In a heartfelt Instagram post, Elliot Page opened up about his ongoing journey as a transgender man, touching on both his gender dysphoria and the “joy” he’s felt since announcing his transition in Dec. 2020.
“Dysphoria used to be especially rife in the summer,” Page wrote in the May 10th post, featuring a shirtless image displaying the chest scars left from having top surgery, a gender-affirming breast-removal procedure.
“It feels so f’ing good soaking in the sun now, I never thought I could experience this, the joy I feel in my body,” the post continued. “I am so grateful for what gender affirming care has allowed me and I look forward to sharing more of my journey soon.”
Page's post sparked comments from numerous trans people about the emotional and psychological impact gender dysphoria has on their body image — as well as the freedom they say they feel after receiving gender-affirming care, a spectrum of health services that can sometimes include surgery and hormone therapy.
Such conversations are helpful, say experts, as gender dysphoria is a deeply personal and often misunderstood experience. Awareness, they add, can help us better grasp ongoing conversations around gender and sex.
Dysphoria: What is it?
As defined by the American Psychiatric Association, gender dysphoria is the “psychological distress that results from an incongruence between one's sex assigned at birth," based on external genitalia, "and one's gender identity," meaning the psychological sense of one's gender.
That's not to be confused with body dysmorphia, an excessive preoccupation with an imagined defect or flaw. On the contrary, notes California-based gender psychologist Natalie Zhikhareva (“Dr. Z”), a trans person experiencing dysphoria will look at a part of their body — their chest, for example — and see only what is there.
"They clearly see their chest and express disconnection with what they see while acknowledging its existence," she explains to Yahoo Life, defining gender dysphoria as the "emotional distress one feels due to the incongruence between the gender assigned at birth and their authentic gender."
That experience can manifest at any age, adds Dr. Michelle Forcier, a professor of pediatrics at Alpert School of Medicine, Brown University, who's had trans patients dealing with dysphoria as late as their 70s. Still, it is more commonly seen in new patients in the clinical setting "before or around the time of puberty."
For some, she says, "it can manifest as anxiety, depression and result in self-harm or suicidality and other mental health issues." For others, she adds, "it can manifest as an eating disorder — overeating to hide the body or under-eating to restrict breasts, muscles, hips, etc."
How does dysphoria impact body image?
"If you feel gender dysphoria, you are almost always bound to experience a disconnect with your secondary sex characteristics due to how society genders your body," says Zhikhareva, leading to a feeling of not being grounded in the present and to struggles "in relationships, intimate encounters and friendships."
As a result, she explains, "you may never fully feel complete, grounded and comfortable, and I would even say affirmed in yourself, if body dysphoria is strongly present."
That's why many (but not all) of those experiencing gender dysphoria find treatment by way of gender-affirming care, a spectrum of health services that can sometimes include feminization or masculinization surgeries to help trans women (those born biologically male) and trans men (those born biologically female) to achieve a more masculine or feminine appearance; or hormone therapy, a broad range of treatments to help align a person's physical body with their gender identity (by way of estrogen for trans women or testosterone for trans men).
For many, such care is a vital step towards living full lives, as supported by leading healthcare organizations like the American Psychiatric Association, the American Nurses Association and the World Medical Association. And while these interventions are "not a must," Zhikhareva says, many transgender folks will decide to go this route because their dysphoria is so severe that it will feel like the only option.
It's why "many who do decide that gender transition is for them feel as if they are alive for the first time in their life," she says, noting that it was the feeling conveyed through Page's latest post.
Understanding the psychological benefits of transitioning, she adds, could make a huge difference in building compassion and empathy for trans people.
"I hear people often say, 'Why can’t you just learn to love your body?' when referring to trans and nonbinary folks," Zhikhareva says. "And it saddens me that they are so quick to project their own beliefs when they themselves always took their gender for granted and have no idea how painful incongruence feels."
It's why "access to gender-affirming care should not be a matter up for debate and should be accessible to those who need it," she adds, pointing to the onslaught of anti-LGBTQ policies and legislation in states including Alabama, Arkansas, Kentucky, Tennessee, Utah and West Virginia that limit or ban gender-affirming care for youth.
"Right now, there is so much misinformation," she concludes, "and I feel we neglect to listen to those who have gone through gender transition, and their accounts of how it has bettered not only their relationship with their body, but their overall wellbeing."
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