Table of Contents:

1. Introduction 12. Managed Dysphoria

2. What is Gender? 13. Impostor Syndrome

3. The History of Gender Dysphoria 14. Clinical Diagnoses

4. Gender Euphoria 15. Treating Gender Dysphoria

5. Physical Dysphoria 16. Causes of Gender Dysphoria

6. Biochemical Dysphoria 17. Chromosomes

7. Social Dysphoria 18. How Hormones Work

8. Societal Dysphoria 19. Androgenic Second Puberty 101

9. Sexual Dysphoria 20. Estrogenic Second Puberty 101

10. Presentational Dysphoria 21. Conclusion

11. Existential Dysphoria

Introduction
For as long as human civilization has existed, there have been people
whose experience of their internal gender does not align with the physical “ Trans·gen·der - adjective
Denoting or relating to a person whose sense of
features of their body. The Gala, a middle gender priest class of the personal identity and gender does not correspond
Sumerian empire, existed over 4,500 years ago. The Indigenous cultures with their sex assigned at birth.
of North America recognized a third gender far before European
colonialism, and still do to this day. Roman emperor Elagabalus (218 AD)
insisted on being referred to as Lady rather than Lord, and even put forward a ransom for anyone who could conduct genital
reconstruction surgery.

In spite of this, however, the modern understanding of the transgender experience has only existed for approximately 130 years.
Even the word “transgender” only dates back to 1965, when John Oliven proposed it as a more accurate alternative to David
Cauldwell’s term “transsexual” (coined in 1949), which itself replaced Magnus Hirsch eld’s term “transvestite” (1910).

To be transgender is to have a gender identity which does not match the gender you were presumed to have based on the genitalia
you were born with. This can mean a person born with a penis is actually a girl, that a person born with a vulva is actually a boy, or
that a person with either genital con guration may not wholly t either side of that spectrum and is non-binary.

A trans person can come to recognize this at any point in their life. Some children identify it at as soon as they are able to grasp the
concept of the differences between the sexes, others don’t start to feel anything until the onset of puberty, and still others do not
realize that anything is wrong at all until they are fully adults. Many people are simply never exposed to the idea that their gender
could mismatch their birth sex, or what that feels like, and thus simply accepted their fate.

Even more common is a perception that even tho they have feelings about being unhappy with the gender they were assigned at
birth, they believe that this is not the same as what transgender people experience. Some may feel that a wish to be transgender and
have transition available is some kind of disrespect towards “real” trans people who knew they were actually boys or girls “born in
the wrong body.” These narratives of the transgender experience that have been spread by popular media create a very false
impression of just what it means to be transgender and what growing up transgender feels like.

This experience of discontinuity between the internal and external self is what we describe as Gender Dysphoria. Every trans
person, regardless of their position within or outside of the gender binary, experiences some form of Gender Dysphoria. This is
something of a political topic within trans communities, as different groups have their own ideas of what Gender Dysphoria is, how
it manifests itself, and what quali es a person as being trans. By and large, however, this debate is feckless and fruitless, as the
de nition at the top of this page encompasses the beginning and the ending of how these terms intermingle.

The purpose of this site is to document the many ways that Gender Dysphoria can manifest, as well as other aspects of gender
transition, in order to provide a guide for those who are questioning, those who are starting their transgender journey, those
already on their path, and those who simply wish to be better allies.

Title artwork based on works by Jumpei JP Ueoka

What is Gender?
If you trace the etymology of the word to its Latin roots, gender simply
means “type”. The Norman French term gendre was in use in the 12th
Cog
century to describe “the quality of being male or female.” @CognitiveSoc

Magnus Hirschfield was writing about Third Genders and

Many people attribute the term to psychologist John Money, who transitioning between sex and gender in the late 1800s.
proposed using “gender” in 1955 to differentiate mental sex from physical This book of his, entitled "What do people need to know about
sex. However, Money was not the rst to do so. Cultural Anthropologist the Third Gender?" was written in 1901.

Margaret Mead used the term in 1949 in her book “Male and Female” to This stuff isn't new, it was just sidelined.

distinguish gendered behaviors and roles from biological sex. The

American Journal of Psychology (vol. 63, no. 2, 1950, pp. 312) described
the book thusly:

“ A book, moreover, which gives beyond its premise; for it informs the
reader upon ‘gender’ as well as upon ‘sex,’ upon masculine and
feminine roles as well as upon male and female and their reproductive
functions.

Margaret Mead moves from the specific delineation to the more general
comparison of male and female in several communities, finally coming
to an analysis of sex-patterns in our own midst and for our own time. 8:28 AM - Feb 15th, 2020

Human Sex (the adjective, not the verb) is broken down into three
categories:

Genotype: The genetically de ned chromosomal kareotype of an organism (XX, XY, and all variants there of)
Phenotype: The observable primary and secondary sexual characteristics (genitals, fat and muscle distribution, bone structure,
etc)
Gender: The internal mental model of a person’s own sex.

Any of these three aspects can fall into a position on a range of values. Your elementary school health class probably taught you that
Genotype is binary, either Female (XX) or Male (XY), when the reality is that there are a dozen other permutations that can occur
within human beings.

Likewise, many people believe that Phenotype is also binary, but biology has
recognized for hundreds of years that when you plot out all sexual characteristics
across a population, you actually end up with a bimodal distribution where the
majority of the population falls within a percentile of two groups. This means that
some people will, simply by nature of how life works, fall outside of the typical two
piles. Many people fall in the middle, with characteristics of both sexes.

Gender, however, is a lot more… esoteric. There are a lot of different ways that people have attempted to illustrate the gender
spectrum, but none have quite thoroughly captured it, because the spectrum is itself a very abstract concept.
The short of it is, some people are very male, some people are very female, some people feel no gender at all, some people feel both,
some are smack in the middle, some land along the edges. Some people oscillate all over the spectrum in unpredictable ways,
changing like the wind. Only an individual can identify their own gender, no one else can dictate it for them.

Gender is part social construct, part learned behaviors, and part biological processes which form very early in a person’s life.

Present evidence seems to suggest that a person’s gender is established during gestation while the cerebral cortex of the brain is
forming (more about that in the Causes of Gender Dysphoria section). This mental model then informs, at a subconscious level,
what aspects of the gender spectrum a person will lean towards. It affects behavior, perceptions of the world, the way we
experience attraction (separate from sexual orientation and hormonal in uences) and how we bond with other people.

Gender also affects the expectations that the brain has for the environment it resides in (your body), and when that environment
does not meet those expectations, the brain sends up warning alarms in the form of depression, depersonalization, derealization,
and dissociation. These are the brain’s subconscious ways of informing us that something is very wrong.

On the social side, gender involves presentation, how we communicate, what our expectations are from life, and the roles that we
ful ll as we walk through life. These are all cultural factors, things which have developed within the population over time, but
regardless of being essentially “made up”, they are still connected to a gender identity. A person tends to connect to the social
aspects of their internal gender, without even realizing they are doing it, and when they are denied access to those social aspects,
this results in discomfort with their social position in life.

John Money’s experiments attempted to con rm his belief that gender is entirely a social construct, and that any child can be raised
to believe themselves to be whatever they were taught to be. His experiment was a massive failure (see the Biochemical Dysphoria
section). Gender does not change, every human is the same gender at 40 that they were at 4. What changes is our own personal
understanding of our gender as we mature as individuals.

