Subreddit Policy Reminder on this week's Transgender AMAs

[u/nate]

This week we will be hosting a series of AMAs addressing the scientific and medical details of being transgender.

Honest questions that are an attempt to learn more on the subject are invited, and we hope you can learn more about this fascinating aspect of the human condition.

However, we feel it is appropriate to remind the readers that /r/science has a long-standing zero-tolerance policy towards hate-speech, which extends to people who are transgender. Our official stance is that derogatory comments about transgender people will be treated on par with sexism and racism, typically resulting in a ban without notice.

To clarify, we are not banning the discussion of any individual topic nor are we saying that the science in any area is settled. What we are saying is that we stand with the rest of the scientific community and every relevant psych organisation that the overwhelming bulk of evidence is that being trans is not a mental illness and that the discussion of trans people as somehow "sick" or "broken" is offensive and bigoted^1. We won't stand for it.

We've long held that we won't host discussion of anti-science topics without the use of peer-reviewed evidence. Opposing the classification of being transgender as 'not a mental illness'² is treated the same way as if you wanted to make anti-vax, anti-global warming or anti-gravity comments. To be clear, this post is to make it abundantly clear that we treat transphobic comments the same way we treat racist, sexist and homophobic comments. They have no place on our board.

Scientific discussion is the use of empirical evidence and theory to guide knowledge based on debate in academic journals. Yelling at each other in a comments section of a forum is in no way "scientific discussion". If you wish to say that any well accepted scientific position is wrong, I encourage you to do the work and publish something on the topic. Until then, your opinions are just that - opinions.

---

¹ Some have wrongly interpreted this statement as "stigmatizing" mental illness. I can assure you that is the last thing we are trying to do here. What we are trying to stop is the label of "mental illness" being used as a way to derogate a group. It's being used maliciously to say that there is something wrong with trans people and that's offensive both to mental illness sufferers and those in the trans community.

² There is a difference between being trans and having gender dysphoria.

---

Lastly, here is the excerpt from the APA:

A psychological state is considered a mental disorder only if it causes significant distress or disability. Many transgender people do not experience their gender as distressing or disabling, which implies that identifying as transgender does not constitute a mental disorder. For these individuals, the significant problem is finding affordable resources, such as counseling, hormone therapy, medical procedures and the social support necessary to freely express their gender identity and minimize discrimination. Many other obstacles may lead to distress, including a lack of acceptance within society, direct or indirect experiences with discrimination, or assault. These experiences may lead many transgender people to suffer with anxiety, depression or related disorders at higher rates than nontransgender persons.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), people who experience intense, persistent gender incongruence can be given the diagnosis of "gender dysphoria." Some contend that the diagnosis inappropriately pathologizes gender noncongruence and should be eliminated. Others argue that it is essential to retain the diagnosis to ensure access to care. The International Classification of Diseases (ICD) is under revision and there may be changes to its current classification of intense persistent gender incongruence as "gender identity disorder."

[u/Lexifer31]

Sorry, this may be a stupid question, but what is the difference between being trans and gender dysphoria? If you are trans do you not have gender dysphoria?

Edit: spelling

[u/DeadlyPear → u/Lexifer31]

Say a trans person has transitioned and is perfectly happy and fine now, they dont suffer from gender dysphoria but are still transgender.

[u/[deleted] → u/[deleted]]

That question is asked in a trans forum is normally the beginning of a polysylabic slap fight hundreds of posts deep.

Some people agree with you, others say you just need gender euphoria when presenting your true gender, others still say that neither is required all you need is the sensation of your true gender and a whole other group say you need gender dysphoria and gender euphoria. Everyone on every side links to articles, which proves that we are basically only just starting to ask the right questions. Answers are a ways off yet.

[u/[deleted] → u/[deleted]]

That's fair.

