identity

The identity trap and alt. ways to work with gender dysphoria

In this video I talk about ways to work with gender dysphoria for those that want to work with gender dysphoria in ways other than transition and medical intervention, and also for those who still have some gender dysphoria after transition and medical intervention.

Transcript:

So, hello, this is my second video and I am going to talk about ways to work on dysphoria other than medical interventions or transition. So, the reason for this is that first of all not all gender dysphoria requires transition or leads to transition. I think this idea kind of become pervasive and it’s not really true. However, there are people who do benefit from transition medical treatment. There’s evidence that shows that at least many people do experience reduction in their gender dysphoria but not everyone. Also, even among those who do undergo gender transition often still have dysphoria. I’ve known many trans people over the years and many of them may have felt like their transition was a success or beneficial but still suffer from these issues.So, the ideas that I’m going to describe here could be beneficial either if you are looking for ways to work on gender dysphoria without going through this process or maybe you might feel good about transition but want also to have better ways to work on stuff. So, we describe a number of ideas. Not all these apply to everyone. So, just sort of choose the ones that apply to you.

So, the first thing i want to talk about is the identity trap. For whatever reason in the last
20 or 50 or 30 years in Western thought we really got into this idea of identities, particularly in academic circles. This idea that we have identities and multiple identities and that identity is really important and that we need to find an identity and form an identity and discover our identity. In general, I think this is not a very good idea at all. I think it is a pretty toxic idea for several reasons. One of the first things to understand about it is that it is not a human universal.  It is a particular cultural point of view of this particular time. If you look at Western philosophy you don’t see people talking about identity very much at all. You don’t really see that until very recently that people were thinking of things in that context.

If you look at Eastern philosophy, you do sometimes see some talk about identity. In Buddhism and maybe Hinduism as well, but it is in a negative context. It is about the traps of identity and about how identification actually gets you away from your true self. We say that these identities are your true self, which is exactly backwards in my view. So, we can talk about this in a few ways.

So, one of the issues of identities is that they really connect to tribalism. Any time you have an identity which is also a group identity, such as identifying as white, or identifying as male, or female or gay or straight or black or any of these things, it creates a sense of us and them. So, there’s people that are in our identity group and people that are outside it and then this leads to tribalism. I think identities originated based in tribalism and evolution where we were part of a tribe and there was an us and a them. We kind of needed an intuition to know who were our people and who were not. So, this creates a lot of divisiveness, and makes it hard to hear things that are outside our tribal view.

Once we identify with a tribe, for example if we identify as trans we are now in that tribe, and so we take this worldview as being true, and other worldviews are rejected. This creates a lack of flexibility and a lack of ability to take in outside information. Once one identifies with something it becomes very difficult to change that. This happens in other contexts too, like in psychology and psychotherapy for things other than gender issues. For example, if you are working with someone who is depressed, sometimes they identify with their depression. They will say being depressed is who they are and that they are that kind of person. In this case it is much more difficult to work with them, and in fact they’re very unlikely to even come to therapy in the first place because they see their depression as who they are.

So, the first thing you have to do is convince them that the depression is not what they are and to try to externalize it which is very difficult. There’s a real difference between identifying a trans vs. saying “I am somebody who has gender dysphoria”.  I think it is a useful exercise to think of yourself as someone who has gender dysphoria vs. a person who is trans because that can lead to more options.

The problem is that adopting identities can increase distress and this is sort of what you see in some of the Eastern philosophy such as Buddhism.  One of the things that we want to do with mindfulness is to loosen the sense of identity – to see that for any identity we are more that that, or that we are outside of that, no matter what it is. There’s actually an exercise I think comes from Hinduism where you say “I’m not this, I’m not that” to take off these identities.  Who would I be if I was not trans? Who would I be if I was not cis? We go through the process of taking off these identities to see what’s underneath.

This idea is in some of the newer Western psychotherapies as well. For example, ACT, where we have this idea of “self as context” which is a being state, vs. “self as content” which is a concept. Identities are essentially concepts, so not authentic being. With identities we are involved with concepts, and acting from rules in our head. So, we’ve been acting from rules in our head, and this is different from acting from our authentic self, which is more like a being state. It is something that is more organic and not rule-based.  It is what we feel in the moment. Once we are in the rules, we’re dissociated from what is in the moment. The rules are a kind of shortcut, they might describe us in some way, but they aren’t what we are in each moment which is ever changing.

