influences put in place to fill us with doubt and keep us
'1153300374133981186'
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This pattern was strongly reinforced during the late 1980s when the Autogynephelia (AGP) theory of Ray Blanchard gained a lot of traction as trans awareness was just starting to escalate. AGP is a pseudo-scientific explanation intended to "explain" the source of trans women's identities using [paraphilias](https://en.wikipedia.org/wiki/Paraphilia). Blanchard separated trans women according to if they were attracted to men or to women, while simultaneously invalidating their womanhood. His work completely ignored transgender men, and he dismisses non-binary identities outright.
This pattern was strongly reinforced during the late 1980s when the autogynephelia (AGP) theory of Ray Blanchard gained a lot of traction as trans awareness was just starting to escalate. AGP is a pseudo-scientific explanation intended to "explain" the source of trans women's identities using [paraphilias](https://en.wikipedia.org/wiki/Paraphilia). Blanchard separated trans women according to if they were attracted to men or to women, while simultaneously invalidating their womanhood. His work completely ignored transgender men, and he dismisses non-binary identities outright.
Autogynephelia attests that straight trans women are actually just gay men who seek a feminine appearance to draw desire from straight men, and that trans lesbians are actually straight men who have become so obsessed with their desire for women that they wish to become a woman in order to gain sexual gratification from themselves.
@ -69,15 +69,15 @@ Yes, it boggles the mind, but this was actually considered a valid theory of psy
AGP had been thoroughly dismissed by modern psychology by the late 2000s, but the damage has been done. In the public's eye, trans women were all perverted fetishists. Media portrayals of trans women mirrored this attitude, further spreading negative imagery into the public consciousness.
Transfeminine individuals then internalize these messages, and come to the conclusion that they are not actually transgender, just fetishists. It happened to me, it's happened to nearly every millennial trans woman I know who figured themselves out as a teen.
Transfeminine individuals then internalize these messages, and come to the conclusion that they are not actually transgender — just fetishists. It happened to me, and it's happened to nearly every millennial trans woman I know who figured themselves out as a teen.
You are not a fetishist, the feeling you get from thinking of yourself as a woman is gender euphoria.
You are not a fetishist. The feeling you get from thinking of yourself as a woman is gender euphoria.
### Patriarchal Oppression
A common source of invalidation for AFABs is the conflation of gender with the systemic oppression of women, particularly among non-medically-transitioning non-binary people. The message of "oh you just don't want to be a woman because of how women are treated" is far too often heard, and it can deeply infest your subconscious to the point of self doubt. But this doesn't make much sense, because if you're AFAB and not a woman, that makes you transgender. And on average, society treats transgender folks worse than women. So transitioning to escape systemic oppression is a dumb concept (and I personally have never met a trans person who has done this).
A common source of invalidation for AFABs is the conflation of gender with the systemic oppression of women, particularly among non-medically-transitioning non-binary people. The message of "oh you just don't want to be a woman because of how women are treated" is far too often heard, and it can deeply infest your subconscious to the point of self-doubt. But this doesn't make much sense, because if you're AFAB and not a woman, that makes you transgender, and, on average, society treats transgender folks worse than women. So transitioning to escape systemic oppression is a dumb concept (and I personally have never met a trans person who has done this).
Radical Feminism's messaging of abandoning female gender roles can also make parsing your own feelings harder. "Am I actually non-binary, or am I just a feminist?" "Am I actually a man, or am I just a very butch lesbian?". For this, I encourage you to talk to cis woman feminists, especially lesbians. They'll complain about systems of oppression and the patriarchy, but the problems are all external, and they *want to be women*. Even very butch lesbians want to be women, just in a different way from mainstream femininity.
Radical feminism's messaging of abandoning female gender roles can also make parsing your own feelings harder. "Am I actually non-binary, or am I just a feminist?" "Am I actually a man, or am I just a very butch lesbian?". For this, I encourage you to talk to cis woman feminists, especially lesbians. They'll complain about systems of oppression and the patriarchy, but the problems are all external, and they *want to be women*. Even very butch lesbians want to be women, just in a different way from mainstream femininity.
Then you have the problem of people believing that to be non-binary is to be androgynous, and to be androgynous is to be less feminine. Feminine enbies are valid! It is okay if you do not want to remove your breasts. It is okay if you enjoy your curves. It is okay if you do not mind being called "she" and "her". That does not make you any less transgender.
@ -85,30 +85,30 @@ If you feel like you are not a binary woman, than you are not a binary woman. Ci
### Toxic Masculinity
Male-assigned kids grow up positively drenched in messaging of what it is to "be a man". There are so few examples of positive masculinity in popular media, and AMAB Masculine Enbies are also so commonly erased in trans representation that being a genderqueer male can feel very lonely. AMAB Enbies are often either grouped in with gay cis men or treated like trans women.
Male-assigned kids grow up positively drenched in messaging of what it is to "be a man". There are so few examples of positive masculinity in popular media, and AMAB masculine enbies are also so commonly erased in trans representation that being a genderqueer male can feel very lonely. AMAB enbies are often either grouped in with gay cis men or treated like trans women.
You can just be genderqueer! Your identity is valid!
### Transmedicalism
This one hits *everybody*. Transmedicalism (aka Truetrans) is a transgender ideology derived from the Harry Benjamin scale (ranks 5 and 6). It seeks to reinforce the pre-WPATH rules, requiring intense physical dysphoria, demanding medical transition, and often invalidating all non-binary identities. At its core, transmedicalism is a supremacist concept, elevating binary trans people above the needs of any other gender identity, and a push back against the expansion of the transgender identity. They wish for more gatekeeping than we have today, rail against enbies using the transgender label, and would prefer to see fewer people receive treatment for their gender dysphoria.
This one hits *everybody*. Transmedicalism (aka Truetrans) is a transgender ideology derived from the Harry Benjamin scale (ranks 5 and 6). It seeks to reinforce the pre-WPATH rules, requiring intense physical dysphoria, demanding medical transition, and often invalidating all non-binary identities. At its core, transmedicalism is a supremacist concept, elevating binary trans people above the needs of any other gender identity, and is a push back against the expansion of the transgender identity. They wish for more gatekeeping than we have today, rail against enbies using the transgender label, and would prefer to see fewer people receive treatment for their gender dysphoria.
To put it succinctly, many transmedicalists hate that the newer generation "has it so easy," despite the fact that many of their ranks are part of that generation. This ideology started among disgruntled trans elders, but has since spread to other binary individuals, particularly among young trans men.
If a trans person's first exposure to transness is a transmedicalist, this can severely set back their own self-acceptance and push them even further into the closet. Transmeds are well known to actually tell people "No, you are not trans."
**Do not believe these lies.** They are bully tactics explicitly designed to gaslight and dismiss people's pain for self gratification.
**Do not believe these lies.** They are bully tactics explicitly designed to gaslight and dismiss people's pain for self-gratification.
There are related hurtful concepts a trans person can internalize, revolving around seeing transition as a list of required actions. One such idea is a belief that a person shouldn't expect being gendered correctly or even complain about misgendering as long as they haven't changed their gender marker. In other words, legally conditioned pronoun respect, or translegalism. Not only can changing gender marker be a complicated, prolonged process, not only cannot some people afford to out themselves by pursuing it, but also most countries wouldn't allow a gender marker outside of the gender binary. Translegalism convinces a person that they deserve misgendering because of their ID.
There are related hurtful concepts a trans person can internalize, revolving around seeing transition as a list of required actions. One such idea is a belief that a person shouldn't expect being gendered correctly or even complain about misgendering as long as they haven't changed their gender marker. In other words, legally conditioned pronoun respect, or translegalism. Not only can changing gender marker be a complicated, prolonged process, not only can some people not afford to out themselves by pursuing it, but most countries wouldn't even allow a gender marker outside of the gender binary. Translegalism convinces a person that they deserve misgendering because of their ID.
### Trans-Exclusionary Reactionary Feminism / Gender Critical Movement / Gender Essentialism
[Gender Essentialism](https://en.wikipedia.org/wiki/Gender_essentialism) is the belief that there are an innate attributes to a person's existence that are derived based on what sex organs the person is born with. TERF and GC ideology was born out of the lesbian separatist movement of second wave feminism and fully denies the existence of transgender biology and non-binary identities. The movement has been largely overtaken by right-wing reactionaries, racists, and homophobes, and is now being bolstered by evangelical Christian organizations.
[Gender Essentialism](https://en.wikipedia.org/wiki/Gender_essentialism) is the belief that there are innate attributes to a person's existence that are derived based on what sex organs the person is born with. TERF and GC ideology was born out of the lesbian separatist movement of second wave feminism and fully denies the existence of transgender biology and non-binary identities. The movement has been largely overtaken by right-wing reactionaries, racists, and homophobes, and is now being bolstered by evangelical Christian organizations.
These people will stop at nothing to invalidate your existence. Do not give them the time of day.
### Gender Abolitionism / Postgenderism
[Postgenderism](https://en.wikipedia.org/wiki/Postgenderism) is a [transhumanist](https://en.wikipedia.org/wiki/Transhumanism) philosophy originating in radical feminism which states that gender causes more harm than good, and seeks to eradicate it from our society. Old school TERFs latched on to GA as reasoning for why trans people should not exist. This trans exclusionary faction of Gender Abolition believes that all gender is a construct and that anyone who feels strongly connected to a binary gender is either nefariously propagating gender stereotypes or ignorantly following systemic indoctrination. They do not believe in the existence of gender dysphoria, and will attempt to invalidate those who experience it.
[Postgenderism](https://en.wikipedia.org/wiki/Postgenderism) is a [transhumanist](https://en.wikipedia.org/wiki/Transhumanism) philosophy originating in radical feminism which states that gender causes more harm than good, and seeks to eradicate it from our society. Old-school TERFs latched on to GA as reasoning for why trans people should not exist. This trans-exclusionary faction of gender abolitionism believes that all gender is a construct and that anyone who feels strongly connected to a binary gender is either nefariously propagating gender stereotypes or ignorantly following systemic indoctrination. They do not believe in the existence of gender dysphoria, and will attempt to invalidate those who experience it.
Note, this is NOT about trans people who identify as Postgender or Gender Abolition as a whole. This is specifically about TERF abuse of the concepts.
Note, this is NOT about trans people who identify as postgender or gender abolitionism as a whole. This is specifically about TERF abuse of the concepts.

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In cultures worldwide, for as long as human civilization has existed, [there have been people](https://en.wikipedia.org/wiki/Transgender_history) whose experience of their gender identity do not align with the anglo-european concepts of binary sex based on genital structure. The Gala, a middle gender priest class of the Sumerian empire, existed over 4,500 years ago. The Indigenous cultures of North America recognized [a third gender](https://en.wikipedia.org/wiki/Third_gender) far before European colonialism, and still do to this day. Tribal [cultures all across Africa](https://medium.com/@janelane_62637/the-splendor-of-gender-non-conformity-in-africa-f894ff5706e1) recognize numerous gender identities, which [Europeans tried to wipe out](https://daily.jstor.org/the-deviant-african-genders-that-colonialism-condemned/). Human beings have long lived with identities, norms, and degrees of conformity to those norms which differ from the so-called "traditional" idea of gender in westernized culture today.
In cultures worldwide, for as long as human civilization has existed, [there have been people](https://en.wikipedia.org/wiki/Transgender_history) whose experience of their gender identity do not align with the Anglo-European concepts of binary sex based on genital structure. The Gala, a middle gender priest class of the Sumerian empire, existed over 4,500 years ago. The Indigenous cultures of North America recognized [a third gender](https://en.wikipedia.org/wiki/Third_gender) far before European colonialism, and still do to this day. Tribal [cultures all across Africa](https://medium.com/@janelane_62637/the-splendor-of-gender-non-conformity-in-africa-f894ff5706e1) recognize numerous gender identities, which [Europeans tried to wipe out](https://daily.jstor.org/the-deviant-african-genders-that-colonialism-condemned/). Human beings have long lived with identities, norms, and degrees of conformity to those norms which differ from the so-called "traditional" idea of gender in westernized culture today.
In spite of this, however, the modern western understanding of the transgender experience has only existed for approximately 130 years. Even the word "transgender" only dates back to 1965, when John Oliven proposed it as a more accurate alternative to David Cauldwell's term "transsexual" (coined in 1949), which itself replaced Magnus Hirschfield's term "transvestite" (1910).
In spite of this, however, the modern western understanding of the transgender experience has only existed for approximately 130 years. Even the word "transgender" only dates back to 1965, when John Oliven proposed it as a more accurate alternative to David Cauldwell's term "transsexual" (coined in 1949), which itself replaced Magnus Hirschfeld's term "transvestite" (1910).
Being transgender can mean that a person born with a penis is actually a girl, that a person born with a vulva is actually a boy, or that a person with any genital configuration may not wholly fit either side of that spectrum and is non-binary.
A trans person can come to recognize this at *any point* in their life. Some children identify it at as soon as they are able to grasp the concept of gender, others don't start to feel anything until the onset of puberty, and still others do not realize that anything is wrong at all until they are fully adults. Many people are simply never exposed to the idea that their gender could mismatch their sex assigned at birth, or what that feels like, and thus simply accepted their fate.
A trans person can come to recognize this at *any point* in their life. Some children identify it at as soon as they are able to grasp the concept of gender, others don't start to feel anything until the onset of puberty, and still others do not realize that anything is wrong at all until they are fully adults. Many people are simply never exposed to the idea that their gender could mismatch their sex assigned at birth, or what that feels like, and thus have simply accepted their fate.
Even more common is a perception that even though they have feelings about being unhappy with the gender they were assigned at birth, they believe that this is not the same as what transgender people experience. Some may feel that a wish to be transgender and have transition available is some kind of disrespect towards "real" trans people who knew they were actually boys or girls "born in the wrong body." These narratives of the transgender experience that have been spread by popular media can create a very false impression of just what it means to be transgender and what growing up transgender feels like.
Even more common is a perception wherein, even though someone may have feelings about being unhappy with the gender they were assigned at birth, they believe that this is not the same as what transgender people experience. Some may feel that a wish to be transgender and have transition available is some kind of disrespect towards "real" trans people who knew they were actually boys or girls "born in the wrong body." These narratives of the transgender experience that have been spread by popular media can create a very false impression of just what it means to be transgender and what growing up transgender feels like.
This experience of discontinuity between the societal presumed gender and the internal sense of self is what we describe as Gender Dysphoria, and is common among nearly all trans individuals, regardless of their position within or outside of the gender binary. This has at times been something of a political topic within trans communities, as different groups have their own ideas of what Gender Dysphoria is, how it manifests itself, and what qualifies a person as being trans. So as not to get lost in that topic, this site will define Gender Dysphoria in broad terms of incongruence with sex assigned at birth. If you experience gender identity in a way that does not match what was assigned to you at birth, your claim to the transgender identity is valid, no matter how that incongruence manifests for you.
