Many concepts are hard to explain to those who have not experienced them — and gender dysphoria is one of the most profound examples. These difficult feelings about gender, feelings that many trans folks grapple with, are near impossible for many to understand — so they dismiss, ridicule, and attempt to invalidate them. But gender dysphoria is real and scientifically documented.

Pundits such as Ben Shapiro often try to classify being transgender as a mental disorder, ostensibly with the goal of reducing the validity of trans people’s gender identities. Shapiro has also called it a mental illness. However, the American Psychiatric Association has never classified gender dysphoria as a mental illness and stripped its classification as a “disorder” in 2013.

The reason for this is simple: The fundamentally necessary treatment — transitioning — is a physical one, not a mental one. The body, not the mind, is the source of the problems. The mental symptoms arise from distress over the physical problem (as well as transphobia in society).

This means gender dysphoria, while real, gets misunderstood as a condition that is fundamentally psychological; as if psychiatric interventions are called for. But as Roy Richard Grinker points out in a recent op-ed for The New York Times:

Being trans should be a personal or social identity, not a psychiatric one. Indeed, for many transgender rights advocates, a category of gender dysphoria makes no more sense than having a category of mobility dysphoria for someone distressed by a lifelong need for a wheelchair, or African-American dysphoria for people who experience emotional distress associated with discrimination against them as minorities.

In other words, the distress is real, but including it within a taxonomy of psychological discomfort misidentifies the locus of the problem. Dysphoria exists, but construing it as a psychological condition “puts the responsibility on trans people for their suffering, and not on the social and moral environment that stigmatizes them.”

Dysphoria varies to some degree from person to person, but creates an intense discomfort with one’s own body and social relations. This leads to depression, anxiety, dissociation, and other mental-health issues — which, in my case, led to me dropping out of college. These were persistent issues, from a young age, that only worsened with time. Now, six years after beginning my transition, they are non-existent. My life feels normal in a way I did not know could even exist.

The core question for those doubting its validity is simple: If one thing — and only one thing — is scientifically shown to improve the well-being of someone who is suffering, would you deny it to them? Treatments like therapy and medication can sometimes help lessen the symptoms, but they fail to address the underlying problem. Transitioning leads to far better outcomes — and, in a very real sense, saves lives. Suicide is tragically common among people with gender dysphoria.

Scientifically-minded anti-trans activists will cite a study from 2011 in Sweden. The conclusion of the paper states,

Sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment.

Though spun to suggest transitioning is not effective, the conclusions were simply that more is often necessary — owing to the trauma of grappling with transphobia, gender dysphoria, and the other problems that plague trans people.

I know these problems first-hand all too well. By the time I began my transition at 24, I was at rock bottom; I had known since my younger years that this is who I truly am. From my preteen years I was actively trying to get up the nerve to transition, always feeling like I would feel more ready someday, at some unspecified future time. I never was. And that constant waiting wore me down.

Often anti-trans activists misunderstand or misrepresent the nature of gender dysphoria altogether. What is often called “gender non-conforming” behavior is not synonymous with dysphoria — a child presumed to be a boy wearing a dress isn’t necessarily an expression of gender dysphoria. Routinely, concerned women will express fears that they — tomboys in their youth — would be forced to transition in today’s climate. This simply has no basis in reality.

In fact, early on in my transition, many regarded me as having a tomboyish aesthetic, rarely wearing feminine clothing, typically opting for a t-shirt and jeans. Only after a couple of years of living as a woman did I even begin to develop an appreciation for women’s fashion and routinely wear clothing like dresses and skirts.

Gender dysphoria is largely not about perceptions of how something is “gendered” — though items and activities culturally perceived as belonging to one’s real gender can feel validating. In other words, it’s not that one is trans because they want to wear dresses, but wearing dresses can serve as an affirmation of one’s gender.

Contrary to popular perception, this is a problem that can present itself quite young. Many of my earliest memories around age five involve trying to understand why I was seen as a boy — and how alienating it felt. But it was several more years before I was even aware being transgender was a thing you could be, and I felt too afraid to come out.

Knowing that my feelings were valid at a young age could have saved me many years of depression. Hormones and surgery are not provided to minors — only hormone blockers — but social transitioning often alleviates the worst parts of the symptoms.

When I studied abroad in Japan in high school, I was put in a class of all girls with the daughter of the family hosting me, and the normalcy of simply being treated like everyone else in that kind of environment provided me with a feeling of comfort I would not surpass until actually transitioning. I felt like I was just one of the girls.

As weird as many people may find gender dysphoria, that is what so many of its sufferers ache for most: a sense of normalcy. These days, it’s often the most mundane that feel the most special — the days when I don’t feel like someone who has had to struggle most of my life to just feel like myself, and just any other woman living her life.

No one can expect those without it to understand what gender dysphoria feels like — simply that it is real and a very difficult burden.