You actually see this when people do adopt a trans identity. People read a transgender internet group, and then come to a point where they accept this identity, and the their distress actually increases. If their distress increases when they take on the identity, then the reverse of that is to disidentify and see if that lowers distress. It can be just an experiment to take on that identity and then take it off. If identifying increases your stress and disidentifying decreases your distress then maybe that is the right way to go, but it is something that you have to experiment with yourself.

The second thing that I want to talk abut is “cognitive traps”.  So there are a lot of these going on in the community where you adopt a belief system that leads you in a kind of spiral towards greater and greater identifying. This is encouraged in various ways. For example, the idea that “if you have dysphoria it means you’re trans”.  If you say you feel some discomfort about your gender and you aren’t sure; they will say that means you are trans because cis people don’t feel discomfort about their gender. So any discomfort you feel confirms the trans identity. Especially if you are someone who by the process of identifying increases your dysphoria. Then you are going to be in a spiral, so now you have more distress and confirms you are trans even more. So, these things activate a spiral.

That’s what I mean by cognitive trap, it is this feedback loop that makes things worse and worse. So then the antidote is the reverse process, like saying this story doesn’t necessarily mean that you are trans, and I am just a person with gender dysphoria. So then, you can see if maybe that will reduce your distress and you can begin to reverse the loop.

Another kind of distortion is found in one of the tests the community will frequently put out.  They ask “If you would prefer to be the other gender, then that means you are trans and must transition.”  That is not true, because that is not the actually choice you are making by transitioning. These interventions are only partial and so the real choice you are making is between having a more normative body of your natal sex, or undergoing a kind of partial gender reassignment and being in a trans body. You can make that choice, and for many people that might be right choice, but you can’t make the choice of changing your body fully and becoming fully the opposite gender because that is not possible with today’s technology. So that is one thing to really consider. You have to be in touch with the reality of the real choice you are making.

One reason to let go of the identification is that if you don’t identify with the gender dysphoria it can be placed in context with rest of your life, and you can consider whether you will cause other problems that are worse.  So then the question of the choices that you make is based on a holistic view of yourself. It is not just gender, but is based on everything.

Another trap that exists is for people who experience erotic fantasies of feminization of some kind. Not everyone with dysphoria experiences this but some people do. Then the community will say “that fantasy is proof that you have this essential identity of trans” which also leads you into the identity trap I talked about.  You don’t choose what your fantasies are like.  You have a certain sexuality generally which doesn’t change, but you do choose how you identify. For example, you can choose the meaning you place on your sexuality, but not the fantasy itself.  You can choose the meaning you place on it. You can say “well, I just have this fantasy”, and maybe you can enact that fantasy with a consenting adult or maybe you can not enact it all.  It’s a question of what choice is best for you.

The danger of these fantasies is they can lead you away from the ability to form healthy romantic relationships.There’s nothing wrong with the sexuality per say, but it is a question of whether it can lead you to connect to another person or if it leads to a kind of self-absorption. If it prevents you from connecting to others, then that is a problem.

Sometimes people have a kind of dual sexuality where they have both erotic feminization fantasies and a more heterosexual male sexuality as well. In that case it really depends. You might find somebody you can enjoy both these things with but in some cases only one of them will lead to successful relationship, so I think it is better to choose what will lead to relationships and love and all those kinds of things.  The problem is not about what is normal at all, it’s not about heterosexuality being normal, that doesn’t matter. It is about whether it is functional and can lead to connection.

Sometimes,there can be obsessions and compulsions around these things and if that is the case then the idea of obsessions and compulsions are something that is generally understood in psychology so it can be something you can work with somebody about. Seeing someone who knows about those issues could be helpful. When I talk about choice the goal is to empower you to have as much choice as you can in this process. Some things we don’t choose. We don’t choose our feelings. We don’t choose our erotic fantasies but we do choose our responses to them. This is true in theory, but in practice people don’t always have choice. Maybe because there is something really distressful interfering.