This experience of discontinuity between the societal presumed gender and the internal sense of self is what we describe as **gender dysphoria**, and is common among nearly all trans individuals, regardless of their position within or outside of the gender binary. This has at times been something of a political topic within trans communities, as different groups have their own ideas of what gender dysphoria is, how it manifests itself, and what qualifies a person as being trans. So as not to get lost in that topic, this site will define gender dysphoria in broad terms of incongruence with sex assigned at birth. If you experience gender identity in a way that does not match what was assigned to you at birth, your claim to the transgender identity is valid, no matter how that incongruence manifests for you.
The purpose of this site is to document the many ways that Gender Dysphoria can manifest, as well as the numerous forms of gender transition, in order to provide a guide for those who are questioning, those who are starting their transgender journey, those already on their path, and those who simply wish to be better allies.
The purpose of this site is to document the many ways that gender dysphoria can manifest, as well as the numerous forms of gender transition, in order to provide a guide for those who are questioning, those who are starting their transgender journey, those already on their path, and those who simply wish to be better allies.
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@ -22,7 +22,7 @@ Growing up in the closet, even when you don't know you're in the closet, becomes
- When a video game gives you the option of choosing your gender, you tend to choose differently than your assigned gender. This may be accompanied with excuses to defend that choice. "It defaulted to male and I didn't care." "I don't want to stare at a guy's butt for hours."
- A preference for literature and film with characters of your true gender, or with characters who break gender norms (Mulan, Little Women).
- A preference for literature and film with characters of your true gender, or with characters who break gender norms (_Mulan_, _Little Women_).
- Pornographic outlets which satisfy strong desires or feel more relatable, such as a draw towards gay/lesbian porn, bridal kink, or transformation sequences.
@ -65,9 +65,9 @@ Because so much abuse is handed down onto gender non-conforming children, many t
- Buying in to ultra-conservative attitudes towards gender and sexuality.
- Expressing Homophobia and Transphobia in self defense to ward off suspicion.
- Expressing homophobia and transphobia in self-defense to ward off suspicion.
- Aggressively passive engagement in anything connected to one's true gender.
- Aggressively-passive engagement in anything connected to one's true gender.
Finally, another very common coping mechanism is to find means of escape or mental engagement in order to forget your own feelings.
@ -76,7 +76,7 @@ Finally, another very common coping mechanism is to find means of escape or ment
- Long hours spent at work.
- Chain binging movies, TV shows or books.
- Chain-binging movies, TV shows, or books.
- Spending all idle time playing video games or on social media.

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date: "2020-01-26T20:41:55.827Z"
title: "How Gender Dysphoria Manifests: Physical Dysphoria"
linkTitle: "Physical Dysphoria"
description: "Body discomfort is only one of the many ways Gender Dysphoria manifests."
description: "Body discomfort is only one of the many ways gender dysphoria can manifest."
preBody: '_disclaimer'
siblings:
prev: /en/euphoria
@ -21,7 +21,7 @@ tweets:
# Physical Gender Dysphoria
Everyone has heard of the "born in the wrong body" narrative. Physical Dysphoria is discomfort over the shape of one's body due to the sexual characteristics it presents. So what body features are we talking about here?
Everyone has heard of the "born in the wrong body" narrative. Physical dysphoria is discomfort over the shape of one's body due to the sexual characteristics it presents. So what body features are we talking about here?
{!{
<style>
@ -98,15 +98,15 @@ All sexually dimorphic features which develop during and after puberty as a resu
The genitals of a transgender person on hormone therapy do not behave remotely like their cisgender counterparts.
- The Estrogenic Penis softens, erections become less pronounced, the skin thins and begins to perspire like a vaginal wall. The scrotum softens and changes color, with the perineal raphe becoming more distinct. Due to the cessation of random erections, the erectile tissue will atrophy if not regularly put to use, causing the entire penis to shrink over time. Vibration becomes more effective for arousal.
- The estrogenic penis softens, erections become less pronounced, and the skin thins and begins to perspire like a vaginal wall. The scrotum softens and changes color, with the perineal raphe becoming more distinct. Due to the cessation of random erections, the erectile tissue will atrophy if not regularly put to use, causing the entire penis to shrink over time. Vibration becomes more effective for arousal.
- The Androgenic Vagina becomes dryer & prone to tearing (lubrication can be an issue). The skin of the clitoris thickens, and the clitoral glans grows in length and girth due to the onset of random erections. Labia also become thicker, and often hairier. The onset of HRT often results in extreme sensitivity of the clitoris.
- The androgenic vagina becomes dryer & prone to tearing (lubrication can be an issue). The skin of the clitoris thickens, and the clitoral glans grows in length and girth due to the onset of random erections. Labia also become thicker, and often hairier. The onset of HRT often results in extreme sensitivity of the clitoris.
{!{ </div></div></div> }!}
Primary characteristics can only be altered through surgical intervention. Some secondary sexual characteristics are also one-way trips and require medical intervention to undo, namely the growth of breast tissue and the deepening of the vocal chords. Estrogen does not make the voice more feminine, Testosterone does not make breasts shrink (aside from the loss of fat). Changes to skeletal structure (such as enlarging from testosterone and the widening of hips from estrogen) can only occur prior to the age of 25, while the body is still growing.
Primary characteristics can only be altered through surgical intervention. Some secondary sexual characteristics are also one-way trips and require medical intervention to undo, namely the growth of breast tissue and the deepening of the vocal chords. Estrogen does not make the voice more feminine, and testosterone does not make breasts shrink (aside from the loss of fat). Changes to skeletal structure (such as enlarging from testosterone and the widening of hips from estrogen) can only occur prior to the age of 25, while the body is still growing.
Some secondary traits can be surgically enhanced (Breast Augmentation, body contouring, facial masculinization / feminization), and some cannot be changed at all.
Some secondary traits can be surgically enhanced (breast augmentation, body contouring, facial masculinization / feminization), and some cannot be changed at all.
Physical dysphoria manifests in several different ways. Sometimes this is felt in a sort of phantom limb phenomenon, where the person can feel sensations from a penis or vagina that is not there, an ache in a uterus that does not exist, or a sense of absence on the chest from breasts that have not grown in.
@ -118,24 +118,24 @@ It may be felt as horror or revulsion when looking at or touching the external g
'1220143004821938176'
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It can manifest as a compulsion to be rid of certain body traits, such as obsessively shaving body or facial hair. This can also manifest in the opposite compulsion, leading to meticulous grooming of those traits in order to try to control them, like maintaining a perfect beard, persistently keeping ones nails manicured and polished, or spending hours in the gym attempting to hone ones shape.
It can manifest as a compulsion to be rid of certain body traits, such as obsessively shaving body or facial hair. This can also manifest in the opposite compulsion, leading to meticulous grooming of those traits in order to try to control them, like maintaining a perfect beard, persistently keeping one's nails manicured and polished, or spending hours in the gym attempting to hone one's shape.
Undesired physical features may prompt a person to experience envy of people who have been forced to remove those features due to illnesses, such as testicular or breast cancer. AMABs with severe genital dysphoria tend to have a wish for some kind of freak accident that would cause the loss of their phallus.
Sometimes it may just simply be a feeling of being incorrect, which you may not even attribute to gender or sex. For most of my life I believed that the reason I hate my body was because I was fat. It wasn't until I started transition that I realized I don't hate my fat at all, I hated having *male* fat. The feminine curves that HRT gave me make me feel so much more in tune with my body.
Sometimes it may just simply be a feeling of being incorrect, which you may not even attribute to gender or sex. For most of my life, I believed that the reason I hate my body was because I was fat. It wasn't until I started transition that I realized I don't hate my fat at all; I hated having *male* fat. The feminine curves that HRT gave me make me feel so much more in tune with my body.
{!{ <div class="gutter">{{import '~/tweet' ids=[
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The dysphoria one feels about their body can and will change over time, for better and worse. For example, many trans women enter into transition feeling no disconnect with their genitals, but later find that as larger sources of dysphoria melt away, that they become less comfortable with their original configuration. Alternatively, some may assume that they will absolutely need facial feminization surgery, but then 2 years in to transition, realize they're actually okay with how they look.
The dysphoria one feels about their body can and will change over time, for better and worse. For example, many trans women enter into transition feeling no disconnect with their genitals, but later find that as larger sources of dysphoria melt away, that they become less comfortable with their original configuration. Alternatively, some may assume that they will absolutely need facial feminization surgery, but then, two years into transition, realize they're actually okay with how they look.
It's okay for you to realize you need more or less than when you started.
It's okay if you don't hate anything about your body, and just wish you looked more feminine or masculine.
It's okay if you don't hate anything about your body and just wish you looked more feminine or masculine.
It's okay if you only hate some aspects of your body, and don't wish to change all of its sexual characteristics.
It's okay if you only hate some aspects of your body and don't wish to change all of its sexual characteristics.
It's okay if you don't need medical transition *at all*. Body feelings are not the be-all-end-all of transition.

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public/en/presentational-dysphoria.md
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# Presentational Dysphoria
Clothes. Hair. Makeup. Jewelry. Glasses. Piercings and other body modifications. Even personal hygiene can be a factor of presentation, such as the shaving of body hair, or how you take care of your skin. All of these things are gendered in society, clothing and hair especially.
Clothes. Hair. Makeup. Jewelry. Glasses. Piercings and other body modifications. Even personal hygiene can be a factor of presentation, such as the shaving of body hair or how you take care of your skin. All of these things are gendered in society, clothing and hair especially.
While the sexual revolution of the 1960s and the business fashion craze of the 80s did wonders for blurring the gap between masculine and feminine presentation (largely by normalizing masc fashion as androgynous), there are still enormous pressures to conform to traditional gender norms. Gender Non-Conforming dress is so instantly marked as queer that any time a woman wears a tailored suit she is marked as a lesbian, and a dad who [puts on an Elsa costume because his son wants to have a Frozen party](https://twitter.com/cbsnews/status/1088441623846023168?lang=en) is labeled as subversive and abusing his child.
While the sexual revolution of the 1960s and the business fashion craze of the 80s did wonders for blurring the gap between masculine and feminine presentation (largely by normalizing masc fashion as androgynous), there are still enormous pressures to conform to traditional gender norms. Gender non-conforming dress is so instantly marked as queer that any time a woman wears a tailored suit she is marked as a lesbian, and a dad who [puts on an Elsa costume because his son wants to have a Frozen party](https://twitter.com/cbsnews/status/1088441623846023168?lang=en) is labeled as subversive and abusing his child.
Long hair on men has been seen as [an act of rocker rebellion](https://www.youtube.com/watch?v=PbAoXw_DqvM) for decades, and men with long hair get discriminated against as being layabouts and bums. Short hair on women is often read as queer or butch (unless they're old, then it's expected), and women are often pressured to keep their hair long. Pierced ears on men became somewhat more normalized in the 90s, but are still seen as an act of rebellion, and some employers won't allow men to wear earrings. Makeup on men is so stigmatized by toxic masculinity that even men who *like* makeup feel pressured to avoid it.
Like it or not, presentation is gendered, and it is extremely common for trans people to want to present themselves in the fashion of their true gender, and a desire to be free of the shackles of gendered presentation is common among all trans people, regardless of where they sit on the gender spectrum. For AMAB individuals they may manifest as a wish to incorporate more feminine elements, for AFABs it may manifest as a want for more masculine appearance. This may come as a full push towards the opposite of their assigned gender, or a desire to seek a middle-ground in pursuit of androgyny. It may even simply be a wish to *not* present as your assigned gender.
Like it or not, presentation is gendered, and it is extremely common for trans people to want to present themselves in the fashion of their true gender, and a desire to be free of the shackles of gendered presentation is common among all trans people, regardless of where they sit on the gender spectrum. For AMAB individuals they may manifest as a wish to incorporate more feminine elements; for AFABs it may manifest as a want for a more masculine appearance. This may come as a full push towards the opposite of their assigned gender, or a desire to seek a middle-ground in pursuit of androgyny. It may even simply be a wish to *not* present as your assigned gender.
**Not all transfems present feminine, not all transmascs present masculine, not all non-binary people seek androgyny. Butch AMAB trans people are valid, femme AFAB trans people are valid. Presentation is not gender, gender is not presentation.**
**Not all transfems present feminine, not all transmascs present masculine, and not all non-binary people seek androgyny. Butch AMAB trans people are valid; femme AFAB trans people are valid. Presentation is not gender; gender is not presentation.**
Presentational Dysphoria typically appears early on in the form of a fascination with the styling of another gender, and a wish to be able to present as people of that gender do. That desire may be fulfilled somewhat by seeking out styling that is unisex, but typically that wish is self-gatekept by statements of "I'm not confident enough to attempt that." AMABs often run into issue here where this desire often gets trapped behind heteronormative expectations, causing an interest in feminine presentation to be misinterpreted as sexual desire.
Presentational dysphoria typically appears early on in the form of a fascination with the styling of another gender, and a wish to be able to present as people of that gender do. That desire may be fulfilled somewhat by seeking out styling that is unisex, but typically that wish is self-gatekept by statements of "I'm not confident enough to attempt that." AMABs often run into issue here where this desire often gets trapped behind heteronormative expectations, causing an interest in feminine presentation to be misinterpreted as sexual desire.
Post-transition Presentational Dysphoria is usually simply a case of high discomfort when attempt to present as one's assigned gender. It may not even be about how one looks, but just the way the clothing makes you feel. For the first year and a half of my own transition I could not bear to wear unisex t-shirts because they just made me feel more masculine. Even now I have to cut the collars out of them, because the close neck makes me feel dysphoric.
Post-transition presentational dysphoria is usually simply a case of high discomfort when attempting to present as one's assigned gender. It may not even be about how one looks, but just the way the clothing makes you feel. For the first year and a half of my own transition I could not bear to wear unisex t-shirts because they just made me feel more masculine. Even now I have to cut the collars out of them because the close neck makes me feel dysphoric.
### Presentation's Affect on Physical Dysphoria.
### Presentation's Effect on Physical Dysphoria.
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@ -46,23 +46,23 @@ Post-transition Presentational Dysphoria is usually simply a case of high discom
Clothing can also play a major role in the level of physical dysphoria a person experiences. Men's clothing is always cut very boxy, straight up and down on the vertical and very square in the horizontal. Women's clothing is cut for more curves, accentuating waistlines and hip shape. Men's pants feature a lower crotch to make room for external genitals, and no fitting for curves, where women's bottoms are the opposite. Women's clothing is often form fitting, where men's clothing is rarely form fitting at all. Men's clothing is often made of sturdier and thicker materials, meant to be worn as a single layer. Women's clothing is often made of thinner and stretchier materials, expected to be layered together.