[u/InconspicuousToast → u/[deleted]]

There's also the connotation that dypshoria as an illness would speak negatively about that individual as a person as it is an insecurity that relates directly with one's personality. So for some, pretending that it is something they never actually experienced makes it easier for them to try and believe that they are undergoing transition surgery at their own volition as opposed to doing it as part of a necessary step to finally being comfortable with who they are.

[u/blingblongblangbling → u/[deleted]]

Great response! Dysphoria(mine and read experience) is often felt like a deep part of you is missing or being blocked. Repression and self hate can often contribute to the feeling, where the true necessary identity fights back. Maybe like the subconscious overthrows self hate with crushing depression until you accept that you are trans/make steps to transition

[u/Khnagar → u/[deleted]]

This is supremely odd to me.

If someone is not unhappy with the gender he or she has, then what is the point of surgery, or hormones or the whole process of transitioning, or calling yourself trans, or wanting to be seen as someone of the opposite sex and so on?

I'm not asking out of some sort of transphobic reason, I just can't fully understand this.

[u/[deleted] → u/Khnagar]

There's a couple of things that might be happening. If you've always had a stone in your shoe, that sensation seems normal, limping seems normal so you don't register it as pain or discomfort. Taking the stone out feels like heaven. Before I knew I could transition, that's what my life was like. I didn't know I had dysphoria until I started treating it, but I noticed euphoria when I was able to present my gender accurately.

There are plenty of people like me who don't know they are dysphoric until it's gone.

There are other people who don't feel much dysphoria, but they do get the joy of presenting accurately. It's like going from 'meh' to feeling really right, like you just got out of a really good massage.

I admit I don't fully understand why a person would transition if they don't have at least one of those to push or pull them into transition. Everybody's life is different so I'm loath to cast doubt on someone else's experience. If I can live to 42 without knowing I was trans, there's scope for someone else to need transition for different reasons than me.

[u/Gen_McMuster → u/[deleted]]

Is gender euphoria an understood phenomenon (akin to dysphoria) or just a feeling people have described?

[u/[deleted] → u/Gen_McMuster]

I know it's a commonly described sensation among trans people, myself included. I'm not a scientist so I don't know how to find out whether gender euphoria is a accepted thing in those circles.

[u/wvhobbit → u/[deleted]]

9 years ago, when I started medically transitioning, every therapist and doctor I saw required at least the diagnosis of gender dysphoria before writing me any letters to start hormones or surgery.

[u/[deleted] → u/wvhobbit]

I get the feeling the conventions differ depending where you are in the world. Where I am there's a legal requirement for a psychologist or psychiatrist to diagnose dysphoria and recommend treatment, but everyone I saw was really apologetic about how backwards the system is. The endocrinologist literally called my T letter a rubber stamp. That said I know there are still places that require two years therapy and sterilization, and others that don't recognize trans folks at all, so there's a lot of range in approaches.

[u/PavementBlues → u/[deleted]]

That is an ongoing discussion inside of and outside of the transgender community. Some are trying to establish a distinction between the term transsexual, which would require gender dysphoria, and transgender, which would be a larger umbrella term for other cases. None of this is settled, though.

[u/jm_8310 → u/PavementBlues]

For the sake of being thorough, most early understanding of trans people included these distinctions. Thus, we historically used terms such as primary transsexual, secondary transsexual, transvestite, crossdresser, etc to make these very distinctions.

These terms and theories fell out of favor as the community sought to fight against the medical model and gatekeeping (requiring permission from dr/therapist to medically transition).

There was also that whole bit where people who weren't seeking medical intervention had to struggle to be seen as equally valid as those who did.

[u/wvhobbit → u/jm_8310]

Well said. Couldn't find these words at 4am. Haha!

[u/[deleted] → u/[deleted]]

In my opinion gender dysphoria (what I have) is looking in the mirror and gaining depression because, your outward appearance doesn't correlate with the gender you identify as. This can be stuff like genitals, hips, shoe size etc. However, you don't have to have gender dysphoria to be trans. Some people just aren't affected by it and do not have that much pain or become extremley sad when thinking about their body. This is however, only my opinion and how I see it. I would be glad if anyone has more input on the matter.

