this post was submitted on 24 Aug 2025
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This is super longwinded but I'm having trouble putting the ideas together concisely, apologies in advance to anyone reading.
I generally hear people describe being trans as feeling like you were born into the wrong body, like biologically male with a woman's soul in some sense. But my experience with being cisgendered is one of feeling like my spirit would belong wherever it was born to. I identify as a man and would feel out of place in a woman's body, but if I had been born into a woman's body I would feel out of place in a man's. That's my mental picture of what being cisgendered is. I'm not sure I'm articulating this great but hopefully it's coherent.
That gives me the impression that being transgendered is an emotional discomfort, and I've wanted to hear an opinion on if the resistance to labelling it as a mental illness is because of the societal stigma against mental illnesses and how some people think successful treatment should always mean suppression and never accommodation (which would look like gender-affirming care if being trans counted).
Part of where this is coming from is I've been dealing with my own mental demons lately after some traumatic experiences in the past couple years, and the way I think about it is different when I'm looking inward. If it's another person behaving strangely it is easy to say they are suffering and deserve care, but when it's me I am a crazy person doing crazy things and I know better.
I do feel inclined to see being trans as a mental illness (for the reasons I've given above). I believe I'll be open to hear what I'm getting wrong there. It's not something I've ever been comfortable enough to ask though because I expect that statement to be received offensively (for the reasons given above). I get a lot less hostility in general over who I am and I still sometimes have a very strong gut reaction to perceive that stuff as an attack.
The current science points to gender dysphoria being caused by the brain developing as one sex while the body develops as another.
If you ask whether someone is primarily their brain or their body, I think most would say identity resides in the brain and subsequent mind. In that sense, gender dysphoria is a genetic and hormonal disorder, basically a condition of yes, having the "wrong body" for the brain they developed as a fetus. This glosses over a lot of details and sex is complicated, but that's the rough sketch. The condition arises from the brain and the mind, and in that sense can be labelled a mental illness, but that would ignore a lot of context and evidence we have about what is going on.
It is with this understanding and with the guidance of substantial empirical evidence that transition and gender-affirming care are recommended - it is the only treatment that alleviates symptoms (conversion therapy, for example, increases risk of suicide), but also these are treatments with a very high success to failure ratio. Gender affirming surgeries have lower regret rates than practically any other surgery, much lower than knee replacement surgeries, for example.
So we deal with gender dysphoria differently than we deal with other mental illnesses because of what we know about the condition. We know that people with body dysmorphia like anorexics feel distress about their body and might seek surgery to "fix" their bodies, but we don't have the large body of evidence that those surgeries improve patient outcomes, relieve symptoms, or are low risk. So we treat anorexia differently than gender dysphoria, because they have different causes and require different treatments.
So gender dysphoria could be classed as a mental illness in a way, but it's important not to be confused by this and think it's a fabrication or that people with gender dysphoria could just think their way out of their condition - it's biological and not able to be solved with therapy or anti-depressants. Trans people respond really well to living as their gender (go figure!), and we see the same with cis people who are raised as the wrong gender (like in the case of David Reimer). We also see that cis people who are forced to take cross-sex hormones, like when homosexuals were given criminal punishments of estrogen treatments in the UK as in the case of Alan Turing, that those people become gender dysphoric in the same way. Gender dysphoria is not just for trans people, forcing cis people to be on the wrong hormones make them depressed too - are cis people just mentally ill when they have symptoms from being forced to live and medically transition to the other sex? It's not different for trans people.
What I was getting at with saying I wouldn't be comfortable switching now, but I would have been fine born into it is there there's a shock that would come with a change from what you've lived, and that being cisgendered wouldn't negate that shock, it would be miserable, but I don't feel an attachment in the sense that I feel glad I was born a man. That's what I meant when saying if I had been born a woman I wouldn't be happy with the idea of changing to be a man.
This is what I was trying to get at with the difference between suppression and accommodation, and gender-affirming care being accommodation. But I don't think it's fair to reduce all mental illnesses to being not biological and being "solved with therapy or anti-depressants", I think that is part of the stigma against them. Some of them should be accommodated and not suppressed. Physical treatments are often more helpful than those things, different illnesses need to be addressed in different ways, not treated as a generic umbrella for characteristics society doesn't approve of.
Sorry for not addressing all of it but I'm skeptical that you read what I wrote there because I explicitly spoke in favor of gender-affirming care as the treatment and your response reads to me like I was arguing against it.
It sounds like for you to understand the existence of trans people you probably first need to accept that other people experience gender and sexuality differently than the way you do
I'll introspect on that. It generally takes me time to digest. I'm embarrassed here. But I do agree that gender-affirming care is the correct treatment. I read your response like I was not explicit about being in favor of it.
I think I should log off and mull on it because right now I'm just being an asshole. I'm a very slow learner and it generally takes a few days after I argue vehemently against something for it to sink in that I was wrong. I interpreted the first response like you thought I was arguing it should be addressed in a way other than gender-affirming care and responded like that was an attack, which is really shitty of me and pretty embarrassing.
Before I do that though, I'm commenting a follow-up to ask you to elaborate on if there's something specific I can introspect on. I'll read and think over the next few days.
One last edit:
Logging off is because I know this is an issue I have. Right now I don't have much to be proud of other than my character, so in a moment I'm bad at listening and taking in criticisms that might suggest bigotry, because it feels like an attack on my identity. I'm aware that in reality I should be listening and not fighting, it just takes me an unreasonable amount of time and I act like a jackass until I've processed. Hence, logging out to introspect. Better late than never.