I won’t go into the DSM-V Gender Dysphoria criteria. The involvement of Kenneth Zucker was enough to keep Gender Dysphoria under mental conditions, and people keep weaponizing that decision. They keep doing so even though a lesser known statement by the American Psychiatric Association that clears up that transgender identity is not per se the mental illness, BUT xyz. They screwed us over on purpose and then it was revealed Zucker had vested interest in continuing his own thing.
I am talking about the WHO’s ICD-11 Gender Incongruence which is outside mental illnesses but it is still under Sexual Health related conditions. I find this odd, because I don’t think being transgender is a sexual thing, despite overlapping with sexual health a lot, but I still think is a misclassification and our enemies gleefully take the chance to weaponize this as well. In fact, reducing transness to a “sex thing” is a main line of attack for right-wing strategies, for instance saying “trans stripper” for drag queen story hour, or Project 2025 equating LGBTQ people with “pornography”, especially trans people. Using this argument for book bans etc.
So I got myself thinking, it is not the mind that is wrong it is the endocrine system. After all the gonads are operators for the endocrine system. The intervention is at the endocrine system. So why not start thinking of transness as an endocrine condition primarily?
Now, I start thinking I might be on the asexual spectrum, so I put the fact on the table. But this is not to undermine my proposal, I just think many people might not be seeing that because for most people sex is an important part of life and the overlap between “who you are”, “who are you going to bet with”, and “who you are going to bed as” is bigger. But of the three, I only see “Who you are” relating to gender identity, “Who you are going to bed” as sexual orientation, I don’t see much theory in the latter “going to bed as sth”.
So I think that the classification is in error, and it is motivated by erroneous constructs we tried to shake away by replacing “Transexual” with “Transgender” to focus more on identity and biosocial aspects of gender identity. So I don’t think that gender incongruence belongs in Sexual Health organically, I believe it is primarily and inherently an endocrine condition (your system does not produce the right hormones for you) treated with endocrine interventions (suppress the production of, or remove the organs that are the producers of the wrong hormones, or correct the results of exposure to wrong hormones). Sex hormones for sure, but hormones. The important thing here is the Self. We agreed against conversion; we preserve the Self, fix the hormones, not the other way round. It is an endocrine condition.
yes, I think it’s technically considered a neuro-endocrine developmental disorder
I would be delighted if this is a case. A neuro-endocrine developmental difference is more or less what I was talking about. I’d love if you could point me to some links.
But to be honest, “technically considered” is far far away from media coverage and public understanding. They mostly conflate gender dysphoria with being trans. (Not to mention that recently this discussion was rolled backed even further…). It is not in DSM, not in ICD, not in the media. Apart from me and you I’ve never met anyone even remotely considering this idea.
As a follow up question, if it is a developmental neuro-endocrine condition, there is a score of conceptual leeway for defining it in relation to neurodivergent and intersex conditions, perhaps as a distinct statistically prominent modality of overlap between the two.
(Side thought: Perhaps this can help promote the cause the other way, the opposite of phobes trying to sexualize the thing. Perhaps they both fare better with some demographics, because they lack the fetishist/homophobic connotations TERFs sustain themselves on.)
I think it’s just the scientists and doctors who specialize in this area who are aware of this, e.g. here’s a talk from the (relatively famous) neuro-endocrinologist Robert Sapolsky talking about it: www.youtube.com/watch?v=8QScpDGqwsQ
some people want to label trans folks as natural variation, and realistically it probably is for many - but I think you can’t deny that many of us experience distress from having the wrong sex, so … I tend to think if there is dysphoria it’s still a pathology, even if that is rooted in the distress people experience rather than anything like how others view the condition.
(Imagine a world where society is 100% accepting of trans people, there is no stigma at all, etc. - would a typical transsexual still experience distress? I think so, and I think that is grounds to examine this still as a disorder rather than merely natural variation.)
Obviously this doesn’t apply to so many trans and non-trans people who don’t experience dysphoria, who may or may not medically transition, and who don’t experience any distress from the incongruence between their unconscious sex and their natal sex.
My distress does not arise purely from social relations, I experienced mental health symptoms that seemed entirely caused by having the wrong amounts of hormones - things like anhedonia, depression, anxiety, parasomnias, etc. went away just from suppression of testosterone, and it seems that this tracks the experiences of many other people who medically transition (so much so that the community has coined a new term “biochemical dysphoria” to describe this), so I believe biologically there is something pathological / disordered going on for some of us.