These negative symptoms (depression, derealization, social discomfort) are the symptoms of Gender Dysphoria.

What Gender is not is sexual orientation. We describe orientation using terms relative to one’s gender
(homosexual/heterosexual/bisexual), but gender itself does not affect sexuality and sexuality has no role in gender.

In generalist terms this essay will be describing gender in a sense of binary identities (male/female) vs non-binary identities
(agender, bigender, genderqueer, etc), but this is purely for the sake of writing simplicity. Please know that the depth of gender
experience and expression is far, far more complicated than this simple breakdown.
A Brief History of Gender Dysphoria
In 1948, noted sexologist Dr. Alfred Kinsey (yes, that Kinsey) was contacted by a woman whose male child adamantly insisted that
they were in fact a girl, and that something had gone very wrong. The mother, rather than trying to suppress her daughter, wished to
help her become who she knew herself to be. Kinsey reached out to a German endocrinologist named Dr. Harry Benjamin to see if
he could help the child. Dr. Benjamin then developed a protocol of estrogen therapy for the teen, and worked with the family to nd
surgical help.

Benjamin then went on to re ne his protocol and treated thousands of patients with similar feelings over the course of his career.
He refused to take payment for his work, instead taking satisfaction from the relief he granted these patients, and using their
treatment to further his understanding of the condition. He coined a term for this feeling of incongruence in 1973: Gender
Dysphoria. Unfortunately, this term would not be used in the United States until 2013, with the American Psychiatric Association
opting for the term Gender Identity Disorder instead.

Harry Benjamin Diagnostic Scale

If you are a trans person reading this, you may have heard the name Harry Benjamin before, but probably not in a favorable context.
In 1979 his name was used (with permission) in the forming of the Harry Benjamin International Gender Dysphoria Association
(HBIGDA), which released a Standards of Care (SoC) for transgender people. This SoC came to be known as the Harry Benjamin
Rules, and were infamously limiting in regards to how Gender Dysphoria could be diagnosed. Patients were placed within a six tier
scale based upon their level of misery and sexual dysfunction. If you did not land at Tier 5 or higher, classi ed as a “True
Transsexual”, you were usually rejected for treatment.

The problem was, Tier 5 and 6 required that you had to be exclusively attracted to your own birth sex. Transition had to be making
you straight, not gay, and bisexuals were not allowed. You also had to be experiencing severe distress with your body and genitals,
and already be living as your true gender without treatment. Many trans people got around these limitations through community
coaching and performative presentations, but for many people (myself included) it was believed that if you did not t all the criteria,
then you were not trans enough to transition.

In 2011 the HBIGDA reorganized itself to respond to mounting pressures in trans understanding and acceptance, taking on the new
name World Professional Association for Transgender Health (WPATH). Under guidance by actual transgender people (a rst for
the organization), WPATH then proceeded to release an entirely new Standards of Care (SoC, version 7, the rst in ten years) which
abandoned the Benjamin Scale, focusing on speci c individual symptoms and disconnecting gender from sexuality entirely. Two
years later, in 2013, the American Psychiatric Association changed their diagnostic criteria to match the WPATH SoC in their
Diagnostic and Statistical Manual of Mental Disorders (DSM) version 5, replacing Gender Identity Disorder with Gender Dysphoria.
With this change, medical transition became available to all trans people in the United States.

This is why trans presence across the world has suddenly exploded in the last decade. With easier access comes larger numbers,
with larger numbers comes more visibility, with more visibility comes more awareness, and with more awareness comes more
people accessing treatment. A study conducted in 2014 showed 0.6% of adults and 0.7% of youth in the United States identi ed as
transgender, a study conducted in 2016 showed 1.8% of high school age students identi ed as transgender, and a survey conducted
by GLAAD in 2017 showed a whopping 12% of respondents 18 to 34 did not identify as cisgender.

Transgender people are coming out of the woodwork; we are everywhere.

So What Is Gender Dysphoria?

There is a common misconception among both cisgender and transgender
people that Gender Dysphoria refers exclusively to a physical discomfort
“ Dys·pho·ri·a - Noun
A state of unease or generalized dissatisfaction with
with ones own body. However, this belief that body discomfort is central life. The opposite of euphoria.
to Gender Dysphoria is in fact a misconception, and is not even a majority
component of a Gender Dysphoria diagnosis. Gender Dysphoria crosses a
large number of all aspects of life, including how you interact with others, how others interact
with you, how you dress, how you behave, how you t into society, how you perceive the world
around you, and yes, how you relate to your own body. Consequently, proponents of the
WPATH SoC 7 and the DSM-5 have taken to a habit of saying that you do not have to have
dysphoria to be transgender. This statement is often repeated like a mantra, as it informs
people who do not feel signi cant body discomfort that they may also be transgender.

In principle, Gender Dysphoria is a feeling of wrongness intrinsic to the self. There is no logical
backing to this wrongness, there is nothing which explains it, you can not describe why you feel
this way, it is just there. Things in your existence are incorrect, and even knowing which things
are incorrect can be hard to properly identify.

The way I used to describe it is like wearing an adult’s glove when you are a child. You can put
your hand into the glove, and your ngers feed into the digits of the glove, but your dexterity
with the glove is severely hindered. You might be able to pick something up, but you can not manipulate it like an adult could. Things
just aren’t quite right.

Evey Winters described it this way in her Dysphoria post.

“ Have you ever been sitting somewhere in a public or a formal place and all of a sudden the bottom of your foot itches? It’s not like
you can remove your shoes right there and scratch it, so you endure the feeling of dying inside while this itch grows and grows until
you are ready to murder the next person that speaks to you.

Or when I was younger I used to watch cable TV in the mornings before school. Because it was cable TV in rural WV in the early 90’s,
every so often I’d turn on my favorite channel to watch my shows while I ate my maple oatmeal and I’d be seeing Power Rangers —
but the audio would be from another station (usually the weather channel). The video was fine. The audio was fine. But the
mismatch between them? That’s the kind of frustration that sits with you all day as a child.

It’s the feeling you get when you ask for a crisp refreshing Diet Coke and the server says, “Is Pepsi ok?”

It is knowing that something is wrong and not being able to do a damn thing about it.

Gender Dysphoria is, at its core, simply emotional reactions to the brain knowing that something does not t. This incongruence is
so deep inside the brain’s subsystems that there is no obvious message of what the problem is. The only way we have to identify it is
via the emotions that it triggers. Our consciousness receives either positive (euphoria) or negative (dysphoria) feedback according
to how well our current environment aligns with our internal sense of self. Part of transition is learning to recognize those signals.

Cisgender people receive them as well, but since the signals usually align with their environment, they take them for granted. There
have been a few notable occasions, however, when a cisgender person has been put into a situation where they experience gender
dysphoria. Attempts to raise cisgender children as the opposite sex (Content warning: suicide) have always met with failure when
the child inevitably declares themselves differently.

These impulses of euphoria and dysphoria, arousal and aversion, they all manifest in many different ways, some obvious, some much
more subtle. Dysphoria changes over time as well, taking on new shapes as one moves from pre-awareness into understanding and
through transition. The goal of this essay is to break down these manifestations into their distinct categories and describe them so
that others may learn to recognize them. This is a very lengthy essay, so I have separated it into multiple pages.

