PTA2. Gender Dysphoria. #Transgender


Gender Dysphoria

June 3, 2015

Hopefully you have had Time to check out the article I suggested.

You may still feel in the dark, closeted in your home; catching mere glimpses, through the narrow keyhole of the media.

A vast majority of people presenting as Gender Dysphoric children, go on to be predominantly gay, lesbian, or bisexual, but not Transgender.

Most trans teens go on to be trans adults.

People with Gender Dysphoria feel so strongly about living their life as the other gender (or both or neither), more than half, in some studies, contemplate suicide as a viable solution to the societal problem of them.

For many FTM men, menstrual moments are monthly murders of the mind.

Their goal is to achieve body satisfaction, usually in the eye of the beholder, so going to the mall or just down the street doesn’t make one feel like the star of a hazing ritual.

They achieve satisfactory transition socially in what pronouns, legal names or language is used, how they dress, talk, walk, the use of make up or breast binders or augmenters, and other utilitarian utensils.

Even the wrong pronoun can feel like a public stoning.

Medical transition occurs through the use of cross gender hormones.

For MTFs, the hormone of choice is Estrogen.  For FTMs, it is Testosterone.

Each have side effects as well, and are usually, at least in Canada, prescribed with Consultation from an (Pediatric) Endocrinologist.

In some cases, puberty is delayed, by hormone blockers, if the child is having strong cross gender identification.  This prevents the development of Secondary Sex Characteristics, like breast development, hair growth, or voice changes.

This is important because once these specific anatomical features develop, they are essentially irreversible, apart from surgery.

The child who opts for delaying puberty, and then maintains transgender thoughts and feelings, within a stable and enduring sense of Gender Identity, often ‘passes’ much more effectively as an adult.

Top Surgeries (above 16), and Bottom surgeries (over 18) depend on informed consent, and the skill and technique of the surgeon, and not all procedures save adequate sensory function.

Many individuals seek Top surgery at first, and delay Bottom surgery until years later, or do not pursue it at all.

Health guidelines have been established by the entity WPATH; The World Professional Association for Transgender Health.

Some individuals do not seek support as they can live as Gender Queer (on a spectrum of all of the above), or Agendered (no sense of either gender), with little or no ‘help’.

There is recent biological evidence arising, that it is your gender identity, not your biologic sex, which determines your attraction to the smell of a male’s armpit.  Isn’t that a stinker?

Amid the temporal collage of real images and messages from the web, all trying to capture attention, our most precious gift, the butterfly of the mind, with rainbow wings, flits around trying its best not to get confused.

It must beware of the trap of thinking, that gives one no way to make sense, of the surrounding jungle.

Trans people we meet, may challenge our ability to download their avatar, because we live in a much more Binary world, compared to those who experience Gender Fluidity.

And when we see something that doesn’t match our expectations, we may become curious, or feel internal resistance, and perhaps become offended.

The mixed messages do not seem to compute.

Cis society teaches us that to start understanding someone, one starts by identifying a person’s biologic sex.

Once that Binary prong in the road is taken, the friction of interaction, one is taught, should lessen.

But a tension arises, when your alphabet is missing letters.

Not all humans are either A or B, and by now, that should not be hard to C.

Opening one’s eyes to these omissions creates a much more accurate view of who we are, and the sentence of life becomes easier to right.

In the big picture, there might be a spoon, but gender categories are a blurred spectrum in our Matrix.

The once extras are now the Neo-gender-stars.

Their posse parades, primed in pretty pink polo pants, posh piercings paired with phallic phones, perhaps pirouetting post PVP, proud of Pat parenting.  The lines of gender are blurring, and we all pick our specific shades and ringtones.

It is much more likely that all of us pace, down the highway of life; trying to pass as who we want others to think we are, or as who we want to be.

We rely on mirrors, windows and Selfies, to reflect back to us, the face that we hope is still there.   And if we are lucky, or time it just right, that perfect smile will be there, the next time.

It becomes harder, when you know, that they can see through the disguise they think you are wearing.

It seems even more impossible to explain to them, that skin can be a mask too, and the disguise can be the real identity.

The bystander doesn’t realize what they think they hate in you, they actually hate in themselves.

And nowadays, isn’t almost all human behavior attention seeking?

I wonder how Kim Kardashian is feeling right now?

It is all about the plans you make, and the lives you allow others to lead, as your expectations and fantasies  create their image in your eyes.

There is the opportunity to notice, along the way, that humans are not necessarily bound to their chromosomes.

We are special, equipped with a complex mind, able to integrate many signals.

Gender Dysphoria is the sign, of something much more testing than a mere detour in the road.

The Dysphoria creates an uncomfortable anticipation, that peaks in panic and relived fatality, when one fails to pass.

There is a danger that when the ‘the public’ looks in the rear view mirror, they may only want to see themselves.

Without shoulder checking, the societal blind spots only become more dangerous, and fear of gender benders worsens.

All roads do lead to Rome, but many of us live in a disconnected suburb.

Those brave enough to release the tension, and come out, often face an eruption of anger.  This represents the lava of rage burning through their parent’s and friend’s; not to mention stranger’s, vicarious future plans.

Those plans were written by society prebirth, and those life maps may seem impossible to rewrite.

But that is the challenge for every great parent, friend, and stranger, to face that other version of themselves, and love it despite it not being like them in every way.

Please see the final chapter in Part 3, titled; Transphobia and Autogynephilia

Simon Trepel, MD

Simon Trepel, MD FRCPC, is a practicing Child and Adolescent Psychiatrist, in Winnipeg, Canada.  He is an Assistant Professor, at the University Of Manitoba, in the Faculty of Medicine, and the Co-founder of the GDAAY Clinic.  He is, more importantly, the proud Father of 2 beautiful Daughters.  He writes in his spare time about things he knows something about, and occasionally about things he doesn’t; like Yoga, and Italian flavored coffees.  He was not referring to coffee that tastes like an Italian person.

Check out his Blog, called Simon Says Psych Stuff, at



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