We need real treatments for sex dysphoria

Sex dysphoria is real, and devastating.

It can get worse after you’ve been exposed to the idea that “treatment” exists to make your body “right” aka in alignment with your mental map. Because that is physically impossible, sex dysphoria, when treated this way, will start to take on the quality of body dysmorphic disorder. Endless striving toward a horizon line. Never enough. Never right enough.

(It can also get worse when it becomes a core part of your identity–just like a drug problem gets compounded and more difficult to quit once you have built your identity and social group around being a weed-smoker or a tweaker; just like an eating disorder can take on new dimensions when egged on by a “pro-ana” community. But this needs to be addressed in another post.)

Where the sex dysphoria more clearly results from and is secondary to gender dysphoria, the current treatments may be moderately “successful” in terms of patient satisfaction. Insofar as most women can’t afford to really unpack their traumas and still keep living in the world where they’re going to be repeatedly retraumatized, we tend to break ourselves to fit that reality in one way or another. When we find a way to break ourselves that seems to make an easier fit, that feels like relief.

Let me now break the false dichotomy, though, between sex dysphoria that seems to be its own root, and sex dysphoria resulting from gender dysphoria. The differences are important in terms of how they came to be, and how they need to be treated, but they are not uncorrelated. One is not more “real” than the other, in terms of constituting “real transness.”

Sex dysphoria and gender dysphoria are interlinked phenomena. What I think of as sex dysphoria per se, is simply the type that was somatized before it was intellectualized or put into language–so it feels “natural,” inevitable and inborn. It seems to be only about the body and not at all about the culture. This is the type that, for example, has a little girl harming her genitals for being “wrong” and stuffing socks down her pants, when she herself does not necessarily even think of it in terms of “gender” but rather, body. The kid who says she IS a boy, not that she wants to be. The person who would answer Poly Styrene’s question, “Did you do it before you read about it?” with a yes. Who found her experiences apparently described by the idea of “trans,” rather than thinking of it as a way to escape being female. This person is more likely to be called “truscum” here on tumblr.

Gender dysphoria is the type, for example, affecting a girl who, at puberty, loses the more sexually indeterminate body of childhood and despises her breasts, her curves for marking her out as a target. Or the type affecting, for example, a girl who has been a tomboy from childhood and has been marked by an understanding of herself as “wrong” and “not like other girls.” This type is more recognizable as belonging on a continuum of common female experience, though finding one’s breasts so troubling as to actually take steps to remove them is not something all girls go through. On the edge of this “type” you find girls and women who simply find female reality unbearable enough that they are willing to contort themselves into thinking they are trans to try to escape it. Girls and women with this kind of dysphoria are more likely to be called “genderspecials” here on tumblr and told they are co-opting from “true trans people.” As rainbowreject has written about, this pushes some girls and women further into the idea that in order to be “real,” they must focus more on the feelings of “wrongness” to enlarge their meaning, so they will qualify as “actually trans.”

It’s worth noting that a girl can easily develop a pretty severe type of sex dysphoria as a result of hating how her body is “read” by others and how they treat her because of that “reading.” The sad performance poem where the young woman says “I don’t hate my body; I hate how other people see me because of it.” is a great example of this. She “doesn’t hate her body” but will likely internalize the idea that it is the problem, “wrong,” and “mismatched,” enough to remove her breasts with an elective double mastectomy.

Increasingly, women with both types of dysphoria do move on from there–and there’s currently a push from the medical side to get more ftms to consider “bottom surgery.” Recently there was a large conference to discuss new techniques and “advances.” This is the “gender specialist care provider” answer to both kinds of dysphoria. This is what they mean when they say “treatment.” Surgery. Bodily trauma. Testosterone injections. Double mastectomies. Taking a piece of your arm or leg and pressing it into duty as a phallus. Watch some videos of this kind of surgery sometime and tell me that it’s an appropriate treatment for a condition diagnosed by a mental health professional.

The thing is that I now know I am not an isolated case–I have met other women who have suffered from both “kinds” of dysphoria (in reality, they usually co-exist; the distinction is more about which came first and how consciously it was adopted) who are, like me, now successfully treating it with non-surgical, non-hormonal means. One of the most useful first steps is to begin to separate out sex dysphoria from gender dysphoria; to not put the “gender journey” story onto the sex dysphoria.

You know, with the kind of treatment that is not going to make anybody any money. The kind of treatment that doesn’t serve any autogynephile agendas, or any male agendas at all. The kind of treatment that involves peer support and sharing what’s worked with each other so we can all broaden our set of effective tools and strategies. The kind where we support each other in radical self-acceptance and facing reality, instead of encouraging each other into more and more extreme delusion and self-harm. The kind of treatment where we look at trauma as an original root cause.

The kind where we make room to acknowledge the terrifying thing that often underlies sex dysphoria: the fact that mentally mapping a male body to superimpose your own, can be a subconscious strategy for trying to neutralize a sexual threat. Where we understand ftm sex and gender dysphoria as a uniquely and inherently female experience.

The kind of treatment that is apparently so threatening to somebody that he–or they–hacked into our private, secret peer support group and violated the healing space of a bunch of women talking about our experiences of sexual violation and other trauma–with a concerted brute force attack and assorted other wormy bullshit.

We aren’t going to stop working this out with each other. We are working on root causes and real treatments–the kind that don’t reinforce the idea that our bodies need “fixing.” The kind that actually work.