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Deconstructing gender dysphoria and gender-affirming therapies

For people dealing with gender dysphoria, transitioning—be it social or medical—can be the key to living their authentic self.

When people feel that the gender they were assigned at birth does not align with their gender identity, they may be experiencing “gender incongruence.” This can cause distress, depression, and confusion that may be attributed to a medical condition called “gender dysphoria.” Many people suffering from gender dysphoria face societal pressures to conform to cisnormativity, which assumes that all people are cisgender or align with their assigned gender at birth.

An inner struggle

While feelings of gender dysphoria are commonly experienced especially by transgender people—such as agender, genderqueer, and gender non-conforming people—not all suffer from this condition. Being transgender simply means having a gender identity that is different from that assigned at birth, and does not look into one’s desire to be another gender.

As trans people perceive an identity different from the norm, some battle with internalized stigmas that make it difficult to accept gender diversity. However, since gender is fluid, people are free to identify outside the male or female gender binary. As gender notions vary over time, it is only until recently that diverse gender identities were acknowledged in the medical field.

In 2019, the World Health Organization made progress in transgender health by removing “gender incongruence” from its International Classification of Diseases. Though the transgender community has achieved more visibility, gender dysphoria remains widely misunderstood, leaving those suffering from it caged in bodies that do not align with who they are.

Understanding diversity

Dr. Patrick Eustaquio, a clinician from LoveYourself Inc., explains why some queer people are more likely to experience gender dysphoria than others, “While its specific cause is still unknown, it is—like any condition—due to the interplay of biopsychosocial factors.” Although researchers have yet to determine if there are any genetic links in people with gender dysphoria, establishing gender roles, such as early conversion and aversion to gender diversity in children, can contribute to gender dysphoria.

As LGBTQ+ people suffer heightened discrimination and abuse from their diverse sexual orientation, gender identity, and expression (SOGIE), they are more susceptible to having mental disorders compared to heterosexual and cisgender people. In stress theory, Meyer’s minority stress model probes into these social stressors, citing that negative social conditions could mentally and physically impair people in stigmatized categories.

Aside from the symptoms associated with gender dysphoria, Eustaquio mentions how it could lead to other issues like “interpersonal conflicts, violence, rejection, discrimination, anxiety, substance use, poor self-esteem, and worse, suicidality.” For patients, these negative health outcomes may persist for years.

Although gender dysphoria may start in early childhood, some patients may only seek treatment—like counseling, hormonal therapy, or reassignment surgery—many years after experiencing initial symptoms. As this gap may lead to prolonged depression and anxiety, supporting early treatment against gender dysphoria—including social or medical transitioning—could potentially improve the lives of patients.

While medical interventions can help in affirming one’s gender, it is not the only solution to treat gender dysphoria. As an initial step, socially transitioning—like using correct pronouns and adapting a different name—can be beneficial for trans people to feel more comfortable as they transition. Along with this, trans people do not need to have gender dysphoria just to “confirm” their identity. In fact, it is a belief that should not be enforced nor normalized.

A way out

Gender-affirming hormonal therapy (GAHT) is considered an option for those struggling with gender dysphoria who would want to undergo medical transition and as per Eustaquio, is the gold standard for its association with increased quality of life and decreased depression and anxiety. However, hormonal medications, which include estrogen and testosterone, may present problems for those with preexisting conditions.

According to Eustaquio, estrogen is harmful to those who are already at risk for blood clotting disorders, have a history of stroke, and have active or end-stage chronic liver disease. On the other hand, testosterone should not be prescribed to those with untreated polycythemia (a type of blood cancer) and unstable coronary artery disease. Furthermore, those with hormone-sensitive growths of abnormal tissue masses, otherwise called hormone-sensitive neoplasm, cannot take hormonal medications at all.

While the use of GAHT remains hotly contested among lawmakers and laypeople alike, many of the treatments used for gender affirmation started among and continue to be offered to cisgender men and women. For example, women use hormonal contraceptives for birth control or to manage irregular periods such as with polycystic ovarian syndrome. Furthermore, women with premature menopause and men with abnormally low levels of testosterone may be recommended hormone replacement therapy. Furthermore, gender-affirming surgeries such as chest and genital surgeries and forms of facial reconstruction that were first done on cis men and women are now being applied in GAHT.

Besides GAHT, Eustaquio also stressed the importance of mental and behavioral treatment as well as peer support for gender dysphoria management. Research indicates that the transgender population experiences almost three times the risk of probable anxiety disorder compared to the general population due to low self-esteem and poor interpersonal functioning. Notably, though, the prevalence of depression and anxiety decreases among trans people after they have undergone hormonal treatments.

But with the prevalence of stigma and lack of information in the country, transgender health issues are rarely discussed in the medical industry leaving those in need of treatment at a loss for effective and competent healthcare. As experienced by Eustaquio, medical students lack the exposure to health issues of transgender people. This can greatly affect the way they would deal with patients when in practice—furthering the stigma and maltreatment, especially of trans patients. This may discourage patients from seeking medical help at all. In fact, a study done at the LoveYourself Inc. TransHealth Clinic found that more than half of their newly enrolled patients were already on GAHT and that over nine out of 10 were self-medicating, likely due to the lack of inclusive and competent healthcare available.

Happiness as a privilege

“Gender euphoria” is the term used to describe the joy of alignment between one’s gender identity and gender expression. However, gender norms and social stigma make it very difficult for queer people to experience this as often as cisgender people do.

According to research by the World Health Organization, many trans people feel stigmatized and disrespected in health care settings. Some cases outline how before even getting the chance to see a doctor, transgender Filipinos are treated with contempt and embarrassed by the registrar. Instances like this discourage them from seeking any healthcare at all.

While it is clear that medical schools need to update their curricula and healthcare staff should be trained to be more inclusive, there are multiple layers to this problem that stem from culturally rooted transphobia. Ensuring a healthier environment for queer and transgender people will thus require a systemic overhaul.

Despite the existence of GAHT and a plethora of evidence that shows its effectiveness against gender dysphoria, seeking treatment remains an immense obstacle for Filipinos suffering from it. As this persists, this leads to depression and low self-esteem, especially among adolescents. Healthcare workers along with educators and mental health professionals need to all be equally educated to support gender affirmation. The SOGIE bill, which prohibits the discrimination of people based on sexuality and gender identity or expression, should be passed into law. After decades of depriving queer people of their rights that gender euphoria is viewed as a privilege, it is high time they receive the quality of life they deserve as fellow human beings.

By Ysabel Dinsay

By Francesca Salting

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