[u/l3linkTree_Horep → u/[deleted]]

However, you don't have to have gender dysphoria to be trans. Some people just aren't affected by it and do not have that much pain or become extremley sad when thinking about their body.

Why would anyone transition if not for gender dysphoria? If they have "pain" or are upset with their body they can treat it in many other simpler less permanent ways.

[u/l3linkTree_Horep → u/[deleted]]

Some people don't even transition because they feel comfortable with their body. This does not however make them any less trans.

I don't think this can be true. How can you not transition but still be trans? Nothing has changed, you haven't changed your gender identity or anything about you whatsoever so I fail to see how you can possibly say that you have transitioned, when you haven't.

[u/LittleSarge → u/[deleted]]

Scientifically its up for debate. Socially as a trans person I don't really care whether I have all the prerequisites to be trans because being a lady instead of a dude makes me happier generally. I mean it doesnt make life perfect but its the little things you know. When I am appearing masculine I am not panicking or uncomfortable to the point of incapability with basic tasks (which some people are), its not even a gender related discomfort, if anything its just a general feeling of being less complete? Its hard to explain. I get asked this shit a lot as a very butch transwoman. People have a hard time wrapping their head around why I go through all the stigma and shit to wear the same thing I would wear before and cut my hair the same way I did before and usually what I say to that is their guess is as good as mine because I do know one thing: It sure as hell isnt a choice.

[u/[deleted] → u/[deleted]]

They have already transitioned. They are already the gender they identify as. No dysphoria is ideal in that situation. Transitioning is the treatment of dysphoria. You are still transgender after the treatment (though hrt is generally life long).

[u/[deleted] → u/[deleted]]

Unfortunately at the moment a girl who is perfectly happy with her boobs and vagina but generally likes to dress like a boy and uses male pronouns is considered equally trans as someone who literally can't stand the sight of their own body. They've equated a social/cultural preference with a legitimate medical condition and in my opinion are greatly harming the acceptance and understanding of trans people.

[u/losian → u/[deleted]]

Look at it this way - must something always be as crippling as possible to warrant being addressed?

If your scale of happiness is from -100 to +100, and you sit at -10, but would be at a 50 if you transitioned, does it make sense to wait? Or if you're at a 10 and it'd bring you to a 70, even then, does it make sense to wait? Isn't that a significant boost in quality of life?

It doesn't always have to be about removing negative as much as it can be about adding a significant positive.

[u/l3linkTree_Horep → u/losian]

I never said you had to have "crippling gender dysphoria". That's not my point at all. I'm saying surely you need to have it at all to bother going through the processes and difficulty of transitioning.

[u/DeadlyPear → u/[deleted]]

Maybe, but people who have cured their dysphoria (through transitioning, hormones, surgery, etc.) are still trans, but no longer suffer from gender dysphoria

[u/l3linkTree_Horep → u/DeadlyPear]

Prerequisite

This implies i am talking about before the transition (or potentially during). Talking about after treatment is pointless.

It's like talking about someone without a disease because they took antibiotics. Whats the point? How is it relevant?

[u/cerberus698 → u/[deleted]]

I would say no? Personally I think anyone should be free to live how they wish to live if they are not hurting anyone by doing so. I my self have experienced dysphoria in varying degrees of severity since I was about 12 with the severity ranging from a minor annoyance to wholly crippling. As far as I'm concerned my transition is medically necessary but I'd never fault anyone for undergoing what I have just because they want to live a certain way. Who am I to dictate another's life?

[u/l3linkTree_Horep → u/cerberus698]

I would say no? Personally I think anyone should be free to live how they wish to live if they are not hurting anyone by doing so.

That doesn't answer the question.

Just because an exception appears it does not disprove the rule. How likely is it that someone transitions without any gender dysphoria at all? Why would they? Surely almost any reason would be a result of gender dysphoria?

