Dysphoria and Surviving It
Content notes: gender dysphoria, medical transition, suicidal thoughts, self-harm, sexual violence
A german translation of this post is available.
„How does gender dysphoria feel?” is a really hard question. Imagine describing what pain or hunger feel like to an artificial intelligence that has never experienced those sensations. Every animal with a central nervous system knows what pain feels like, that includes humans. You never have to explain pain to anyone. We all experience it very early in our lives and we all know it, with rare exceptions.
I’ve been struggling to describe this feeling and sensation that has been such a big part of my personal experience as a trans woman. For a very long time I didn’t have the right words and no fitting metaphors for that. Only over the past year, while my own dysphoria became much stronger to the point of being unbearable, did I find some ways to express this.
A few words up front, though: I am writing this from my personal perspective. I absolutely don’t speak for all trans women, let alone all trans people. I’m writing about body dysphoria, the distress regarding one‘s own body. There’s also what I would call social dysphoria, wich has more to do with how people interact with you and is often triggered by misgendering and deadnaming. Different kinds of dysphoria often interact and overlap. Not all trans people experience dysphoria, many experience it in very different ways, and it’s certainly not a requirement for being “really trans”. Being a woman (or any gender for that matter) doesn’t require a specific anatomy or body shape, and medical transition steps should serve to improve the transitioning person’s life, not just to conform to other people’s expectations.
As I’ve written in the post about my childhood, after a certain age, around 5 or so, I no longer really recognize myself in photos from that time. Sure, I remember that I looked like that but it’s like I was wearing some strange form of make-up or mask. Back then what I saw on photos or in the mirror seemed somehow off to me, disconnected from myself, but I didn’t have the words to describe that and I thought that maybe it’s just a part of growing up. This was the first aspect of body dysphoria that became noticeable and it only got worse once puberty hit. A few years of testosterone-induced changes to my facial features and the addition of patchy but very dark and visible beard growth made my face unrecognizable to me. Whoever that was in the mirror, it wasn’t me anymore at all. When you don’t recognize yourself anymore it also becomes difficult to find motivation to care for yourself, to put any effort into getting your life together, because you don’t know who you’re even doing it for.
The first steps in my medical transition process luckily had a very big impact on my own perception of my face. A clean shave always felt like peeling away at least a small part of the mask but it only lasted for a few hours before a visible beard shadow appeared again that was hard to cover up. After a few months of hair removal sessions I could finally get through a whole day without that. Then when I started hormone replacement therapy it took only a few months before I noticed subtle changes in my face. Every week a little more of someone I could actually recognize as myself peeked through. Now, over a year later, I can look into my bathroom mirror every morning and no matter how tired I look or how messed up my hair is and even after not shaving for three days, it’s always myself who I see.
My other main source of dysphoria was much more difficult to address. Ever since the beginning of puberty I felt increasingly disconnected from the parts between my legs. I wouldn’t even call them „my genitalia” because they certainly never felt anything like „mine” in the way that other appendages like my hands or feet do. Usually I don’t think about my feet. They’re just there and unless I step on something or accidentally hit my toes I don’t consciously think about them. I assume this is similar for most people. We aren’t really aware of the body parts that are where they belong. I felt very differently about the genitalia I was born with, constantly aware of them and always perceiving them as a foreign body, like they had been permanently glued there somehow. And not only did they feel like a foreign object but a foreign object made from human skin and flesh, not part of my body but someone else’s. It always felt like being touched between my legs by another person. If this sounds horrifying, it is. For me as someone who has survived sexual assault this was constantly re-traumatizing.
The moments when genital related dysphoria was strongest were during erections. And as everyone with a penis knows, conscious control over those is limited at best. Physical intimacy was always a balancing act. On one hand being close to a partner and experiencing sexual pleasure was something I wanted, on the other hand those things usually intensified my dysphoric experience. Also, I found myself unable to openly talk about this problem before I had come out as trans. Often I tried to ignore how bad I felt during sex but that didn’t work reliably at all. So more often than not I just let things happen even when I didn’t enjoy them in order to “perform normally”. As a result it also took me a long time, until my late twenties, to learn to say “no” in sexual contexts out of fear of someone noticing what was going on with me.
