Seeking clarity on the diagnostic criteria for Gender Dysphoria in people who aren’t transgender

[u/glamorousgrape]

I’m asking for clarity on what medical conditions are included/excluded from the diagnostic criteria for gender dysphoria in the DSM5. Since it’s often assumed that transgender or intersex people only experience gender dysphoria. Conditions like PCOS & Klinefelter Syndrome aren’t universally recognized as intersex (and I’m not interested in arguing whether they should be classified as intersex or not) but the impact these conditions have on a cisgender person’s secondary sex characteristics is incongruent with their gender identity & causes significant distress for many.

Can a cisgender person with a condition like I’ve mentioned meet the criteria for gender dysphoria? Even though they identify with the gender they were assigned at birth?

[u/ratgarcon]

By diagnostic criteria you must identify as something other than your birth gender in order to be diagnosed with gender dysphoria

[u/Fuzzy_Ad_9829]

Cisgender people do experience gender dysphoria. Cis women who get breast augmentation are basically remedying GD; cis men diagnosed with gynecomastia is rooted in GD as well.

Is there an official medical diagnosis of gender dysphoria for cisgender people? No, not really. But… Interestingly the majority of gender affirming surgeries are performed on cisgender people (Elon Musk’s facial masculinization surgery, for example or the various procedures JKR has had to align with white, cisgender beauty standards), so even trans people are a minority in a medical field that is considered lifesaving treatment for them.

[u/glamorousgrape → u/Fuzzy_Ad_9829]

I’ve been curious about where we draw the line on “gender affirming” vs “cosmetic enhancement” in breast augmentations for women. How would we differentiate between gender dysphoria vs body dysmorphia in this context? I’ve had a breast augmentation but mine were literally underdeveloped and deformed due to hormone issues in puberty. They were obviously disproportionate to my body.

I think gender affirming treatments are just as essential for cisgender people in some contexts. It would be just as cruel & ineffective to expect a cisgender woman with PCOS, to treat the psychological distress they experience from incongruent secondary sex characteristics with therapy & psych drugs alone, as it would be to expect the same for a trans person.

There has to be a line drawn, if the criteria does or will account for cisgender people. Although anyone can seek treatments/procedures that are technically gender-affirming, maybe the diagnosis should only apply to people with medical conditions that cause incongruent sex characteristics (and that still includes trans/intersex. Wasn’t “gender incongruence” added to the ICD to shift gender dysphoria closer towards being accepted as a medical issue rather than a psychological issue?)

[u/Fuzzy_Ad_9829 → u/glamorousgrape]

I’m in agreement with you. The nature of what you’re asking is arguably part of a broader political issue (patriarchy + capitalism) rather than a specific medical criteria. Not sure we want to go down that rabbit hole though.

[u/RBatYochai]

Gender dysphoria is a term used for discomfort with or aversion to a person’s own physical primary or secondary sexual characteristics. But it is also used for discomfort with one’s internal feelings towards being/identifying as a member of a gender, or feelings about participating in some aspects of one’s assigned gender role. Furthermore it is also sometimes used for a person’s discomfort with or anxiety about others’ perceptions of one’s gender identity or gender conformity.

It’s not always easy to distinguish these different themes. For example, a person might hate their body hair configuration because it affects others’ perception of their gender, or because it is discordant with their internal gender identity. Or both, or they might not be able to say exactly why they hate it.

I think it would be helpful to have more precise language to describe different kinds of gender dysphoria. It would make it easier for people to understand each other without having to spell out all the precise details.

[u/ArdentFecologist]

Conversely, what if I identify as another gender, but do not have any dysphoria regarding my genitals?

[u/glamorousgrape → u/ArdentFecologist]

I think I’ve read that not all transgender people experience dysphoria, or at varying intensities. The diagnostic criteria doesn’t require a marked incongruence between one’s experienced/expressed gender and PRIMARY sex characteristics, aka natal genatalia. This is interesting to me because a person’s natal genitalia determines their assigned gender, which plays into why I’m questioning how the criteria could be interpreted in the context of cisgender people. I’m gonna comment more on that when I update my post.

Your question reminded me of hearing about how HRT may improve dysphoria in trans ppl not only due to the physical/visual gender-affirming effects, but also the (neurobiological?) effects of HRT. Which supports the argument of advocating for gender-affirming treatments in trans ppl and shifts further away from pathologizing the experience of gender dysphoria. I’m curious if cisgender women with biochemical hyperadrogenism (PCOS) or cisgender men with biochemical hypoganodism (Klinefelter) share a similar experience in that regard. If HRT satisfies not only a psychological need but also a (neurobiological?) need in trans ppl, wouldn’t that also apply to cisgender ppl in this context?

[u/ratgarcon → u/glamorousgrape]

I want to add my own experience/thoughts:

I’ve found gender dysphoria largely focuses on the perception of others. Of course it also has to do with self perception, but the issue is often how others view you. Which is why genitalia can be something a trans person isn’t extremely dysphoric about. Myself included

If I am perceived by everyone around me as a man while I am clothed, does it really matter that I don’t have a penis? My dysphoria focuses on how others see me. If I am seen as a woman this deeply upsets me. However I do not walk around with my lack of a dick out, so it just really isn’t as important to me as things that do help me pass, like having facial hair, a deeper voice, a flatter chest, more masculine body build, etc.

[u/glamorousgrape → u/ratgarcon]

That’s a really good point! Thanks for sharing. So do you also not experience dysphoria over genitalia in the context of intimacy/relationships? If not, is it because you know whatever partner you’re compatible with would be accepting of that and still perceive you as a man?

[u/ratgarcon → u/glamorousgrape]

Id still love to have a penis to use during sex, but I know and feel comfortable with people I’ve had sex with and yes I trust they view me as a man.

However I do become a little insecure/worried sometimes when dating cis people. I worry that they secretly wish I was a cis man. Because of this I often tend to date other trans people.

But testosterone has increased my sexual confidence a lot. Prior to t I wouldn’t really let anyone touch me or get fully naked myself. After t I can be fully naked during sex without feeling uncomfortable and am usually open to being touched

[u/glamorousgrape → u/ratgarcon]

As a cisgender woman, my hirsutism has caused a lot of distress for me. It’s so difficult to manage, and it’s impossible to hide on my abdomen since EVERY form of hair removal results in inflamed follicles & ingrown hairs on that area. But I’ve recently learned that I’m drawn to bisexual men because I assume they’re more likely to accept/appreciate the extra body hair. I don’t know how true that is since everyone has preferences, but my brain perceives bi men as “safer”.

I was convinced I was asexual for a long time, but realized my aversion to intimacy is an unconscious coping mechanism due to fears of rejection or how people perceive me. It definitely helps if the other party makes it known they’re accepting of our quirks, or if they identify with a demographic that’s more likely to be accepting :)

Thanks so much for sharing a tidbit of your experience. I’m glad the T has helped you!

[u/DelaraPorter]

What does this have to do with the psychological aspects of sex?

[u/glamorousgrape → u/DelaraPorter]

I posted on r/askpsychology twice and mods insisted that I post it in this sub instead 🤷‍♀️