Some people have trauma issues. I’m not say all gender issues are caused by trauma at all. That is not what I’m saying, but if you do have trauma that can interfere with the choice process. So again, that is something to work on with someone who specializes in trauma potentially or you can read books about it. So, another thing I want to talk about is what I call gender schemas, where you have some ideas about gender that are distorted in various ways.  Distorted may not be the right word, more like rigid. The idea that one sex is good and one sex is bad. Like men are really good and women are really bad or women are really good and men are really bad.  Or maybe that it is unsafe to be a man in the world and safe to be a woman in the world or vice versa.  That is something that you might have to work though and it might not be conscious. In my case it wasn’t something conscious at al but a visceral sense that it was unsafe to be myself and man rooted in all the bullying I suffered.  It was really unsafe to be male and be myself, even though I was completely surrounded by many feminine men and never had a problem with them. It was just for myself it felt unsafe. One remedy to this kind of rigid view is to really recognize the within-group diversity of men and women. For example, to see how men and women are both very diverse groups. There are all kinds of men and all kinds of women. Maybe to look to role-models who are more atypical members of their gender and are similar to you.

Another idea to look at is the universality of suffering. One of the views of the trans community is that gender dysphoria is a very unique kind of suffering. That is an isolating view and contributes to making your world smaller and also contributes to being more attached to identity and the identity trap and increasing suffering. One thing that reduces suffering is to see the universality of it. Even though our suffering is unique in various ways it also universal. We all in some ways want to be something different than what we are. Envy or a sense that other people have the thing I need to be who I want to be in the world. In the Eastern practices, such as the Buddhist practices, we generate compassion by acknowledging the universality of suffering and we start with easier people like our friends because we want good for them because they are suffering, and then we go to neutral people, then we get to our enemies and we see they are also suffering, so they are the same as us in a way.

By seeing ourselves as being part of a universal human experience it reduces the loneliness and reduces that sort of special character of the gender dysphoria which makes it feel like no one else suffers the way I do.  So this gender dysphoria is really unfair and feels really lonely.  It reduces that.  I’ve said this once before and some people said it was trivializing gender dysphoria which is definitely not what I am trying to do, because it is not trivial. It can be very severe and intense even leading some people to suicide because it is so intense. However other kinds of suffering are like that too, they can also be so intense as well.  Seeing the universality of it can help to reduce it. We’re all humans in this boat together.

Finally, the last thing is living according to values. Really discovering what your values really are.  This is known to be helpful because if we are focused on living our values we are focused on expanding ourselves, expanding the world and expanding who we’re helping. This helps us get out of the kind of self-absorption that can be really toxic and also helps us to endure suffering.  I think one of the ideas that comes with the ideology around gender dysphoria is that we are not supposed to have pain and not suffer. This is not true, we all have pain. The question is how do we live despite that and how do we face this pain. How do we say despite our anxiety or fear or pain or anger we are going to live according to our values. This makes life more fulfilling and rewarding.

The Greeks had this distinction between hedonia and eudaemonia. Hedonia was simple pleasures such as having a drink or playing games or dancing and all of these things. They are important in moderation, but in excess can lead to this over filled feeling. There is point where they are good and then as you get more of them they become less satisfying. Then there is the idea of eudaemonia which is the meaningful kind of life. It represents living according to virtues and living according to values. It is always good and does not lead to burnout. That’s a question to ask about transition. Is it living according to your values or not. Is it creating a greater good? If it enables you to live according to your values it is a positive step. If it is shrinking your world, like a couple of other people have said then it is negative. If it shrinking your world and making it harder to live according to your values, then it might not be the best path and that is something to sort out. Again I’m not saying all these medical interventions are bad, they can be good or harmful. So, that is all I have for today and hopefully I will do more videos in the future. Thank you.

 

Identity is not the same as authenticity

I have been again thinking about identity, because it seems to lie at the heart of all the recent discussion of transgender issues. I have also been thinking about how the way we treat identity with respect to gender dysphoria is very different from that with other conditions. In fact, the way we treat identity with respect to gender dysphoria is the polar opposite of the way we look at most other conditions. In many different contexts, I was taught the importance of not making an identity out of someone’s condition.

For example, we try not to say “schizophrenic” instead we say “person with schizophrenia”. We try not to say “a depressive” and instead say “person with depression”. However, with gender issues it is the reverse, we are encouraged to say “trans person” rather than “person with gender dysphoria” and also to affirm those identities.

The reasons for this disidentification process are several. One is to avoid distorting our perception of the person so we do not see them as just their condition. We must remember that they are so much more than that. Another reason for this practice is to avoid stigmatizing them, so they are not seen as being just that particular condition, they are a full dynamic human being with many different parts

Another reason for this, relates to the person seeking to work with their condition themselves. When someone identifies with something it becomes frozen. It is much harder to treat someone for depression if they identify with it. If they say “being depressed is just who I am, it cannot change.” that is much harder to work with that than someone who says that they “have depression”. One technique for those who are too identified with their depression is to externalize the depression. We try to get them to see the depression as not their whole self, and to perhaps say “that is the depression talking”. This tries to bring their whole self into the picture, rather than just the depression, as the rest of the self can get lost when an identity is formed.