Because these structures are meant to fit the masculine or feminine forms, they tend to amplify the sensation of wrongness. A classic effect is the way that the difference between men's and women's jeans can have a radical affect on a trans person's comfort level. Unfortunately this works both ways, as even affirming clothing can reveal how your shape is a mismatch.
Because these structures are meant to fit the masculine or feminine forms, they tend to amplify the sensation of wrongness. A classic effect is the way that the difference between men's and women's jeans can have a radical effect on a trans person's comfort level. Unfortunately this works both ways, as even affirming clothing can reveal how your shape is a mismatch.
I, myself am very feminine in my preferred presentation, and I had a longing to wear dresses from when I was just five years old. I abhorred wearing suits, hating the way they fit on my body, since they always tugged in ways that felt very incorrect for what my body needed. I refused to wear any denim for most of my life because men's jeans always felt so incorrect (women's jeans and leggings, however, feel amazing). Then as I entered into transition and began to present more female, my dysphoria struck again in the ways my body did not conform to what women's clothing was expecting (too much in the crotch, too wide and bulky in the shoulders, too large in the waist, not large enough in the chest). It wasn't until the second year that I had experienced enough change in my shape to where women's clothing was properly affirming of my shape.
I, myself, am very feminine in my preferred presentation, and I've had a longing to wear dresses from when I was just five years old. I abhorred wearing suits, hating the way they fit on my body, since they always tugged in ways that felt very incorrect for what my body needed. I refused to wear any denim for most of my life because men's jeans always felt so incorrect (women's jeans and leggings, however, feel amazing). Then as I entered into transition and began to present more female, my dysphoria struck again in the ways my body did not conform to what women's clothing was expecting (too much in the crotch, too wide and bulky in the shoulders, too large in the waist, not large enough in the chest). It wasn't until the second year that I had experienced enough change in my shape to where women's clothing was properly affirming of my shape.
What does this look like? Well, it looks a lot like other common body image issues. A tendency to avoid anything form fitting, leaning towards softer fabrics and baggier clothes. A classic gender dysphoria trope is the kid who wears nothing but sweatpants and hoodies. Clothes will be oversized in order to keep them from hugging the body. AFABs may prefer to wear compressing sports bras in order to minimize their chests, and avoid anything with a tight waistline.
What does this look like? Well, it looks a lot like other common body image issues: a tendency to avoid anything form fitting, leaning towards softer fabrics and baggier clothes. A classic gender dysphoria trope is the kid who wears nothing but sweatpants and hoodies. Clothes will be oversized in order to keep them from hugging the body. AFABs may prefer to wear compressing sports bras in order to minimize their chests, and avoid anything with a tight waistline.
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Internally it most often manifests as intense jealousy of the people you wish you could be. Jealousy over an influencer's body shape, a strong desire for the outfit of a person on the street, and most especially envy of other trans people. This feeling often persists well into transition, because this sensation of wanting to be other people of your gender is actually completely natural, even for cis people.
Internally it most often manifests as intense jealousy of the people you wish you could be: jealousy over an influencer's body shape, a strong desire for the outfit of a person on the street, and most especially envy of other trans people. This feeling often persists well into transition, because this sensation of wanting to be other people of your gender is actually completely natural, even for cis people.
### Presentation's Affect on Social Dysphoria.
### Presentation's Effect on Social Dysphoria.
Presentation can be important for avoiding misgendering, especially early in transition. A lot of trans people feel a need to perform their gender in order to be accepted for who they are, leaning in to feminine or masculine presentation more than they actually would like in order to make up for their body and ensure that people gender them correctly. Those pursuing medical transition may find this need becomes less important as their bodies change and they become able to be gendered correctly without all of the performance.
Performative Presentation was practically required prior to the reformation of WPATH in 2011; anyone who showed up to a doctors appointment without extreme feminine or masculine presentation risked be labeled a fake and losing their treatment under the Harry Benjamin Scale. Trans women actually would lose their estrogen simply for wearing jeans and a blouse instead of a dress, or for not putting on enough makeup. This is one of the reasons why [transmedicalist](https://en.wikipedia.org/wiki/Transmedicalism) ideology is so dangerous: it would see us returning to this system, labeling anyone who doesn't meet stereotypical views of femininity and masculinity as not actually transgender.
Performative presentation was practically required prior to the reformation of WPATH in 2011; anyone who showed up to a doctors appointment without extreme feminine or masculine presentation risked be labeled a fake and losing their treatment under the Harry Benjamin Scale. Trans women actually would lose their estrogen simply for wearing jeans and a blouse instead of a dress, or for not putting on enough makeup. This is one of the reasons why [transmedicalist](https://en.wikipedia.org/wiki/Transmedicalism) ideology is so dangerous: it would see us returning to this system, labeling anyone who doesn't meet stereotypical views of femininity and masculinity as not actually transgender.
Presentation is especially important among prepubescent children, as they lack any significant secondary sexual characteristics. Clothing and hair are the only ways we have to show the gender of a child, so much so that if a baby simply wears a pink shirt, strangers assume it is a girl. Even unisex clothing for kids is strongly gendered by way of colors and graphics. For trans children it can be extremely distressing to be either forced to cut their hair, or required to grow it out. Denying dresses to a trans girl or transfeminine non-binary child, or forcing them onto a trans boy or transmasculine non-binary child, can be debilitating to their morale.
Presentation is especially important among prepubescent children, as they lack any significant secondary sexual characteristics. Clothing and hair are the only ways we have to show the gender of a child, so much so that if a baby simply wears a pink shirt, strangers assume it is a girl. Even unisex clothing for kids is strongly gendered by way of colors and graphics. For trans children, it can be extremely distressing to be either forced to cut their hair or required to grow it out. Denying dresses to a trans girl or transfeminine non-binary child, or forcing them onto a trans boy or transmasculine non-binary child, can be debilitating to their morale.

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public/en/second-puberty-fem.md
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# Estrogenic Second Puberty 101
## What to expect from Feminizing HRT
## What To Expect from Feminizing HRT
This is a compilation of reported medical transition changes collected from testimonials of AMAB trans people taking estrogen based hormone therapy. This information is gathered from social media and chat rooms. Yes, that means this is all anecdotal, but historically, most of transgender medical study is anecdotal because no one wants to fund transgender medical research.
This is a compilation of reported medical transition changes collected from testimonials of AMAB trans people taking estrogen-based hormone therapy. This information is gathered from social media and chat rooms. Yes, that means this is all anecdotal, but historically, most of transgender medical study is anecdotal because no one wants to fund transgender medical research.
**Note that this is a list of _possible_ changes. There is no guarantee that every person on feminizing HRT will experience all of these. Your age, genetics, medical history, degree of masculinization from natal puberty, and hormone regimen can all have impacts on results. There is also just a degree of randomness -- every body is different -- and some things can take years to appear.**
**Note that this is a list of _possible_ changes. There is no guarantee that every person on feminizing HRT will experience all of these. Your age, genetics, medical history, degree of masculinization from natal puberty, and hormone regimen can all have impacts on results. There is also just a degree of randomness — every body is different — and some things can take years to appear.**
### Breast Growth
Despite public perceptions, the majority of transfems do not pursue breast augmentation, as it often isn't necessary (and for many, is not within reach). Every human is born with breast tissue, it simply remains inactive without estrogen to make it grow. Development typically takes 2-5 years, but can continue for more than ten years, just as it does for cisgender women.
Despite public perceptions, the majority of transfems do not pursue breast augmentation, as it often isn't necessary (and, for many, is not within reach). Every human is born with breast tissue, it simply remains inactive without estrogen to make it grow. Development typically takes 2-5 years, but can continue for more than ten years, just as it does for cisgender women.
Expect aches and pains in the chest, along with lots of tenderness, in the area surrounding and behind the areola. Avoid bumping into anything, as it *will* hurt. Nipples and areolas will become much more sensitive while also becoming larger and darker. You'll want to invest in some sports bras.
Expect aches and pains in the chest, along with lots of tenderness in the area surrounding and behind the areola. Avoid bumping into anything, as it *will* hurt. Nipples and areolae will become much more sensitive while also becoming larger and darker. You'll want to invest in some sports bras.
This may be accompanied with lactation. Some secretion is normal and can be expected as milk ducts form and open up, so there is no cause for alarm. However, significant discharge without intentional stimulation may be a sign of a prolactin imbalance, so you should tell your doctor if this happens.
@ -47,11 +47,11 @@ Testosterone causes water retention in ligaments and tendons, rendering them les
</div>
}!}
As the skin begins to soften and slim down, the hands gradually begin the shrink. Without testosterone, less blood flows to the hands, causing further reduction in tissue sizes. Ring size will drop as fat and fluids move off the fingers. Finger length shortens as ligaments thin and stretch.
As the skin begins to soften and slim down, the hands gradually begin to shrink. Without testosterone, less blood flows to the hands, causing further reduction in tissue sizes. Ring size will drop as fat and fluids move off the fingers. Finger length shortens as ligaments thin and stretch.
### Smaller Feet
Much like hands, the feet also experience changes in shape. Androgens encourage more blood flow to the feet, and encourage water build up in cartilage. Estrogens allow the ligaments in the foot to stretch more. Collectively this causes the arch of the foot to increase, shortening its total length by as much as two centimeters. Many people report a drop of one to two shoe sizes.
Much like hands, the feet also experience changes in shape. Androgens encourage more blood flow to the feet, and encourage water build up in cartilage. Estrogens allow the ligaments in the foot to stretch more. Collectively, this causes the arch of the foot to increase, shortening its total length by as much as two centimeters. Many people report a drop of one to two shoe sizes.
### Thinner & Softer Fingernails
@ -59,61 +59,61 @@ Fingernails are made of keratin, and many keratin genes are activated by androge
### Reduced Body Hair
Do not expect a total cessation of body hair, once the follicles are made terminal by DHT they remain that way. However, much like fingernails, hair thickness is an expression of keratin genes activated by androgens. Removing testosterone causes the body hairs to become thinner and lighter. Genetics plays a major role in this, however.
Do not expect a total cessation of body hair; once the follicles are made terminal by DHT, they remain that way. However, much like fingernails, hair thickness is an expression of keratin genes activated by androgens. Removing testosterone causes the body hairs to become thinner and lighter. Genetics plays a major role in this, however.
### Changes in Body Temperature Placement
Androgens encourage extra blood flow to extremities, making them warmer. Because of this, women tend to have warmer core temperatures but lower oral and surface level temperatures. You may see your basal body temperature drop to around 97.6.
Androgens encourage extra blood flow to extremities, making them warmer. Because of this, women tend to have warmer core temperatures but lower oral and surface level temperatures. You may see your basal body temperature drop to around 97.6°F (36.4°C).
This unfortunately results in a reduced tolerance to cold, so expect to need to layer clothing more frequently, especially since many buildings [set their thermostats for male comfort levels](https://www.popsci.com/study-finds-gender-bias-office-air-conditioning/).
This, unfortunately, results in a reduced tolerance to cold, so expect to need to layer clothing more frequently, especially since many buildings [set their thermostats for male comfort levels](https://www.popsci.com/study-finds-gender-bias-office-air-conditioning/).
### Changes in Perspiration Patterns
With the above shift in temperature distribution, this also results in a significant change in how one sweats. Sweat becomes more of a full body experience, as opposed to largely centered on the head and armpits. Underboob sweat becomes a thing.
With the above shift in temperature distribution, this also results in a significant change in how one sweats. Sweat becomes more of a full body experience, as opposed to being largely centered on the head and armpits. Underboob sweat becomes a thing.
### Reduction and/or Change of Body Odor
A major component in male body odor is the presence of [the steroid pheromone androstadienone](https://www.sciencedaily.com/releases/2007/09/070916143523.htm) in sweat. Androstadienone is metabolized directly from testosterone, so halting testosterone removes the source. Without it, sweat takes on a much sweeter smell, which is often attributed to feminine odors.
People taking spironolactone may experience a total cessation of any body odor, due to the way the drug alters cortisol uptake within the body.
People taking spironolactone may experience a total cessation of any body odor due to the way the drug alters cortisol uptake within the body.
### Reduced Muscle Mass
Androgens stimulate muscle growth, which is why anabolic steroids (which are literally testosterone) are so common amongst body builders. People running on androgens naturally have more muscle mass, particularly in the upper body, without even having to work out. Removing androgens causes that muscle mass to atrophy and makes it harder to gain muscle. This is a major contributor to the feminine shoulder and neck line, as well as the waist line.
Androgens stimulate muscle growth, which is why anabolic steroids (which are literally testosterone) are so common amongst bodybuilders. People running on androgens naturally have more muscle mass, particularly in the upper body, without even having to work out. Removing androgens causes that muscle mass to atrophy and makes it harder to gain muscle. This is a major contributor to the feminine shoulder and neck line, as well as the waist line.
With this comes a significant loss in strength. Carrying things becomes more difficult, pickle jars become harder to open.
### Fat Redistribution into Feminine Proportions
Androgens encourage the body to deposit fats into the abdomen, while estrogen encourages the body to deposit fats into the thighs, buttocks, and hips. Switching profiles causes new fats to be deposited according in the estrogen profile, and fats that were stored while on androgens break down. This produces the illusion of fat migration as the shape of the body changes. The waist line shrinks and defines itself below the ribs, and the belly becomes softer and flatter.
Androgens encourage the body to deposit fats into the abdomen, while estrogen encourages the body to deposit fats into the thighs, buttocks, and hips. Switching profiles causes new fats to be deposited according to the estrogen profile, and fats that were stored while on androgens break down. This produces the illusion of fat migration as the shape of the body changes. The waistline shrinks and defines itself below the ribs, and the belly becomes softer and flatter.
Because estrogen deposits weight much lower on the body, and the muscle mass in the upper body is lost, this lowers the center of gravity, which alters one's walking gait. It becomes more natural to cantilever the body with the hips while walking, as opposed to the shoulders.
### Facial Feature Changes
Along with body fat migration, fat in the face also migrates. The neck, chin and jaw line thin out while the lips and upper cheeks puff up. The brow and upper eye lids lift, exposing more of the eyeball. Changes in skin and musculature around the eye can alter the shape of the eyeball, changing focal depth and altering vision clarity. The color of the eyes may also change and become bolder, as testosterone causes the pigmentation in the iris to fade.
Along with body fat migration, fat in the face also migrates. The neck, chin, and jawline thin out while the lips and upper cheeks puff up. The brow and upper eyelids lift, exposing more of the eyeball. Changes in skin and musculature around the eye can alter the shape of the eyeball, changing focal depth and altering vision clarity. The color of the eyes may also change and become bolder, as testosterone causes the pigmentation in the iris to fade.
