Different Dysphorias And Esoteric Embodiments

By reader request! A couple weeks ago, one of my twitter followers wrote me saying they were having a hard time explaining the concept of non-op, non-binary and partial transitions to a friend, and was wondering if I could write a little something up explaining the basics. Although it took me a little bit longer than I’d hoped, I’ve finally gotten around to fulfilling the request. Enjoy!

Probably the principle origin of people’s difficulties in comprehending non-op, non-binary and partial transitions is the rhetoric with which transgender issues have been framed, often by trans people ourselves. We often rely on rather preliminary and simplified metaphors, such as “woman trapped in a man’s body“, in order to convey the basic concepts to an uncomprehending and often startlingly uninformed cisgender public. Trying to explain gender identity to someone who’s never experienced it as a conflict (and therefore, effectively, never actually experienced its presence at all, even if they do indeed inhabit its presence) is a little bit like trying to explain what water tastes like. Or explaining the difference between green and blue to someone who is congenitally blind.

(sly word game intentional)

We use these simplifications basically because we’ve been forced into the position of needing them. While it would theoretically benefit the discourse of gender to not get off on the wrong foot by presenting concepts we simply need to deconstruct later, it’s already immensely difficult just to broach the subject in a serious way at all without being mocked, pathologized or treated with contempt.

But the problem, of course, is that not everyone who ends up exposed to those Trans 101 simplifications is actually engaged in an actual dialogue about the actual nature of gender and its actual variations, and aren’t going to stick around to hear the part where we say, to paraphrase The Doctor, “…well actually it’s nothing like that (but feel free to think of it that way if it helps).” Most people who end up hearing the Trans 101 simplifications hear them by way of cultural osmosis. Just another bit of uninterrogated “general knowledge” amongst the million other little itty bitty pub-quiz scraps of information people absorb while milling about their daily lives invested in whatever the hell it is normal people invest themselves in. I assume it involves something called “bills”, “W2s” and “the Johnson account”.

Consequently, we end up with everyone ever walking into any discussion of trans issues with this wicked silly inaccurate set of preexisting assumptions, based on the idea that our simplified metaphors, our “kind of like, but not really” statements, are the actual truths of transgender experience. At best, you get someone friendly who thinks “Sure, okay, female brains in male bodies who’d rather be in female bodies, I can dig it”. Often, you get some entitled, bigoted asshole who thinks “that’s fucking stupid. So what if I think I’m really a penguin? Should I be able to get Spheniscoplasty?” (not that they’d be nearly as clever as to say “Spheniscoplasty”, but I am, and I wanted to take the opportunity while I had it).

A lot of the time, this can kinda sorta work. If the identity under consideration is that of a binary-identified, generally-gender-conforming, pre/post-op transsexual person, those simplifications will mostly convey everything that needs to be conveyed, because there’s no “extra” variables that require a more nuanced, complex and accurate perspective. But a lot of the time, it doesn’t. Due to the fact that those simplifications just plain don’t reflect the actual reality of gender variance, it’s only by shear coincidence that they ever do an adequate job of explaining an actual individual’s identity and lived experience. A coincidence that by no means applies to the majority of trans people.

To actually speak to the lived experiences of trans people, you have to speak to the immense variation and diversity in those experiences. To speak to that diversity, you have to recomplicate the simplifications. To have those recomplications be comprehensible, you have to simplify how you complicate them. Which is just beautifully impossible enough to be irresistible.

To start with, let’s unpack this whole “female brain” business. Just like what renders a body “male” or “female” cannot be adequately reduced to any particular trait, such as genitals, karyotype, reproductive capability or endocrine function, and in fact is just a loose, aggregate, perceptual assignment we make on a given body, so too is there no particular trait of a brain, mind, self or identity we can point to and say is the male/female/”other” switch. Gender identities, and the categories of it such as man, woman, bi-gender, agender, androgyne, neutrois, genderqueer, etc., ultimately can only be usefully described as concepts of self, that either apply or don’t. Loose, aggregate, perceptions of our minds and selves subjectively assigned to them.

For now, the scientific evidence is strongly leaning in the direction of saying that yes, the forms of gender variance we collectively describe as transgender are very likely a result of neurobiological traits. But as said, it’s not a single, isolated trait. There’s no “gender lobe” or “trannithallamus”. Brains are sort of too complicated for that anyway. Neuroplasticity allows that different brains can configure themselves in very different ways so as to meet different (or the same!) needs.  The likely truth is that there are several different neurological functions and structures, which can operate or be configured in different ways from individual to individual, that play into what we understand as gender and gender identity. While we have nowhere near the requisite knowledge of the human brain to begin compiling a strict, ordered taxonomy of neurobiological variables related to gender and gender identity, we can infer some basic delineations from subjective experiences of self.

Some of these functions are connected to proprioception and “body map”, the brain’s expectations for what kind of a body is going to be on the other end of its stem. But these functions of the brain aren’t simplistic or isolated either, and have lots of different aspects. As such, there can be many kinds of body dysphorias (for instance, Body Identity Integrity Disorder), and many kinds of gender dysphorias, as well as different degrees thereof. Dysphoria in relation to body hair can occur in the absence of dysphoria in relation to breasts. Dysphoria in relation to secondary sexual characteristics can occur in the absence of dysphoria in relation to genitals. And dysphoria in relation to genitals can occur in different degrees (such as sometimes being present, but just not acute enough to end up manifesting as a pressing need that outweighs the costs, risks and sacrifices inherent to lower surgery, or sometimes being so intense that one can’t bear to live with one’s congenital configuration long enough to pursue conventional surgery, and instead performs self-castration ).