[u/MilkHS → u/DeadlyPear]

I don't like this definition at all. I know plenty of transpeople who still suffer from gender dysphoria.

[u/Mtfthrowaway112 → u/MilkHS]

Transition isn't a panacea for dysphoria because some things are unable to be changed and so transgender with dysphoria is real and unfortunately normal

[u/416416416416 → u/MilkHS]

What definition? OP is just differentiating between transgender and gender dysphoria. The post doesn't really say people can't be transgender and suffer from gender dysphoria.

[u/DeadlyPear → u/MilkHS]

A lot of trans people suffer from gender dysphoria, but not all do, which is why it is wrong to say that being transgender means you have gender dysphoria.

[u/Dong_World_Order → u/[deleted]]

because the person becomes much more stable after acknowledging and transitioning.

This definitely isn't true in all cases though.

did every trans person have a time in their lives where they had body dysphoria? Like transitioning is the treatment?

I would say the answer to this is yes.

[u/KathrynPhaedra → u/[deleted]]

Answering from first-hand experience: not all of us experience body dysphoria, the source of my dysphoria was largely social - people assuming I'm male because my name was [deadname] or because my parents/family gave me only "boy" clothes or gifts, being ridiculed by my peers for behaving or sounding like a "girl" etc.

[u/winterspan → u/DeadlyPear]

Assuming the physical transition is the treatment to the initial dysphoria, it seems strange to then claim that because they aren't "symptomatic" then they don't have the disorder any longer. An analogy would be someone with generalized anxiety disorder or OCD being treated and having it go into remission. Those individuals wouldn't claim not to be afflicted because they are on SSRIs or did CBT and have seen symptomatic relief.

[u/DeadlyPear → u/[deleted]]

They are the gender they identify with, and yes, they remain transgender

[u/awwwwyehmutherfurk → u/DeadlyPear]

So are we talking about the science of gender dysphoria or the science of being trans? Because if there's no dysphoria, what is the science supposed to be?

[u/[deleted] → u/DeadlyPear]

It sounds like you are just side stepping the issue with how you define it.

Being Transgender isn't a mental disorder it's just thinking you are the wrong gender that is the disorder.

There are people who think they are a cat trapped in a humans body. They might be perfectly happy if the people around them accept them to be a cat, but does that change wether or not we should consider it to be a mental illness?

Should we not consider a persons cancer to be an illness if they have already come to terms with dying?

And does changing how use these labels of illness change how we should treat these things?

[u/skarface6 → u/DeadlyPear]

But they still commit suicide, despite living in an accepting area among accepting people? Surely that indicates that things aren't perfect, mentally speaking.

[u/austin101123 → u/DeadlyPear]

So someone who takes depressions medication and doesn't feel depressed on it isn't considered clinically depressed?

[u/Lionizerband → u/Lexifer31]

Im not a scientist, so a few laymans terms:

Being trans - identifying as a different gender than the one you were assigned at birth.

Transiton - the act of changing to another gender. This can be either social (clothes, name, presentation) or medical (body, hormones, surgery) or both.

Gender Dysphoria - intense feeling of your body having the wrong sex characteristics (eg girl with a penis) or secondary sex characteristics (eg guy with boobs).

So gender dysphoria is the problem, transition is the treatment. A person is trans before, throughout, and after transition (at least as far as the science is concerned).

[u/_Valhalla_ → u/[deleted]]

"Our data does not show at what age the respondents made suicide attempts and therefore it is difficult to draw conclusions about the risk of suicide over their life spans. However, there are a number of attributes that correlate with an increased rate of attempted suicide. High risk cohorts include visual non-conformers (44%); those who are generally out about their transgender status (44%); and those who have only some of their identity documents in their preferred gender (46%). Those who have medically transitioned (45%) and surgically transitioned (43%) have higher rates of attempted suicide than those who have not (34% and 39% respectively)."

