Dysphoria Discourse

There has been yet another explosion of discourse over on Trans Twitter as a result of a couple of prominent people talking about their beliefs regarding dysphoria and what it means to be “really” trans.

The term “transmed” has come about, as an attempt at a more “gentle” form of what many folks call “truscum,” namely that you must feel dysphoria to be Really Trans, and that the end goal absolutely must be a “proper” transition, which is such an incredibly reductive, prescriptive, and invalidating set of concepts that it does much more harm than good to people who are already having difficulty questioning themselves and need support and compassion to figure out where they stand and what they need.

The problem with discussing dysphoria is that it’s such an ineffable, subjective concept that it’s impossible for two people to even agree on what it is – hell, it’s difficult for one person to agree on what it is – and it can also refer to so many things, many of which overshadow each other and behave in confusing ways, and thus how can any objective criterion be formed based on what essentially comes down to what someone’s feeling?

Much of the discussion around what it means to be “really” trans takes either the form of “you must have this much dysphoria” or “screw that, you don’t need dysphoria to identify as trans at all.” My feeling on it is more the following:

  1. On what basis do you identify as trans?
  2. Is that possibly a form of dysphoria that you just don’t realize is dysphoria?
  3. And if not, what harm does it do if someone identifies as trans but “really” isn’t?

Dysphoria itself can take many, many forms, and generally you only really focus on the current largest one. Throughout my own journey I’ve gone through the following phases:


As a child, most of what I now realize is dysphoria was rooted in being told things by adults who claimed to know me and my future, in ways which deeply conflicted with how I felt about myself:

“You’re going to grow up to be a big, strong man someday”

“This will put hair on your chest”

“Boys don’t play with toys like that”

“Your writing style is too girly”

“It’s so cute that you spend all your time with [best friend, who happened to be female] – do you want to marry her when you grow up?”

All of these are indications of dysphoria in terms of gender role and societal expectation.


When puberty hit, so did a giant wave of dysphoria. Every bodily change – my dropping voice, my growing body and facial hair, my rapidy-masculinizing facial structure – felt like an absolute betrayal. This is body dysphoria.

What was even worse was I started to gain this constant feeling that something was simply fundamentally wrong. I got depressed and withdrawn, and I spent a lot of time fantasizing about being something else, something not even human. I don’t even know what this would be called aside from just plain dysphoria.

My dreams often turned sexual but in a body-horror sort of way, focusing on just how wrong everything about becoming a sexually-mature male was.

I started to grow my hair long. Whenever someone called me “ma'am” or “miss,” I would feel internally very happy. I wouldn’t correct their mistakes. Unfortunately, other people would “stand up” for me and correct them. This is presentational dysphoria.

Most of my friends were women or gender-weird, and I cherished them so much, but at the same time, social pressures insisted that me spending a lot of time with a girl meant that we were “dating” and that there should necessarily be a sexual desire component there, and… well, toxic masculinity made it inevitable that these relationships would go in a direction that nobody wanted.

I tried coming out to my parents. I would tell my dad that I didn’t feel like my skin was my own. “Oh, we should take you to the doctor for that.” With my mom, I wrote a letter about how I felt, but swayed a bit too far on the “feeling inhuman” side of things, and that ended up not going over particularly well either. I tried bargaining with her about my reality and my feelings. Then I gave up.

Early adulthood

My first job out of college was at a defense contractor that also wanted to make computer games. It was a really, really weird place. By this point I was pretty sure I was trans and, whenever possible, I’d relax and just let my body language be naturally feminine, which is what felt right. Sometimes some coworker would see and ask me if I’d hurt my back or why I was walking that way.

There was also constant chatter of transphobic jokes throughout the office. In one of our game promo videos there was a scene where they’d used placeholder art in a gender-swapped way, and in one case the company VP said, “wait, that girl got a sex change to be a guy? I don’t think that works that way.” And I had to bite my tongue, because even though this was back in 1999 and the idea of a “trans man” was nowhere close to mainstream I knew better but I didn’t want to out myself as knowing anything about any of this.