Also, while I can’t even begin to claim to understand how it operates, there does seem to be a sort of “endocrine dysphoria”, or a manner in which a given brain seems configured to “expect” certain hormone levels, and can’t properly function without them, or ends up dysfunctional when awash in the “wrong” hormones. This appears very true of cisgender brains just as much as transgender ones. Many trans people (including yours truly and gorgeous) report intense relief and comfort and inner peace arising from exogenous endocrine therapy before any real physiological changes are even possible. This could be placebo effect, and I’d love to see a double blind study (if such a thing weren’t so hamstringed by how ethically dubious it would be to give a trans person placebo hormones), but based on what we already know of the very real fact that hormones affect mood and disposition, it doesn’t seem like an at all unreasonable hypothesis. Conversely, when cisgender people are given “cross-sex” hormones, the results tend to be intense depression, anxiety, irritability and even suicidality. Almost the same psychological symptoms we observe in pre-transition trans people.

Morphological dysphoria is by no means the full extent of the variables that are at play in transgenderism. Transition, as much as it is about bringing one’s body and chemistry in alignment with one’s needs and sense of self, is also usually very much a social transition. The changes in name, pronouns, gender presentation and interpersonal and cultural role are often just as, if not more, significant in terms of easing one’s sense of distress and allowing one to feel happy, whole, fulfilled, at home in one’s own personhood. Little validations like being referred to as “she” in the third person can make a world of difference in those early stages of transition before one has even gotten a presciption in hand, and being misgendered can still be devastating even after it has long since become an absurdity to describe your body as being of your birth sex. So acknowledging that non-physiological elements are also in play is something of a requirement to account for the whole of trans experiences.

And just because things like names, pronouns, gender presentation and gender roles are socio-culturally mediated does not mean we need to discount a neurobiological underpinning to this element of gender. Perhaps there are structures in the brain that although could not possibly drive us to “wear skirts” or “grow your hair out” or “be referred to by this arbitrarily defined syllable instead of that one”, there could very well be structures that create in us a need to articulate and express ourselves as “female” or “male” within the terms and understanding of whatever socio-cultural context we happen to be born into. Or, just as easily, not strictly as “female”/”male”, but as combinations, in-between states, one or both experienced in varying degrees of intensity from “no particular desire to express as masculine or feminine” to “burning, undeniable need to express as masculine or feminine”. It would also make sense to imagine such inner drives existing in iterations of identity coded as cisgender as well, and would even make sense from an evolutionary and biological standpoint. And by no means would such a neurobiological variable have to be directly connected to those variables that end up predisposing physiological dysphorias. Hence the very real fact of butch trans women and femme trans men, femme cis men and butch cis women.

So let’s say, just for the sake of a slightly more functional oversimplification, that we’ve got a number of basic variables at play, probably neurobiological in nature. Morphological gender dysphorias, connected to different gendered aspects of the body and occurring in different degrees. Endocrine dysphoria, also occurring in different degrees. Predispositions towards expression of gender, mediated by socio-cultural context. And finally, for the sake of completeness, sexual orientation, which, of course, is ludicrously multifaceted and also socio-culturally mediated. Now, just as easily as we say, “yes, these tend to occur in certain ways within certain kinds of bodies, but physiological sex doesn’t determine their configuration”, we can also say “yes, there are some trends in terms of how these relate, such as those with one kind of gender dysphoria usually having other kinds too, but none of these variables directly determines another.” Correlations, yes. Causal relationship? Highly improbable. Most likely explanation? They share a common but separate causal factor, as yet undetermined (blahprenatalhormonesblahblahblah), which if it is in play such that it affects one of these variables is likely, but not certainly, going to affect others.

In other words, imagine your brain is made out of thousands and thousands and thousands of lego bricks (each of these representing a particular neurobiological trait, function or predisposition). Most of these lego bricks are white, and have nothing to do with gender or sexuality. But amongst the bricks that do play a role in gender and sexuality (of which there are many), some are blue (“male”/”masculine”), some are pink (“female”/”feminine”) and some are purple (“androgynous”). Some are light blue and some are deep blue, some are STRONGLY pink and others are only faintly pink, some are intensely purple, some are just a soft lavender, and some are kind-of-blue-kind-of-purple or kind-of-purple-kind-of-pink. The more bricks of a given colour you have, the more likely you are to have other bricks of that colour too. But nonetheless the bricks can occur in any combination. And those combinations will end up producing lots of different beautiful patterns.

None of those patterns are any more or less valid than any other.

Given this model of gender variance, it’s not at all hard to imagine how we end up with such a wonderful range of diversity within the trans community. Some people have the combination of lego bricks that produces a non-op femme transsexual lesbian. Some end up with the combination that produces a pro-op masculine gay transsexual man. Some produce a genderqueer MtF spectrum butch who desires lower surgery but has no interest in HRT. Some produce a masculine, straight man who enjoys cross-dressing. Some produce the “archetypal” femme, binary-ID’d, androphilic, pro-op transsexual woman or masculine, binary-ID’d, gynephilic, pro-op transsexual man. Some only deviate from the transsexual archetype in one little way, like LOOKING totally binary, femme, androphilic, transsexual but not actually identifying internally within that binary. And some only deviate from the cisgender/heterosexual norm in one tiny, culturally-insignificant way, like being a tomboy, gay man, or just not comfortable identifying as “man” or “woman” even though no one would suspect it from your superficial appearance and personality.