I have talked about identities as self-concept in the past. However, another important aspect of identity which I neglected is group identity. A lot of identities involve identification with a group. When people talk about identities they are often talking about things like race, class, national identity, political identities and certainly gender. Group identities divide us into groups. They say who is “us” and who is “not us”. The desire to be part of a group is a very basic human desire. We are tribal creatures. However, when group identities come into play, they tend to override objective reasoning. There is a sense that our group is right and the other group is wrong. Reason is no longer used to explore the truth, but is instead used to support our moral position. Arguments become moral, rather than rational, and moral reasoning trumps objective reasoning. This is part of what makes discussion of trans issues so difficult. Identity comes into play, and discussion becomes very difficult.

Another problem with group identities is that they can result in a loss of individuality. Connecting with a group and being a part of a group can be such a good feeling, especially if it is a group of people that reflects parts of oneself that have not been reflected before. A lot of my own impulse to transition 20 years ago arose in part from my encounter with the community. It felt so good to encounter people that shared the same feelings about gender that I did, as my gender feelings felt like a deep secret that I would never share with anyone and did not share with anyone “real”. Talking to people who had the same feelings and could relate to my experience was so great. I do think it played a role in my adopting the transgender identity. I am not saying that I adopted this identity due to peer pressure, as the reason I adopted this identity also related to the deeply held feelings that I had. It is rather the intersection between my deep feelings ,and the group that led to my development of this identity. I think this is true of most identities, they are the intersection between biological factors, temprament, and social identity. Cross-gender feelings exists in all cultures but how they are expressed is different depending on cultures. In one culture one might be considered a shaman, in another an abomination, in another a transsexual. Cultures and subcultures say these feelings mean certain cultural identities and the ultimate expression lies at the intersection between the cultural ideas and the internal feelings.

In a way, there is something strange about talking about people “discovering their authentic identities”, because I actually see authenticity as something that opposes identity. I see it as something that lies beyond identities. Identities freeze things into place, and are almost like heuristics. They are shortcuts for who we are, that help explain who we are to others, but are always partial. So, affirming someones identities, is in a way taking them away from authenticity. It is not surprising that many of the people who write of detransition cite mindfulness as an important factor, because mindfulness is precisely a method for loosening identities and the holds they place on us.

I am not trying to say identities are all bad, indeed they are important. They are important because they allow us to feel a part of a group. They are important precisely because they act as heuristics. If we had to feel authentically into each moment of every day that would be a very slow, inefficient process, and probably quite difficult to pull off. Also there are problems associated with lack of stable identity, such as borderline personality disorder for example. Like Jack Engler said “you have to be someone before you can be no one”. Sometimes being authentic can be very difficult or impossible due to the pain associated with it, that can be a reason to live in identities. There is nothing wrong with that, it can be what is right for that time and it can serve an important protective function. Exploring identity is generally seen as part of normal adolescent development, because it relates to being in the world and playing roles in society. However, it seems like we have taken to reifying identities and mistaking them for the person themselves, when they can only be an approximation.

Can transition be the best solution? Yes, but I believe the answer lies under identity and not in identity, because that is where the creativity lies. So, I think it would be much better when looking at these issues to see someone as a person with gender dysphoria, rather than a trans person or a potential trans person. The same applies when exploring one’s own issues. This means the whole person doesn’t get lost and many solutions are possible. It also changes the question from “determining if someone ‘is’ transgender” to determining what the best way to move them towards wholeness.

Identity fusion predicts gender reassignment surgery

Here is an interesting study which talks about identity fusion and its connection with transsexualism. Abstract pasted below. Full text here (via transsexualism.tumblr.com)

Transsexuals vary in the sacrifices that they make while transitioning to their cross-gender group. We suggest that one influence on the sacrifices they make is identity fusion. When people fuse with a group, a visceral and irrevocable feeling of oneness with the group develops. The personal self (the sense of “I” and “me”) remains potent and combines synergistically with the social self to motivate behavior. We hypothesized that transsexuals who felt fused with the cross-gender group would be especially willing to make sacrifices while transitioning to that group. Our sample included 22 male-to-female (MtF) and 16 female-to-male (FtM) transsexuals. Consistent with expectation, those who were fused with their cross-gender group (1) expressed more willingness to sacrifice close relationships in the process of changing sex than non-fused transsexuals and (2) actually underwent irreversible surgical change of their primary sexual characteristics (vaginoplasty for MtF transsexuals and hysterectomy for FtM transsexuals). These outcomes were not predicted by a measure of “group identification,” which occurs when membership in the group eclipses the personal self (the “I” and “me” is subsumed by the group; in the extreme case, brainwashing occurs). These findings confirm and extend earlier evidence that identity fusion is uniquely effective in tapping a propensity to make substantial sacrifices for the group. We discuss identity fusion as a social psychological determinant of the choices of transsexuals.

