Is it Gender Dysphoria or Sex Dysphoria or maybe they both exist and are different things

[astoundedgoat]

Following on from some sex/gender threads here this morning I wanted to ask something. I fully understand the difference between sex and gender. But we only hear the term "gender dysphoria" when the reality for a lot of trans people seems to be that there can ben gender dysphoria without sex dysphoria, i.e. a biological male who identifies as a woman, but is completely comfortable with retaining male external genitalia.

But when a young man or woman rejects her biology - for example at the onset of puberty, is that the same thing? (The link between autism and "gender" dysphoria might - huge "might" here - I am aware of the research, but not fluent in it - LINK - be relevant here)

Is a person transgender because he or she rejects the gender identity that society imposes on him or her by sex OR because he or she rejects the BODY that has been imposed on him or her by sex. Does it matter?

If gender and sex are different then what is being rejected/embraced - gender or sex? Does that/should that make any difference to how we should respond and offer support?

(I'm not trying to stir - I was lying awake wondering about this last night and reminded about it this morning by some threads and thought I would ask here)

This has been a deliberate change of language by HCP.

50 odd years ago, trans surgery was called ‘sex change’, but you can’t actually change sex, so it was rebranded ‘sex reassignment’, but the sex bit sounds too fetishy, so then it became ‘gender reassignment’ but that doesn’t shore up the ‘born in the wrong body’ myth so NOW it’s called ‘gender confirmation surgery’ - it’s all profit driven, of course. There is big money in these surgeries.

As the language for the surgery had changed, the language for the condition that justifies the surgery has had to change as well. This leaves the muddled mess you’ve noticed.

There is a panel discussion by US doctors on YouTube that talks about this.

I think under the "trans" umbrella, there are lots of people having lots of different experiences.

I do think there are people who are experiencing some kind of extreme body dysmorphia- In this group, I'm thinking of people who have multiple and/or extreme plastic surgeries to try and achieve their desired look. It is, in most cases, driven by a desire to look more like the other sex, or an idealized version of the other sex, and this could be considered as sex dysphoria if you wanted to think of it that way. I'm obviously including things like "top surgery" and genital surgery in this group, but also people who, for example, have multiple plastic surgeries to alter the look of their face etc. Obviously, this is at least partly driven by a dissatisfaction with the look of their body.

In some ways it is very odd that we treat this group with surgery. If, for example, someone wants a leg amputated, we don't consider that OK to treat without surgery. Obviously some people do go through extreme plastic surgeries without wanting to look like the opposite sex, but I do think most people recognise this group as potentially mentally ill.

I don't think everyone or even most people under the "trans" umbrella fall into this group. There are plenty of people who want to appear/dress/present as the opposite gender without major surgery. They may take hormones to help with this or get laser surgery or similar, but they tend not to want to take things to extreme. I guess you could say these people are "gender non-conforming" or have gender dysphoria, and if society were more accepting of the way they chose to present themselves, they might not consider themselves "trans" at all.

In some ways, I'm not sure conflating the two groups is helpful because in many ways they probably have different needs and end goals.

I think the second group is probably larger- although I do think some people in this group, especially F2M can feel pushed down the surgery route as it's "expected" of them.

That might be so in the US, but in the UK where this was NHS driven, so not for profits, it was different.

It was handled in the 60s & 70s as a psychiatric and physical assessment process via hospitals to look for causes and solutions.

It involved an in patient stay in a psych unit for testing and various experimental options were often tried.

Surgery was a last stop option and only taken in about 10% of cases.

At that point they were then sent to the only NHS clinic that then existed (in London) and there was a minimum two year wait.

The term sex change was colloquial and used mostly by the media. It is pretty much the only place still using it. I have seen it in the UK press more than once in 2018.

When patients at the clinics underwent surgery in the early/mid 70s (which was early days as the clinic only opened in the late 60s) the patient had to sign a waiver before surgery to say they understood that this did NOT change your sex. It was renamed Gender Reassignment specifically for that reason on the forms,

Cannot tell you how it has changed since then, but that is how it was then and possibly the reason the 'old school' transsexuals who people often talk about on here have a realistic approach to all of this.