And even amongst all those combinations, personal choices, personal preferences, the unique circumstances of an individual’s life and their unique opportunitites or limitations, can render it such that even the exact same iteration of gender may be embodied in different ways by different individuals.

None of those embodiments are any more or less valid than any other.

This diversity is very, very cool. Let’s learn to understand it, so we can accept it, so we can appreciate it, so we can love it, so we can let those who live within it live and be loved.



  1. Anders says

    If I were to look for the source of gender dysphoria I’d look at the hypothalamus, where we have the network that regulates the release the hormones that work on the pituitary. We have sexual dimorphism in the distribution of estrogen receptors which could act as a measuring device for estrogen (men have low levels of estrogen). The network is also regulated by opioids, which may or may not be relevant for you Natalie.

      • Anders says

        That was my thought, yes. But we’re very far from establishing that. If I was to research this, I would read up on what is known about the receptors but I would also try to see if opiate abuse was more common than expected in the trans population. If it’s so, that’s encouraging but would still need more research.

        The problem is that you can’t really give opiates to trans people – there’s some clinical benefit (it would be nice if we could calm down a suicidal trans person with a shot of codeine) but not, I think, enough to warrant the risks.

        But. There are new non-addictive opioids in the pipeline. The addictive effect comes from mu receptors, but the pain-killing effects come from kappa receptors, so drug companies are trying to develop selective kappa receptor specific drugs. We could always try one of them when they reach the market. If the effect is coupled to the mu receptor then it’s still usable for short-term severe gender dysphoria, but we can’t use it long-term. After all, we give opioids to chronic pain patients.

        If it all works out we can use this for trans people who have yet to feel the anti-dysphoric effects of HRT and also cis people who have to have hormone suppressors for e.g. cancer.

        • Anders says

          Do you have any sense that methadon affects your gender dysphoria? Might be a little difficult to make observations while having opiate abstinency, of course.

      • Anders says

        So… here is what I found. The tl;dr version is:

        In both animals and humans, chronic opioid administration decreases LH, whereas FSH is not or is only minimally affected. The effect on LH occurs primarily by inhibiting hypothalamic GnRH secretion, although opioids also decrease the negative feedback of sex steroids on pituitary LH secretion. In turn, sex steroid hormones are required for and have major modulating effects on the sensitivity of the HPG axis to opioids and their antagonists, explaining why the effects of opioids on the HPG axis vary not only within the menstrual cycle but also with puberty and menopause.

        Decreased LH would lower testosterone levels, and in general opioids seem to have an inhibitory effect on the hypothalamus. This is consistent with the hypothesis that chronic opioid use may decrease gender dysphoria both directly (via influence on hypothalamus) and indirectly (by lowering testosterone). It would be able to calm down an unruly hypothalamus in trans men, but since it doesn’t affect estradiol the indirect effect wouldn’t be there.

        I do not recommend this way to self medicate, however. If you must self-medicate (and I understand that this can be necessary to survive) – buy estrogen on the net (testosterone would be more difficult to get, alas). All the major endocrinal systems become messed up by chronic opioid use.

        Here’s the original article (for those with an unnatural interest in opioid effects on endocrine function): http://edrv.endojournals.org/content/31/1/98.full#content-block


    • Dagda says

      as an additional remark:
      the endocrine system is propably part of the/ a body map in the brain.
      For Reference Antonio Damasios work about the self.

      • Anders says

        Oh, absolutely. I’m very influenced by his books – perhaps too influenced. Might be a good idea to pick up some of his critics some day.

        I think the hypothalamus is one of the structures he lists as essential to the core self.

  2. says

    And dysphoria in relation to genitals can occur in different degrees

    A bit of TMI following:

    This sentence (and following paragraph with squicky imagery) is what made me so adamant against calling myself trans. I live with my penis. I tolerate its existence. I masturbate with it. If I was given a magic pill that would give me all the secondary characteristics of a woman, but make it so I could never have lower surgery, I would be fine with that.

    The problem is that living with my penis, I’m reminded every morning how I’m not in a woman’s body. This morning I woke up in a huge funk because although I felt super-girly and feminine for some reason, I was hard as a stone, and now I’m depressed to the point of seriously pondering leaving work and not giving a damn for the consequences.

    It’s days like today that make me sob my fucking heart out, and it’s days like the majority of days where I feel that it’s not that bad, whatever that’s always worried me about being trans. That I’d go to a therapist who’d deny me access to HRT because I’m “not trans enough.” That I’d be in this state for my whole life and even if I got married and had kids I’d have to lie to my family about why I wake up some mornings sobbing my heart out, why I take long looks at myself in the mirror and see a stranger, and why I look at women’s fashion not because I like how it looks on that woman over there, but how I’d think it’d look on me.

    This, though. Thanks for this:

    None of those embodiments are any more or less valid than any other.

    • Anders says

      I’d give some serious thought about whether a partner you can’t confess that to is really worth it.