However, rst I must stress something very important, so important that I am putting it into big bold letters:

EVERY SINGLE TRANS PERSON EXPERIENCES A DIFFERENT SET OF DYSPHORIA SOURCES AND INTENSITIES

There is no one single trans experience, there is no standard set of feelings and discomforts, there is no one true trans narrative.
Every trans person experiences dysphoria in their own way to their own degree, and what bothers one person may not bother
another.

Ok, that disclaimer out of the way, let’s get to the meat and potatoes.
Gender Euphoria
Before I can talk about discomfort, I have to talk about relief. Gender
Euphoria is itself a sign of Gender Dysphoria. You might be asking “
Eu·pho·ri·a - Noun
A feeling or state of intense excitement and
yourself, “how can happiness be sadness?” The answer to that is simple. happiness. Elation, joy, glee.

Imagine a person who was born in a cave, who spent their entire life living
underground, their only source of illumination being candles and oil lamps. Imagine they’ve never been above ground, they don’t
even know the surface exists. Then one day a cave-in happens in a side tunnel, and reveals an opening to the surface. Sunlight pours
into the opening, and at rst it is blinding and the person runs away in fear. Later they return to the opening, and as the person’s
eyes adjust they look out through the hole and see a bright and brilliant world full of colors they didn’t even know existed.

That world is scary, it’s huge and full of unknowns, so they crawl back into the cave for safety, but that hole is still there, and they see
the light every time they pass it. Gradually they peek out more and more frequently, and further and further from the opening. They
start to want that light, they nd reasons to visit it more often.

Eventually they realize that they don’t want to go back into the hole any more. They have to go back, because that is where their
family and friends are, but this place is so much better, they want to stay here. Going back into the hole feels wrong, it starts to hurt
to be in the dark so much.

This is what Gender Euphoria is like, it is brief ashes of a light that may be too bright to handle at rst, too confusing to understand,
but as time goes on you become more accustomed to them and you realize that this is where you belong, and the darkness becomes
the dysphoria.

Many trans people have no idea how much pain they are in until they nd
small bits of relief. Cosplay, stage acting, drag, role playing games, video
Nightling Bug
games; small little forays into a different gender than they have lived as. @NightlingBug
They nd that it feels just a little bit more comfortable. They’ll make up Fish don't notice water. It's all around them. Most fish have never
excuses for why (“If I’m gonna be looking at this character’s ass, it might as left it.

well be a girl’s ass.”), they’ll try to convince themselves it’s all just for fun, And often, trans people in denial don't notice the gender
dysphoria that suffuses their daily lives.
or an artistic expression. They might tell themselves that the bits of joy
I'm just going to list some idiosyncrasies and discomforts that I
they feel at hearing a different pronoun are just novelty. But soon they didn't realize were dysphoria:
nd themselves looking for reasons to get that more often. More and
11:25 AM - Jan 10th, 2020
more frequently they’re role playing characters of a different sex, building
more costumes, buying more clothes, performing more often. You nd
yourself wanting to do that all the time, because it just feels better than your real life, and being “you” starts to hurt. Eventually, the
old you becomes the costume.

This is the most fundamental reason why we as a community say “you do not need dysphoria to be trans”, because black ink on a
black canvas isn’t visible without close examination and a lot of light.

Anything that can be a source of dysphoria has an equal and opposite euphoria.
Examples:
Erin, leggings mom
@ErinInTheMorn
Being gendered correctly
Just finished 22 valentines cards for my son's daycare class. We
Being addressed by your chosen name wandered about Target to get some candy. It is great just existing,
Wearing correctly gendered clothing being myself, with my son and living life being seen the way I truly
am.
Seeing and feeling changes in your body
Even all of his daycare friends say "your mom's here!" :)
Seeing yourself in the mirror (removal of depersonalization)
Socializing in a way that conforms with gendered expectations 6:18 PM - Feb 13th, 2020

Getting a haircut in a masculine / feminine / androgynous manner

Shaving your legs
𝓙𝓸𝓬𝓮𝓵𝔂𝓷

@TwippingVanilla
NOT shaving your legs
It really is. Just... existing. No mask, no filters, no misconceptions.
Being included in something you wouldn’t otherwise because of your Fully actualized. It’s bliss. Cis folk take it so for granted.
assigned gender (e.g. bridal party or bachelor shower)
7:52 PM - Feb 13th, 2020
Feeling sexy / having sex in a way that aligns with your gender and
sexuality. Erin, leggings mom
@ErinInTheMorn
Even just being out in the world as yourself and being seen as yourself can
Yes they do!
be massively euphoric.
7:55 PM - Feb 13th, 2020

What euphoria is NOT is a sexual high, turn on, or fetish. Sometimes

euphoria can trigger a sexual response, and there are many factors at play
that cause that (feeling good about your body is a turn on, for example), but it is not a source of sexual excitement. Trans people are
not “getting off” on presenting or acting like their true selves.

That said, many people who have not yet realized they are trans may resort to fetishes and kinks to express their gender and/or
relieve their dysphoria. They may maintain some of these kinks through transition. There is no shame in this, how they nd sexual
ful llment is their own business. However, these things are alongside their gender. A trans person’s sense of gender persists
inde nitely, it does not go away when they go back to their daily lives.
Physical Gender Dysphoria
Everyone has heard of the “born in the wrong body” narrative. Physical Dysphoria is discomfort over the shape of one’s body due to
the sexual characteristics it presents. So what body features are we talking about here?

Primary Sex Characteristics Secondary Sexual Characteristics

The core reproductive features which develop during All sexually dimorphic features which develop during and Skeletal Build
pregnancy after puberty as a result of hormone exposure. In general, Range of Height
these features are all nearly identical for both male and Size of Feet and Hands
Gonads female prepubescent children. Width of Shoulders
Testicles Rib Cage Breadth
Ovaries Fat Distribution Thickness and Density of Limbs
External Genitalia Waist, Hips, Butt Shape Forehead, Brow, Cheek and Jaw bones
Penis Thighs, Arms, Back Pelvic Width
Clitoris Cheeks and Jaw Line Skin Texture and Tone
Scrotum Muscle Mass Voice Pitch and Resonance
Labia Neck, Shoulders and Upper Body Breast Development
Vulva Arms and Legs Facial Hair
Internal Reproductive Organs Abdominal Body Hair (excluding genitals and arm pits)
Prostate / Skene’s Gland
Uterus

Primary characteristics can only be altered through surgical intervention.

For Your Information
Some secondary sexual characteristics are also one-way trips and require
The genitals of a transgender person on hormone therapy do not
medical intervention to undo, namely the growth of breast tissue and the behave remotely like their cisgender counterparts.
deepening of the vocal chords. Estrogen does not make the voice more
The Estrogenic Penis softens, erections become less
feminine, Testosterone does not make breasts shrink (aside from the loss pronounced, the skin thins and begins to perspire like a
vaginal wall. The scrotum softens and changes color, with the
of fat). Changes to skeletal structure (such as enlarging from testosterone perineal raphe becoming more distinct. Due to the cessation of
and the widening of hips from estrogen) can only occur prior to the age of random erections, the erectile tissue will atrophy if not
regularly put to use, causing the entire penis to shrink over
25, while the body is still growing. time. Vibration becomes more effective for arousal.
The Androgenic Vagina becomes dryer & prone to tearing
Some secondary traits can be surgically enhanced (Breast Augmentation, (lubrication can be an issue). The skin of the clitoris thickens,
and the clitoral glans grows in length and girth due to the
body contouring, facial masculinization / feminization), and some cannot onset of random erections. Labia also become thicker, and
often hairier. The onset of HRT often results in extreme
be changed at all. sensitivity of the clitoris.

