Gender Dysphoria vs. Sex Dysphoria

What are we treating?

Photo by Fahad Bin Kamal Anik on Unsplash

Puberty was a nightmare. It wasn’t necessarily what happened to her body that rattled Clara, though she definitely hated her period, and was terribly embarrassed by the breasts now visible beneath her t-shirts. What she really hated was the way other people responded to her. That had changed just as much as her body had.

At age 10, her mother told her she could no longer run around without a shirt, as she had been doing since she’d been small, blasting through the playground with the shirtless boys. At age 12, she’d been told by the girls, with a sneer, that she must start wearing a bra. And there were the quieter expectations, that she give up the sweatpants, the short hair, the snarl. The expectation to feminize was hush-hush but ubiquitous. Worst of all were the leers from boys and men, who no longer met her eyes; instead, they stared at her chest.

All of it made her feel she wanted to wriggle out of her own skin, and veer off the path laid before her. She had never wanted to be a girl, but she felt positively ill at the thought of being a woman.

She’d had a unit in fifth grade about transgender people. She knew vaguely about gender identity, but none of those lessons had seemed relevant at the time. As her discomfort grew, though, so did the seeds of those ideas. By the time she was 15, they had blossomed into a full-on identity. Clara was trans. Clara was a boy. Clara was Clark.

Clark was affirmed by his parents, by his school, by his therapist, by his doctors. Testosterone. Later, top surgery. At age 25, when I interviewed him for my last book (names have been changed), he didn’t regret it, exactly. It was more that a question lingered in the back of his mind: what was it that upset him so much—his body, or the way people treated him based on it? Was the problem his sex, or the expectations attached to it? Did the discomfort come from deep inside him—or was it imposed on him from the outside?

I didn’t have the vocabulary at the time, but if I had been able to articulate these ideas, I would have asked: did he have sex dysphoria, or was the problem gender?