And may be the reason why the more modern crowd do not.

Bear in mind that only transsexuals want to modify their body because that is the basis of the severe dysphoria condition. The numbers are very low still (about 200 cases per year in the UK).

The term transgender covers a mile wide range and many more people with a huge assortment of ideas and likely causes of what they are and want.

They often do not have gender dysphoria, as such, so no desire to alter the body just to transition socially.

For this reason there is a big push to demedicalise the whole thing, to alter the GRA so that no medical diagnosis is required (this is why only 4850 have used it because you have to know you have a medical condition first and only transsexuals agree they do).

This is also why you will see on social media - Twitter, Youtube etc - transsexuals reclaiming that term and rejecting the wider trans movement on an increasing basis.

Though as our numbers are small we are swamped by the activist yells and screaming.

homefromthehills that’s really interesting!

m.youtube.com/watch?v=6mtQ1geeD_c

The dr in the above video trained at John Hopkins, the university hospital that pretty much invented the techniques for MTF ‘bottom surgery’ in the 1960s.

They stopped doing the surgeries in 1979 after a study showed those who had had SRS (sex reassignment surgery) were no happier in the long term than those that didn’t.
Some people think the real reason was that conservative Christian staff were a bit embarrassed about the institution being a world leader in trans related medicine but the dr that instigated that decision stands by it today and sites a 2011 Swedish study that showed transfolk were more likely to die by suicide after surgery than they were before.

John Hopkins continued to study trans related health and see patients for counselling and hormone therapy, referring them to private surgeons for surgery, so for a number of years, there were no US academic institutions performing, innovating or researching surgery for transfolk, and thus progress was shaped by profit (capitalism in action).

John Hopkins have recently reinstated in house surgery, partly because of the imbalance caused by a profit driven industry and partly because times have changed.

I think the quotes from the dr who halted surgeries are very sensible and in line with the Hippocratic oath but we all know there is a lot of lobbying and pressuring on these topics, so it’s unsurprising that he receives a lot of criticism!

www.jhunewsletter.com/article/2014/05/hopkins-hospital-a-history-of-sex-reassignment-76004/

www.hopkinsmedicine.org/center_transgender_health/services/

John Hopkins is an incredible institution and an acquaintance of mine, Dorry, is currently making history there, performing the first organ transplant surgeries for HIV patients (from HIV donors).
www.hopkinsmedicine.org/transplant/news_events/hiv-positive-to-hiv-positive-transplants.html

@homefromthehills - thank you for posting.

I’ve become increasingly aware that many older transfolk are just as likely to be adversely affected by some of the changes TRA folk are pushing for as women are, with the added problem of getting lumped in with it all rather than being treated as individuals.

Do you have any resources on the kinds of changes your generation would like to see in any new reforms? I think we can assume changes are coming, so it’s up to us to try and shape them as appropriately as we can.

I looked at a document made by the Beaumont Society last night (from a couple of years ago) and they flag up concerns about elder care, especially in residential facilities, inconsistency and inappropriate treatment in prisons, the need for more unisex/single stall loos and the abolition of the spousal veto. All seems very reasonable to me!

Are there any other similarly well established advocacy bodies?

If you or any of your trans friends have opinions/concerns/priorities that you are willing to share I would love to hear them - I think problems have occurred because the GRA 2004 and EA 2010 are not properly aligned with each other, so any reform should really replace both together, in order to prevent the kinds of inconsistencies we are observing in prisons, for example.

Thank you very much for the interesting and thoughtful replies - I really appreciate it.

Betty, I am not part of any trans community so don't know a lot of others. But most transsexuals I have heard speak on line do not want any changes - bar a tightening up of the interaction between the GRA and EA and see properly codified exemptions for those even with a GRC (refuges, hospital tests etc).

This seems a sensible step because it will help women build the protections they seek.

Right now too many places, shortlists, the Guides, Swimming pools etc are assuming Self ID exists / or afraid of being sued by angry activists when it is.

They need the rules clearly set out and told to follow them.