For many years I managed to live with this but after coming out and starting to live as myself it became much worse. While the dysphoria about my face slowly subsided thanks to hormone replacement therapy (HRT) and hair removal, dysphoria about genitals remained unchanged and became that much more noticeable. I was no longer able to engage in any sexual activity and eventually even simple things like walking or sitting became very difficult. Walking for longer than maybe an hour often resulted in dizziness and nausea. Taking a shower had to be done as quickly as possible while staring at the wall in order to at least not see any of this mess of a body. The distress from this became so intense that it lead to frequent suicidal thoughts and a general state of hopelessness. There were also several instances of self-injury.
I only had very few options to deal with the strong dysphoria during that time. One thing that helped pretty reliably was very hot baths. The heat and the feeling of weightlessness in the water dampened everything enough that I could at least fall asleep afterwards. Still, lack of sleep was a major problem and I would often wake up at night and have difficulty falling asleep again. Distractions like movies or video games stopped working after a certain point, too.
Things got better though, much better. I’m writing this while recovering from a vaginoplasty surgery, more commonly known as “bottom surgery”, “gender affirming surgery” or similar terms. My genital dysphoria now no longer exists, it’s simply gone. I expected there to be quite a long period, maybe weeks or months, where I would have to get used to having a vagina, clitoris and labia. That was not the case. After the pain and general exhaustion went away, everything just “clicked” and felt right. This is the first time my body actually feels whole, like one coherent unit. Nothing feels out of place or disconnected. I can look at myself without problems. Everything looks and feels like it’s in the right place.
That brings me to the other side of all this: Euphoria. While body dysphoria refers to a state of distress about aspects of one‘s body, the corresponding euphoria is the opposite, a positive, affirming feeling of things being as they should be. The result of my surgery is clearly the most obvious and extreme example of this where severe dysphoria turned into strong euphoria practically over night but there where other more unexpected instances too.
One very common and usually intended result of estrogen based HRT is growth of breast tissue. I never really had dysphoria about being flat-chested. I didn’t use any breast prosthetics because those actually caused dysphoric feelings. Only once while traveling I had to use a stuffed bra because it turned out that even just slightly better passing improved my safety on that trip significantly. But once my breasts started growing, even though I had unusually strong growing pain, I had a clearly positive feeling about them and I wouldn’t want to miss them now. A similar thing happened after my tracheal shave surgery. Initially I decided on this procedure because the external appearance of a very visible “Adam’s apple” was disturbing to me and it’s also one of the easiest ways people “clock” you (meaning they recognize you as trans without being told). Both issues were solved by having this very minor surgery. However afterwards I noticed something else: my throat just felt better, especially when my larynx was moving (e.g. when talking or swallowing). I experienced a feeling of relief that I had not expected.
One common question from people who don’t experience dysphoria is how it is different from just not liking parts of your body. Many people have some aspect about their own body that doesn’t match their own and/or society’s expectations. I have those too: Among other things I consider my feet to be quite ugly and I really don’t like my nose. But they still feel like proper parts of my body. They don’t feel foreign and disconnected. I just don’t like them very much and that’s ok.
People have also asked how they could help someone who has severe dysphoria. Sadly I don’t have a really good answer for that. My dysphoria was mostly about how my body feels to myself, not about how it looks to others on the outside. Because of that, compliments on my appearance for example usually didn’t really help. Providing distractions was generally worth a try even if not always successful. Sometimes it was best to just give me space and time to let the worst phases pass while just being there with me. I sometimes engaged in self-injuring behavior when I was alone. Having some company usually prevented me from doing that.
What eventually fixed my dysphoria was receiving the appropriate medical treatment. I had to fight hard to get it and I don’t think I could have made it without the incredible support and assistance from those closest to me and from a therapist who was a great ally against the brutal bureaucracy that people have to face in order to medically transition.