Physical dysphoria manifests in several different ways. Sometimes this is

felt in a sort of phantom limb phenomenon, where the person can feel sensations from a penis or vagina that is not there, an ache in
a uterus that does not exist, or a sense of absence on the chest from breasts that have not grown in.

It can be felt as a sort of reverse phantom effect, where the person is persistently aware of something that should not be there. The
brain is receiving sensory input that it does not expect, such as the weight of breasts, or the presence of testicles or a uterus, and
this input takes priority because it isn’t expected.

It may be felt as horror or revulsion when looking at or touching the external genitals, triggering emotional outbursts or a strong
desire to remove the offending organ. AFAB (assigned female at birth) trans people may experience feelings of wrongness during
menstruation, or a sense of alien disconnect from their hormone cycle.

It can manifest as a compulsion to be rid of certain body traits, such as

obsessively shaving body or facial hair. This can also manifest in the
Not Even a Chef
opposite compulsion, leading to meticulous grooming of those traits in @EloraEdwards
order to try to control them, like maintaining a perfect beard, persistently When my friends back in high school would discuss who their
keeping ones nails manicured and polished, or spending hours in the gym ideal woman was, they were all describing physical traits of a
person they’d want to date... as I explained who I wanted to be.
attempting to hone ones shape.
I always thought everyone had a dirty little secret like mine. A bit
of closet shame.
Undesired physical features may prompt a person to experience envy of
4:35 PM - Jan 22nd, 2020
people who have been forced to remove those features due to illnesses,
such as testicular or breast cancer. AMABs with severe genital dysphoria tend to have a wish for some kind of freak accident that
would cause the loss of their phallus.

Sometimes it may just simply be a feeling of being incorrect, which you may not even attribute to gender or sex. For most of my life I
believed that the reason I hate my body was because I was fat. It wasn’t until I started transition that I realized I don’t hate my fat at
all, I hated having male fat. The feminine curves that HRT gave me make me feel so much more in tune with my body.

The dysphoria one feels about their body can and will change over time,
for better and worse. For example, many trans women enter into puppy's panda
transition feeling no disconnect with their genitals, but later nd that as @meimeimeixie
larger sources of dysphoria melt away, that they become less comfortable I was told that because I didn't have genital dysphoria, I wasn't
with their original con guration. Alternatively, some may assume that "trans enough" to transition. I subsequently lived a decade of
denial and self-hatred.
they will absolutely need facial feminization surgery, but then 2 years in to
Funnily enough, after starting to transition, I began to recognize
transition, realize they’re actually okay with how they look. some of my anguish for what it was: genital dysphoria.

2:24 PM - Oct 16th, 2019

It’s okay for you to realize you need more or less than when you started.

It’s okay if you don’t hate anything about your body, and just wish you 𝓙𝓸𝓬𝓮𝓵𝔂𝓷

@TwippingVanilla
looked more feminine or masculine.
@MamaCoffeeCat Me pre-hrt: I don’t hate my penis at all.
It’s okay if you only hate some aspects of your body, and don’t wish to Me 2.5 years on hrt: GET THIS THING OFF ME.
change all of its sexual characteristics. 7:22 AM - Oct 17th, 2019

It’s okay if you don’t need medical transition at all. Body feelings are not
the be-all-end-all of transition.

Total body physical dysphoria is not a requirement to be transgender. AFABs do not have to hate their chest, AMABs do not have
to hate their penis. Every trans person’s experience is different. All are valid.

Internalized Body Image Issues

The world is full of subconscious messages about how men and women’s bodies should be shaped. We are bombarded with
advertising and media creating a normalized view of what is and is not beautiful. Don’t be too fat, don’t be too skinny, don’t be too
tall, don’t be too short, don’t have too broad of a chin, don’t have too large of a nose, wear makeup but don’t wear too much makeup,
don’t leave the house without a bra, but don’t let the bra show. On and on and on, the constant barrage of expectations of gendered
appearance.

Everyone absorbs these messages, and trans people internalize the factors which matter to the gender they align with. Trans girls
grow up mapping feminine standards onto themselves, trans boys map masculine standards on to themselves, and enbies often
internalize shame around androgyny. This is on top of the shame they are loaded with for not living up to their assigned gender’s
standards.

What is the end result of this? Kathryn said it best:

Kathryn is a Salazzle Kathryn is a Salazzle

@TransSalamander @TransSalamander

If you're under the assumption that you're a cis guy but Don't feel too bad about never realizing it. I just had this
have always dreamed of being a girl, and the only eureka moment myself.
reason you haven't transitioned is because you're But that's literally dysphoria. You feel discomfort being
afraid you'll be an "ugly" girl:
reminded of the disconnect between who you want to
That's dysphoria. You're literally a trans girl already, be (who you ARE) and what you look like.
hon.

9:38 AM - Dec 31st, 2017 9:42 AM - Dec 31st, 2017

Biochemical Dysphoria
The primary sexual features of the body begin development during the 8th week of human gestation. Typically by week 11 it is
possible to determine the genitals of a fetus via ultrasound. The brain, however, forms between weeks 14 and 24. Current prevailing
understanding of neurological development suggests that it is during these 10 weeks when the brain will either masculinize or
feminize based upon the presence of testosterone in the infant’s bloodstream (initiated by the SRY gene on the Y chromosome, or
introduced from other sources). This process locks the brain into a pattern of either desiring estrogens or androgens.

If your brain is wired for one gonadal hormones (such as testosterone) and your body produces the other hormone (such as
estradiol), this can result in a biochemical malfunction within your brain chemistry. This produces a sort of brain fog, a reduction in
mental capacity, and a general state of anxiety and unease. This is the source of the rst two symptoms that often alleviate with
medical hormonal therapy, Depersonalization and Derealization (DPDR).

Depersonalization is a disconnect from your own body, an inability to

Brea
believe that the person you see in the mirror is actually yourself. You feel theredgrrl
like you are watching someone else in your body. You may nd yourself
not caring about what happens to your body, lack of concern with weight
changes or improving your tness because you have no ownership of this
eshy vehicle that transports you around your life.

