Gender dysphoria

Utterly brilliant What she said:

A question that tormented me when I first discovered I’m trans was why I didn’t realize it until I was 45 years old. From what I see on Reddit, that question torments many late bloomers who don’t figure this out until well into adulthood. The pop-culture narrative says that trans people are supposed to have always known, right?

Well, I didn’t, and yet I was also definitely trans.

The torment only increased as I reflected back over my life, discovering one sign after another of my feminine identity. Some of them quite blatant. Why didn’t I know? Why didn’t I realize? Was I just stupid? A clueless idiot, bumbling my way through life?

That explanation was not dismissed so easily: it aligned with many of the messages I’d been given about myself over the years. Further, I often felt like a clueless, bumbling idiot because I just didn’t understand how boys work or how to emulate what they were doing. So maybe that was the answer.

It took years, but ultimately I came to realize that I was asking the wrong question. I shouldn’t have wondered why I didn’t know sooner. Rather, I should have been asking “what stopped me from knowing sooner?” 

[…]

Everyone else gets to play “be yourself,” while we play “fit in or die”. What we need is a disguise. A mask made of carefully-constructed persona that matches the expectations created by our gendered bodies. The better we build this disguise, the better we fit in, the less punishment we receive. The less danger of exile we face.

So, without even noticing that we’re doing it, we pull back from engaging with people. We observe more and do less, trying to figure out the unwritten rules. We over-think the heck out of every situation before we try anything, working out our best guess as to how we’re supposed to behave.

A really comprehensive roundup:

In 2018, a physician and researcher named Lisa Littman published a paper in the journal PLOS One describing what she termed “rapid-onset gender dysphoria” (ROGD). She hypothesized that some young people—particularly those assigned female at birth—might claim a transgender identity after increasing their social media use or befriending trans peers. According to this perspective, online platforms supposedly “infect” teenagers with the idea that they are trans, creating clusters of youth who suddenly identify in new ways.

From the moment Littman’s paper appeared, researchers and advocacy groups criticized its methodology. Littman’s survey collected responses solely from parents recruited on three websites openly skeptical or critical of medical care for trans youth. These anti-trans or “trans-skeptical” forums—4thWaveNow, Transgender Trend, and Youth Trans Critical Professionals—advertised Littman’s survey to parents who already believed their child’s trans identity was misguided. Unsurprisingly, 76.5% of respondents felt their child was “incorrect” in identifying as transgender.

Critics also pointed out that the youth themselves were never surveyed. Parents who participated were asked to diagnose their children with gender dysphoria (a clinical term referring to distress due to a mismatch between one’s internal sense of gender and assigned sex at birth), even though most parents do not have training in psychology or medicine.

[…]

Although Littman’s original 2018 article used the term ROGD, many discussions in conservative blogs and online groups substituted or conflated it with “transgender social contagion.” This idea claims that trans identity spreads from teen to teen like a virus—an online trend rather than a real expression of self.

While the ROGD paper didn’t use the “social contagion” phrase outright, it alluded to the concept through references to “peer influence” and social media immersion. Almost immediately, these concepts were embraced by anti-trans activists, policymakers, and media personalities. The theory gave them a sort of “scientific” veneer to argue that trans kids are just “confused.” As a result, many now simply refer to both ROGD and “transgender social contagion” interchangeably, even though they are (at least in Littman’s framing) slightly different.

The autistic traits in our sample may represent an epiphenomenon of GD rather than being part of an Autism Spectrum Disorder (ASD) condition, since they significantly decreased after 12 months of GAHT.

Results suggest that nonautistic transgender individuals might be more prone to experience alexithymia (including at clinically significant levels) than nonautistic cisgender people. When autism occurs in transgender people, the average level and clinical rate of alexithymia is higher than among nonautistic transgender people and potentially higher than among autistic cisgender people. Our findings are in keeping with evidence of a subgroup of transgender people with “subclinical autism” and inconsistent with the notion that autism among transgender and gender diverse people is a “phenomimic” of autism. Lastly, our study highlights the potential importance of screening autistic and nonautistic transgender people for alexithymia.

This systematic review assessed the state and quality of evidence for effects of gender-affirming hormone therapy on psychosocial functioning. Forty-six relevant journal articles (six qualitative, 21 cross-sectional, 19 prospective cohort) were identified. Gender-affirming hormone therapy was consistently found to reduce depressive symptoms and psychological distress. Evidence for quality of life was inconsistent, with some trends suggesting improvements. There was some evidence of affective changes differing for those on masculinizing versus feminizing hormone therapy. Results for self-mastery effects were ambiguous, with some studies suggesting greater anger expression, particularly among those on masculinizing hormone therapy, but no increase in anger intensity. There were some trends toward positive change in interpersonal functioning. Overall, risk of bias was highly variable between studies. Small samples and lack of adjustment for key confounders limited causal inferences. More high-quality evidence for psychosocial effects of gender-affirming hormone therapy is vital for ensuring health equity for transgender people.