      • earth & stars says

        Sometimes not disclosing has nothing to do with whether or not we think the other person is ‘worth it’ and everything to do with our level of comfort at having certain kinds of information floating around in the world. There are certainly bits of my history that I don’t bring up because they’re A) nobody’s business but mine, B) heavily stigmatized, and C) things that have been used against me before by people I trusted. If I were in a position where my misassignment at birth wasn’t obvious to my sexual partner or partners, I’m honestly not sure that I’d bother saying anything. It’s a bit like being an incest survivor in that I’ve come to terms with it and don’t see it as something that needs to be part of the picture unless it becomes relevant.

      • earth & stars says

        …I’ve just realized that I mistook the sense of Ms. Lorraine’s comment, and thus, possibly, the sense of yours too, Anders. I’ll retire from the thread until my reading comprehension comes back from its trip to the corner store.

    • Aubergine says

      Hey lass, I am (or was) rather in the same boat. I never minded my penis and I always thought I could not be trans for that reason. As with you, there was a lot more behind it, and I wound up needing hormones and facial surgery. (I couldn’t stand seeing my face in the mirror.) So these days I am a quite content non-op.

      Not to be a cheerleader (ha), but if you’re just not happy in your skin there’s nothing wrong with looking at the possible steps you could take to ease your discomfort. There’s no reason it has to be all or nothing.

      • says

        Right. That’s the thing, like Natalie’s said, sometimes it’s just hormones, sometimes it’s more. I would be content with having secondary feminine characteristics. I don’t think I’d be happy with just those, but I could live my life fine. I want GRS, and I’ll probably go through with it eventually.

        Though I’ll still be somewhat depressed cause with current medical science I won’t be able to have kids of my own :\

        • Anders says

          Don’t write yourself off just yet. Mats Brännström (who runs the uterus transplant research here in Gothenburg) has said that it’s clinically possible to transplant a uterus to a trans woman today. I assume it would be necessary to create a canal between uterus and neovagina. You’ll have to be on immuno-suppressants, but the great thing about a uterus is that you can remove it again when you decide you have all the kids you want. And they’ll have to born via c-section.

          So what about gametes – can we make you an egg with your chromosomes? Not yet. We could take a set of chromosomes from sperm, but they wouldn’t work. There are subtle differences between ‘egg chromosomes’ and ‘sperm chromosomes’ so the fetus is not viable. It happens from time to time – a fertilized egg spits out one set of chromosomes and duplicates the other.

          But maybe we could take stem cells from your skin and turn them into eggs. We are very far from that today, but who knows? Technology advances so fast that my textbooks from the mid-90’s are already hopelessly out of date when it comes to cloning techniques, etc. Maybe within 20 years.

          • Sarah says

            It might not be that far out. Here’s a report of stem cell conversion to sperm cells which were then used to successfully fertilize eggs, and resulting offspring were healthy and themselves reproductively viable. This was mice, not people, and sperm, not eggs. But it proves the basic technique works, and elsewhere there are reports that similar processes have been shown to work with human stem cells, and I think I even saw one that showed eggs from stem cells, too. So practical treatment options for people may be a ways off yet, but the idea already works.


          • says

            So we perform the uterus transplant, then create cloned ova from stem cells from the original woman, then fertilize the ova with sperm from partner or donor, then implant the ova into the transplanted uterus? Totally medically viable, though probably a far, far ways from being actually available (will become available to infertile cis women first, of course, such as those who’ve had to have hyterectomies AND removal of ovaries), but also probably very, very, VERY expensive. Given how little stock I place in the “importance” of children having one’s own DNA (why not just find a surrogate mother or, better yet, adopt?), I’m not sure I’d support such treatments being provided by insurance or national healthcare. Unlike basic transition treatments (HRT, SRS, etc.), it’s not a potentially life-saving necessity for maintaining a minimal standard of quality of life, it would simply be something nice for those who consider it important enough to make the investment. But not worth the cost to the general pool of medical resources. Certainly worth the investment in terms of research, though, and going from a theoretical viability to a functional reality.

            But Cat, I loves ya, but why so much investment in traditional childbirth? I KNOW that pregnancy would be a beautiful experience, but you CAN still have children. It’s not so much an “I can never have kids” thing, just a “we can’t have kids the way most women get to” thing.

          • Anders says

            Well, we could always implant any ol’ egg if the important thing is to have morning sickness and back pain. 🙂 But yeah, creating that egg is going to cost a lot. You need specialized equipment, hormones, a special medium to grow the cells in… I guess at least $100 000 at least in the beginning.

            It’s easier to create sperm, by the way. You just need to mature them part of the way and then the rest can happen in a hamster. There’s one case of that, where a cis man lacked one of the key proteins to produce sperm. These proteins are highly conserved in evolution so they took a bit of the testicles and transplanted to a hamster. Testicles are insulated from the immune system so they didn’t need to give the hamster immunosupressants. Then they milked the hamster and sorted out the human sperm (human sperm cells look very different from hamster sperm cells) and performed IVF as normal.

          • says

            I’m thinking it’s mostly related to the “I’m not a real woman if I can’t have my own kids” trope. I know it’s a poisonous misogynistic, transphobic meme, but I still can’t help that thought.