Zinnia Jones gives these descriptions for Depersonalization:

A sense of detachment or estrangement from your own thoughts,

feelings, or body: “I know I have feelings but I don’t feel them”
Feeling split into two parts, with one going through the motions of
participating in the world and one observing quietly: “There is this
body that walks around and somebody else just watches”
Feeling as if you have an “unreal” or absent self: “I have no self”
#TransformationTuesday - As I’ve often said on posts
Experiencing the world as distant, dreamlike, foggy, lifeless, colorless,
like this, our eyes re ect our lives. The biggest difference
arti cial, like a picture with no depth, or less than real I see in how trans people look after transition is always
Being absorbed in yourself and experiencing a compulsive self- the eyes; often looking sad or distant in the past, and
being bright and full of life in the present
scrutiny or extreme rumination
NOV 5, 2019
Having an ongoing and coherent dialog with yourself
Feeling like a veil or glass wall separates you from the world
Emotional or physical numbness, such as a feeling of having a head lled with cotton
Lacking a sense of agency – feeling at, robotic, dead, or like a “zombie”
Inability to imagine things
Being able to think clearly, but feeling as if some essential quality is lacking from your thoughts or experience of the world
A sense of disconnectedness from life, impeding you from creative and open involvement with the world

You may put little care into your physical appearance, reaching for only the basic utilitarian needs in clothing and personal hygiene.
Alternatively, you may hyperfocus on your appearance, attempting to try to spark some kind of joy, any kind of feeling of pride in
your own body, only to be met with more hollowness.

You may be unconcerned with the state of your body, perhaps not even fearing death, because you have so little attachment to your
life.

Derealization is a detachment from the world around you, a mental sense that everything you perceive is false.

Your surroundings seem alien or unfamiliar, even if you’ve always been there, like someone has swapped out your house for a
stage replica.
Moving through the world feels like you’re walking on a treadmill, with the buildings moving around you instead of you through
them.
 Feeling emotionally disconnected from people you care about, as if
you were separated by a glass wall, or like they are just actors Nightling Bug
@NightlingBug
pretending to be the people they claim to be.
You have an underlying sense that you are "not like" most
Surroundings that appear distorted, blurry, colorless, two- people. Your friends might get you, but you draw an instinctive
dimensional or arti cial, or a heightened awareness and clarity of and unconscious line between you and "normal" people. When
you interact with a "normal" person, you're not sure what to
your surroundings. Leaves on trees feel like they have extra sharp
say or how to act.
edges, for example.
You find it hard to prioritize your own feelings. You're
Distortions in perception of time, such as recent events feeling like aware of emotions you *should* be feeling, but they're
distant past. distant and fake-seeming. When someone else is upset,
it's much more real and urgent. You believe this is just
Distortions of distance and the size and shape of objects your stoic, protective nature.
Feeling like a passive observer in the events of your life You often feel directionless in life. When asked about
career goals in High School, you didn't really care about
If you found yourself strongly relating to The Matrix or The Truman Show, your answer. Even careers centered in your interests
seemed kind of intolerable. You struggle to imagine a
you might be experiencing derealization. This can also manifest as a
future for yourself where you are happy or fulfilled.
feeling of otherworldliness, like you don’t belong in this society. You’re just
You only take steps to better your life when external forces
walking around waiting for your super powers to appear, or for an owl to *make* you. You'd rather withdraw and self-minimize and focus
y up with your letter to Hogwarts. As a teen I was obsessed with an on escapist hobbies. You're just not motivated to attain nice
things for yourself. (You tell yourself that this is a zen
episode of The Outer Limits where a boy discovers a spaceship under his acceptance, a freedom from desires.)
house and learns that he and his parents aren’t actually human.
1:00 PM - Jan 10th, 2020

DPDR sometimes comes with an emotional stunting. You are able to laugh
and nd humor, but rarely ever genuine joy. Moments of sadness or grief
cause you to just go numb, dissociated by the event that caused it. This can also go in the opposite direction, where the person is
under so much anxiety that their emotional response is extremely disproportionate to the catalyst, resulting in severe crying or
violent outbursts from seemingly small events.

It’s important to note that DPDR is not exclusive to Gender Dysphoria. This condition is co-morbid with several other mental health
issues, including chronic depression, obsessive compulsive disorder, and borderline personality disorder. DPDR should not be taken
as a sign of Gender Dysphoria purely on its own, it’s just a big alarm signal that something is very wrong. It’s also usually pretty easy
to spot externally, once you know how to watch for it. People with DPDR tend to have a mile long stare as they move about in the
world; eyes so gloomy and dead that they look like a shell. One of the most common comments on transition timelines is how the
eyes gain so much spark.

The Ebb and Flow

The intensity of physical and biochemical dysphoria is highly in uenced by other factors in the body. Because it is a function of
endocrine balance, it is also manipulated by those balances. This means that it can rise and fall from day to day. For example:

If your blood sugar is out of whack, or you have a thyroid condition, it could cause your dysphoria to spike.
If you are having dopamine withdrawal because of ceasing stimulants, that can make it worse.
If you start on an SSRI Antidepressant and start running with more serotonin, that can make it less intense.
Transfeminine AMABs (people assigned male at birth) with testicles experience surges in testosterone in relation to attraction
and desire, which can make them more dysphoric.
Transmasculine AFABs (people assigned female at birth) with unsuppressed ovaries experience rises and falls in estrogen and
progesterone over the course of their menstrual cycle, making their dysphoria intensify and lessen based on what day of the
cycle they are on.

There are dozens of systems in the body that all work in tandem, and they all uctuate from day to day, manipulating general mental
state. This general dysphoria can amplify the affect of all other dysphoria. One day you can shrug off misgendering like it’s nothing,
and then the next it hurts like a stab in the heart every time. One day you see yourself in the mirror, the next you’re staring at the old
you.
Some people experience this in a gender uid way, with some days leaning male, same days leaning female, and other days not
feeling any gender, or both. Others just feel it like a seasonal river; sometimes it swells because of rains up stream, sometimes it
slows to a trickle because of drought.

All of this is valid, and just because you feel very dysphoric one day and not dysphoric the next does not mean that you aren’t really
trans.

This Happens Both Ways

Sometimes you will hear naysayers suggesting that taking hormone
therapy always improves mental health. I heard this myself when I came
Secret Gamer Girl
out to my mother. “Estrogen makes everyone happier.” This is at out @SecretGamerGrrl
false. When cis people are put on cross hormone therapy it always results
Worth noting that in the event a confused cis person were to
in dysphoria. This is one reason why Spironolactone is rarely ever attempt medical transition without being stopped by any of the
prescribed to men, because the anti-androgen factor causes mental absurd number of gate keepers and actual medical
professionals whose sign-off is typically needed, here's what
instability. Five to ten percent of cis women suffer from Polycystic
would happen: They take some pills, or a shot
Ovarian Syndrome (PCOS), a condition which causes the ovaries to which will then proceed to make them feel absolutely
produce testosterone instead of estrogen. Ask any one of them how their awful, like pouring sugar into the gas tank of their brain.

