So something a lot of trans people talk around while discussing transition, hormones, surgery, and other technologies we may or may not access is the idea of dysphoria or dysmorphia or dissonance. That is, the clash between what your body appears to be and what you know your body should be. Trying to maintain this dichotomy is known to be harmful trans people’s mental health.
I don’t know where this dysphoria comes from, or what causes it, but I’m not interested in the etiology. I have no idea whether trans people are socialized into being trans or it has a genetic cause, or a developmental cause, but then neither does anyone else. Being trans has no known etiology and everyone who claims otherwise is trying to sell you something. So just forget about etiology now. Work on practical needs. The DSM-IV-TR describes diagnostic criteria for gender identity disorder as:
A. A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex). In children, the disturbance is manifested by four (or more) of the following:
repeatedly stated desire to be, or insistence that he or she is, the other sex
in boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing
strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex
intense desire to participate in the stereotypical games and pastimes of the other sex
strong preference for playmates of the other sex
B. Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex.
C. The disturbance is not concurrent with a physical intersex condition.
D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
First of all, these criteria are completely cissexist (and allows for no one outside the binary), but that’s not really the point. I also think that many cis and trans people miss the language in D. that says “clinically significant distress or impairment.” A lot of cis people like to theorize all kinds of things about trans people and our lives, why we transition. And the popular narrative is a kind of softer, defanged narrative that says “All my life I felt I was assigned the wrong sex.” Said in any number of ways. But this narrative, however it’s worded, fails to convey what this is like.
What it is like for me is pain. It is the pain of having your skin wrapped badly around your body, fitting awkwardly at best. Reminding you that everything is wrong whenever you move, whenever you go to the toilet, whenever you undress, whenever you shower, whenever you wake up, whenever you go to bed, whenever you see a mirror. It is a constant pain. Everything reminds you of it – the pronouns others use for you, the name others use for you. The clothes you wear.
It’s like living in a world where everything is made of sandpaper and it’s always grinding into your skin – your skin that does not fit your body.
You know what your body should be like, should look like. That you have parts you should not and do not have parts that you should. Your body does not behave like it should, move like it should, smell like it should. Your skin is the wrong texture. Puberty changes your body in ways that alienate you further from your own ill-fitting skin. Your voice is wrong, your face is wrong, your chest is wrong, body hair and facial hair are wrong. Some of your internal organs are wrong. In some ways, your skeleton is wrong.
This is not about “I want to play with dolls, wear dresses, go to the hairdresser, go shopping, wear makeup,” or any other insulting and superficial characterizations of trans women’s femininity. That is placing the cart before the horse. What it’s about is this pain and doing what it takes to ease the pain. And you learn that all you do is ease the pain. Because it never stops. The romanticized stories of transition to surgery and a woman happily after? Those are the approved narratives that were told to the public. They were shaped to cis expectations.
But the truth is that it is still difficult. Hormones help a lot. After a time, your skin fits a lot better, but you can still see and feel and hear every single flaw. Flaws that cis people may never notice (but many will helpfully point to other flaws you may have missed!). Sometimes you might not even be able to judge what or how you look because the flaws you can see dominate everything else. But, just in case you happen to forget this even for a little while, you are reminded of the entirely naturalized idea that being trans is such an abject state you deserved to be mocked and attacked – even killed – just for daring to exist, daring to make peace with your own body. Even surgery (any surgery) does not fix this, fix the fact that you live in a transphobic – a trans hating – society. While it can do wonders for your comfort in your skin, it does not always do wonders for your history of living with dysphoria, or even correct all the dysphoria you have now.
Medical transition is the only treatment that helps. Medications don’t, electroshock therapy doesn’t, adminstration of hormones for your CASAB doesn’t work, psychotherapy doesn’t, nothing else works. They have all been tried.
And I am sick and tired of reading cis people’s extremely uninformed beliefs about why trans people are trans, and the motivations they believe we have for transitioning. You’re all fucking wrong: It’s pain.
Edit: One commenter suggested my writing universalized this a bit. This is my description of my experiences, and I am glad if others identify with similar or if they have their own experiences of dysphoria. The point is that this is not something that you can collapse down into something simplistic and benign, as many seem wont to do.