This is an extremely subtle and slow moving process that takes years, and it is easy to think nothing is changing at all. Take selfies to compare.
### Changes to Scalp Hair
With the removal of androgens, blood flow to the scalp increases. Follicles that had been lost to male pattern baldness may reactivate, causing some return of the hair line and a filling in of bald spots. Scalp hair becomes thicker and follicles grow stronger, allowing hair to grow to longer lengths.
With the removal of androgens, blood flow to the scalp increases. Follicles that had been lost to male pattern baldness may reactivate, causing some return of the hairline and a filling-in of bald spots. Scalp hair becomes thicker and follicles grow stronger, allowing hair to grow to longer lengths.
With this thickening, curliness may become more pronounced, and a change in hair color may also occur. You might find your hair taking on a texture more like your mother's than your father's.
### [Anterior Pelvic Tilt](http://en.wikipedia.org/wiki/Pelvic_tilt)
As musculature atrophies, ligament flexibility increases, and weight shifts lower on the body, the orientation of the pelvic bone in relation to the spine and femurs rotates forward. Not by much, only about 10-20 degrees, but enough to cause a change in the alignment of the spine and hips, increasing arch of the back and causing the buttocks to jut out more. The added arch to the back can cause a relative drop in total height, between 1 and 2 inches (2-5cm) depending on pelvic shape.
As musculature atrophies, ligament flexibility increases, and weight shifts lower on the body, the orientation of the pelvic bone in relation to the spine and femurs rotates forward — not by much (only about 10-20 degrees), but enough to cause a change in the alignment of the spine and hips, increasing the arch of the back and causing the buttocks to jut out more. The added arch to the back can cause a relative drop in total height, between 1 and 2 inches (2-5 cm) depending on pelvic shape.
Note, this is NOT the same as the [hip rotation](https://youtu.be/OROoZzoVwfk?t=12) that occurs in AFAB puberty and during pregnancy. That is the result of migration of bone cells, altering the shape of the pelvic bone itself. **However**, hip rotation *can* occur if the person is young enough to still be within initial puberty, where the body is producing elevated human growth hormone. There have also been examples of hip rotation happening over long periods of time in trans elders. In 2017 an 80 year old trans woman reported on reddit that over the course of her 30 years on HRT, her doctor observed changes in her pelvis consistent with female hip rotation.
Note: this is NOT the same as the hip rotation that occurs in AFAB puberty and during pregnancy. That is the result of migration of bone cells, altering the shape of the pelvic bone itself. **However**, hip rotation *can* occur if the person is young enough to still be within initial puberty, where the body is producing elevated human growth hormone. There have also been examples of hip rotation happening over long periods of time in trans elders. In 2017 an 80 year old trans woman reported on reddit that over the course of her 30 years on HRT, her doctor observed changes in her pelvis consistent with female hip rotation.
### Reduced Tolerance of Caffeine, Alcohol, and/or Psychotropics
Less body mass means less blood to dilute chemicals into. Losing testosterone also means a slower metabolic rate, decreasing the speed at which toxins are reduced from the blood stream. Some anti-androgens also put strain on the liver, further reducing how quickly chemicals are processed.
Less body mass means less blood to dilute chemicals into. Losing testosterone also means a slower metabolic rate, decreasing the speed at which toxins are reduced from the bloodstream. Some anti-androgens also put strain on the liver, further reducing how quickly chemicals are processed.
### Mental Changes
As covered in the [Biochemical Dysphoria]() section, brains can be wired for a certain hormone profile, and running on the wrong profile is like using a laptop with low batteries or an overheated processor. Starting HRT almost universally results in a cessation of depersonalization and derealization (DPDR) symptoms within the first two weeks. A mental fog lifts, and it becomes easier to concentrate on complex concepts (assuming you don't also have other mental processing difficulties such as ADHD).
As covered in the Biochemical Dysphoria section, brains can be wired for a certain hormone profile, and running on the wrong profile is like using a laptop with low batteries or an overheated processor. Starting HRT almost universally results in a cessation of depersonalization and derealization (DPDR) symptoms within the first two weeks. A mental fog lifts, and it becomes easier to concentrate on complex concepts (assuming you don't also have other mental processing difficulties such as ADHD).
##### ADHD
@ -123,19 +123,19 @@ The good news is that estradiol prompts the brain to produce MORE dopamine.
{!{ <div class="gutter flex" style="justify-content: flex-end"><div class="card"><div class="card-body"><h4 class="card-title">Authors Note:</h4> }!}
There is a known problem with Spironolactone hampering working memory due to it's affects on mineralcorticoids. This can significantly worsen ADHD issues and make it much harder to maintain focus or be aware of your surroundings. I was involved in a car accident in 2017 that I blame on spiro fog.
There is a known problem with spironolactone hampering working memory due to its effects on mineralocorticoids. This can significantly worsen ADHD issues and make it much harder to maintain focus or be aware of your surroundings. I was involved in a car accident in 2017 that I blame on spiro fog.
{!{ </div></div></div> }!}
##### Emotional Expansion
The alleviation of DPDR almost universally is accompanied with a much broader capacity for emotion and expression. The stoicism and dissociation lifts and emotions land with much greater intensity. Highs are higher and lows are lower. Those who may have been unable to cry, before transition, gain it back, both for sadness and for joy.
The alleviation of DPDR almost universally is accompanied with a much broader capacity for emotion and expression. The stoicism and dissociation lifts and emotions land with much greater intensity. Highs are higher and lows are lower. Those who may have been unable to cry before transition gain it back, both for sadness and for joy.
Unfortunately this also means that if you had trauma from events earlier in life (and who doesn't), you may start to experience PTSD episodes. This is why it is good (and in some places, required) to have a therapist.
Unfortunately, this also means that, if you had trauma from events earlier in life (and who doesn't), you may start to experience PTSD episodes. This is why it is good (and, in some places, required) to have a therapist.
##### Mood Swings
As estrogen levels fluctuate between doses you may experience noticeable and sometimes dramatic shifts in your mood. Unexplained crying happens; PMS rage happens; be ready for it.
As estrogen levels fluctuate between doses, you may experience noticeable and sometimes dramatic shifts in your mood. Unexplained crying happens; PMS rage happens; be ready for it.
##### Appetite
@ -151,24 +151,24 @@ Many people report having better sleep patterns after starting HRT. This is like
##### Extroversion
It's extremely common for trans people of all types to find themselves much more sociable post-transition. This may not actually be a factor of hormone therapy, however, an simply be a result of no longer having to suppress large portions of their personality.
It's extremely common for trans people of all types to find themselves much more sociable post-transition. This may not actually be a factor of hormone therapy, however, and may simply be a result of no longer having to suppress large portions of their personality.
### Sensory Enhancements
Transgender HRT has [been shown several times](https://academic.oup.com/cercor/article/28/5/1582/3064956) to cause changes in the distribution of gray matter and white matter within the brain for trans people on both forms of HRT. New structures and neuro-pathways are formed as a result of the shift in hormone profiles, and this results in changes of sensory perception. These are some of the changes that have been observed and reported, but it is is not clear if this is a function of the hormones themselves, or a factor of the brain receiving the hormones it is wired for.
Transgender HRT has [been shown several times](https://academic.oup.com/cercor/article/28/5/1582/3064956) to cause changes in the distribution of gray matter and white matter within the brain for trans people on both forms of HRT. New structures and neuro-pathways are formed as a result of the shift in hormone profiles, and this results in changes of sensory perception. These are some of the changes that have been observed and reported, but it is not clear if this is a function of the hormones themselves, or a factor of the brain receiving the hormones it is wired for.
- **Improved sense of smell**, especially of other bodies. Human sweat becomes very discernible, even overpowering at times.
- **Improved sense of smell**, especially of other bodies. Human sweat becomes very discernible — even overpowering at times.
- **Improved color perception**. Colors may become bolder, richer.
- **Improved spatial awareness**. Many trans people experience poor proprioception and a tendency towards clumsiness that goes away after starting HRT.
- **Changes in perception of taste**. Certain foods become more or less palatable; Cilantro, for example, may become more or less soapy. Increased tolerance of capsaicin (spicy peppers). Chocolate and wine become more flavorful.
- **Changes in perception of taste**. Certain foods become more or less palatable; cilantro, for example, may become more or less soapy. Increased tolerance of capsaicin (spicy peppers). Chocolate and wine become more flavorful.
Users of Spironolactone often develop strong cravings for foods high in salt, such as pickles, olives, or potato products. This is because Spiro is a potassium sparing diuretic which causes you to pee out all your sodium. The brain creates cravings to encourage you to replace that sodium.
Users of spironolactone often develop strong cravings for foods high in salt, such as pickles, olives, or potato products. This is because spiro is a potassium-sparing diuretic which causes you to pee out all your sodium. The brain creates cravings to encourage you to replace that sodium.
### Spatial Shift, Reduced Confidence
There is a very frequently reported experience of feeling smaller within the world, even when wearing heels. People taller than you seem to tower over you, and spaces feel larger.
People have also reported a tendency to be less prone to start arguments, an a desire to avoid confrontation rather than create it. Testosterone has been shown to increase a persons sense of confidence, and removing it has the opposite affect.
People have also reported a tendency to be less prone to start arguments, as well as a desire to avoid confrontation rather than create it. Testosterone has been shown to increase a person's sense of confidence, and removing it has the opposite effect.
### Genital Changes
@ -179,7 +179,7 @@ People have also reported a tendency to be less prone to start arguments, an a d
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All genitalia are constructed from the same tissues, they are merely organized differently during gestation. Much of the behavior of these tissues is regulated by the hormones ones body runs on. Skin secretions, textures, sensitivity and erectile behavior are all hormonal expressions. Which means that when you remove androgens and add estrogens, these tissues start acting like they are in the shape of a vulva, even though they aren't.
All genitalia are constructed from the same tissues; they are merely organized differently during gestation. Much of the behavior of these tissues is regulated by the hormones one's body runs on. Skin secretions, textures, sensitivity and erectile behavior are all hormonal expressions, which means that when you remove androgens and add estrogens, these tissues start acting like they are in the shape of a vulva, even though they aren't.
##### Increased Sensitivity
@ -187,23 +187,23 @@ The skin on the glans and shaft becomes much thinner and fragile, more prone to
#### Moisture and Feminine Odor
The skin along the shaft begins to secret the same fluids as the vaginal canal, particularly during arousal (yes, trans girls get wet). These fluids encourage the development of the same microbiome that develops within the vaginal canal. The combination of these factors means that odor (and taste) of the penis changes to align more to that of a vulva.
The skin along the shaft begins to secrete the same fluids as the vaginal canal, particularly during arousal (yes, trans girls get wet). These fluids encourage the development of the same microbiome that develops within the vaginal canal. The combination of these factors means that odor (and taste) of the penis changes to align more to that of a vulva.
##### Color and Texture Changes
The scrotum is an analog of the outer and inner labia, and softens to take on a softer, more velvety texture, extending down into the perineum. The skin along the perineal raphe (the vertical line where the vulva opening had been before the scrotum formed) will also darken. Some people experience a kind of striping pattern along the scrotum.
The scrotum is an analog of the outer and inner labia, and takes on a softer, more velvety texture, extending down into the perineum. The skin along the perineal raphe (the vertical line where the vulva opening had been before the scrotum formed) will also darken. Some people experience a kind of striping pattern along the scrotum.
##### Fewer Erections
Without free floating testosterone, the levels of [DHT](https://en.wikipedia.org/wiki/Dihydrotestosterone) in the bloodstream drop significantly. DHT plays a major role in the stimulation of random erections during sleep through the enlargement of the prostate, and these erections are what is responsible for the maintenance of the erectile tissue. Without DHT, the prostate shrinks again, and random erections cease (no more morning wood).
Without free-floating testosterone, the levels of [DHT](https://en.wikipedia.org/wiki/Dihydrotestosterone) in the bloodstream drop significantly. DHT plays a major role in the stimulation of random erections during sleep through the enlargement of the prostate, and these erections are what is responsible for the maintenance of the erectile tissue. Without DHT, the prostate shrinks again, and random erections cease (no more morning wood).
However this means that the erectile tissue will begin to atrophy. Prolonged atrophy will result in shrinkage of the entire organ, for better or worse. The shape of the penis changes as this occurs, often becoming more conical. The glans is the first part to shrink and may lose the ability to become rigid. Penetrative sex may become more difficult, and erections themselves may become painful.
However, this means that the erectile tissue will begin to atrophy. Prolonged atrophy will result in shrinkage of the entire organ, for better or worse. The shape of the penis changes as this occurs, often becoming more conical. The glans is the first part to shrink and may lose the ability to become rigid. Penetrative sex may become more difficult, and erections themselves may become painful.
This can be countered by regularly inducing erections, but that may become more and more difficult as time goes on.
##### Clear Ejaculate
The majority of the liquid that makes up ejaculate originates in the prostate. It is a completely clear fluid, with a slimy texture. The white color and stickiness that is usually attributed to male ejaculate is caused by semen and seminal fluid from the testicles. The production of both semen and seminal fluid is a product of testicle function, so as the testicles shutdown (either because of anti-androgens or from estrogen dominance), these fluids halt, leaving only the prostate fluid.
The majority of the liquid that makes up ejaculate originates in the prostate. It is a completely clear fluid, with a slimy texture. The white color and stickiness that is usually attributed to male ejaculate is caused by semen and seminal fluid from the testicles. The production of both semen and seminal fluid is a product of testicle function, so as the testicles shut down (either because of anti-androgens or from estrogen dominance), these fluids halt, leaving only the prostate fluid.
Some people lose even that, and stop having any emissions at all during orgasm.
@ -215,7 +215,7 @@ Once the testes have stopped functioning, the cells start to atrophy, shrinking
### Sexual Changes
Initial start of HRT may result in a total loss of sex drive as testosterone levels plummet. This can last 3-12 months, and in some cases doesn't return at all. Starting progesterone often serves as catalyst for its return. If/when sex drive comes back, the new libido [may be a completely different experience](https://curvyandtrans.com/p/5BF1EA/libatious-libidos) that one may not recognize at first.
Initial start of HRT may result in a total loss of sex drive as testosterone levels plummet. This can last 3-12 months, and, in some cases, doesn't return at all. Starting progesterone often serves as a catalyst for its return. If/when sex drive comes back, the new libido [may be a completely different experience](https://curvyandtrans.com/p/5BF1EA/libatious-libidos) that one may not recognize at first.
##### Heightened Erogenous Zones
@ -231,7 +231,7 @@ Initial start of HRT may result in a total loss of sex drive as testosterone lev
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}!}
The entire body becomes more responsive to touch, and with that unlocks stronger erogenous zones. Breasts, abdomen, inner thighs and neck, in particular, become more arousal inducing.