mental health has been, and they will give you an ear full. At which point one assumes they would immediately
cease taking the hormone supplements they did not
actually need and resume a normal life with no lasting
One very potent demonstration of this is the tragic case of David Reimer. consequence
At seven months of age David and his twin brother were given Should a REALLY stubborn and confused cis person
circumcisions to treat a bad case of phimosis (a skin condition on the ignore feeling like total garbage and keep on taking HRT
they shouldn't be taking for several months, they might
foreskin). David’s went horribly wrong, and the penis was destroyed. The
also experience some acne and/or their skin clearing up
decision was made to perform vaginoplasty and raise him as a girl, and looking great, and a woman might start growing
including estrogen therapy at pubescence. By the age of 13 he was deep facial hair

into suicidal depression and suffering greatly, as no amount of coaching a man in such a position might deal with gynecomastia
after like, a year or so, give or take, of again, feeling like
and encouraging can make a boy enjoy being a girl. When his parents complete garbage from taking unneeded estradiol
informed him of what had happened, he returned to a male presentation, supplements. Anyone, in a similar timeframe, might be
looking at their genitals acting like the wrong sort, which
switched to testosterone therapy, and over the course of his teen years
again, I kinda figure is something where one would go
had multiple operations in order to transition back to male.
"hey this ain't right" and just stop taking the medication
they are misusing. Where, again, things would just then
People know when they’re living the wrong gender. go back to normal.
Oh and all of this is me talking about HRT. Usually what bigots
Psychologist John Money oversaw David’s case and was largely are doing is talking about
responsible for the decisions that were made in David’s upbringing. puberty blockers as if they were HRT. If some confused cis kid
Money, seeking to make a name for himself, massively misreported on takes puberty blockers the grand total of what would actually
happen is.. not starting puberty until they realized they were
David’s case, calling it a complete success in his reports. The result of this taking them for no particular reason and stopped. No side
echoes to this day, as Money’s reports were used as an example of why effects of any sort to worry about
performing genital corrective surgeries on intersex infants was an 8:50 PM - Jan 29th, 2020
appropriate course of action. Fifty years later there are still doctors who
believe that you can just change a child’s genitals and raise them as that
gender, and it will stick.

This is the tragedy of the intersex community. Roughly one in every 60 births results in some kind of intersex condition (though not
all of these are related to genitalia). Often times the “corrective” procedures used on intersex children results in a loss of function
and/or sensation. Far too frequently, doctors would opt towards forced female assignment because it was easier to construct a
vulva than a penis.
Social Dysphoria
All social gender dysphoria orbits around one central concept: What
Gender do people believe me to be? Social Dysphoria is about how the
outside world perceives you, how others address you, and how you are Nightling Bug
@NightlingBug
expected to address them. This applies differently prior to the trans
When you interact with very masculine men, you're nervous.
person becoming self-aware of their own gender, versus how Social You don't really know how to carry on a conversation with
Dysphoria is experienced after a trans awakening (cracking one’s shell). them, or want to. You feel an expectation, from them, to be
something you're not. You quietly judge them for being too
"bro"-y, "basic."
While still in the dark, the only awareness is that something seems off
Being vulnerable around strange men is terrifying. You're
about the way you interact with your interactions with other people.
anxious when you use the public men's room. Changing
People of your assigned gender seem to interact with each other in ways in a gym locker room is unthinkable. You do not feel
that do not feel natural to you. Their behaviors and mannerisms feel ownership of these spaces. You are very concerned
about strange men observing you, or your body.
strange and surprising, where interactions with individuals of your true
You're awkward at social touch. You might crave touch,
gender feel easier. You relate to people closer to your own truth. like most people, but you feel like you're almost entirely
incapable of receiving it warmly. When giving a hug,
For example, an AMAB trans person may nd themselves very something about your torso feels like it will be *offensive*
uncomfortable in groups of men. They may feel out of place and struggle to others. (Whatever it is, they don't notice.)

You can't talk about sex, or attraction, or the bodies of

to t in among their male peers. Masculine social interactions don’t come
people you're supposed to be attracted to. Even when
naturally to them, and trying to emulate their male friends feels awkward. your commentary is solicited, everything you could say
They may feel themselves drawn more to friendships with women, but feels unwanted and inappropriate, even if it'd be fine
coming from someone else. You freeze up.
become frustrated at the social and heterosexual dynamics that come into
You struggle even to voice innocent physical
play between men and women, preventing them from forming platonic compliments to others, like "Looking good!" You are
relationships. This is if women are willing to form friendships at all. They hyper-aware that virtually anything could sound like
unwanted sexual attention, coming from you. You feel like
may nd themselves deeply hurt when women shy away from them on
your attention is uniquely, universally unwelcome.
principle.
When an AFAB friend expresses disapproval, you're
devastated. You scramble to get their approval back. You're
This feeling of wrongness intensi es as the person becomes more and worried you're coming across as a simpering "nice guy," all of
more aware of their own incongruence, and upon realizing who they really whom you despise. You just value your AFAB friends' opinions
more highly, for reasons you can't explain.
are it takes on a new shape. For binary trans people this often may be
about the intense need to be seen as your true gender, be it male or 12:25 PM - Jan 10th, 2020

female. Some non-binary people experience this more as euphoria at

being seen as neither male or female and thus only being referred to in
ungendered ways, or from being read as different genders by different people in the same setting. Some experience intense
euphoria when people are incapable of reading their gender and become confused.

Social dysphoria is where pronouns and misgendering come into play; being addressed with a gendered pronoun such as she, he,
him, or her which is not the pronoun that aligns with our gender is extremely discomforting. Granted, this is true for all people,
including cisgender people, but where a cis person will be insulted by being misgendered, a trans person will feel hurt. It’s like nails
on a chalkboard, or steel wool across skin. Hearing the wrong pronoun is a reminder that the person you are talking to does not
recognize you for the gender that you are.

Gender neutral pronouns can also be unsettling for binary trans people if used in a way that make it clear the person is avoiding the
pronoun that matches them. This often is an indication that a person has been read as being transgender, and the person addressing
them doesn’t know what pronouns they use. Asking their pronouns can resolve this situation immediately, but the paradox is that
even in that scenario, having their pronouns asked may itself induce dysphoria around having been recognized as being trans. It is
sort of a catch-22.

Singular they can also be used maliciously when a transphobic individual refuses to use the correct pronoun, but knows they will get
in trouble for using the wrong pronouns. Tone and intent matter a lot.
The same also applies to names. Being called by one’s given name (deadname) instead of their chosen name can feel invalidating
when done ignorantly, and downright dismissive when done intentionally.

It may also manifest as joy or embarrassment at being labeled as your true gender while still living as your assigned gender.
Examples:

An AMAB person being labeled a girl, intending insult, but it causing them to blush rather than get angry.
An AFAB person being called Sir, and feeling better for it.

The discomfort caused by social dysphoria can pressure a trans person to

act and present in an exaggerated manner in order to try to convince the
Dr. Emmy Zje
rest of the world that they really are who they say they are. Transfeminine @Emmy_Zje
people may concentrate on makeup and feminine clothes, and become The irony in “trans women mimic gender stereotypes” is the only
quieter in order to seem more demure, speaking in a higher voice. time I DID mimic stereotypes was when I was forced to interact
with men. And I did so out of a sense of survival and a longing to
Transmasculine people will lean on masculine clothing styles, stand taller, try and fit in.
suppress displays of emotion, start speaking louder, and make their voices I didn’t transition into stereotypes…I transitioned out of them.
intentionally deeper.
5:03 AM - Jan 22nd, 2020

Physical vs Social Dysphoria

Some physical traits which may cause discomfort all the time for some trans people may only manifest as a social dysphoria for
others. For example, some people may only be self conscious about their physical appearance when it causes them to be
misgendered or clocked (read as being trans), and feel completely comfortable when interacting in environments where they are
always seen and treated as their true gender.

I, myself, have no direct physical dysphoria around my voice, I actually really enjoy singing in my natal baritone, and when I am home
with just my family I let my voice relax. When out in public, however, being able to speak in a feminine voice plays a critical role in my
being seen as a woman by strangers, so I put a lot of effort into training it into a feminine sound. My feminine voice turns on the
instant I answer the phone or leave the house, it isn’t even a conscious thing.