I was excited to see this study, because I have been talking and thinking about identity fusion and its role in transsexualism. It was great to see that someone was studying this. Some in the reddit trans community even talk about the process of fusion, talking about how you go from “I sometimes fantasize about being a woman / have dysphoria” -> “I think I am trans” -> “I am a woman”. They talk about it as if it is inevitable, its not. That is fusion in action and can be reversed by the process of defusion.

A quote for the main body of the study:

“we showed that fusion was also a potent predictor of the steps that aspiring group members take to become group members.”

You can see this phenomenon in action as people become more identified with the community and their views shift, often very quickly as documented here. People who are starting to question, in just a few weeks become determined to take hormones as they become identified with the group.

Also:

Furthermore, whereas past researchers (Smith et al., 2005) have identified variables (e.g., gender dysphoria) that motivate transsexuals to eschew their natal sex, our findings identified a variable (identity fusion) that appears to motivate transsexuals to embrace the cross-gender sex.

This again supports the idea of multiple factors being involved, and fusion being part of the motivation that leads to transition and ultimately surgery.

This study primarily talks about fusion from a group perspective the person’s identity with a group. This is something I have neglected but have come to see the importance of it, particularly after several conversations with Deborah. Part of having a identity is a sense of belonging with a group of people that seem like you, and belonging to the tribe is a key factor in human motivation. Feeling like there are people like you is so exciting, especially afar a long time of feeling that you are the only one.

Part of my own experience was similar to this. My dysphoria actually went away during my late teen years when I was dating and having some success socially. It came back when I went to college, and I still remember how powerful that feeling that there were other people like me when I encountered one of the early online forums for trans people. It was like “wow, people can really do this, and there are people like me!” That feeling of belonging after such long periods of not belonging was so powerful.

This study found this effect occurred in both FTM and MTF transsexuals, but only measured gynephilic FTM’s and androphilic MTFs, but I suspect that shouldn’t make much a difference.

The measure of fusion also measured specifically fusion with cross-gender identity. I would be interested in a measure of fusion with the community itself also. I suspect the effect would be even stronger.

Also many people report that their dysphoria increases upon deciding they are trans.This process of fusion could be a mechanism for that. Identifying with the group itself can propel people along the path. Likewise taking a step back from the community can reduce dysphoria, here is an example of someone experiencing relief by taking a step back from the community.

I think it shows the importance of taking a step back and taking things slowly after the heady rush of first being exposed to the community, and reading as many different perspectives as possible.

The problem of real vs. fake

The distinction between “real” and “fake” comes up a lot when discussing transgender issues. This is also sometimes framed as “valid” vs. “invalid”. I think this distinction is a false one in most cases, and serves to obscure thinking on these issues. People are very invested in whether their identities or conditions are “real” or“fake” and therefore have a strong stake in proving points that makes their identities “more real’. Likewise, opponents of transgenderism attempt to prove (or just assert) that transgender identities are “really fake”.

This whole discussion is a category error. Identities are not real or fake, because they are narratives. Narratives are stories and are constructed and culturally-specific. This does not make them “fake” though. It is an unfortunate assumption of Western culture that things that have material existences such as rocks or hormones, or body parts are “more real” than things that are concepts or narratives or stories. When it comes to the question of how to be more happy or how to best live our lives, this is not true. Concepts and narratives have as much, or even more to do with this question. They are very powerful. Dark thoughts can lead to suicide itself. People live and die by the millions over narratives. Would you say that religion has had less impact on human action and happiness than the spleen? or molybdenum? Constructed things are neither less real nor less powerful than physical things.

It is important to note that I am definitely not saying that everything is constructed. The postmodernists, having discovered that narratives are constructed sometimes go too far when they decide that everything is constructed. Bodies are not constructed (though the meanings placed on them sometimes are). Instincts aren’t constructed,impulses aren’t constructed, hormones aren’t constructed, chairs aren’t constructed. This does not make them “more real” though, and certainly doesn’t make them “more important” which the next leap in the chainfrom “more real”.