The entire body becomes more responsive to touch, and with that unlocks stronger erogenous zones. Breasts, abdomen, inner thighs, and neck, in particular, become more arousal-inducing.
##### Orgasm
@ -243,7 +243,7 @@ It is [not at all unheard of](https://www.them.us/story/sexual-attraction-after-
### Cyclical Period-like Symptoms
Obviously, we do not mean blood flow, that would be ludicrous. Symptoms vary greatly (just as they do in cisgender women) and typically last for 2-4 days, repeating every 26-32 days (though some report experiencing it every two weeks). This happens independent of medication dosing schedules. The use of a period tracker app like Clue can reveal the pattern.
Obviously, we do not mean blood flow; that would be ludicrous. Symptoms vary greatly (just as they do in cisgender women) and typically last for 2-4 days, repeating every 26-32 days (though some report experiencing it every two weeks). This happens independent of medication dosing schedules. The use of a period tracker app like Clue can reveal the pattern.
- Cramping in the intestine and abdominal muscles, ranging from a slight flutter in the gut to strong painful spasms.
- Bloating and water retention
@ -257,12 +257,12 @@ Obviously, we do not mean blood flow, that would be ludicrous. Symptoms vary gre
- Breast engorgement and nipple tenderness
- Acne
- Fatigue
- Appetite changes, spontaneous cravings (see: chocolate cravings)
- Appetite changes and spontaneous cravings (see: chocolate cravings)
- Spontaneous shifts in libido
- Changes in genital odor
No, there have not yet been studies on this yet, but it is reported by far, **far** too many individuals to be an anomaly (including by yours truly), and has been confirmed by multiple people's own doctors. There is also precedent of this happening with cisgender women who have had hysterectomies (I personally know two cisgender women who have cycles but do not menstruate, without any medical intervention).
Running on estrogen and progesterone activates a gene sequence which instructs the hypothalamus to attempt to cycle ovary and uterine behavior just as it does in female assigned individuals, regardless of the absence of ovaries or a uterus. This cycle affects numerous organs and subsystems in the body, causing the release of a variety of different hormones and enzymes that can affect function and even behavior.
Running on estrogen and progesterone activates a gene sequence which instructs the hypothalamus to attempt to cycle ovary and uterine behavior just as it does in female-assigned individuals, regardless of the absence of ovaries or a uterus. This cycle affects numerous organs and subsystems in the body, causing the release of a variety of different hormones and enzymes that can affect function and even behavior.
A more thorough explanation of this will be coming in a later update to the site.

44
public/en/second-puberty-masc.md
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@ -27,15 +27,15 @@ tweets:
# Androgenic Second Puberty 101
## What to expect from Masculinizing HRT
## What To Expect from Masculinizing HRT
This is a compilation of reported medical transition changes collected from testimonials of AFAB trans people taking testosterone hormone therapy. This information is gathered from social media and chat rooms. Yes, that means this is all anecdotal, but historically, most of transgender medical study is anecdotal because no one wants to fund transgender medical research.
**Note that this is a list of _possible_ changes. There is no guarantee that every person on masculinizing HRT will experience all of these. Your age, genetics, medical history, degree of feminization from natal puberty, and hormone regimen can all have impacts on results. There is also just a degree of randomness -- every body is different -- and some things can take years to appear.**
**Note that this is a list of _possible_ changes. There is no guarantee that every person on masculinizing HRT will experience all of these. Your age, genetics, medical history, degree of feminization from natal puberty, and hormone regimen can all have impacts on results. There is also just a degree of randomness — every body is different — and some things can take years to appear.**
### Voice Drop
Androgens cause the tissue that comprises the vocal chords to thicken and harden, permanently lowering the pitch of the voice. This is not a very fast change, but rather incremental over the first few years. Some people do not experience any voice change at all, it varies person to person. The change will not be drastic, if you are a soprano you are not going to become a bass, but it could bring you down to a contralto or tenor.
Androgens cause the tissue that comprises the vocal cords to thicken and harden, permanently lowering the pitch of the voice. This is not a very fast change, but rather incremental over the first few years. Some people do not experience any voice change at all, it varies person to person. The change will not be drastic; if you are a soprano, you are not going to become a bass, but it could bring you down to a contralto or tenor.
This does *not* mean that your voice will automatically become read as male. Pitch is only a piece of how people gender voice, and the way you speak plays a much larger role. Vocal training will be needed to amplify resonance and change speaking style.
@ -59,13 +59,13 @@ Often one of the first things to change: sweat and general body odor will become
### Body Hair, Everywhere
Androgens significantly increase the presence of body hair on the legs, groin, buttocks, chest, back and arms. Hair will grow in thicker, longer and darker. This will likely happen well before facial hair growth, which can take over a year to start. Rogaine / Monoxidil can help with that, but be careful as it is poisonous if ingested, especially to cats.
Androgens significantly increase the presence of body hair on the legs, groin, buttocks, chest, back, and arms. Hair will grow in thicker, longer, and darker. This will likely happen well before facial hair growth, which can take over a year to start. Rogaine/minoxidil can help with that, but be careful, as it is poisonous if ingested (especially to cats).
### Male Pattern Baldness
MPD is caused by [Dihydrotestosterone](https://en.wikipedia.org/wiki/Dihydrotestosterone) (DHT), an androgen which metabolizes from Testosterone. Having more T in your body means more DHT can form, and the gene that contributes to MPD causes the hair follicles on the scalp to receive less blood, choking them out until the follicles die. There will likely be *some* loss of hair line eventually, no matter what, but if there is a history of baldness among the men in your family, then you can expect to see that as well. Again, Rogaine can help with this.
MPB is caused by [dihydrotestosterone](https://en.wikipedia.org/wiki/Dihydrotestosterone) (DHT), an androgen which metabolizes from Testosterone. Having more T in your body means more DHT can form, and the gene that contributes to MPB causes the hair follicles on the scalp to receive less blood, choking them out until the follicles die. There will likely be *some* loss of hair line eventually, no matter what, but if there is a history of baldness among the men in your family, then you can expect to see that as well. Again, minoxidil can help with this.
The synthetic androgen [Nandrolone](https://en.wikipedia.org/wiki/Nandrolone) does not metabolize into DHT and may be a viable alternative in place of direct Testosterone if hair loss is a concern. However, DHT is important for genital growth, so this is a double-edged sword.
The synthetic androgen [nandrolone](https://en.wikipedia.org/wiki/Nandrolone) does not metabolize into DHT and may be a viable alternative in place of direct testosterone if hair loss is a concern. However, DHT is important for genital growth, so this is a double-edged sword.
### Thicker and Oilier Skin
@ -85,7 +85,7 @@ Both fingernails and toenails will grow thicker over time as keratin levels rise
### Increased Muscle Mass
Androgens stimulate muscle growth, which is why anabolic steroids (which are literally testosterone) are so common amongst body builders. The body will naturally gain more muscle without even having to exercise, but *with* exercise there can be substantial gains, particularly in the arms and shoulders. Beware, you won't know your own strength at first.
Androgens stimulate muscle growth, which is why anabolic steroids (which are literally testosterone) are so common amongst bodybuilders. The body will naturally gain more muscle without even having to exercise, but *with* exercise there can be substantial gains, particularly in the arms and shoulders. Beware; you won't know your own strength at first.
Added lean muscle in the upper body redefines the shoulder and neck line, creating a more masculine silhouette. It also improves the body's ability to process lipids, making weight loss easier.
@ -95,18 +95,17 @@ Where estrogen encourages the body to deposit fats into the thighs, buttocks, an
### Facial Feature Changes
Along with body fat migration, fat in the face also moves. The neck, chin and jaw line will fill out while the lips and upper cheeks shrink. The color of the eyes may also change and become fainter in the long term, as testosterone causes the pigmentation in the iris to fade.
This is and extremely subtle and slow moving process that takes years, and it is easy to think nothing is changing at all. The greatest shifts seem to happen in years 3 and 4. Take selfies to compare.
Along with body fat migration, fat in the face also moves. The neck, chin and jawline will fill out while the lips and upper cheeks shrink. The color of the eyes may also change and become fainter in the long term, as testosterone causes the pigmentation in the iris to fade.
This is an extremely subtle and slow moving process that takes years, and it is easy to think nothing is changing at all. The greatest shifts seem to happen in years 3 and 4. Take selfies to compare.
### Increased Tolerance of Caffeine, Alcohol, and/or Psychotropics
More mass means more blood to dilute chemicals into. Increasing testosterone also means a higher metabolic rate, increasing the speed at which toxins are removed from the blood stream.
More mass means more blood to dilute chemicals into. Increasing testosterone also means a higher metabolic rate, increasing the speed at which toxins are removed from the bloodstream.
### Mental Changes
As covered in the [Biochemical Dysphoria]() section, brains can be wired for a certain hormone profile, and running on the wrong profile is like using a laptop with low batteries or an overheated processor. Starting HRT almost universally results in a cessation of depersonalization and derealization (DPDR) symptoms within the first two weeks. A mental fog lifts, and it becomes easier to concentrate on complex concepts (assuming you don't also have other mental processing difficulties such as ADHD).
As covered in the Biochemical Dysphoria section, brains can be wired for a certain hormone profile, and running on the wrong profile is like using a laptop with low batteries or an overheated processor. Starting HRT almost universally results in a cessation of depersonalization and derealization (DPDR) symptoms within the first two weeks. A mental fog lifts, and it becomes easier to concentrate on complex concepts (assuming you don't also have other mental processing difficulties such as ADHD).
##### ADHD
@ -118,14 +117,14 @@ If you have ADHD, there may be some changes in your symptoms. Androgens amplify
The alleviation of DPDR almost universally is accompanied with a much broader capacity for emotion and emotional regulation. Emotions become somewhat more controllable and suppressible, less likely to overwhelm on the spot. *Please note: suppressing emotions is a very quick way to develop trauma.*
However, the ability to express them may become reduced. Some people lose the ability to cry after starting on testosterone, but this is *not* a universal experience and may be tied into how strong your T dose is. The reasons behind this aren't well known, although some studies have found that androgens alter function in parts of the brain connected to emotional processing. If you do lose the ability to cry, it may return in time as your brain become more acclimated and you come out of second puberty.
However, the ability to express them may become reduced. Some people lose the ability to cry after starting on testosterone, but this is *not* a universal experience and may be tied into how strong your T dose is. The reasons behind this aren't well known, although some studies have found that androgens alter function in parts of the brain connected to emotional processing. If you do lose the ability to cry, it may return in time as your brain becomes more acclimated and you come out of second puberty.
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Emotional dis-regulation occurs the most commonly before and immediately after dosing (injections or gel) and results in reduced patience, increased aggression.
Emotional deregulation occurs the most commonly before and immediately after dosing (injections or gel) and results in reduced patience and increased aggression.
##### Increased Appetite / Eating Capacity
@ -133,7 +132,7 @@ You are going to be hungry. Testosterone cranks the body's metabolism up signifi
##### Sleep
Some people report problems with insomnia and having fewer memorable dreams. This is far from a universal, however.
Some people report problems with insomnia and having fewer memorable dreams. This is far from universal, however.
{!{ <div class="gutter flex" style="justify-content: flex-end">{{import '~/tweet' ids=[
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@ -141,7 +140,7 @@ Some people report problems with insomnia and having fewer memorable dreams. Thi
##### Confidence
Testosterone is known to induce a strong sense of self-confidence in people. Problems seem less significant, self-esteem is stronger, fewer anxieties. Many people report a tendency to be more prone spark arguments, and more willing to speak out in the face of conflict and self advocate. This does *not* mean more hostile or argumentative, simply that ones tolerance for bullshit is lower.
Testosterone is known to induce a strong sense of self-confidence in people. Problems seem less significant, self-esteem is stronger, fewer anxieties. Many people report a tendency to be more prone to spark arguments, and more willing to speak out in the face of conflict and self advocate. This does *not* mean more hostile or argumentative, but simply that one's tolerance for bullshit is lower.
##### Extroversion
@ -155,11 +154,11 @@ It's extremely common for trans people of all types to find themselves much more
</div>
}!}
All genitalia are constructed from the same tissues, they are merely organized differently during gestation. Much of the behavior of these tissues is regulated by the hormones ones body runs on. Skin secretions, textures, sensitivity and erectile behavior are all hormonal expressions. Which means that when you add androgens, these tissues start acting like they are in the shape of a penis and scrotum, even when they aren't.
All genitalia are constructed from the same tissues; they are merely organized differently during gestation. Much of the behavior of these tissues is regulated by the hormones one's body runs on. Skin secretions, textures, sensitivity and erectile behavior are all hormonal expressions. Which means that when you add androgens, these tissues start acting like they are in the shape of a penis and scrotum, even when they aren't.
##### Bottom Growth
DHT (mentioned above) plays a critical role in the development of the erectile tissue within the genitals. As DHT levels rise with the increase in Testosterone, this will cause the Skene's Gland (sometimes referred to as the female prostate) to swell. This will induce random erections within the clitoris, causing the erectile tissue to grow. The amount of growth varies from person to person, but 1-3 inches is common.
DHT (mentioned above) plays a critical role in the development of the erectile tissue within the genitals. As DHT levels rise with the increase in Testosterone, this will cause the Skene's gland (sometimes referred to as the female prostate) to swell. This will induce random erections within the clitoris, causing the erectile tissue to grow. The amount of growth varies from person to person, but 1-3 inches is common.
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@ -190,7 +189,7 @@ Vaginal and uterine atrophy often happens within the first five years, and a hys
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Libido will almost certainly go through the roof for the first year or two, the strongest immediately following dosing. May find yourself more assertive during sex and more prone to being dominant and/or a top.
Libido will almost certainly go through the roof for the first year or two, with the strongest effects immediately following dosing. You may find yourself more assertive during sex and more prone to being dominant and/or a top.
##### Orgasm
@ -198,7 +197,7 @@ Libido will almost certainly go through the roof for the first year or two, the
'1374053191445270534'
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The "shape" of ones orgasm can change. Rather than a cascade, it strikes like an explosion from the groin.
The "shape" of one's orgasm can change. Rather than a cascade, it strikes like an explosion from the groin.
##### Attraction
@ -208,13 +207,10 @@ Testosterone has been shown to increase arousal from visual stimuli. As such, yo
The increase of androgens within the body causes the hypothalamus to down-regulate production of the hormones which control the ovaries. This will reduce total estrogen available, and may halt ovulation. Without ovulation and with lower FSH levels, the uterus will be less inclined to build up and release a lining, causing the cessation of blood flow.