            Yes, adoption and surrogacy are options – and for all intents and purposes I’d probably take advantage of those options. I still can’t shake the bouts of depression I have when I’m met with those thoughts.

          • says

            I’m just all for people doing what they need to do to be healthy and happy, uh, so long as they’re not harming people in the process, you know? Live and let live.

          • says

            Whoa, seriously? I actually looked up if it trans woman uterus transplants were possible the other day and was disappointed when it looked like the answer was no. Having a uterus bothers the hell out of me, and I’d love to have it taken the hell out, but I’ve never felt I had a good enough reason to get a hysterectomy… but if I could give it to someone who actually wants it, that would be awesome and I’d feel completely justified. So if it’s actually possible for that to happen.. wow. That’s awesome.

          • Anders says

            Not to put a damper on things, but so far this is done in Gothenburg. That’s not such a barrier it might seem because organs can stay alive for quite some time in a refrigerated box. So you can fly it from one place to another. And of course, there’s one team that know how to do it.

            Second, you can’t give your uterus to anyone. They must match you immunologically. And that can be tricky.

            But, yeah. Theoretically you could put yourself on an organ donor list and say “have my uterus if you find someone who wants it.”

        • Anders says

          And it’s possible to have a uterus transplant now (unless transphobia bars the way). The child won’t have your DNA but I think you’ll be able to love it anyway.

    • says

      FWIW, I’ve had a partner who went for HRT but not SRS. It was fine; the bits I couldn’t deal with on men were fine on her. And moreover, I was worried beforehand, not knowing I would find it so easy. I know that’s TMI but I hope it helps in terms of others’ acceptance.

  3. says

    Another top-notch effort here, Natalie.

    Or explaining the difference between green and blue to someone who is congenitally blind.
    (sly word game intentional)

    Someone who sees the world in shades of grue, I would think? Also, there are fascinating studies that your linguistic culture has measurable effects on colour perception. 🙂

    Props for the the Doctor Who quote and using the word spheniscoplasty! (I noticed a shear that should be sheer.)

    Commenting on phone, I’ll add more serious thoughts if no one else has covered them by later.

    • JP says

      Oh, I hadn’t even picked up on the ‘grue’ reference! I was too busy pondering how brilliant ‘congenitally blind’ was in this context. Altogether a pretty genius sentence, no matter how you parse it.

    • Alex says

      I’d actually assumed the joke was based on the blue/green colour distinction being one of the last to evolve, linguistically. Consequently, there are many cultures that don’t distinguish verbally between blue and green [and, as a result, tend to have a harder time distinguishing between them visually]. And that this was a reference to the cultural constructedness of gender/gender roles.

      >.> but “grues” makes more sense and requires less over-analysis.

  4. Sebor says

    I think people who make the penguin argument should be required to live in the arctic until they understand their fallacy.

    • northstargirl says

      The penguin argument never fails to push my berserk button. I would pay a large sum of crisp new Internet money for the perfect snappy comeback to it that would shut up the next person who tries it on me.

      • Sebor says

        That was kinda the point. Just like there are no penguins in the Arctic there are no penguins born to human mothers. Just thought it would be nice to let the grues figure it out on their own.

    • Anders says

      If you look in the middle of the brain, you will find a section called post central gyrus. That’s where the sensory body map is located. The right hemisphere seems to be more important than the left (you get strange symptoms if you have a stroke in the right hemisphere, but not if you get it in the left. Those interested in reading more should look here: http://en.wikipedia.org/wiki/Anosognosia)

  5. says

    I’d love to see a double blind study (if such a thing weren’t so hamstringed by how ethically dubious it would be to give a trans person placebo hormones),

    isn’t it always “ethically dubious” to give a person who needs medication a placebo instead? isn’t that why such studies generally make it very clear that there is an even chance of getting the placebo and getting the actual medicine?

    basically what I’m asking is, is there a reason why this would be more ethically dubious than with other medical double blind studies, considering some that such studies are done even in situations where the drug in question is potentially life-saving (and thus the placebo is a withholding of a potentially life-saving drug)?

    • Alex says

      Yes, using placebos when a known viable treatment exists is morally suspect. However, the analogy to medical drug tests is somewhat flawed because the number of studies done against placebo on humans is extremely low. Medicines are not being evaluated against “doing nothing”, they’re being evaluated against “current best treatment”, and most studies reflect this methodology.

    • Anders says

      That’s not the only reason we randomize – it’s necessary if we are to use statistics and show efficacy. I have heard of a case where they tried a new HIV drug that should only be taken once per day, rather than the three drugs they were taking today, and that was against placebo. The patients felt that it was worth a risk to get rid of the hassle.

      The study would be technically easy to run; I think the largest problem would be to find enough patients. And the patients would get check-ups from specially trained and dedicated personnel. People who have read up on trans people. How common is that? So there would be some benefit for the participants.

      No, the problem is that I don’t really see what clinical benefit for trans people there would be. I’ve been talking about this before, but article 17 of the Helsinki declaration (2008) specifically states:

      Medical research involving a disadvantaged or vulnerable population or community is only justified if the research is responsive to the health needs and priorities of this population or community and if there is a reasonable likelihood that this population or community stands to benefit from the results of the research.

      There’s no doubt in my mind that trans people are such a population and that (rightly) limits what we can do. So, yeah, what they said but perhaps a little more in-depth.