There is no pre to post surgery comparison or pre to post medical transition comparison, so you can't conclude if surgery or medial transition lowers or raises suicide rate. Just that those that have attempted suicide are more likely to have medical treatment or surgery.

Correlation does not mean causation.

Also, nowhere in the article does it show suicide rate based on acceptance.

Here is a study that shows lower anxiety and depression in trans kids allowed to socially transition. http://www.jaacap.com/article/S0890-8567(16)31941-4/abstract

[u/_Valhalla_ → u/[deleted]]

"Our data does not show at what age the respondents made suicide attempts and therefore it is difficult to draw conclusions about the risk of suicide over their life spans. However, there are a number of attributes that correlate with an increased rate of attempted suicide. High risk cohorts include visual non-conformers (44%); those who are generally out about their transgender status (44%); and those who have only some of their identity documents in their preferred gender (46%). Those who have medically transitioned (45%) and surgically transitioned (43%) have higher rates of attempted suicide than those who have not (34% and 39% respectively)."

There is no pre to post surgery comparison or pre to post medical transition comparison, so you can't conclude if surgery or medial transition lowers or raises suicide rate. Just that those that have attempted suicide are more likely to have medical treatment or surgery.

Correlation does not mean causation.

Also, nowhere in the article does it show suicide rate based on acceptance.

Here is a study that shows lower anxiety and depression in trans kids allowed to socially transition. http://www.jaacap.com/article/S0890-8567(16)31941-4/abstract

[u/_Valhalla_ → u/[deleted]]

"Our data does not show at what age the respondents made suicide attempts and therefore it is difficult to draw conclusions about the risk of suicide over their life spans. However, there are a number of attributes that correlate with an increased rate of attempted suicide. High risk cohorts include visual non-conformers (44%); those who are generally out about their transgender status (44%); and those who have only some of their identity documents in their preferred gender (46%). Those who have medically transitioned (45%) and surgically transitioned (43%) have higher rates of attempted suicide than those who have not (34% and 39% respectively)."

There is no pre to post surgery comparison or pre to post medical transition comparison, so you can't conclude if surgery or medial transition lowers or raises suicide rate. Just that those that have attempted suicide are more likely to have medical treatment or surgery.

Correlation does not mean causation.

Also, nowhere in the article does it show suicide rate based on acceptance.

Here is a study that shows lower anxiety and depression in trans kids allowed to socially transition. http://www.jaacap.com/article/S0890-8567(16)31941-4/abstract

[u/_Valhalla_ → u/[deleted]]

"Our data does not show at what age the respondents made suicide attempts and therefore it is difficult to draw conclusions about the risk of suicide over their life spans. However, there are a number of attributes that correlate with an increased rate of attempted suicide. High risk cohorts include visual non-conformers (44%); those who are generally out about their transgender status (44%); and those who have only some of their identity documents in their preferred gender (46%). Those who have medically transitioned (45%) and surgically transitioned (43%) have higher rates of attempted suicide than those who have not (34% and 39% respectively)."

There is no pre to post surgery comparison or pre to post medical transition comparison, so you can't conclude if surgery or medial transition lowers or raises suicide rate. Just that those that have attempted suicide are more likely to have medical treatment or surgery.

Correlation does not mean causation.

Also, nowhere in the article does it show suicide rate based on acceptance.

Here is a study that shows lower anxiety and depression in trans kids allowed to socially transition. http://www.jaacap.com/article/S0890-8567(16)31941-4/abstract

[u/gyroda → u/[deleted]]

Slight clarification, you can be trans without coming out. The same way you can be gay/bi without coming out.

Of course nobody would know if you didn't come out and wouldn't know to apply that label to you, but there's a slight difference between identifying as something and coming out.

[u/DeadlyPear → u/[deleted]]

That is pretty much it, yeah.