“One of us!”
A very curious and surprisingly phenomenon is that closeted trans people have a tendency to nd each other without ever knowing
they’ve done it. There’s a funny pattern that I have heard duplicated over and over where one person in a friend group realizes they
are transgender, starts to transition, and that inspires other members of the group to also realize they are trans and come out as
well.

Trans people subconsciously tend to gravitate towards each other’s

friendships, both out of a need for peers who think and act the same as us
kiva, unholy transfiguration
without judgments, and due to a kinship of social ostracization. This is not @persenche
exclusive to trans people, of course, and occurs with all types of queer @Whorrorer i can know a cis woman for a year and not feel like
people, but the way it has a rippling effect is quite powerful. It’s very i'm all that close to her.

similar to the way an entire friend group will get married and have kids all i can know a trans woman for three hours and feel like i've known
her my whole life.
in response to one member of the group initiating.
7:32 PM - Jun 7th, 2019

Trans people often continue to self-select their groups post-transition as

well, as we simply understand each other better than cis people can.
There is an energy that occurs when a group of trans people get together in a location, the room becomes charged with camaraderie
and commiseration. We all have so much in common in our histories, so many shared experiences, that (short of personality
con icts) we instantly bond together.
Societal Dysphoria
Gender roles exist, and as much as we may try to buck them and point out the sexism that exists, there will always be expectations
placed on people for their gender. The strongest of these are in marital and parental roles; “Husband”, “Wife”, “Mother”, “Father”,
these terms come with loads of baggage attached to them, and the wrong role, or even any role at all, can feel like a lead lined
straight jacket. You are given a whole book full of behaviors and actions, likes and dislikes, that you are just expected to ful ll, and if
you fail to meet those requirements then you are seen as a bad spouse or a bad parent.

An AFAB parent who gives birth may experience severe dysphoria around being labeled as a mother. The vast majority of resources
for birth are extremely female gendered, so just the very process of conceiving, carrying, and giving birth is exceptionally loaded
with gender expectations. If you are pregnant then you are labeled a mom, regardless of how you actually feel about your role, and
with that comes a whole load of assumptions. Assumptions about caregiving, breastfeeding, and child rearing.

Cisgender-passing transfeminine individuals also run into this. If you are holding an infant or tending to a child then you are labeled
a mom (unless the child is mixed race, then you’re demoted to nanny, but that’s a whole other topic). This can be validating, because
it is a sign that you’ve been seen as a woman, but it can also be extremely invalidating when cis women start to talk about what they
think are shared experiences with reproductive processes.

Some unexpected ways that Societal Dysphoria can appear are in the need to conform to the social standards of your true gender.
For example, many trans women have stories about feeling the need to cover up their chest pre-transition out of an intrinsic sense
of modesty. A discomfort at swimming topless is a common trait, even when there is no understanding of one’s true self; something
just knows.

Shame
Failure to live up to these roles can manifest intensely as shame and humiliation. Growing up closeted and struggling to t into
common gender tropes often results in signs of disappointment from parents and peers who expected otherwise. A father may be
disappointed that their AMAB child isn’t willing to engage in sports or other masculine activities. Female peers may demonstrate
disapproval of an AFAB teenager choosing to hang out with a male social circle. Teen boys may ostracize an AMAB trans person who
doesn’t join in with their humor.

These kinds of situations can lead to bullying and abuse, pushing the trans person to feel isolated, alone, and out of place. This sense
of division then creates feelings of shame for failing to be the person everyone expects them to be. This then manifests as
depression on top of other dysphoria, compounding their pain.

The shame becomes especially intense at the moment of revealing

themselves to be trans. Transphobic friends and family having negative,
Dr. Emmy Zje
sometimes even violent reactions to a trans person coming out of the @Emmy_Zje
closet converts that shame into extreme guilt and disgrace. An adult trans Guilt is a byproduct of shame, shame is a byproduct of
person in a marriage may feel a tremendous amount of remorse at transphobia, and transphobia is a byproduct of lies based in fear.

upending their spouse’s life by revealing themselves. They may expect Once you realize this, you can begin to see “trans” for what it
is...a beautiful manifestation of nature. A gift to be cherished, not
reproach from their neighbors and peers, and fear how that will affect a curse to be hidden.
their spouse and/or children.
5:58 AM - Dec 1st, 2019

This too is a form of gender dysphoria, as these in uences would not have
been felt if the person had been cisgender.

The other way shame comes in to play is in the systemic transphobia present in our society. Trans adults of today grew up watching
transphobic media in their childhood. The transsexual obsession of the late 80s and early 90s was horri cally traumatic for trans
kids of the time, watching all the adults and peers around them laugh and jeer at and be disgusted by people who they not only
identi ed with, but strongly empathized and looked up to. This shame sits with us for our entire lives; it is a fundamental reason for
why so many trans people do not come out until their late 30s or later, because only when they reach mid-life are they able to
overcome that shame.
Shame also tends to build up until it boils over into radical action. A very common aspect among trans people’s histories are cycles
where they will build up their presentation, ghting their feelings less and less, until suddenly they feel overcome with the shame
and purge everything, vowing to never pursue those feelings again. This pattern repeats over and over again.

Dating and Romantic Relationships

Societal Dysphoria strongly comes into play with courtship rituals. Being
forced into being the boyfriend or girlfriend when you are not a boy or a
Callie
girl is extremely disorienting and often feels very unfair. AMABs may nd @Calliethulhu
themselves wishing they were the one being pampered, and AFABs may
I get the thinking. Trans girls grow up falsely believing they're
become uncomfortable with the amount of attention they receive from guys, and so are assumed/expected/raised to experienced and
their prospective partners (beyond the discomfort that women express normative heterosexual attraction to women. If you're
a trans lesbian, you transition, but you're still into women. So
experience, as this includes genuine attention, not just unwanted
it's the same, right? No
attention). The expectations placed on them by their partners to ll these So let's talk details. To begin with, it's worth pointing out
courtship roles may feel like a heavy burden to bear. By contrast, dating as that most trans lesbians don't exactly experience
normative heterosexual attraction to women in the same
your true gender becomes euphoric. Buy a trans girl owers and see how
way that cishet men do. Dysphoria and confused gender
much she swoons. feelings mess with that a whole lot

Before I transitioned, just the thought of doing any sexual

A closeted trans person may feel so much pressure to conform to or romantic with a girl made me nauseous, because
heterosexuality that they suppress their own instincts with regards to doing that would feel like I was adopting a masculine role
- the role of the boyfriend, the male lover - and that
relationships and take on a performative role. Many a trans woman has
kicked my latent dysphoria into overdrive
attempted to play the role of a heterosexual husband to a wife, only to
When I first transitioned, my family and friends assumed I
realize with transition that they would much prefer the role of the wife. was going to be solely or primarily interested in men.
They may not even be attracted to women. Every mainstream cultural message I'd ever absorbed
about women (including trans women) told me I needed
to be into men
Beyond discomfort, many trans people realize that the dynamics of
Many trans healthcare systems operate on a really really
relationships that they have experienced simply did not t the shape of crude system where a cis doctor asks you a bunch of
how they appeared. Many trans people come to realize after transition stuff like 'what toys did you play with as a child?' to see if
you match up well enough with what a woman is
that they had never actually dated like a cis person of their assigned
"supposed to be". And women are "supposed to be" into
gender, instead always having romantic relationships that t their true men
orientation. Male to male and female to female relationships have So, there's a lot of internal and external pressure faced
completely different patterns from heterosexual relationships; different by trans lesbians to disavow their own lesbianism and
experience attraction to men. This is nothing like what
courtship rituals, different perceptions, different communication styles. any straight man experiences, but it is a whole lot like
Men relate differently to men than they do to women, and women to what cis lesbians experience!