Transsexuals will mostly be fine with that as far as I can see. But as I say under 5000 of us v 500,000 transgender without a GRC is the elephant in the room - trumpeting loudly out there.

That half a million want in by removing the medical/psychiatric gatekeeping.

If we do that then the voice you hear shouting at you now will legally call the shots. That scares me as much as I suspect it will you.

Politicians need to be told to go back and read the transcripts of the passage of the GRA through parliament in 2004. I bet almost none have. They seem to think they are improving the act for the benefit of those it was designed for.

And need to see this is not true.

Reading it will clearly show them who it was created for (transsexuals with a medical diagnosis). The birth certificate change only happens on that basis of medical assessment and there are a few other restrictions. Not all 4850 with a GRC have changed the birth certificate.

There is no way the GRA would have passed if those medical assessments were not there or if more than the clearly defined small number of transsexuals qualified.

I know that - more importantly the trans activists do too.

Doctors told them about 5000 would qualify under the act in 2004 and 4850 have 14 years later.

There has been very little trouble since as a result of the act. Virtually all the trouble is coming from the 500,000 unable or unwilling to fulfil the mutual bond of trust and respect to apply or qualify.

If MPs get this they will surely conclude this is an act that is working exactly as designed to do.

And those who it was designed for are saying they do not want it to change (other than discussing how to tighten up the safeguards built in to protect women). We are up for any such discussion. The activists seemingly are not.

And that the women it most impacts are also opposed to changing it to self ID.

And so the only ones who want it changed are those who cannot be bothered to apply for it today or follow its rules and will only do so if these requirements are scrapped, fundamentally altering the meaning and purpose of who and why it was created for.

This is how I see it, but I accept I have a vested interest so could not be called unbiased. Though I am trying to be.

Homefromthehills
A few corrections, where you state surgeries requested are low as in around 200 a year. This is misleading as that is not the surgeries requested but completed. And around 200 per year is at full capacity given the handful of surgeons involved in SRS.

In 2004 when drs suggested around 5,000 would apply for the GRC that was on the basis that the trans community in the uk was tens of thousands, this vastly underestimated the numbers which today are estimated to be in the hundreds of thousands, the reason so few apply for a grc are twofold, one is that it is a convoluted porocess and can be expensive if letters are requested from private medical professionals, and the GRA has very little practical use for the majority of trans people since the Equality ACT was set out 6 years later in 2010.

Garam, I don't think I said surgeries requested. Just referenced the number per year that happened from totals per year for a decade up to about 2010. I found this in a list on some NHS site on line.

I think it is clear from reading the debates that passed the GRA that they thought they were referring to transsexuals who would mostly have surgery unless there were health related factors. 70% of those with a GRC have had medical intervention I understand.

That a wider 'trans community' existed WAS known in 2004, because about 90% of those going to the NHS in the 1970s asking for a 'sex change' were turned away as not considered suitable. Similar numbers of children at clinics change their mind and do not transition now.

Only 10% of those that doctors saw were put through. So we have long known that far more 'trans identified' people existed who did not have severe dysphoria and an urgent need to medically transition.

The numbers who qualified under the GRA were not misjudged and clearly had an impact on the passing of the act, as, most specifically, did the medical diagnosis on the ability to change birth certificates.

This has always depended on change only in extreme cases and with medical reasons cited and justified.

I believe that must remain a firm rule. Self ID without a medical diagnosis should not be sufficient ground to alter a birth certificate.

One reason is it sets a major precedent in law if personal choice and not medical justification is made the basis to alter such a key record.

14 years ago nobody saw the press for self ID. If we change the basis for a new birth certificate what comes next? How do you stop someone in the near future deciding the law should be considered as allowing parents to self declare the sex of their child on their birth certificate in opposition to what a doctor observes?

I think this is a principle we ought not to remove and birth certificates should stay under the control of a doctor's decision.

I want those who wish to self ID to live freely as they choose and changing their other documents can all be done without a new law anyhow. Just go for it and live free and campaign for third spaces.

And if someone wants to change legality via birth certificate there is a route for them to do so. They just have to justify it by following the gatekeeping process demonstrating a medical necessity.