A big part of dysphoria here was having to hide my nature and continue to pretend to be “one of the guys.” This is social dysphoria because of gender roles, and in addition there was a great deal of perceptual dysphoria because of not being perceived in a way concordant with how I felt..

At the same time, I went to a couple of support group meetings, and seeing all the people around me who were at varying levels of comfort and in different levels of presentational ability – and most of them not conforming to the “beautiful supermodel” ideal that had been ingrained in me from the worst possible cultural sources – filled me with a different kind of dysphoria, a “I will never pass, I will never look the way I want to, I will never seem human” sort of dysphoria.

I ended up going back to my university for grad school; if I was going to be uncomfortable it might as well be in a familiar setting.

Graduate studies

Many of my colleagues were women. This felt safe, this felt good, this felt like I could be myself, if it weren’t for the town I was in (CW: suicidal ideation, transphobia, homophobia, slurs).

I also got more involved in the world outside computer science. I focused a lot on my music, and this attracted the attention of a local performing-arts group. When their main organizer got in touch with me, he opened his email with:

Dir Sir/Madam,

and my response was,

Either will do.

This led to an amazing friendship, and while half of the active members of the group weren’t particularly gender-safe, both Gerald (the organizer) and Delphine (a former member who was still involved despite dealing with some major health issues) became fast friends and trusted confidants who were absolutely amazing and wanted to encourage me to actually explore my gender stuff and feel good about myself.

Unfortunately I couldn’t take them up on that, because I was still scared.

I decided that I needed to absolutely prove myself and my abilities, so that I could be so good and indispensable that nobody could reject me regardless of how ridiculous I came across to them. I put on a strong outward front, while at the same time I was crumbling inside.

I was open about my thoughts and feelings online, which attracted harassment and eventual doxing, and people threatening to out me to my university, people intent on keeping me in the closet and keeping me scared about how I felt. I had no support network for this.

I was finally seeing a therapist who at least pretended to know something about gender stuff. But she was clueless and adhered closely to a particularly strict interpretation of the Harry Benjamin standards (the predecessor to WPATH) which had enormous amounts of gatekeeping. At one point she gave me an ultimatum: come out of the closet or she couldn’t be my therapist anymore.

I came out to my parents for the second time. It was a disaster. I continued to feel trapped, and I was told that my feelings were invalid and that I didn’t know what I felt. This was also a conversation in which I got a double whammy of “Why didn’t you tell us before?” (even though I tried to!) and “But you’re too young to be making these decisions.”

Actual adulthood

So, after getting sick of the doctoral program and leaving with “just” a master’s degree, I did some contracting in Albuquerque for a while, at a small startup. The office administrator and I had conversations about gender stuff but I had to put up a mask of being a guy, still, although she kept on joking about trying to “draw out [my] feminine side.” In retrospect I wish I’d taken her up on that, although the whole situation was a giant stress bomb waiting to go off, and well, the less said about what happened at the company, the better.

I so much wanted to come out to my friends but no time ever felt quite right. I mostly put my gender exploration into my comics and my music.

I continued to have dreams about gender, usually taking on more of a non-binary feeling of indeterminacy. At the time, though, the term “non-binary” still didn’t exist, and transgender stuff was very much an all-or-nothing thing. I contacted some therapists who refused to work with an “in-betweener” like me, and I gave up.

Then I got the job at Ubisoft, at their new experimental gaming studio in New York. I thought this was a place where I could finally be myself, but the actual work environment made me scared.

I started doing DIY HRT, ordering estrogen from abroad. It felt amazing. I referred to this as “Project 721077” on my blog at the time (hint: convert it to hexadecimal), but scare stories about health problems and DVTs convinced me that I needed to wait until I could get under a doctor’s supervision for this. Meanwhile my mom saw some of the gradual changes in my body shape and rather than ask me about gender or hormones she started to insist that I was showing signs of “diabetes” and tried getting me to enroll in Weight Watchers and so on.

After things went sour at Ubisoft, I went to Amazon in Seattle. I so desperately wanted to join in with the trans community – after all, this is where Ingersoll was! – but I was scared, and a couple of bad actors at the company again used my gender identity as a bargaining chip to threaten to “blackmail” me to my supervisors in exchange for my silence on some… not very great activities they were a part of. And being scared, rather than doing what I should have done and go to HR, I complied.