This debate happens also with autism (and other disabilities), btw - some people have autism and don’t mind it at all, they feel it’s consistent with who they want to be, and the problems they experience from autism are all rooted in society not adequately accommodating their difference, and there isn’t anything innately disordered about their condition (it’s natural variation, not pathology). For others, it’s not that way and the autism can be a source of innate distress and disability in ways that those people feel is pathological and not consistent with who they want to be, and which would be a problem even in a world where society accommodates them as much as possible. So, autism can be either pathology or variation, depending on the individual, the severity, the particular traits, etc.
In terms of citations and links to some of the research on this topic establishing that “gender dysphoria” is a neuro-endocrine developmental disorder:
- Joshua Safer’s “Evidence supporting the biologic nature of gender identity” (DOI)
- Joshua Safer’s “Etiology of Gender Identity” (DOI)
- the collective research of Daphna Joel and Dick Swaab for the current scientific theories of “brain-sex”:
- Joel & Swaab, 2019, “The Complex Relationships between Sex and the Brain”, (DOI)
- Joel, 2015, “Sex beyond the genetalia: The human brain mosaic”, (DOI)
- Swaab, 2008, “A sex difference in the hypothalamic uncinate nucleus: relationship to gender identity”, (DOI)
- Swaab, 2000, “Male-to-female transsexuals have female neuron numbers in a limbic nucleus”, (DOI)
- Swaab, 1995, “A sex difference in the human brain and its relation to transsexuality”, (DOI)
Some videos touching on the biology:
- Trans People and Biological Sex: What the Science Says by Julia Serano
- Robert Sapolsky: Brain Gender
- Neuro-biology of trans-sexuality: Prof. Robert Sapolsky
- Sex and Sensibility by Forrest Valkai
The best explanation we have for why people end up with gender dysphoria is that during early development as a fetus, the brain sexually differentiates one way and later the body sexually differentiates another way.
EDIT:
oh, and I think what you are missing about the transphobes is that they are usually science denying, they already reject the science on biological sex, intersex conditions, and what we know about gender dysphoria - just like homophobes reject what we know about the biology of homosexuality, they are not in any way beholden to the science, and I think it’s entirely wrong-headed to expect the right science and theory to somehow fix or solve transphobia - it just doesn’t work that way, the bigots will hate us and want to eliminate us no matter what.
Also, they will sexualize us regardless of how we’re categorized - it’s not like the ICD is why trans people (and tbh queer people and women in general) are sexualized. It’s more like the other way around, the ICD category is reflecting the existing way people think about us in terms of sexual matters.
EDIT2:
Oh, and this also covers some of the same ground:
- What is the Cause of Gender Incongruence? from the Gender Dysphoria Bible
- The causes of gender incongruence Wikipedia article
You make some good points, that perhaps should be better explored on a more sound activist and philosophical basis.
Variation for example is a relatively statistical term. “Disorder” is a normative term. It sets some level above which it is considered pathological. This is like an age-old discussion about what is pathological in psychiatry and even medicine more general. The term “disorder” itself was chosen as less stigmatizing from the previous “disease”, but now it is considered itself stigmatizing. We are also talking about “mental health stigma” which is one of the intersectional oppressions that quietly affects trans people (another invisible one is whorephobia for example).
Intersex conditions are now called, if memory serves, differences of sex development. There is a reason for that, which is to reduce stigma. This is why we moved from Gender Identity Disorder, to Gender Dysphoria, to Gender Incongruence. Why should we go back to a stigmatizing term again? Because some people experience high-levels of biochemical dysphoria. Sure, the latter two terms make that point without bringing back the problematic term. After all cis people seeking similar treatments are not considered disordered. But the latter is classed outside mental health altogether. Also, assigned sex at birth is an established and meaningful term derived from intersex activism, since intersex people are literally assigned to a gender with lifelong consequences. In that light I think the shorthand “natal” sex is still problematic.
What are we left with? The disorder is that the gendered self is incongruent with the embodied aspects of sexual maturation. So I think the response misses the point because nobody seeked to invalidate high or even low levels of biochemical dysphoria. I think perhaps the majority of trans people do seek hormonal treatment, so I don’t see merit in highlight the emergence of a separate term like “biochemical dysphoria” other than “voice dysphoria”, “bottom dysphoria” and other stuff we say to communicate with each other without them being separate diagnostic categories.