Another error that the postmodernists make is taking the idea that narratives are constructed and neither true nor false to mean that they are all equal. They are not equal. Narratives can be more useful than others, narratives can be more healthy than others. Some narratives are life-affirming and lead to flourishing, and others lead to destruction. An extreme case of a destructive narrative can be found in something like the “Jim Jones cult” which led to mass suicide. This also illustrates just how powerful narratives are, as they can override even survival instincts.

There may be low-level biological instincts and imprinting that lead people to develop transgender identities. However, the story that arises to explain these instincts is distinct from the instincts themselves. Neither is more real than the other, but it might be possible to decouple them.

Certain conditions like PCOS and autism correlate with transgender identity, both of which are known to not be caused by childhood experience. (That doesn’t make them more real than things that caused by childhood experience though!) It very well might be the case that some people benefit from cross-gender hormone therapy. Many trans people report the find hormone therapy improves their mood and functioning and they should be allowed to make that choice. However, this question is distinct from the narrative that is told to explain it. People with thyroid hormone deficiency function better when given thyroid hormone, but do not have a story that their “true thyroid is functional and they must take thyroid hormone to affirm their healthy thyroid identity.” This is partially because they don’t need to construct such a story, because thyroid deficiency is not stigmatized. Gender is such a polarizing topic that people who want hormones because they feel it makes them function better is seen as not a sufficient reason. They somehow have to prove that they are really a member of the other gender in order to get that medicine.

This distinction between “real” and fake” leads to endless discussion on whether trans women have “female brains”,which contain the assumption that if this question is true transgender identities are “real” and if this question is false transgender identities are “false”. There are several studies which show brain differences between trans folk and controls. In some cases these studies are confounded for the effects of cross-gender hormones in other cases not. A few of them do show a couple of brain structures that look similar between trans women and cis women This study is often quoted.

However, other show intermediate structures and others show trans women having structures in common with cis men. Here is a great article about a study showing that trans women’s brains show differences from controls, but not that they are like cis women’s brains.

There is a related idea that if there are such brain structures, then the condition is physical and therefore real. However, nearly all mental health conditions show up in the brain. Autism, schizophrenia, bipolar, and depression all show up in the brain. The real truth is that mental health conditions are no less real than physical health conditions and should not be stigmatized. People who suffer from things like depression or bipolar are stigmatized while those that suffer from heart disease or cancer usually aren’t. This whole discussion is a red herring really, but becomes important when we decide physical conditions are “more real’ than mental conditions. This distinction is doubly false because mental conditions are physical conditions also.

In summary I recommend experimenting with banishing the idea of “real vs. fake” from thinking about gender issues, it might reduce the emotional charge and help to promote clear thinking, and answer the real question which is what response to gender dysphoria will lead to the most happiness and well-being.

Am I really trans? Mu.

A student was struggling with gender issues and decided to visit Gender master Aiden who was renowned for helping people with these issues.

The student poured out story after story, evidence of being trans, evidence of not being trans, childhood experiences, fantasies, thoughts, feelings, and tales of great suffering.

Aiden listened carefully and attentively. The student asked “Am I trans?” Aiden said “Mu.” and whacked the student across the shoulders with zir cane. Aiden then paused and slowly sipped zir tea. “Delicious!” zie said.

The student was enlightened.

Commentary

Mu is not yes. Mu is not no. Mu is not maybe. Mu means the question should be unasked, because it contains a hidden assumption. The following questions are properly answered Mu.

Am I trans? Mu.
Am I genderqueer? Mu.
Am I cis? Mu.
Am I nonbinary? Mu.

Am I trans or is it a fetish? Mu.
Are trans women women? Mu.
Are trans men men? Mu.

Are my issues psychological or biological? Mu.
Are my issues real? Mu.
Are trans issues caused by a female/male brain? Mu.

Are trans identities valid? Mu.
Are cis identities valid? Mu.
Are X identities valid? Mu.
Is my identity valid? Mu.
Is another person’s identity valid? Mu.
Is X identity a thing? Mu.

Are trans identities invalid? Mu.
Are cis identities invalid? Mu.
Are X identities invalid? Mu.
Is my identity invalid? Mu.
Is another person’s identity invalid? Mu.
Is X identity not a thing? Mu.