Amazon stresses led to me leaving for a job at Sony in San Francisco; I thought people there would be more welcoming (and in fact the person who recruited me was supposedly on-board with my gender stuff!) but as a software engineer in the tech bubble of 2007 I still never felt comfortable taking the vital next step, even though pretty much everyone on the design side of the team was queer (but any time anything about my less-than-pure-cishet nature became known, people always reacted with shock and “oh my god I had no idea!” in ways that made me not want to go further).

I finally did find a doctor who was willing to do guided HRT. This was too late for me to get any reasonable feminizing effects, but at least the feeling of hormonal dysphoria went away – for the two months I was on spironolactone, anyway. But I turned out to have an intolerance for it, and my doctor refused to put me on any other antiandrogen, so I was stuck taking just estrogen, which helped somewhat but didn’t actually mitigate the hormonal dysphoria I felt due to testosterone.

I asked about getting an orchiectomy. The gatekeepers refused to allow it; they believed I couldn’t possibly know because I hadn’t been on spiro for a whole year, and apparently the fact that two months on spiro had me feeling the best I’d ever felt in my entire life wasn’t enough.

Later I went back to Amazon, and this time was determined to make things work for myself. I still didn’t feel comfortable with my immediate teammates, but by this time there was an actual transgender affinity group (in addition to the greater LGBT group) who I felt comfortable talking with about things. And then I finally started on what brings this diatribe back on-topic.

Medical transition

My primary source of dysphoria by this point wasn’t anything in terms of social or presentation, but purely hormonal. I absolutely needed my testosterone to be gone.

I found a urologist who was willing to do an orchiectomy on a purely informed-consent basis. And then suddenly my hormonal dysphoria was gone, and I felt amazing.

But then over time, other parts of my dysphoria snuck back in. I had dysphoria around my name and my perceived gender; when working at HBO I finally came out at work and started presenting more feminine, and the complete lack of response to it (aside from some occasional cheers) was incredibly liberating. And my teammates were great about using non-binary pronouns for me (which still didn’t feel right but I still felt – and sorta still do feel – that female pronouns were “a lie,” like I’m not deserving of them or something). But for every form of dysphoria which was allayed – hormonal, pronoun, naming – another one was ready to grow and fill the ecological niche left behind.

My biggest one at this point was dysphoria around my genitals; GRS solved this, at least. But since then I still have plenty of other forms of dysphoria to contend with:

  • My voice is still entirely too masculine
  • People still call me “sir” or assume me to be a Mr. or use masculine pronouns for me (even people who should know better)
  • When people do call me “ma'am” they usually end up quickly realizing their “mistake” and apologize profusely, which becomes a double-whammy; they do not understand that they had it right the first time, and they double-down on getting things wrong!
  • I wish my boobs were bigger (but I don’t want to deal with surgery for that right now)
  • I wish my face weren’t so masculine (but I don’t want to deal with surgery for that either)
  • I wish my writing didn’t now come across so masculine
  • I wish I had a different childhood
  • I wish everything could have been different


Okay, so, that got a bit more personal than I was expecting. But my point in all this is that:

  • People who identify as trans without dysphoria probably do have some sort of dysphoria
  • There are so many different things that qualify as dysphoria
  • At the same time the narrative that is built up for the One True Trans Experience is absolute bullshit
  • It is okay to not think you have dysphoria but still think you are trans

And, of course,

  • if you are trans without dysphoria and every indicator after transitioning (or choosing not to transition!) still is that you have a gender identity that is discordant with your assigned gender and you still feel you don’t have dysphoria: YOU ARE STILL VALID

Nobody can tell you how you feel. They will try to, but they are wrong.

I would much rather see a world where people decide they are trans and are allowed to back out of that gracefully, than the world I came to be in where you have to be absolutely sure and fit a perfect cookie-cutter mold and everything works out exactly how society expects.

I am absolutely frustrated at how much I lost out on because gatekeeping and social pressures kept me from exploring my truth when I wasn’t in a position to already be 100% certain about it, and my big wish for society is that nobody else has to go through that.


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