Depersonalization and gender dysphoria

Zinnia Jones recently identified a gap in research on gender dysphoria: The co-morbidity of GD with depersonalization, and more mystifying, Hormone Replacement Therapy’s capacity to alleviate it.

Since experiencing this completely unexpected shift in my consciousness, I’ve been deeply interested in what the physical basis for this change could be. While research on HRT in trans people consistently indicates that it can relieve depressive and anxious symptoms, very little information is available on the biological basis of depersonalization symptoms, let alone the specifics of how depersonalization disorder can affect trans people. Medical transition, particularly HRT, is associated with a reduction in depersonalization and derealization – but how? Intriguingly, estrogen itself modulates NMDA receptors, and some of its effects can be blocked by NMDA antagonists (implicated in the effects of dissociative drugs). Estrogen has also shown some success in treating the negative symptoms of schizophrenia, which have a degree of phenomenological overlap with experiences of depersonalization. There are many pieces that seem relevant here, but as of yet very little to fit them together into a more complete model of how the action of estrogen can treat depersonalization (and even less to explain how testosterone treatment is equally successful at reducing depersonalization in trans men).

In short, these phenomena fascinate me, and there is an urgent need for more research into these areas given the severe impact of this syndrome on those trying to bear this living death. Depersonalization wrecked my life, draining it of all the promise it supposedly held. It stole my soul without the courtesy of killing me. If there is anything that can help us fight back against this condition, that matters.

And that’s why I decided to try lamotrigine.

(She does so under medical supervision, so Don’t Try This At Home, Kids.)

Read more here.



  1. Raucous Indignation says

    That is fascinating. And I know so little neuro-psychology that I can’t even hazard a plausible possiblity.

  2. anat says

    A long while ago Hj Hornbeck wrote about the apparent overlap between gender dysphoria and autism. Recently I received more information that attacks that possible connection from another direction. It is important to know who made the diagnosis of autism. There are many healthcare and mental healthcare practitioners who are qualified to diagnose autism, but many of them do not specialize in caring for people with autism. In a discussion, clinicians who do have such specialty said about half of the kids sent to them with a diagnosis of autism by say, school psychologists or pediatricians turn out to not be autistic, but they do exhibit many of the behaviors that are characteristic of autism. In such children the autistic-like behaviors turn out to be a way to deal with stress or anxiety, and if the stress is alleviated or the anxiety treated many of the autistic-like behaviors go away. Therefore before making any claims about overlap between autism and anything else the first thing to do is to make sure the people claimed to be autistic have been properly diagnosed by someone with the right specialty and expertise.