{!{ <div class="gutter">{{import '~/tweet' ids=[
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] tweets=meta.tweets className="hide-mentions" }}</div> }!}
You may still experience other period symptoms, however, as the hypothalamus can continue to express other aspects of the monthly cycle. This can even continue following a total hysterectomy, although it is not common.
**This does *not* mean that you are infertile, however.** Ovulation can still occur even if you are not menstruating. Additionally, halting testosterone will make the old orbs wake up, they do not die.
**This does *not* mean that you are infertile, however.** Ovulation can still occur even if you are not menstruating. Additionally, halting testosterone will make the old orbs wake up; they do not die.

14
public/en/sexual-dysphoria.md
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@ -2,7 +2,7 @@
date: "2020-01-26T20:41:55.827Z"
title: "How Gender Dysphoria Manifests: Sexual Dysphoria"
linkTitle: "Sexual Dysphoria"
description: "Sometimes a Cigar doesn't want to be smoked."
description: "Sometimes a cigar doesn't want to be smoked."
preBody: '_disclaimer'
siblings:
prev: /en/societal-dysphoria
@ -18,9 +18,9 @@ tweets:
# Sexual Dysphoria
Closely related to Societal Dysphoria is dysphoria centered around sexuality, sexual relationships, and the act of having sex. [Heteronormative](https://en.wikipedia.org/wiki/Heteronormativity) gender roles come loaded with the expectation that [AMABs will top and AFABs will bottom](https://en.wikipedia.org/wiki/Top,_bottom_and_versatile). These dynamics get reinforced by our popular media, by toxic masculinity, and especially by our pornography, even in *transgender* pornography (the bulk of trans/cis pornography involves the trans woman topping). Deviations from these roles often result in shame, both from partners and from peers.
Closely related to societal dysphoria is dysphoria centered around sexuality, sexual relationships, and the act of having sex. [Heteronormative](https://en.wikipedia.org/wiki/Heteronormativity) gender roles come loaded with the expectation that [AMABs will top and AFABs will bottom](https://en.wikipedia.org/wiki/Top,_bottom_and_versatile). These dynamics get reinforced by our popular media, by toxic masculinity, and especially by our pornography, even in *transgender* pornography (the bulk of trans/cis pornography involves the trans woman topping). Deviations from these roles often result in shame, both from partners and from peers.
Of course, this is not an absolute, by any means, and many heterosexual cis couples do find ways out of these molds, finding a new dynamic in their relationship, or engaging in kinks to satisfy desires. Some couples find they aren't sexually compatible at all and seek other partners. However, there are many many external pressures discouraging this kind of self-awareness and discovery, and breaking away from those demands can be extremely difficult, even traumatic. This is particularly true when there is a background of conservatism or religious virtuism.
Of course, this is not an absolute by any means, and many heterosexual cis couples do find ways out of these molds, finding a new dynamic in their relationship, or engaging in kinks to satisfy desires. Some couples find they aren't sexually compatible at all and seek other partners. However, there are many, many external pressures discouraging this kind of self-awareness and discovery, and breaking away from those demands can be extremely difficult — even traumatic. This is particularly true when there is a background of conservatism or religious virtuism.
Cisgender gay relationships shirk this by virtue of necessity, opening the doors for individuals to explore what role leaves them more fulfilled. Some gay couples have an established dominant/submissive dynamic, and they enter into the relationship with that already understood. Others resolve it by switching up which partner is dominant. Yet, gay relationships can still get caught up in these kinds of expectations in regards to [butch/femme](https://en.wikipedia.org/wiki/Butch_and_femme), [bear](https://en.wikipedia.org/wiki/Bear_(gay_culture)), and [twink](https://en.wikipedia.org/wiki/Twink_(gay_slang)) dynamics.
@ -32,7 +32,7 @@ What does all this mean? Trans people who enter into perceptually heterosexual r
This can lead to one feeling less enthusiastic or even disinterested in sex, as half of what makes up sex drive is the mental context of the situation. Many trans people never even experience sex until adulthood, functionally operating as sex-averse due to how severely their dysphoria has shut down all sex drive. They may still perform for the sake of their partners, but not get as much enjoyment as they could, and even end up disconnecting from reality around them in order to accomplish the task.
This dysphoria may be so significant that they find themselves taking a sexual identity that they don't actually connect with. It is not unheard of for a trans person to realize after coming out that they never actually felt a connection to the sexual orientation that they had identified with previously, but were rather using it as a way to feel less dysphoric in their sex lives.
This dysphoria may be so significant that they find themselves taking a sexual identity that they don't actually connect with. It is not unheard of for a trans person to realize after coming out that they never actually felt a connection to the sexual orientation that they had identified with previously, but were instead using it as a way to feel less dysphoric in their sex lives.
Some trans women, for example, identified as gay men pre-transition out of a desire to have a partner that treats them like women during sex, but find themselves to actually be lesbians once that demand is lifted. Others may attempt to live as gay men, but find that the role doesn't fulfill them because they know their partners see them as men.
@ -64,8 +64,8 @@ But on top of all of this, I was *terrified* to be seen expressing legitimate se
I could not stand to be associated with that male gaze. Even around the most beautiful women, I would avoid even looking at them, because I did not want to be seen as the kind of person that stares at women. I did not want to be seen as a predator.
This is the coercive male gaze: [compulsory heterosexuality](https://en.wikipedia.org/wiki/Compulsory_heterosexuality) placed upon closeted trans women due to heteronormative ideologies. A cognitive dissonance that causes intense guilt and shame surrounding appreciation of ones peers and gendered interests.
This is the coercive male gaze: [compulsory heterosexuality](https://en.wikipedia.org/wiki/Compulsory_heterosexuality) placed upon closeted trans women due to heteronormative ideologies — a cognitive dissonance that causes intense guilt and shame surrounding appreciation of one's peers and gendered interests.
Once you remove this male framework – once one is able to perceive themselves as female and accept these interests and observations are valid – that shame and guilt completely evaporates. Even when the interest is sapphic in nature and genuinely includes sexual desire, it is no longer tainted with this layer of objectification. I am able to appreciate the femininity and the beauty of my female peers without judgments, I can compliment them without fearing being perceived as a creep, or having my intentions misinterpreted.
Once you remove this male framework – once one is able to perceive themselves as female and accept these interests and observations as valid – that shame and guilt completely evaporates. Even when the interest is sapphic in nature and genuinely includes sexual desire, it is no longer tainted with this layer of objectification. I am able to appreciate the femininity and the beauty of my female peers without judgment, and I can compliment them without fearing being perceived as a creep or having my intentions misinterpreted.
It was a dysphoria I could not possibly have put into words until after it had finally been relieved. I was even more relieved as I began to integrate into queer women's spaces and came to realize that _women are exactly as thirsty as men are_, we're just (usually) much more respectful about it. It was a release of guilt that I didn't even know I was carrying.
It was a dysphoria I could not possibly have put into words until after it had finally been relieved. I was even more relieved as I began to integrate into queer women's spaces and came to realize that _women are exactly as thirsty as men are_; we're just (usually) much more respectful about it. It was a release of guilt that I didn't even know I was carrying.

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@ -33,7 +33,7 @@ tweets:
'1215731319973523456'
] tweets=meta.tweets className="oneblock" }} </div> }!}
All social gender dysphoria orbits around one central concept: What Gender do people believe me to be? Social Dysphoria is about how the outside world perceives you, how others address you, and how you are expected to address them. This applies differently prior to the trans person becoming self-aware of their own gender, versus how Social Dysphoria is experienced after a trans awakening (cracking one's shell).
All social gender dysphoria orbits around one central concept: "What gender do people believe me to be?" Social dysphoria is about how the outside world perceives you, how others address you, and how you are expected to address them. This applies differently prior to the trans person becoming self-aware of their own gender versus how social dysphoria is experienced after a trans awakening (cracking one's shell).
While still in the dark, the only awareness is that something seems off about the way you interact with your interactions with other people. People of your assigned gender seem to interact with each other in ways that do not feel natural to you. Their behaviors and mannerisms feel strange and surprising, where interactions with individuals of your true gender feel easier. You relate to people closer to your own truth.
@ -41,9 +41,9 @@ For example, an AMAB trans person may find themselves very uncomfortable in grou
This feeling of wrongness intensifies as the person becomes more and more aware of their own incongruence, and upon realizing who they really are it takes on a new shape. For binary trans people this often may be about the intense need to be seen as your true gender, be it male or female. Some non-binary people experience this more as euphoria at being seen as neither male or female and thus only being referred to in ungendered ways, or from being read as different genders by different people in the same setting. Some experience intense euphoria when people are incapable of reading their gender and become confused.
Social dysphoria is where pronouns and misgendering come into play; being addressed with a gendered pronoun such as she, he, him, or her which is not the pronoun that aligns with our gender is extremely discomforting. Granted, this is true for *all* people, including cisgender people, but where a cis person will be insulted by being misgendered, a trans person will feel hurt. It's like nails on a chalkboard, or steel wool across skin. Hearing the wrong pronoun is a reminder that the person you are talking to does not recognize you for the gender that you are.
Social dysphoria is where pronouns and misgendering come into play; being addressed with a gendered pronoun such as she, he, him, or her which is not the pronoun that aligns with our gender is extremely discomforting. Granted, this is true for *all* people, including cisgender people, but where a cis person may be insulted by being misgendered, a trans person will feel hurt. It's like nails on a chalkboard, or steel wool across skin. Hearing the wrong pronoun is a reminder that the person you are talking to does not recognize you for the gender that you are.
Gender neutral pronouns can also be unsettling for binary trans people if used in a way that make it clear the person is avoiding the pronoun that matches them. This often is an indication that a person has been read as being transgender, and the person addressing them doesn't know what pronouns they use. Asking their pronouns can resolve this situation immediately, but the paradox is that even in that scenario, having their pronouns asked may itself induce dysphoria around having been recognized as being trans. It is sort of a catch-22.
Gender-neutral pronouns can also be unsettling for binary trans people if used in a way that make it clear the person is avoiding the pronoun that matches them. This often is an indication that a person has been read as being transgender, and the person addressing them doesn't know what pronouns they use. Asking their pronouns can resolve this situation immediately, but the paradox is that even in that scenario, having their pronouns asked may itself induce dysphoria around having been recognized as being trans. It is sort of a catch-22.
Singular they can also be used maliciously when a transphobic individual refuses to use the correct pronoun, but knows they will get in trouble for using the wrong pronouns. Tone and intent matter a lot.
@ -64,11 +64,11 @@ The discomfort caused by social dysphoria can pressure a trans person to act and
Some physical traits which may cause discomfort all the time for some trans people may only manifest as a social dysphoria for others. For example, some people may only be self conscious about their physical appearance when it causes them to be misgendered or clocked (read as being trans), and feel completely comfortable when interacting in environments where they are always seen and treated as their true gender.
I, myself, have no direct physical dysphoria around my voice, I actually really enjoy singing in my natal baritone, and when I am home with just my family I let my voice relax. When out in public, however, being able to speak in a feminine voice plays a critical role in my being seen as a woman by strangers, so I put a lot of effort into training it into a feminine sound. My feminine voice turns on the instant I answer the phone or leave the house, it isn't even a conscious thing.
I, myself, have no direct physical dysphoria around my voice; I actually really enjoy singing in my natal baritone, and when I am home with just my family I let my voice relax. When out in public, however, being able to speak in a feminine voice plays a critical role in my being seen as a woman by strangers, so I put a lot of effort into training it into a feminine sound. My feminine voice turns on the instant I answer the phone or leave the house, it isn't even a conscious thing.
### "One of us!"
A very curious and surprisingly phenomenon is that closeted trans people have a tendency to find each other without ever knowing they've done it. There's a funny pattern that I have heard duplicated over and over where one person in a friend group realizes they are transgender, starts to transition, and that inspires other members of the group to also realize they are trans and come out as well.
A very curious and surprisingly common phenomenon is that closeted trans people have a tendency to find each other without ever knowing they've done it. There's a funny pattern that I have heard duplicated over and over where one person in a friend group realizes they are transgender, starts to transition, and that inspires other members of the group to also realize they are trans and come out as well.
{!{ <div class="gutter">{{import '~/tweet' ids=[
'1137185510793678848'

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@ -2,7 +2,7 @@
date: "2020-01-26T20:41:55.827Z"
title: "How Gender Dysphoria Manifests: Societal Dysphoria"
linkTitle: "Societal Dysphoria"
description: "Because a Role is a Role, and a Toll is a Toll, and it's a heavy toll to live the wrong role."
description: "Because a role is a role, and a toll is a toll, and it's a heavy toll to live the wrong role."
preBody: '_disclaimer'
siblings:
prev: /en/social-dysphoria
@ -26,13 +26,13 @@ tweets:
# Societal Dysphoria
Gender roles exist, and as much as we may try to buck them and point out the sexism that exists, there will always be expectations placed on people for their gender. The strongest of these are in marital and parental roles; "Husband", "Wife", "Mother", "Father", these terms come with loads of baggage attached to them, and the wrong role, or even any role at all, can feel like a lead lined straight jacket. You are given a whole book full of behaviors and actions, likes and dislikes, that you are just expected to fulfill, and if you fail to meet those requirements then you are seen as a bad spouse or a bad parent.
Gender roles exist, and, as much as we may try to buck them and point out the sexism that exists, there will always be expectations placed on people for their gender. The strongest of these are in marital and parental roles; "Husband", "Wife", "Mother", "Father", these terms come with loads of baggage attached to them, and the wrong role, or even any role at all, can feel like a lead-lined straitjacket. You are given a whole book full of behaviors and actions, likes and dislikes, that you are just expected to fulfill, and if you fail to meet those requirements then you are seen as a bad spouse or a bad parent.
An AFAB parent who gives birth may experience severe dysphoria around being labeled as a mother. The vast majority of resources for birth are *extremely* female gendered, so just the very process of conceiving, carrying, and giving birth is exceptionally loaded with gender expectations. If you are pregnant then you are labeled a mom, regardless of how you actually feel about your role, and with that comes a whole load of assumptions. Assumptions about caregiving, breastfeeding, and child rearing.
An AFAB parent who gives birth may experience severe dysphoria around being labeled as a mother. The vast majority of resources for birth are *extremely* female-gendered, so just the very process of conceiving, carrying, and giving birth is exceptionally loaded with gender expectations. If you are pregnant then you are labeled a mom, regardless of how you actually feel about your role, and with that comes a whole load of assumptions — assumptions about caregiving, breastfeeding, and child-rearing.
[Cisgender-passing](https://en.wikipedia.org/wiki/Passing_(gender)) transfeminine individuals also run into this. If you are holding an infant or tending to a child then you are labeled a mom (unless the child is mixed race, then you're demoted to nanny, but that's a whole other topic). This can be validating, because it is a sign that you've been seen as a woman, but it can also be extremely *invalidating* when cis women start to talk about what they think are shared experiences with reproductive processes.