I have X experience am I really trans? Mu.
I have X experience am I not really trans? Mu.

Are my feelings dysphoria or depression? Mu.
I feel better on hormones am I really trans? Mu.
I feel worse on hormones am I really trans? Mu.
I am questioning my gender, does that mean I am trans? Mu.

Another student asked Aiden if “zie/zir” were Aiden’s preferred pronouns?
“A finger pointing at the moon.” Aiden replied.

Dysphoria is very ordinary

Many trans people talk about dysphoria as if it is some mysterious thing, that cannot possibly be comprehended by others. Having experienced gender dysphoria, I actually think it is a very ordinary thing. It is the discrepancy between how one would like the world to be and how the world is. You want your body to be one way, and it is a different way. You want to be treated in one way and you are treated in a different way. You want to be seen in one way, and you are seen a different way. This is really a universal experience, shared by all human beings. I find it helpful to see that, it helps to create empathy and compassion, rather than separation and isolation.

It then follows that anything that increases the gap between how you would like the world to be and how it is will increase dysphoria and anything that decreases that gap will decrease dysphoria. Frequently, people report that when they come to a point of identifying as transgender rather than questioning, their dysphoria increases rather than decreases. This is not surprising because they have increased the gap between how they would like the world to be and how the world is. Now being seen as your birth sex hurts more, because you have solidified your idea of being otherwise. The pain of being misgendered increases greatly after taking steps to transition because you have committed to the idea of the world seeing you as the gender you identify with, and they don’t. The more rigid these ideas, the more suffering that there is.

When faced with the challenge of the world being different than you would like it to be, there are two things that you can do to reduce that gap. One is to change the world so that it is more to your liking and the other is to accept the world as it is. It is like the classic serenity prayer:

“God, grant me the serenity to accept the things I cannot change,
The courage to change the things I can,
And the wisdom to know the difference.”

When it comes to gender, there are things you can change it is true, you can change your hormones, you can have surgery, you can change your name, you can change the way you behave in the world. However, you cannot completely change your sex, you cannot control the perceptions of others. Not accepting those two facts, will lead to endless suffering.

I remember having dysphoria that was so severe. It was very important to me that everyone perceive me as female. Whenever this failed in some way I would create some rationalization for why it happened. Sometimes that wasn’t possible, and I would go into a tailspin. I even moved to a place where people were less trans aware in order to attempt to be perceived as female. That didn’t work either. I wanted the world to be other that it was. I still had body dysphoria after surgery because I wanted my body to be other than it was. The only way out, was the path of acceptance. That was what helped to let go of dysphoria, not changing my body, not attempting to convince everyone I was born female, not attempting to convince myself that I was female in every way.

You can change your body or not, but without the acceptance, the dysphoria will not go away. If you are dependent on other’s perceiving you a certain way, that won’t work either, because you do not control the perceptions of others. This acceptance is essential for any path through this maze, whether transitioning or not, going on hormones or not, having surgeries or not. So why not start with that first? I know for myself, if I had practiced this acceptance first, I would have not needed to change my body. I am not sure what is true for you, but I do know we all need to confront the fact the world is other than we would like it to be.

Breaking the testosterone/dysphoria cycle

In Anne Vitale’s T-Note #15 entitled ”Testosterone Toxicity Implicated in Male-To-Female Transsexuals: Some Thoughts”, she speculates on the role of testosterone in causing gender dysphoria in natal males. She talks about how some MTF people try to detransition, and then attempt to take testosterone and their gender dysphoria returns. She presents two case studies where two post-op MTF people have detransitioned, but could not take testosterone without overwhelming feelings to retransition returning. One eventually retransitioned and the other did not go on testosterone.

Note that I generally agree with Anne Vitale only in her descriptions of phenomena, not in her descriptions of the reasons why they happen.

Also note that these people were both okay with presenting as male as long there was no testosterone present. Suggesting that there is not some essential identity involved. This is one of the things that I am critical about in our conceptualization of these issues. I can definitely find plausible the existence of a condition that makes one function better on cross-gender hormones. I also think cross-gender expression can be healthy. However, I cannot find plausible the idea of a medical condition that requires someone to have their cross-gender identity constantly validated by others in order to feel okay with themselves. It was noticing the difference between how hurtful it was when someone did not validate my gender identity, versus how little it hurt when people didn’t validate aspects of myself I was comfortable with that contributed to my questioning of the whole thing. In the first case it was because deep down I didn’t believe in my female identity myself, precisely why it was so threatening when it was challenged.

