The medical texts required you to be gender dysphoric for you to be able to access gender affirming care for being trans. This ignores two important aspects of being trans, autistic perceptions of discomfort and pain; and trans euphoria.
In Australia, the medical texts required you to be “Gender Dysphoric” for you to be able to access gender affirming care.
In Australia, we are supposed to use the ICD, not DSM. The ICD defines “Gender Incongruence” rather than the DSM “Gender Dysphoria“. Even so, when I write support letters, I need to put that in terms of the DSM’s Gender Dysphoria 🙁 *sigh*
In essence, Gender Dysphoria is where you feel uncomfortable or not happy with the “natal” assigned gender (AMAB [Assigned Male at Birth], AFAB [Assigned Female at Birth]).
The DSM V tr for Gender Dysphoria effectively is “A marked incongruence between one’s experienced/expressed gender and natal gender of at least 6 months in duration” by two of the provided prompts AND “The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning”.
Expand to Full DSM Criteria
Following is the full DSM 5 tr Diagnostic Criteria for “Gender Dysphoria”.
A marked incongruence between one’s experienced/expressed gender and natal gender of at least 6 months in duration, as manifested by at least two of the following:
- A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics)
- A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics)
- A strong desire for the primary and/or secondary sex characteristics of the other gender
- A strong desire to be of the other gender (or some alternative gender different from one’s designated gender)
- A strong desire to be treated as the other gender (or some alternative gender different from one’s designated gender)
- A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s designated gender)
The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning. Specify if:
- The condition exists with a disorder of sex development.
- The condition is post-transitional, in that the individual has transitioned to full-time living in the desired gender (with or without legalization of gender change) and has undergone (or is preparing to have) at least one sex-related medical procedure or treatment regimen—namely, regular sex hormone treatment or gender reassignment surgery confirming the desired gender (e.g., penectomy, vaginoplasty in natal males; mastectomy or phalloplasty in natal females).
What this misses, in my professional opinion, is two important things.
1) Does the person have good interoception for discomfort and distress?
Most trans people are autistic, and many autistic people have poor interoception or definitions for sufficient discomfort and pain. Consider how many autistic people burn out because they went far longer than a neurotypical person would have…
2) While you may not feel devastated at being treated as your “natal gender”, you may feel ecstatic and euphoric being treated as your trans gender.
When I write support letters to the endocrinologist for my clients, they need to be phrased carefully to show that the person does indeed meet the criteria for “Gender Dysphoria” aka “Gender Incongruence“.