      • julianmorrison says

        You probably can do observational studies of trans people who take homeopathy, and call that a placebo.

  6. says

    Conversely, when cisgender people are given “cross-sex” hormones, the results tend to be intense depression, anxiety, irritability and even suicidality.

    Does anyone know where I could read more about studies like this? Sounds interesting.

    I also wanted to add: Growing up whenever I heard the “woman in the body of a man” explanation, I always thought it referred to something like “soul of a woman in the body of a man”. As a lifelong non-believer in things like souls I always thought that was bullshit, but the important thing was that just because I disagreed with (what I thought was) their metaphysical understanding of reality, I still understood that they wanted to change gender. (Though now I realize it’s more complicated than that.) And frankly, I didn’t need to understand why in order to think of trans people as human beings who should be allowed to be themselves or do whatever they want to their own bodies.

    My understanding has increased now that I’m older, but my point is that even as a kid I was able to just say “doesn’t hurt anyone, let them do what they want.” Which, I think, is the bare minimum that people should be able to do in order to just treat people as fellow human beings.

      • says

        Alan Turing’s probably not a good example. Not because he wasn’t forced to take the wrong hormones (he was) or that he wasn’t an immensely tragic figure and loss to the world (he certainly was that, too), but because his circumstances would have been masively depressing even without the hormonal treatment.

        His example doesn’t falsify the hypothesis either, and I suspect it’s correct, but I don’t think it actually presents evidence for it either.

        — Abbey

        • says

          Well, just to be clear, I am aware that the “endocrine dysphoria” aspect of my theory here is the shakiest of the hypotheses I presented. I believe it’s likely true, but I’m well aware it could be totally wrong. So please don’t mistake me for being over-confident in it. It’s a tentatively offered, unproven hypothesis, not something I wish to present as definitive fact.

          • says

            Ah, sad (at least for me). That would be a very interesting read, I think.

            Oh well, I suppose there’s only room for so many interesting Reeds in the world. 🙂

    • Megan from NZ says

      If you look at any of the drugs used for feminising hormone therapy that are primarily used for treatement of prostate cancer or hair loss in men, you’ll see one of the major side effects listed on them is depression. That’s about as close to a clinical study as trans* people get.

      • Anders says

        And then we have women who experiment on themselves and take steroids to build muscle. Yep, depression is common there too, and it doesn’t seem to occur in men who take steroids (at least not to that degree).

        I wonder if trans men get depression from testosterone. Difficult to study, though.

  7. cami says

    wow. good one, Natalie. Yes, diversity is very, very cool. What an amazing essay: Spheniscoplasty, trannithallamus, green and blue, W2’s, pro-op, and a Doctor reference. Fucking brilliant. I really liked this phrase: superficial appearance and personality. You did overlooked one important variable, though. What about having conversations with imaginary squirrels that live inside your head?

    I love you!
    PS: I have paid good money for books that were total garbage (She’s Not There)like so many times and I get all this for free? I’m gonna kick you down some cash soon, I promise.

  8. says

    I’ve been thinking along the lines of those variables for a while now. You’re absolutely right, about variance within cis experience. I can’t even tell you how validating this is.

  9. No Light says

    WRT. hormones : I spent years (from the age of twelve) suicidal, feeling intense hatred toward my body, and harming myself.

    At 21 I found out why, my ovaries were not working properly and I was awash with testosterone. My endo said that my levels were more consistent with a man, not a person with my body. It explained my body shape, facial and bodily hair, and skin problems.

    What I wasn’t expecting, from the HRT, was the feeling of mental calm, of my body. feeling connected to my mind, and the clarity of thought. I felt like I was becoming something that I’d always known I was.

    So on encountering trans people it was easy for me to shudder, and remember the hidden horror of brain and body being bathed in the wrong hormones. To experience a lurch in my stomach, a sadness and anger that their journey to the necessary treatment would not be accepted easily, or welcomed, like mine was.

    I’m agender now, with bodily features (like a beard, male fat distribution, odd hairline,, a pelt of body hair) that I think fit well with the boobs and feminine facial features. I’m not a woman or man. and as a gynephile the word ‘dyke” fits very comfortably.

    I’m not sure whether I was born this way, or wade this. way by years of testosterone with very little oestrogen to oppose it. However my non-binary self got here, all I know. is that I’m finally comfy in my skin. I just wish everyone had that chance.

  10. John Morales says


    I’m as cisgendered as they come, but I still find this stuff interesting and informative.

  11. Cynthia says

    “But nonetheless the bricks can occur in any combination. And those combinations will end up producing lots of different beautiful patterns.”

    And that’s why we keep coming back to you, Natalie. You have a turn of phrase that is so beautiful, so…poetic (the only word I can think of). And no one else works in Doctor Who, slippery word games and LEGOS! I mean, really, who else gets all that into one post? Nobody!

    And the information is perfectly timed, it almost makes me believe in fate. I’m in the middle of explaining to my kids how sexuality can be fluid, we don’t know much about how it’s really figured, we just really don’t know. Which means that there is no right answers, no wrong answers. There’s only you, making your choices. I can’t do it for you, because I don’t live in your skin. This post will help them understand that a little better, I think.

  12. min says

    Another great post. After this, im totally going to pursue hormones. I’m glad my friends support me.