Another issue that arises is that much of the legal advancement (and societal discussion surrounding it) leans more heavily to a gender expression civil liberty and its reduction on AGAB. Perhaps the point you are trying to make is the permanence and innateness of the gendered self, but I could do without the biological reductionism of it. I do believe gender identity is permanent and it has a component in the brain and other organs, but I want to make a point that we talk about a self, and it is not bad or mutable if it has an acquired or psychological side. There are plenty acquired traits that are immutable, such as the mother tongue. So far among trans activist I have seen two ends regarding this. Contrapoints evades defining gender identity altogether (Trans people are just this way.) Serano prefers to reduce it to innate sex roles, but even in animals sex-related behaviors are sometimes learned. Either way, this is just a “soft” argument, as I don’t say that there isn’t a biological aspect to transness, but I am not willing to say that it is the only aspect. I prefer the approach of it being a permanent biosocial developmental trait.
This is extremely important for legal recognition, and activists have pushed for explicit recognition of discrimination on the basis of gender identity, and not reducing it to “opposite to AGAB gender expression”, as this reduces it to existing protections of sex discrimination.
So, I don’t think that the argument which is essentially “some people experience extremely high levels of gender dysphoria because their brain was trans since the womb” means we should have a stigmatizing term for it. I think this approach sets apart a special class among trans people for which a medical term should be reserved, and I think it is unintentionally problematic. To sum up, I believe that existing activism in depathologization and legal recognition is in the right direction, and I don’t think that the argument of intensity of gender dysphoria for a subset of trans people is sufficient to grant the use of the stigmatizing term “disorder”. People who experience dysphoria, most of which might want endocrinological treatment, can use the established vocabulary regardless of levels, and don’t see how the proposal to move Gender Incongruence to endocrine conditions is affected by these arguments.
Something the general public doesn’t understand is that disorders are only disorders if they’re actually an issue for the person. An obsessive compulsion is only OCD if it’s an issue; if the person doesn’t care, it’s probably not a disorder. A neuro-endocrine difference is only a disorder if the person feels it is. And even then, “disorder” doesn’t mean they’re required to do anything about it if they don’t want to, because it’s their body and their choice. This goes against the eugenics-y idea most people have that diagnosis means you must have that “fixed”.
I wish people would interpret these as potential issues with studied options rather than brokenness requiring fixing.
The DSM situation adds a layer of nuance yet though.
i agree that the categorisation seems wron and harmfull, but i also think it is a mistake to reduce transness to ones body producing the wrong (amounts of) hormones. many trans people do not even care about their hormones. many care about other things related to gender and their bodies as well. i think it is a social and personal phenomenon, than can include or cause people wanting changes to their bodies, like their endocrine systems. the endocrine systems part therefore imo fall under a category such as “wanting/needing to change ones body (for social or personal reasons)”, while being transgender should imo be classified as a social/identity thing, the same as cis gender. thats my thoughts on it :3
“wanting/needing to change ones body (for social or personal reasons)”, while being transgender should imo be classified as a social/identity thing, the same as cis gender.
That’s a given. Even for the DSM-V they published this statement which says “not all trans people have gender dysphoria” and that the diagnosis exists so that those who need healthcare can have some type of code to use in the system. We are talking about the latter use. What this means is the simple question “What are we treating this person for?”
It is the same with the ICD. I don’t think I anywhere equated transness with either condition. I have been vocal about this distinction for many years. We are talking about the diagnostic class with which you get into a public health system to get care.
What category you put that under? There is no conflation of being trans with the diagnostic category.
Perhaps an aspect of your response could mean that this would reduce CARE resulting from this condition, for example justifying therapy sessions or other forms of psychological and social support. But these exist for any number of other physical conditions. They largely fall under the umbrella of “Health Psychology” or even “Community Psychology” or “Social Work”.
Much like people with other endocrine conditions, or chronic pain for that matter, it is in the discretion of the appropriate committees to say that these aspects of psychological and social support are suitable for trans people.
This does not mean that being trans is pathological. There isn’t anyone arguing such points in this space. It just mean if you can get these types of support from within the healthcare system. If you want to. Bottom line is that in the US “Gender Dysphoria” is used ubiquitously and it is plainly listed under Mental Disorders.
So the existing situation is already much much worse in the very aspect that supposedly is problematic with the endocrine approach.