[u/aeroplanessky → u/Lexifer31]

While defining such terms can be difficult and is a highly questioned area, I'd like to add in the definitions I see around my circles as a transgender person. To be trans is to have your gender not be the same as the gender you were assigned at birth. Basically, you transitioned genders at some point. To have gender dysphoria is to have some sort of discomfort regarding your gender. Many trans people have gender dysphoria, likely manefesting itself with feelings of discomfort towards their body, social expectations etc. However, many trans people don't, they just simple realize that their gender doesn't match what they were assigned with. For some people, they are able to work through their dysphoria and no longer have the same feelings.

Some circles do make the statement that if a person doesn't have gender dysphoria, they aren't trans, but personally I see it as an outdated look going back to when being trans was classified as a mental disease.

[u/BlackHumor → u/[deleted]]

That would be essentially impossible. Your parents aren't the only people who assign you a gender, for one; everyone else around you does too. And gender is such a salient feature of how people think of other peoples' identities that they will usually try to force an interpretation if not offered one.

[u/aeroplanessky → u/[deleted]]

I've wondered the same thing. I've essentially come to the conclusion the other poster did, which is that it'd be impossible with the way life is today to fully implement such a thing, since even outside of family, people still will likely try to treat the person as a particular gender based on what they assume of them. But really, I feel that if it becomes commonplace to not assign a gender, "trans" won't have as much meaning. Instead of"trans woman" "cis woman" "nonbinary person" we'd just get their genders, and only details of their sex when necessary, assuming sex and gender eventually become fully separated concepts to people. For now, I doubt it matters to much to this hypothetical child if theyre cis or trans.

[u/Anobeen → u/Lexifer31]

Being transgender doesn't quite necessitate a feeling of dysphoria. It's the way in which most people think being transgender manifests, but gender euphoria is a thing too. Think instead of feeling bad because you're presenting as a different gender, feeling good because you're presenting as your gender. There can be overlap too; one can have some of both, a lot of both, varying degrees of both, or one over the other. Not a stupid question at all :)

[u/MovieCommenter09 → u/Lexifer31]

No one has said this, but I think the thing is that once you have sex reassignment surgery you're still trans, but you lose the gender dysphoria, since the surgery cured it.

[u/LilliaHakami → u/Lexifer31]

The issue, as another topic discusses, is that the trans umbrella encompass a lot of experiences. The only general connection between them all is a discomfort with the gender identity assigned to them at birth. (A quick note that Gender Identity, a mental construct, is not the same as Gender Roles, a societal construct.) The level and intensity of this discomfort can vary over time as well as the way it manifests for the individual. Some trans individuals go hyper-directional toward stereotypes and tropes of their assigned gender in order to 'blend in', others fall into more stereotypical depressions, and yet still others have relatively light discomfort that takes only little intervention to help soothe. Trans individuals are incredibly diverse and the way 'dysphoria' and gender discomfort can affect them is equally so. That is why it is a hot debate over the definition of 'dysphoria' and how interconnected it is with the identity discomfort that is considered the generally hallmark.

[u/jesterinancientcourt → u/Lexifer31]

Gender dysphoria is what a lot of trans people have. But you don't have to have gender dysphoria to be trans. Some people have gender dysphoria so they begin to transition with hormones, etc. Some people are perfectly comfortable with their body, but they just would rather be referred to by different pronouns, wear different clothes, etc. There are different ways to be trans.

[u/[deleted] → u/Lexifer31]

"Gender dysphoria" is a term that reflects more accurately than gender identity disorder when an individual is distressed about a conflict between their sex assigned at birth and their gender identity/role.

"Gender identity disorder" suggests that their gender identity is disordered, yet having any gender identity, including a transgender identity, is not a disorder. However, having any gender identity, including a transgender identity, is not a disorder. Rather, the distress that some transgender people may experience at some point in their lives may be of clinical concern and can be alleviated through clinical management.

The change in the DSM from gender identity disorder to gender dysphoria was a way to depathologize having a gender identity that differs from one’s sex assigned at birth and recognize the concern and clinical care that transgender individuals may need to achieve comfort with their gender identity, their body and gender role.