  13. deanmarold says

    This explanation makes it so much easier to understand how a persons ideal body could be very different to a cisgender ideal, which the simplified explanation doesn’t account for at all. Thanks for laying out all this stuff in such a clear way. Your description of gender as a ‘loose, aggregate, perceptual assignment’ also has me thinking about sexual orientation. I’m wondering what specifically gynophile and androphile might refer to, when these properties they define themselves against are so multifaceted. Anyway, thanks for all your excellent writing Natalie!

  14. says

    Wow you just took all the thoughts swimming in my head about gender and made them pretty fucking cohesive. Basicially I know that gender is a spectrum like sexuality is a spectrum but because gender related to so many aspects of the brain the spectrum looks more like MC Escher’s Concentric Rinds drawing. I kind of have this mental image with things like sexuality including pansexuality demisexuality and asexuality but I could allow the linear spectum description to still workably apply where it just didn’t come close to fitting with gender.

    So yeah. Thanks for this. Now I have esomething to point to when I want people to see my understanding how gender works.

  15. says

    This post was… incredibly relevant to how I’ve kinda felt lately. Anecdotes time!
    For starters, having a uterus bothers me. Same thing with secondary sex characteristics, sometimes, especially if they become a topic of discussion or a major ordeal or something. That said, I don’t want to transition to being male, or change my name, or go by male pronouns (despite the fact that I do enjoy it when people call me ‘he’ on the internet if they don’t know my gender). I don’t even want to look male; I like how the female body looks and I like seeing it in the mirror.

    At the same time though, I usually don’t ‘feel’ female, even when I feel like being ‘feminine’. Hearing about how certain things about me (periods, my particular set of reproductive organs, the ability to get pregnant, and any of my feminine personality traits) are just ‘part of being a woman’ bothers me.

    so I’ll tend to alternate between considering myself genderqueer, and convincing myself I’m not, because I feel like I’m not enough so to actually be genderqueer. I prefer presenting myself as female, and when it comes to pronouns I’m fine with an unspoken policy of “use whatever one you want” and general annoyance when people who know me correct others about not calling me ‘she’. This lax-ness tends to make me feel like I’m faking genderqueer-ity or something though, as much as I don’t know why I’d want to fake it.

    And, finally, there’s the added problems that come with transiness in AFAB-people. That is, “you’re a traitor to feminism!” “You’re just trying to escape misogyny” etc.

    So… this was a nice post, and a nice reminder that I really shouldn’t be so worried about this “but am I REALLY genderqueer?!!?” nonsense.

    One final note: nice use of alliteration.

    • Rawnaeris says

      ^^^This this this.

      I didn’t even realize I was genderqueer until I was discussing methods of appearing male with trans-male aquintences on an asexuality forum. And then the topic really sank in and I had my second “duh!” moment in a month. The first being why I was on an asexual forum to begin with.

      I don’t mind being female or presenting as female, most of the time. But there are days where I look in the mirror and I see myself and I don’t recognize me. The female looking out at me feels wrong. Sometimes though, it’s the other way around. I’m feeling feminine that day, but I see a young male.

      • Rawnaeris says

        And my first sentence doesn’t make sense. I was unfamiliar with the concept of genderqueer until recently. Since I didn’t know what it was, I’d always assumed I was just a really odd cis female.

  16. TBS says

    Very few posts here have left me saying, Really?

    Look, I am as supportive as the next cis man of trans sexuality. I am engaged to a post op trans woman.

    R, had a dificult, near impossible time in transition. And she is an androphile, femme, post-op person. I like to use as shorthand “woman”.

    It probably is not my business, but, while folks playing with gender are interesting, they to a degree make it harder for what I’d like, which is for trans-people to be legally and socially accepted in their actual gender.

    Genderqueer and other movements may have something to add, but to the extent it messes with the above, I do not see it.

    • says

      The transsexual-separatist “we should stop affiliating with non-binary folks because they make us look bad” line of reasoning reads no different to me than the “we should drop the T from LGBT because those tranny freaks make us look bad” line of reasoning.

      We may perceive, and understand, nuanced differences in etiologies. But they don’t. To them, we’re all just icky queers. One big problem to be solved, one singular flaw to be erased. Like it or not, with all our differences and all our commonalities, we’re in this together. And if we can’t understand that, we might as well give up now.

      Fighting for understanding and acceptance of gender variance demands fighting for understanding and acceptance of the gender variance itself, not just particular variants. A trans-feminism that can’t accommodate the full, diverse spectrum of lived trans experiences and inhabited trans identities is not a trans-feminism worth fighting for. At least not for me.

      I’m binary-Id’d and femme and androphilic and relatively, conditionally passable and everything too. But I know that doesn’t make me better than any other trans person, and if I start thinking associating with other iterations of trans identity is “dragging me down”, I’ve lost any claim to being an activist on behalf of the community rather than simply myself. And we already have more than enough people in this world fighting just for themselves.

      And frankly, it’s just plain ignorant and insulting and cissexist to assume non-binary or genderqueer identities are merely “playing” with gender.

      • TBS says

        I will admit to ignorance, risk being cissexist, and dearly hope and endeavor not to make any insult.

        Perhaps this comes from people, and not ideas? Some folks I have met that use the genderqueer label did not seem to me to be serious people. I fully recognize they may not have been the best representatives of this idea.