[Cisgender-passing](https://en.wikipedia.org/wiki/Passing_(gender)) transfeminine individuals also run into this. If you are holding an infant or tending to a child then you are labeled a mom (unless the child is mixed race, in which case you're demoted to nanny, but that's a whole other topic). This can be validating, because it is a sign that you've been seen as a woman, but it can also be extremely *invalidating* when cis women start to talk about what they think are shared experiences with reproductive processes.
Some unexpected ways that Societal Dysphoria can appear are in the need to conform to the social standards of your true gender. For example, many trans women have stories about feeling the need to cover up their chest pre-transition out of an intrinsic sense of modesty. A discomfort at swimming topless is a common trait, even when there is no understanding of one's true self; something just knows.
Some unexpected ways that societal dysphoria can appear are in the need to conform to the social standards of your true gender. For example, many trans women have stories about feeling the need to cover up their chest pre-transition out of an intrinsic sense of modesty. A discomfort at swimming topless is a common trait, even when there is no understanding of one's true self; something just knows.
### Shame
@ -44,13 +44,13 @@ These kinds of situations can lead to bullying and abuse, pushing the trans pers
'1201138482569195526'
] tweets=meta.tweets className="" }}</div> }!}
The shame becomes especially intense at the moment of revealing themselves to be trans. Transphobic friends and family having negative, sometimes even violent reactions to a trans person coming out of the closet converts that shame into extreme guilt and disgrace. An adult trans person in a marriage may feel a tremendous amount of remorse at upending their spouse's life by revealing themselves. They may expect reproach from their neighbors and peers, and fear how that will affect their spouse and/or children.
The shame becomes especially intense at the moment of revealing themselves to be trans. Transphobic friends and family having negative (sometimes even violent) reactions to a trans person coming out of the closet converts that shame into extreme guilt and disgrace. An adult trans person in a marriage may feel a tremendous amount of remorse at upending their spouse's life by revealing themselves. They may expect reproach from their neighbors and peers, and fear how that will affect their spouse and/or children.
This too is a form of gender dysphoria, as these influences would not have been felt if the person had been cisgender.
The other way shame comes in to play is in the systemic transphobia present in our society. Trans adults of today grew up watching transphobic media in their childhood. The transsexual obsession of the late 80s and early 90s was horrifically traumatic for trans kids of the time, watching all the adults and peers around them laugh and jeer at and be disgusted by people who they not only identified with, but strongly empathized and looked up to. This shame sits with us for our entire lives; it is a fundamental reason for why so many trans people do not come out until their late 30s or later, because only when they reach mid-life are they able to overcome that shame.
The other way shame comes into play is in the systemic transphobia present in our society. Trans adults of today grew up watching transphobic media in their childhood. The transsexual obsession of the late 80s and early 90s was horrifically traumatic for trans kids of the time, watching all the adults and peers around them laugh and jeer at and be disgusted by people whom they not only identified with but strongly empathized with and looked up to. This shame sits with us for our entire lives; it is a fundamental reason for why so many trans people do not come out until their late 30s or later, because only when they reach mid-life are they able to overcome that shame.
Shame also tends to build up until it boils over into radical action. A very common aspect among trans people's histories are cycles where they will build up their presentation, fighting their feelings less and less, until suddenly they feel overcome with the shame and purge everything, vowing to never pursue those feelings again. This pattern repeats over and over again.
Shame also tends to build up until it boils over into radical action. A very common aspect among trans people's histories are cycles where they will build up their presentation, fighting their feelings less and less, until suddenly they feel overcome with shame and purge everything, vowing to never pursue those feelings again. This pattern repeats over and over again.
### Dating and Romantic Relationships
@ -65,7 +65,7 @@ Shame also tends to build up until it boils over into radical action. A very com
'1216112014411599877'
] tweets=meta.tweets className="oneblock capped" }}</div> }!}
Societal Dysphoria *strongly* comes into play with courtship rituals. Being forced into being the boyfriend or girlfriend when you are not a boy or a girl is extremely disorienting and often feels very unfair. AMABs may find themselves wishing *they* were the one being pampered, and AFABs may become uncomfortable with the amount of attention they receive from their prospective partners (beyond the discomfort that women experience, as this includes genuine attention, not just unwanted attention). The expectations placed on them by their partners to fill these courtship roles may feel like a heavy burden to bear. By contrast, dating as your true gender becomes euphoric. Buy a trans girl flowers and see how much she swoons.
Societal dysphoria *strongly* comes into play with courtship rituals. Being forced into being the boyfriend or girlfriend when you are not a boy or a girl is extremely disorienting and often feels very unfair. AMABs may find themselves wishing *they* were the one being pampered, and AFABs may become uncomfortable with the amount of attention they receive from their prospective partners (beyond the discomfort that women experience, as this includes genuine attention, not just unwanted attention). The expectations placed on them by their partners to fill these courtship roles may feel like a heavy burden to bear. By contrast, dating as your true gender becomes euphoric. Buy a trans girl flowers and see how much she swoons.
A closeted trans person may feel so much pressure to conform to heterosexuality that they suppress their own instincts with regards to relationships and take on a performative role. Many a trans woman has attempted to play the role of a heterosexual husband to a wife, only to realize with transition that they would much prefer the role of the wife. They may not even be attracted to women.
@ -73,4 +73,4 @@ Beyond discomfort, many trans people realize that the dynamics of relationships
For example, I myself realized after coming out to my wife that all of my previous dating attempts had absolutely been sapphic in nature. My first order had always been to become good friends with them. Dates would never be labeled as dates because we would just sit and talk somewhere, hanging out together. Consequently, several of my relationships ended simply because I was too scared to make the first move out of destroying the friendship. I would spend half my waking day thinking about them and wanting to be around them, not out of sexual lust, but out of personal infatuation. My first girlfriend straight up told me on our first date that I was unlike any man she'd ever dated because I enjoyed talking instead of just trying to get physical. She broke up with me two months later because I wasn't as assertive as she wanted from a partner.
These dynamics get even more complex for non-binary people, some of whom can at best describe their dating style as Queer. Some struggle to identify what role they play in a relationship. Others take a specific role that is typically seen as a binary gendered role. Some non-binary people wish to be seen as a boyfriend/girlfriend, even if they are not a boy/girl. Some want to play a role seen by society as neutral or consisting of aspects from both binary roles.
These dynamics get even more complex for non-binary people, some of whom can at best describe their dating style as queer. Some struggle to identify what role they play in a relationship. Others take a specific role that is typically seen as a binary gendered role. Some non-binary people wish to be seen as a boyfriend/girlfriend even if they are not a boy/girl. Some want to play a role seen by society as neutral or consisting of aspects from both binary roles.

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@ -18,9 +18,9 @@ Treatment options vary significantly depending on the individual person's needs.
### Social Transition
In a phrase: Coming out of the closet. This is simply announcing to the world that you are transgender. You announce that you wish to use a new name and/or new pronouns – or not, you may just wish for people to know that you are trans and do not actually identify with your assigned binary gender. For some non-binary people this may not even be a full step away from their assignment, since gender is a spectrum and there is such as thing as a "non-binary man" and a "non-binary woman".
In a phrase: coming out of the closet. This is simply announcing to the world that you are transgender. You announce that you wish to use a new name and/or new pronouns – or not; you may just wish for people to know that you are trans and do not actually identify with your assigned binary gender. For some non-binary people this may not even be a full step away from their assignment, since gender is a spectrum and there is such as thing as a "non-binary man" and a "non-binary woman".
A social transition is the act of stepping out of the closet, and it can relieve a lot of stress from suppression of ones self.
A social transition is the act of stepping out of the closet, and it can relieve a lot of stress from the suppression of oneself.
### Legal Transition
@ -32,7 +32,7 @@ These are changes to how you style yourself, be it your clothes, your hair, or t
### Medical Transition
For adults this is hormone replacement therapy and surgery. For adolescents this often means puberty blockers until the teen is old enough to be certain of which gonadal hormone they want to have. For prepubescents, this is nothing. Let me repeat that again, since transphobes keep getting it wrong.
For adults, this is hormone replacement therapy and surgery. For adolescents, this often means puberty blockers until the teen is old enough to be certain of which gonadal hormone they want to have. For prepubescents, this is nothing. Let me repeat that again, since transphobes keep getting it wrong.
***PREPUBESCENT CHILDREN DO NOT MEDICALLY TRANSITION***.
@ -42,24 +42,24 @@ Furthermore, no surgeon in the United States will perform a gender altering surg
### Hormonal Transition
**Masculinizing Hormone Therapy** (female to male sexual characteristics) consists of the introduction of testosterone, usually via intramuscular injection or topical gel. The increase in total gonadal hormones typically causes a cessation of ovulation, which is the source of the majority of estrogen produced in the ovaries.
**Masculinizing hormone therapy** (female to male sexual characteristics) consists of the introduction of testosterone, usually via intramuscular injection or topical gel. The increase in total gonadal hormones typically causes a cessation of ovulation, which is the source of the majority of estrogen produced in the ovaries.
**Femininizing Hormone Therapy** (male to female sexual characteristics) consists of the introduction of estrogen, typically estradiol, via oral pills, patches, or regular injections (intramuscular or subcutaneous). The use of slow dispensing implants is also becoming more and more common. It is also common practice to prescribe an anti-androgen to block testosterone production or absorption. In the United States this is usually Spironolactone, a blood pressure medication which has a testosterone blocking side-effect. Outside of the US the most common drug is Cyproterone Acetate, an androgen receptor blocker, which is not available in the US. Doctors may also prescribe Bicalutamide, which also blocks androgen receptors. However, some doctors may simply opt to use larger estradiol doses in order to cause the body to halt testosterone production.
**Feminizing hormone therapy** (male to female sexual characteristics) consists of the introduction of estrogen, typically estradiol, via oral pills, patches, or regular injections (intramuscular or subcutaneous). The use of slow dispensing implants is also becoming more and more common. It is also common practice to prescribe an anti-androgen to block testosterone production or absorption. In the United States this is usually spironolactone, a blood pressure medication which has a testosterone blocking side-effect. Outside of the US, the most common drug is cyproterone acetate, an androgen receptor blocker, which is not available in the US. Doctors may also prescribe bicalutamide, which also blocks androgen receptors. However, some doctors may simply opt to use larger estradiol doses in order to cause the body to halt testosterone production.
**In adolescents**, puberty blockers may involve the above androgen blockers, or if it is covered by insurance, the use of an antigonadtropin (drug which blocks the hormones that cause the production of estrogen and androgen) such as leuprolide acetate (a shot delivered every few months) or histrelin acetate (an annual implant).
**In adolescents**, puberty blockers may involve the above androgen blockers, or (if it is covered by insurance) the use of an antigonadotropic (a drug which blocks the hormones that cause the production of estrogen and androgen) such as leuprolide acetate (a shot delivered every few months) or histrelin acetate (an annual implant).
### Surgical Transition
Transgender surgeries are typically divided into three separate categories:
**Bottom Surgery** (modifications to genitals).
**Bottom Surgery** (modifications to genitals):
- Femininizing:
- Feminizing:
- Orchiectomy (removal of the testicles)
- Scrotectomy (removal of scrotal tissue, following orchiectomy)
- Vaginoplasty (creation of a vaginal cavity)
- Vulvaplasty (creation of a vulva, with or without depth).
- Vulvoplasty (creation of a vulva, with or without depth).
{!{ <div class="gutter"><div class="card"><div class="card-body"><h4 class="card-title">For Your Information</h4> }!}
@ -85,11 +85,11 @@ Phalloplasty does not necessarily require previous hormone therapy, and while it
- Feminizing:
- Breast Augmentation via fat transfer or implants.
- Breast augmentation via fat transfer or implants.
- Masculinizing:
- Bilateral Mastectomy (breast tissue removal) with chest reconstruction
- Bilateral mastectomy (breast tissue removal) with chest reconstruction
- Breast reduction (some fat and breast tissue removal)
**Facial Feminization / Masculinization Surgery** (modifications to the skull, cartilage, and skin on the face).
@ -120,7 +120,7 @@ Phalloplasty does not necessarily require previous hormone therapy, and while it
Other Trans Feminine Surgeries:
- Brazilian Butt Lift. Fat from the belly is transplanted into the butt in order to increase hip to waist ratio.
- Voice Feminization Surgery. An incision is performed in the vocal chords in order to permanently raise the pitch.
- Cinderella Surgery. Bones in the foot are shortened in order to reduce foot size. EXTREMELY RISKY
- Shoulder Reduction. The collar bone is shortened to reduce the width of the shoulders. EXTREMELY RISKY
- Brazilian Butt Lift: Fat from the belly is transplanted into the butt in order to increase hip to waist ratio.
- Voice Feminization Surgery: An incision is performed in the vocal cords in order to permanently raise the pitch.
- Cinderella Surgery: Bones in the foot are shortened in order to reduce foot size. EXTREMELY RISKY
- Shoulder Reduction: The collar bone is shortened to reduce the width of the shoulders. EXTREMELY RISKY

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If you trace the etymology of the word to its Latin roots, gender simply means "type". The Norman French term **gendre** was in use in the 12th century to describe "the quality of being male or female."
Many people attribute the term to psychologist John Money, who proposed using "gender" in 1955 to differentiate mental sex from physical sex. However, Money was not the first to do so. Cultural Anthropologist [Margaret Mead](https://en.wikipedia.org/wiki/Margaret_Mead) used the term in 1949 in her book "Male and Female" to distinguish gendered behaviors and roles from biological sex. The American Journal of Psychology ([vol. 63, no. 2, 1950, pp. 312](https://www.jstor.org/stable/1418948)) described the book thusly:
Many people attribute the term to psychologist John Money, who proposed using "gender" in 1955 to differentiate mental sex from physical sex. However, Money was not the first to do so. Cultural anthropologist [Margaret Mead](https://en.wikipedia.org/wiki/Margaret_Mead) used the term in 1949 in her book *Male and Female* to distinguish gendered behaviors and roles from biological sex. The American Journal of Psychology ([vol. 63, no. 2, 1950, pp. 312](https://www.jstor.org/stable/1418948)) described the book thusly:
> A book, moreover, which gives beyond its premise; for it informs the reader upon **'gender' as well as upon 'sex,'** upon masculine and feminine roles as well as upon male and female and their reproductive functions.
