Our first D word is dysphoria, specifically gender dysphoria. Gender dysphoria is a psychological diagnosis for people with a strong discontent and distress over the gender they were born as. Gender dysphoria was previously named gender identity disorder, but was changed when that name was considered stigmatizing. Some transgender activists believe any diagnosis is stigmatizing and makes gender variance a pathology. Getting rid of a diagnosis is also problematic. The medical system requires a diagnosis before any insurance is paid out for treatment (many insurance companies still do not cover gender confirmation surgeries, considering them merely cosmetic).
There is strong evidence that gender dysphoria has a biological basis. Twin studies have shown that dysphoria is 62% inheritable, suggesting a genetic root. Studies have also shown transwomen are genetically less sensitive to testosterone then cisgender men. Their hypothalamus also responds like a cisgender women. Autopsies have shown transgender people have many brain structures resembling the gender they identify as. Studies have also shown transgender people’s brains react to the pheromone androstadienone like the gender they identify as.
Some transgender activist and doctors argue that gender dysphoria is not in itself a disorder. The distress, they argue, is not caused by their gender identity, but from the intense harassment, discrimination and abuse they face.
In the previous DSM IV intersex people by definition could not have gender identity disorder, it was actually a disqualifying factor. Now in the updated DSM V gender identity disorder is called gender dysphoria. Intersex people also get a diagnosis of disorders of sexual development (DSD, more about this in my next post). People with DSD are now, by definition, able to be diagnosed with gender dysphoria. While I hate the term DSD, I do feel that since many intersex people do change sexes, giving them a diagnosis of dysphoria, while stigmatizing, is more accurate.