However, I still faced the challenge that Anne Vitale addresses in this article. As I talked about before when I escaped from this female identity and got off estrogen I felt more connected to my body and enjoyed the absence of social anxiety and better mental functioning. I still had issues with fatigue and apathy and so decided to try testosterone. I felt amazing in the first 2 months of testosterone, a very great euphoria. However this was only temporary. I soon felt there was a part of me that wanted to return to presenting as a woman as well as erotic fantasies. I felt this pressure within my psyche and resisted it. However after a couple more months I found I couldn’t resist it and so went off of testosterone and went back on estrogen. This relieved that pressure but again it was clear to me my mind wasn’t functioning properly and I felt dissociated. Now I was in real trouble because I felt like I couldn’t go forward and couldn’t go back. Then I tried T again and the same thing happened, then I went back off it again.

By this time I was aware of role of trauma in this process and had a good intellectual understanding of what was going on, but that was insufficient to solve the problem. I went to two different counselors that I had worked with in the past to do work on this issue. I discovered the root of my “female self” was in feelings of profound unsafety around being myself and presenting male. In other words there were vital aspects of myself that I couldn’t express as a male without being subject to violence, much like the violence I suffered in childhood. Through the use of EMDR and IFS I was able to work through this. When that happened it felt like this idea of a female self dissolved and I have since been able to be on testosterone without difficulty. It has been over 2 years now and the feelings have not come back, of course I can’t be 100% sure they won’t come back again, but it felt like something permanently shifted in that moment and there is no pressure in my psyche. It is important to note the fantasies still exist, but they only exist as fantasies and I understand them for what they are. I don’t think the existence of the fantasies itself is changeable, at least not with our current knowledge.

This is why I conceive of this as a psychological process in a feedback loop with an erotic imprint (at least for those in Anne Vitale’s “group 3”) This also fits what I observe in others. People can have the erotic imprint without the psychology (i.e. cross dressers). I think the difference between cross dreamers/crossdressers and those that go onto transition is that they have the same erotic imprinting (they like the same fantasies) but have different psychological responses to it. Also eliminating testosterone does not eliminate the psychology but does reduce the fantasy component. I disagree with her that the developmental process she describes is inevitable, but I do think it reaches a point where it is quite difficult to reverse.

So, the what can you do if you want to halt this cycle and do not want to transition? I have written about some of the psychological issues here, here and here. Intellectual understanding is insufficient for this psychological work, it is a visceral, experiential understanding that is required, and it is probably best done with supportive others.

However, this says nothing about the erotic component which I think behaves more or less like other erotic imprint issues. Unfortunately, most of the psychological treatments have high relapse rates and are not very effective. A couple of examples include aversion therapy, and orgasmic reconditioning. The use of porn exacerbates these problems as overtime it requires more and more stimulation for the same effect. Other things that have shown promise are the use of mindfulness to insert a gap between stimulus and response, and values-oriented living as this problem tends to exacerbated by loneliness, stress and anxiety (and people often transition in response to a life crisis of some kind).

One thing I have learned is that having shame about fantasies makes them worse, and you have to accept them. Lots of people have erotic fantasies that don’t correspond to what is healthy for them to do in their lives. No one would suggest that women with rape fantasies live them in the real world in order to be their “true selves”. It is not any different for people with feminization fantasies or other fantasies. Porn doesn’t tell you who you are! They are things one can perhaps act out with a consenting partner, but they aren’t life maps.

If the fantasies are too powerful and acquire a compulsive quality, there are pharmaceutical treatments that are known to be effective. Of course anti-androgens are helpful for testosterone driven behavior (and if anti-androgens or estrogen improves your well being I think that is great) , however transitioning is a separate decision. Anti-depressents, particularly at higher doses are known to be effective for stopping this compulsive sexual behavior, but the response is highly individualized and that is something that should be done working with a doctor.

Sometimes cross-dressing and other cross-gender behavior has been connected with OCD, and in that case working on the OCD itself may stop things. Treatments that have worked for OCD include cognitive-behavioral therapy, exposure-reponse prevention and again high-dose anti-depressants.

This stuff is very complicated, and I really wish more mental health people were really digging into these things instead of saying “oh you have gender issues, therefore you have gender dysphoria, here have some hormones” Not all gender therapists are doing this, but the ones who see people for one session and write letters for them definitely are, that’s not enough time to diagnose anything.