>
@ -45,17 +45,17 @@ Many people attribute the term to psychologist John Money, who proposed using "g
Human Sex (the adjective, not the verb) is broken down into three categories:
- **[Genotype](https://en.wikipedia.org/wiki/Genotype)**: The genetically defined chromosomal kareotype of an organism (XX, XY, [and all variants there of](https://twitter.com/sciencevet2/status/1035250518870900737?lang=en))
- **[Phenotype](https://en.wikipedia.org/wiki/Phenotype)**: The observable primary and secondary sexual characteristics (genitals, fat and muscle distribution, bone structure, etc)
- **[Gender](https://en.wikipedia.org/wiki/Gender)**: The **un**observable sexual characteristics, the internal mental model of a person's own sex and the way that they express it.
- **[Genotype](https://en.wikipedia.org/wiki/Genotype)**: The genetically-defined chromosomal kareotype of an organism (XX, XY, [and all variants thereof](https://twitter.com/sciencevet2/status/1035250518870900737?lang=en))
- **[Phenotype](https://en.wikipedia.org/wiki/Phenotype)**: The observable primary and secondary sexual characteristics (genitals, fat and muscle distribution, bone structure, etc.)
- **[Gender](https://en.wikipedia.org/wiki/Gender)**: The **un**observable sexual characteristics, the internal mental model of a person's own sex, and the way that they express it.
Any of these three aspects can fall into a position on a range of values. Your elementary school health class probably taught you that Genotype is binary, either Female (XX) or Male (XY), when the reality is that there are a dozen other permutations that can occur within human beings.
Any of these three aspects can fall into a position on a range of values. Your elementary school health class probably taught you that genotype is binary, either female (XX) or male (XY), when the reality is that there are a dozen other permutations that can occur within human beings.
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Likewise, many people believe that Phenotype is also binary, but biology has recognized for hundreds of years that when you plot out all sexual characteristics across a population, you actually end up with a bimodal distribution where the majority of the population falls within a percentile of two groups. This means that some people will, simply by nature of how life works, fall outside of the typical two piles. Many people fall in the middle, with characteristics of both sexes.
Likewise, many people believe that phenotype is also binary, but biology has recognized for hundreds of years that, when you plot out all sexual characteristics across a population, you actually end up with a bimodal distribution where the majority of the population falls within a percentile of two groups. This means that some people will, simply by nature of how life works, fall outside of the typical two piles. Many people fall in the middle, with characteristics of both sexes.
Gender, however, is a lot more... esoteric. There are a lot of different ways that people have attempted to illustrate the gender spectrum, but none have quite thoroughly captured it, because the spectrum is itself a very abstract concept.
Gender, however, is a lot more... esoteric. There are a lot of different ways in which people have attempted to illustrate the gender spectrum, but none have quite thoroughly captured it because the spectrum is itself a very abstract concept.
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The short of it is, some people are very male, some people are very female, some people feel no gender at all, some people feel both, some are smack in the middle, some land along the edges. Some people oscillate all over the spectrum in unpredictable ways, changing like the wind. Only an individual can identify their own gender, no one else can dictate it for them.
The short of it is: some people are very male, some people are very female. Some people feel no gender at all, some people feel both. Some are smack in the middle, some land along the edges. Some people oscillate all over the spectrum in unpredictable ways, changing like the wind. Only an individual can identify their own gender; no one else can dictate it for them.
Gender is part social construct, part learned behaviors, and part biological processes which form very early in a person's life.
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On the social side, gender involves our [habitus](https://en.wikipedia.org/wiki/Habitus_(sociology)): our presentation, our mannerisms and behaviors, how we communicate, how we react, what our expectations are from life, and the roles that we fulfill as we walk through life. The author Susan Stryker described habitus it in her book [Transgender History](https://smile.amazon.com/Transgender-History-second-Todays-Revolution/dp/158005689X):
On the social side, gender involves our [habitus](https://en.wikipedia.org/wiki/Habitus_(sociology)): our presentation, our mannerisms and behaviors, how we communicate, how we react, what our expectations are from life, and the roles that we fulfill as we walk through life. The author Susan Stryker described habitus it in her book *[Transgender History](https://smile.amazon.com/Transgender-History-second-Todays-Revolution/dp/158005689X)*:
> A lot of habitus involves manipulating our secondary sex characteristics to communicate to others our own sense of who we feel we are---whether we sway our hips, talk with our hands, bulk up at the gym, grow out our hair, wearclothing with a neckline that emphasizes our cleavage, shave our armpits, allow stubble to be visible on our faces, or speak with a rising or falling inflection at the end of sentences. Often these ways of moving and styling have become so internalized that we think of them as natural even though---given that they are all things we've learned through observation and practice---they can be better understood as culturally acquired "second nature."
Indeed, these are all cultural factors; things which have developed within the population over time. Regardless of being essentially "made up", they are still strongly gendered and a person tends to connect to the gendered habitus of their internal self, without even realizing they are doing it. When we are denied access to those social aspects, this results in discomfort with one's social position in life.
Indeed, these are all cultural factors: things which have developed within the population over time. Regardless of being essentially "made up", they are still strongly gendered and a person tends to connect to the gendered habitus of their internal self without even realizing they are doing it. When we are denied access to those social aspects, this results in discomfort with one's social position in life.
John Money's experiments attempted to confirm his belief that gender is entirely a social construct, and that any child can be raised to believe themselves to be whatever they were taught to be. His experiment was a massive failure (see the Biochemical Dysphoria section). Gender does not change, every human is the same gender at 40 that they were at 4. What changes is our own personal understanding of our gender as we mature as individuals.
John Money's experiments attempted to confirm his belief that gender is entirely a social construct, and that any child can be raised to believe themselves to be whatever they were taught to be. His experiment was a massive failure (see the Biochemical Dysphoria section). Gender does not change; every human is the same gender at 40 that they were at 4. What changes is our own personal understanding of our gender as we mature as individuals.
These negative symptoms (depression, derealization, social discomfort) are the symptoms of Gender Dysphoria.
What **Gender is *not*** is sexual orientation. We describe orientation using terms relative to one's gender (homosexual/heterosexual/bisexual, etc), but gender itself does not affect sexuality and sexuality has no role in gender.
## What does it mean to be Non-Binary?
## What does it mean to be Non-binary?
Non-Binary can basically be simplified as a lack of exclusive affinity to Male or Female. This may be a lack of affinity to either identity ([agender](https://gender.wikia.org/wiki/Agender)), a total affinity to both ([bi-gender](https://gender.wikia.org/wiki/Bigender)/), a balanced affinity to both (androgyne), an affinity that changes from day to day ([genderfluid](https://gender.wikia.org/wiki/Genderfluid)), a partial affinity ([demigender](https://gender.wikia.org/wiki/Demigender)), or even an affinity to the entire gender spectrum at once ([pangender](https://gender.wikia.org/wiki/Pangender)).
Non-binary can basically be simplified as a lack of exclusive affinity to male or female. This may be a lack of affinity to either identity ([agender](https://gender.wikia.org/wiki/Agender)), a total affinity to both ([bi-gender](https://gender.wikia.org/wiki/Bigender)/), a balanced affinity to both (androgyne), an affinity that changes from day to day ([genderfluid](https://gender.wikia.org/wiki/Genderfluid)), a partial affinity ([demigender](https://gender.wikia.org/wiki/Demigender)), or even an affinity to the entire gender spectrum at once ([pangender](https://gender.wikia.org/wiki/Pangender)).
It could be an affinity to some aspects of a gender but not others. For example, a [demigirl](https://gender.wikia.org/wiki/Demigirl) could be someone assigned female at birth who only feels a partial connection to womanhood and femininity, or may be a male-assigned individual who is taking hormone therapy to relieve physical dysphoria, and has a female phenotype, but does not experience a strong connection to the social aspects of womanhood.
In generalist terms this book will be describing gender in a sense of binary identities (male/female) vs non-binary identities, but this is purely for the sake of writing simplicity. Please know that the depth of gender experience and expression is far, far more complicated than this simple breakdown.
In generalist terms, this book will be describing gender in a sense of binary identities (male/female) vs non-binary identities, but this is purely for the sake of writing simplicity. Please know that the depth of gender experience and expression is far, far more complicated than this simple breakdown.

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Depuis que la civilisation humaine existe, [il y eu des gens](https://fr.wikipedia.org/wiki/Histoire_de_la_transidentit%C3%A9) dont l'expérience de leur genre interne ne correspond pas aux caractéristiques physiques de leur corps. Les Gala, une classe de prêtres de sexe intermédiaire de l'empire sumérien, existaient il y a plus de 4 500 ans. Les cultures indigènes d'Amérique du Nord reconnaissaient [un troisième genre](https://fr.wikipedia.org/wiki/Troisi%C3%A8me_genre) bien avant le colonialisme européen, et le font encore aujourd'hui. L'empereur romain Elagabalus (218 ap. J.-C.) a insisté pour qu'on l'appelle Lady plutôt que Lord, et a même proposé une rançon récompense pour quiconque pourrait effectuer une chirurgie de reconstruction génitale.
Malgré cela, la compréhension moderne de l'expérience transgenre n'existe que depuis environ 130 ans. Même le mot "transgenre" ne date que de 1965, lorsque John Oliven l'a proposé comme une alternative plus précise au terme "transsexuel" de David Cauldwell (inventé en 1949), qui avait lui-même remplacé le terme "travesti" de Magnus Hirschfield (1910).
Malgré cela, la compréhension moderne de l'expérience transgenre n'existe que depuis environ 130 ans. Même le mot "transgenre" ne date que de 1965, lorsque John Oliven l'a proposé comme une alternative plus précise au terme "transsexuel" de David Cauldwell (inventé en 1949), qui avait lui-même remplacé le terme "travesti" de Magnus Hirschfeld (1910).
Être transgenre, c'est avoir une identité de genre qui ne correspond pas au genre présumé en fonction des organes génitaux que l'on a à la naissance. Cela peut signifier qu'une personne née avec un pénis est en fait une fille, qu'une personne née avec une vulve est en fait un garçon, ou qu'une personne ayant l'une ou l'autre configuration génitale peut ne pas correspondre entièrement à l'un ou l'autre côté de ce spectre et être non-binaire.

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Amióta csak létezik az emberi civilizáció, [léteznek olyan emberek](https://en.wikipedia.org/wiki/Transgender_history), akiknek a belső nemükről alkotott tapasztalata nem egyezik a testük fizikai jellemzőivel. A gala, a sumér birodalom középső nemű papi osztálya több mint 4500 évvel ezelőtt létezett. Észak-Amerika őslakos kultúrái jóval az európai gyarmatosítás előtt elismertek [egy harmadik nemet](https://en.wikipedia.org/wiki/Third_gender), amely kultúrát a mai napig őriznek. Elagabalus római császár (Kr. u. 218) ragaszkodott ahhoz, hogy úr helyett úrnőnek szólítsák, és még jutalmat is felajánlott annak, aki nemi szervi helyreállító műtétet tudott végezni.
Ennek ellenére azonban a mai transzneműség fogalma csak körülbelül 130 éve létezik. Még a "transznemű" szó is csak 1965-re nyúlik vissza, amikor John Oliven javasolta, mint David Cauldwell "transzexuális" kifejezésének pontosabb alternatíváját (amelyet 1949-ben alkottak meg), ami Magnus Hirschfield "transzvesztita" kifejezését (1910) váltotta fel.
Ennek ellenére azonban a mai transzneműség fogalma csak körülbelül 130 éve létezik. Még a "transznemű" szó is csak 1965-re nyúlik vissza, amikor John Oliven javasolta, mint David Cauldwell "transzexuális" kifejezésének pontosabb alternatíváját (amelyet 1949-ben alkottak meg), ami Magnus Hirschfeld "transzvesztita" kifejezését (1910) váltotta fel.
Transzneműnek lenni azt jelenti, hogy a nemi identitásod nem egyezik azzal a nemmel, amelyet a nemi szerveid alapján feltételeztek rólad. Ez azt jelentheti, hogy egy pénisszel született személy valójában lány, hogy egy szeméremtesttel született személy valójában fiú; vagy hogy egy olyan személy, akinek bármelyik nemi szerve van, nem teljesen illeszkedik a spektrum egyik oldalára sem, azaz nem-bináris.

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As [Gala](https://en.wikipedia.org/wiki/Gala_\(priests\)), uma classe de sacerdotes de Império Sumério, existiram há mais de 4.500 anos. As culturas indígenas da América do Norte reconheciam um [terceiro gênero](https://en.wikipedia.org/wiki/Third_gender) bem antes do colonialismo europeu e ainda o reconhecem até hoje.
Culturas tribais da África reconhecem numerosas identidades de gênero as quais os europeus tentaram apagar. Seres humanos, por longos tempos, viveram com identidades, normas e graus de conformidade a essas normas que diferem da chamada "tradicional" ideia de gênero na cultura ocidental de hoje.
Apesar disso, porém, o entendimento moderno da experiência transgênero só tem existido há aproximadamente 130 anos. Mesmo a palavra "transgênero" remonta apenas a 1965, quando John Oliven a propôs como uma alternativa mais exata ao termo "transsexual" cunhado por David Cauldwell em 1949, o qual se substituiu o termo alemão "<span lang="de">Transvestitismus</span>" de Magnus Hirschfield de 1910.
Apesar disso, porém, o entendimento moderno da experiência transgênero só tem existido há aproximadamente 130 anos. Mesmo a palavra "transgênero" remonta apenas a 1965, quando John Oliven a propôs como uma alternativa mais exata ao termo "transsexual" cunhado por David Cauldwell em 1949, o qual se substituiu o termo alemão "<span lang="de">Transvestitismus</span>" de Magnus Hirschfeld de 1910.
Ser transgênere pode significar que uma pessoa nascida com um pênis é na verdade uma menina, que uma pessoa nascida com uma vulva é na verdade um menino, ou que uma pessoa com qualquer configuração genital pode não se encaixar completamente em qualquer lado do espectro e é não-binárie.

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*译注：“女士”原意指贵族女性，而非现代的泛用称呼，“领主”一般指男性领主。*
尽管如此，现代意义下的跨性别体验仅仅存在了大约130年。甚至直到1965年约翰·奥利文（John Oliven）为了准确表述才用“跨性别”替代大卫·考尔德威尔在1949年提出的词“易性者”，而后者曾经取代了马格努斯·赫施菲尔德（Magnus Hirschfield）在1910年提出的词“异装癖”。
尽管如此，现代意义下的跨性别体验仅仅存在了大约130年。甚至直到1965年约翰·奥利文（John Oliven）为了准确表述才用“跨性别”替代大卫·考尔德威尔在1949年提出的词“易性者”，而后者曾经取代了马格努斯·赫施菲尔德（Magnus Hirschfeld）在1910年提出的词“异装癖”。
跨性别者的性别认同与基于生殖器的出生性别不一致。那么有阴茎的人可能是女孩，有阴户的人可能是男孩，或者有一种任意生殖器的人可能是不完全符合男或女性别划分的非二元性别者。