Two of us on here have said in other threads we did not find this process unduly hard having actually done it.

And if it matters enough to get the world to accept you and women to trust you then saying, it costs a bit of money and is rather onerous is not going to convince many doubters.

Why should they be expected to accommodate someone who will only bother to apply if we make it as easy as possible?

Being a woman is NOT easy. It should never be easy.

So if you want in then you have to at least make a case that you need this and are willing to show a bit of effort and prove sincerity of purpose. Not that you will only bother if it is cheap and easy.

In any event if the GRA is barely important as you say and so few use it, then what is the push to completely alter and dilute it for those of us who do not think that and have gone through this onerous process?

Self ID clearly risks existing safeguards to women. And devalues the efforts made by those 4850 who have considered it important to go through the medical and psychiatric assessment to show their sincerity.

It is either important enough to make the effort and offer some sign of respect to women being asked to cede rights.

Or is it is not important enough to bother, so then, just live as you wish and change papers you can but don't expect to get big things like a birth certificate in return for nothing other than your say so.

Seems an easy choice and one any trans person can make right now without further pressure for rights or changes to the law.

No one is being asked to cede rights, I get that your opinions play well to the gallery on here, however I must entirely disagree.

I don't believe for the second the anti-trans attitudes displayed on forums like this really give a fig about a GRC, as many have already stated time and again.

Even with a GRC the vast amount of anti-trans attitudes shared on this thread, wouldn't change one iota if every trans person had a GRC.

They would simply campaign against the GRC with more whataboutery as they are now doing with the EA.

Essentially it's a mindset far more prevalent on these forums than in the real world, where the reality is and widely accepted that trans rights are harming no-one, and will continue to move forward with the support of the majority of 'non-trans' women standing in solidarity with trans women.

If you think I am playing to the gallery on here you are wrong.

I was actually driven off here a few weeks ago and I think many posters who know who I am (I was not allowed to reuse my old name or I would have done) are not replying or might be blocking me. I certainly am not respected much on here.

I post fully aware of that and only when I can add something.

So none of this is me sucking up. This is 100% what I believe.

I am quite active on Twitter under my own name nowadays. I am saying the same on there too. Yes, I get some flak. It doesn't matter.

I have been getting on with my life for decades without any fuss and I have read and engaged widely over recent months to find out what on Earth was going on all of a sudden. As I had never expected the public debate that has suddenly appeared

I debated with activists on a trans forum. On here with Feminists. And in public on big general forums. From this I got to see what th4 beefs were and figure out what I really believed.

This and talking to Debbie Hayton, a very good advocate for women and transsexuals and who seems to understand common sense, made my mind up to do the right thing.

Far too much of the public debate is polarised and angry and full of name calling and bizarre ideas. We need a dose of realism as to what is and is not true. That is all I am seeking to do.

To be honest I don't care who thinks what about me. Getting this right so that nobody pays a price for hasty ill judged laws put through on the back of trendy politics is more important.

I fully understand that many on here regard me as no more valid than any other trans person. They have called me a man. It hurts a bit as I haven't been called it (well boy as I was barely ever a man) in real life since just after the Beatles split up. But biologically it is undeniably true. So I am not going to stop them saying it if it helps and it is hardly 'literal violence'. I am against censorship of language on here.

I also understand the basis of mumsnet poster's concerns. Some I agree with and they worry me too.

Yes, most people out there are very accommodating. Though how accommodating depends quite a bit on how much respect you show to others, how far you can keep yourself in the real world without daft nonsense about 'lady penis's' and how much give and take rather than take and take you display in return for their support.

Equally many of them out there once they hear what self ID is about and that most trans people keep their bodies intact leads to a definite switch in thought processes.

I realise there is a generation gap too. This trans trend is a post millennium thing. Not an easy fit with a baby boomer. But I can still see what I think is right and what is wrong.

Agreement is not going to happen if trans people bicker and call names and insist on shutting down discussion and do not see legitimate concerns over same sex spaces and fail to denounce disgraceful acts like the bomb hoax at the women's meeting the other day.

We have to get away from this cycle of hate and mistrust.

So I will keep trying, though not with any great expectations.