        You have a good point, getting tied in parsing etiologies may be counterproductive. I am, though, as much as I dislike it, a member of “they”, to which you refer.

        Before two years past I didn’t even know there was such a thing as a trans-gendered person.

        I guess the two (2) trans-gendered individuals I have actually met really impressed me with the stories they had about transition. I respect J (ftm) and obviously R a great deal. Transition was some serious business.

        I have had some experiences with alter gender folks. I do know it is not a zero sum game, but, yes I just want R accepted as a woman.
        Now I do recognoze this is not a zero sum game. My *experience* with alter gender folks hasn’t been positive, but they can do what they do and not detract feo

      • TBS says

        I will admit to ignorance, risk being cissexist, and dearly hope and endeavor not to make any insult.

        Perhaps this comes from people, and not ideas? Some folks I have met that use the genderqueer label did not seem to me to be serious people. I fully recognize they may not have been the best representatives of this idea.

        You have a good point, getting tied in parsing etiologies may be counterproductive. I am, though, as much as I dislike it, a member of “they”, to which you refer.

        Before two years past I didn’t even know there was such a thing as a trans-gendered person.

        I guess the two (2) trans-gendered individuals I have actually met really impressed me with the stories they had about transition. I respect J (ftm) and obviously R a great deal. Transition was some serious business.

        I have had some experiences with alter gender folks. I do know it is not a zero sum game, but, yes I just want R accepted as a woman.

        My *experience* with alter gender folks hasn’t been positive, I do think there is a qualitative difference between experimenters and those that do SRS, given from what I hear it is a difficult process.

        I still, unfortunately, am them.

        • TBS says

          Goodnes gracious, please ignore above, and many apologies. New tablet, I can’t work it well yet.

  17. Abby Oster says

    Thank you so very much for the most thoughtful dialog I’ve read to date on how biological variances may account my own condition. I spent the first five years of my college career immersed in studies of biochemistry, genetics, cellular physiology and the like. In my own activism, I have often framed my education efforts using the sparsity of scientific research available wed with my own empirical experiences on this path. The lego analogy, proprioception and “body map,” and the hypothalamus as the source of endocrine level discord will all be extremely helpful in future efforts.

    I am graced to live in Seattle, WA, a city with broad acceptance of the entirety of the LGBTQ* However, considerable ignorance is pervasive even among would-be allies. Ironically, all of my factual, logical arguments often prove of only secondary value. It turns out my own personality is what opens peoples minds the most. Who knew!? I do fall on the far side of the gender binary as femininity and that is much more instinctive that societal conditioning I believe, a view supported by this article. Simply, those not entrenched in ignorant bias always respond with sentiments basically stating they can only conceive of me as a woman, period. That has bitten me in the ass a few times when working with other trans / gender variant people who turn their own prejudices loudly toward anything representative of the gender binary. That is their issue and most know better than to pick that fight with moi.

    Simultaneously vexing and yet tremendously healing are my experiences with my girlfriend of 8 months. To quote her in a snarky space, she’s a “bio-born, vagina-clad, lezbo.” Now, here is a woman who came out at 18/19, lived the dyke life to the hilt in San Francisco, and has a penchant for high femmes. She’s also an extremely giving, open-minded woman who can become a fierce force of nature in the face of prejudice. Verbal evisceration is a good description of the fate of the few who were stupid enough to echo transphobic prejudices about me. All of that is to provide some preface. My point has been the rock when the waves dysphoria have crashed down on me in the past. For her, I am “a woman who got screwed in the birth canal.”

    She sees my gender, my identity as inherent, unquestionable, beautiful even when my own brain would tell me that I was disgusting, a freak, not deserving of life, etc., etc. Despite being relatively graced as far as anatomy, bone-structure, etc., any and all hints of being testosterone-affected would often leave me in a suicidal space for nearly a week. Were I not in recovery from alcoholism, entrenched in the recovery community, and without people like her in my life, I am quite sure I’d be dead of my own hand due to dysphoria. Like some others have mentioned, my genitalia used to crush me regularly.

    Due to a legacy of previously living male, I had the financial resources to handle hair removal, vocal training, wardrobe, HRT, therapy in the last two years. Yet, despite all of this, the few hairs remaining that require electrolysis, the male-pattern baldness under my wigs, and other almost delusional perceptions of my anatomy all lead to days when I’d cry so hard that I would end up lying in exhaustion, staring blankly at the wall, and musing suicide options. This piece goes a long way in explaining the biological realities which may have been influencing those periods.

    Now, with the full weight of gender inequity finding another target, I am in relatively desperate straights financially with no immediate plan for how I can possible afford SRS. As a card-carrying grade A lezbo, I’ve even considered prostitution even though that option sounds far less appealing that taking a header into fire ant mound while burning alive. So, with all options weighed, I’ve made good progress toward acceptance of what is while nurturing hopes of what will be one day.

    The last, most difficult part of this process for me has been the shame of simply being born transgender rather than a cissexual woman. I have alternatively viewed it as a curse, a birth defect, a source of irreconcilable hatred toward God or whatever else may have caused it (rational thought was out of the office those days). Down deep, being born this way was somehow fundamentally unacceptable to my brain. And that, that sentiment this article goes a long way toward explaining or at least posit possible biologically based causation.

    I will be sharing this article far and wide with others. Thank you so very much again, Abby


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