“Why is a transgender person not considered to have a mental illness?”

The website Reddit has a popular section called “Explain Like I’m Five,” or ELI5. The idea is that people ask questions about things they want to understand better, and experts or other people who do understand the topic offer answers—not literally aimed at five-year-olds, but in simple, easy-to-understand language to help anyone grasp the concept.

It’s a cool idea, don’t you think?

Last week, someone asked the following question:

“ELI5: Why is a transgender person not considered to have a mental illness?”

Here’s how they explained their question. (I haven’t corrected typos that were in the original post.)

A person who is transgender seems to have no biological proof that they are one sex trapped in another sexes body. It seems to be that a transgender person can simply say “This is how I feel, how I have always felt.” Yet there is scientific evidence that they are in fact their original gender…eg genitalia, sex hormones etc etc.

If someone suffers from hallucinations for example, doctors say that the hallucinations are not real. The person suffering hallucinations is considered to have a mental illness because they are experiencing something (hallucinations) despite evidence to the contrary (reality). Is a transgender person experiencing a condition where they perceive themselves as the opposite gender DESPITE all evidence to the contrary and no scientific evidence?

A lot of people might take offense at this question, but one transgender redditor’s thoughtful, heartfelt reply quickly became the top-voted answer. I thought many of you might like to see what she said, so I asked for her permission to share it with you. Here’s her answer in its entirety:

Transgender person here, and your question is a good one (or at least, a common one that really isn’t answered clearly very often)

The short answer is: yes, Trans people are considered to have a disorder. Gender Identity Disorder and Gender Dysphoria are disorders recognized in the DSM.

There have been a few studies establishing certain evidence to support the idea that this is inherent (a few having to do with brain mapping/MRIs pop up now and again) but the funding and interest for serious, driven research into the field just hasn’t been there until recently. A lot of existing studies are either too old to be taken seriously or flawed due to lack of funding or existing bias. The best guess right now is that the brain is just wired to expect a different set of physical characteristics than it has, and thus causes dysphoria as a way of expressing that it thinks there is something wrong with ones body.

Your question seems to be more “Why don’t we get these transgender people mental help instead of physical modifications to their body” and the answer is:

  1. Trans people already have to have years of therapy from multiple doctors and therapists to get the required letters of recommendation (verification that therapists and doctors have confidence that the person does experience Gender Dysphoria and that they believe that sexual transition would be beneficial to the patient’s mental health) needed to get hormones and SRS (sexual reassignment surgery) and no form of conversion therapy has worked anywhere near consistently.
  2. It is just easier (at this point in time, at least) to modify the body to reduce dysphoria than it is to modify the brain to stop dysphoria altogether.

As far as what I can describe to you from personal experience, I am not in denial about the fact that I have a penis and that I grow facial hair and that my body produces testosterone. I can tell you that the physical presence of these things causes constant distress, feelings of depression and self hate, the whole nine yards. When I wear female clothes, ask you to call me by a different name or use different pronouns, wear makeup, etc., it is more to fool my unconscious self and distract it from the fact that certain parts of my body just feel wrong.

Plenty of other similar conditions, like Body Dysmorphic Disorder, have long been recognized and accepted by the medical community. Sometimes the brain expects your body to be different than it is.

It’s like if you were to take the hard drive out of one computer and into a different computer. You’ll probably be able to boot and do most things, but you’ll occasionally get some errors because that hard drive and the Operating System inside has been set up to expect a certain hardware configuration in the computer, and has problems when what hardware it thinks you have differs from the hardware you actually hook up to it. We (the medical community) don’t know how to reprogram the computer yet, so switching out hardware is the next easiest thing.

Trust me, if there was a pill that got rid of my dysphoria so that I felt content with my male sex characteristics, I would imagine that would be far easier and pain free to take than years of hormone therapy and multiple, very expensive surgeries. Such a thing doesn’t exist yet, so I only have one other choice.

EDIT: I should mention that my experiences doesn’t cover every one you hear. There has been a push in certain groups to remove gender dysphoria from being the identifying factor of being transgender, and make it solely an “identity”. I personally take issue with this (as it removes all scientific aspects from the issue), but many trans people support the idea or just don’t care. It’s the internet, and Reddit is a great trolling ground when the Tumblr bloggers want to stir up trouble. You are likely to hear lots of different opinions.

I love when people have such a clear and simple way of helping me understand what the world looks like through their eyes. Don’t you?

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