I have written previously about the problems of using puberty blockers in adolescents. In this post I’ll look at what the NHS has to say about gender dyphoria in adults.

As I mentioned, the NHS defines gender dysphoria thus:

A sense of unease that a person may have because of a mismatch between their biological sex and their gender identity,

and it has this to say about gender identity:

[It’s] our sense of who we are and how we see and describe ourselves. Most people identify as “male” or “female” [note the inverted commas]…but some people feel their gender identity is different from their biological sex. 

For example, some people may have male genitals and facial hair but do not identify as a male or feel masculine. Some may have female genitals and breasts but do not identify as a female or feel feminine.

Our sense of ‘who we are’ is biological and objective; ‘how we see ourselves’ is not the same thing – it’s entirely subjective. And what do they mean, ‘some people may have male genitals and facial hair’? Are they referring to men? (And correspondingly for women.) As for the notion of feeling masculine or feminine, how can anyone describe it? Such feelings are an inherent and inseparable part of being male or female, respectively.

Being a trans man – Jay’s story
The NHS website also contains a video, Being a trans man – Jay’s story. Before she ‘transitioned’, Jay says ‘I felt like a guy,’ but then immediately contradicts this by saying ‘It was a mixed feeling.’

How can a woman know what it feels like to be a man, or guy, as she calls it? It seems to me this is rather presumptuous of her. I have been a close observer of womankind all my life, but would never presume to say I know what it feels like to be a woman. Jay also says, ‘I would like to experience what that (having a penis) feels like.’ Further confusion is evident by her statement, ‘I see myself as male’ but this is qualified with ‘I see myself as a trans male, particularly, anyway.’ A trans male is not and never can be the same as a biological male.

Now let’s return to the matter of gender identity and re-write the NHS definition in a straightforward way:

Gender identity refers to our sense of how we see ourselves. Most people identify with their biological sex as male or female, as the case may be, but some men do not identify as male and some women do not identify as female.

They hasten to add that ‘gender dysphoria is not a mental illness.’ What is it then? Is it normal, or a variation of normal? Is it an entity found in nature or an abstraction thought up by man?

Symptoms and signs
More confusion is evident in the section headed ‘Signs of gender dysphoria.’ They mean symptoms, not signs. These are set out as:

Low self-esteem, becoming withdrawn or socially isolated, depression or anxiety, taking unnecessary risks, neglecting themselves.

A sign, or physical sign, is something a doctor observes; a symptom is what the patient complains of. For example, if a patient develops pain at the lower right side of the abdomen, this is a symptom. The doctor may observe a raised temperature and tenderness on gently pressing over the painful area. These are signs. Taken together, the symptom and signs may indicate a diagnosis of appendicitis.

If someone suffers from a symptom or symptoms this means they are ill in some way, and being ill by definition is not normal. Furthermore, someone who is ill would usually seek medical attention. This is what Jay in the video did, and she describes the effects of the treatment she underwent with testosterone injections and surgery to remove her breasts.

Cosmetic treatment
These interventions, however, were cosmetic procedures to change Jay’s outward appearance and were not intended to reverse or mitigate a pathological process because, according to the NHS, there is no pathology: gender dysphoria is not a mental illness.

In spite of this, the NHS website tells us:

Treatment for gender dysphoria aims to help people live the way they want to, in their preferred gender identity or as non-binary.

It could be argued that the treatment is directed to the cause of the dysphoria – the sense of unease that people in this situation suffer from as a result of believing they’re in the ‘wrong’ body. Therefore, let’s change the body, in so far as this may be possible. But this approach is fraught with difficulty: lifelong and life changing hormonal manipulation in addition (if undertaken) to irreversible major surgery.

Rhino dysphoria
I should like to make a plea for the abandonment of the term gender dysphoria.

Someone may be unhappy with their body for a variety of reasons. A woman may feel her breasts are too big or too small, or someone may think their ears stick out, or that they are too tall or too short, etc. A woman may have a big beaky nose and wish to have a smaller one, but we don’t say she has ‘rhino dysphoria’ (from the Greek, rhinos, relating to the nose). We say she is unhappy because she thinks her nose is too big and she may opt for cosmetic surgery. Some people, however, are happy with a big nose or at least accept it, such as Barbara Streisand.

In the case of a woman who has a sense of unease over her gender identity, it may be due to a psychological projection of unhappiness she feels for other reasons, but if the belief is strongly held and she is determined to change her external appearance to approximate to that of a man, then such interventions should be seen for what they are: cosmetic treatments.

A person suffering from gender identity confusion should be helped to accept or come to terms with his or her reality. Cosmetic treatment, even if seen as such, amounts to collusion with someone’s fantasies or delusions; it should be a last resort and never used in people under the age of 18. The considerable effort and expense that have gone into the creation and running of gender identity clinics (at present there are seven for adults in England) would be better used for general psychological and psychiatric services.

Text © Gabriel Symonds

Picture credit: pinknews.co.uk