women differently than they do to men, even when they don’t know they One last thing is, the way it feels to be a trans lesbian
experiencing attraction, sex and romance to other
are men or women.
women. It doesn't feel like cishet attraction. It's not
burdened by any of those weird, crude expectations. I
For example, I myself realized after coming out to my wife that all of my don't recognize any of that in my life
previous dating attempts had absolutely been sapphic in nature. My rst When I read cishet experiences of their sexuality, I feel nothing
order had always been to become good friends with them. Dates would but alienation. When I read lesbian experiences, they resonate
with me deeply and I recongize those things in how I
never be labeled as dates because we would just sit and talk somewhere,
experience my sexuality with the people I love and am
hanging out together. Consequently, several of my relationships ended attracted to

simply because I was too scared to make the rst move out of destroying 1:37 PM - Jan 11th, 2020
the friendship. I would spend half my waking day thinking about them and
wanting to be around them, not out of sexual lust, but out of personal
infatuation. My rst girlfriend straight up told me on our rst date that I was unlike any man she’d ever dated because I enjoyed
talking instead of just trying to get physical. She broke up with me two months later because I wasn’t as assertive as she wanted
from a partner.

These dynamics get even more complex for non-binary people, some of whom can at best describe their dating style as Queer. Some
struggle to identify what role they play in a relationship. Others take a speci c role that is typically seen as a binary gendered role.
Some non-binary people wish to be seen as a boyfriend/girlfriend, even if they are not a boy/girl. Some want to play a role seen by
society as neutral or consisting of aspects from both binary roles.
Sexual Dysphoria
Closely related to Societal Dysphoria is dysphoria centered around sexuality, sexual relationships, and the act of having sex.
Heteronormative gender roles come loaded with the expectation that AMABs will top and AFABs will bottom. These dynamics get
reinforced by our popular media, by toxic masculinity, and especially by our pornography, even in transgender pornography (the
bulk of trans/cis pornography involves the trans woman topping). Deviations from these roles often result in shame, both from
partners and from peers.

Of course, this is not an absolute, by any means, and many heterosexual cis couples do nd ways out of these molds, nding a new
dynamic in their relationship, or engaging in kinks to satisfy desires. Some couples nd they aren’t sexually compatible at all and
seek other partners. However, there are many many external pressures discouraging this kind of self-awareness and discovery, and
breaking away from those demands can be extremely dif cult, even traumatic. This is particularly true when there is a background
of conservatism or religious virtuism.

Cisgender gay relationships shirk this by virtue of necessity, opening the doors for individuals to explore what role leaves them
more ful lled. Some gay couples have an established dominant/submissive dynamic, and they enter into the relationship with that
already understood. Others resolve it by switching up which partner is dominant. Yet, gay relationships can still get caught up in
these kinds of expectations in regards to butch/femme, bear, and twink dynamics.

What does all this mean? Trans people who enter into perceptually heterosexual relationships pre-transition sometimes nd
themselves losing interest in sexual intercourse, as penetrative acts do not produce the ful llment that they would expect. In
extreme cases it can feel completely wrong and trigger panic. The sensations may feel pleasurable, but the experience is out of
place, and the act itself feels forced.

This can lead to one feeling less enthusiastic or even disinterested in sex,
as half of what makes up sex drive is the mental context of the situation.
Kathryn is a Salazzle
Many trans people never even experience sex until adulthood, @TransSalamander
functionally operating as sex-averse due to how severely their dysphoria Did any other trans girls get to the point pre-transition where they
has shutdown all sex drive. They may still perform for the sake of their had to basically dissociate in order to top or was that just me lol

partners, but not get as much enjoyment as they could, and even end up 9:43 AM - Jun 8th, 2019

disconnecting from reality around them in order to accomplish the task.

This dysphoria may be so signi cant that they nd themselves taking a sexual identity that they don’t actually connect with. It is not
unheard of for a trans person to realize after coming out that they never actually felt a connection to the sexual orientation that
they had identi ed with previously, but were rather using it as a way to feel less dysphoric in their sex lives.

Some trans women, for example, identi ed as gay men pre-transition out of a desire to have a partner that treats them like women
during sex, but nd themselves to actually be lesbians once that demand is lifted. Others may attempt to live as gay men, but nd
that the role doesn’t ful ll them because they know their partners see them as men.
The Coercive Male Gaze
Author's Note: This speci c type of sexual dysphoria is dif cult to explain in generalist terms, so I am going to take a departure here and write about this from my own
personal experience. The following is presented from my perspective as a binary trans woman. As such, this may not be completely relatable to all trans people. My
apologies.

There is a saying that is very well known in sapphic circles: “Do I want to
be her, or be with her?”

It can be hard to tell the difference between sexual attraction and envy,
especially when you’re a closeted trans teenager. Our entire society is
built upon heterosexuality; it is simply the cultural default, to the point
that even prepubescent children are barraged with messages about male
to female attraction. Consequently, interest in aspects of the lives of the
“opposite” sex is almost always immediately perceived as being sexual
attraction.

What is the result of this? Usually… shame. Trans children often

internalize their view of their peers based on their true gender, and one
does not objectify their equals. Thus the child is motivated to hide those
interests out of a desire to not be seen engaging in that kind of sexual
objecti cation. This is even further compounded if the child has been
raised in a setting with very strict moral codes, such as in a conservative
religious upbringing.

Growing up as a closeted trans teen in an evangelical Christian household,

I knew that if I was ever caught looking at women in what was seen as a
sexual manner, I would be punished. I knew if I was ever found handling
women’s apparel, there would be a lot of very awkward questions which I
was not prepared to answer. This posed a very serious problem for me, as
someone with a strong fascination with women’s apparel, particularly
lingerie.
"Swole Mom" - How Baby, by Lindsay Ishihiro

There is a Simpsons clip where Moe Szyslak is put on a lie detector test,
and by the end of the test he has confessed that he will be spending the night ogling the women in the intimates section of the Sears
catalog. The entire crux of the scene, and the source of the comedy, is the shame that is cast on Moe for engaging in this desperate
act of objecti cation. I grew up knowing that this is how I would be perceived for my interest in women’s clothing.

Out of shame and fear, I did everything I could to hide this passion, because I simply could not bear for someone to view me like the
teenage boys who masturbate to any material they get their hands on. What made this fear even worse was that I also believed that
my interest was sexual.

When you see the world through a duck shaped lens, everything looks vaguely like a duck. The only framework I had been given to
understand my interest in women was through sexual desire, and thus every feminine interest I had became warped into a sexual
desire. My wish to be a bride morphed into a bridal kink, my desire to have a child warped into an interest in pregnancy porn, and my
own need to be a girl was redirected into a transformation fetish.

But on top of all of this, I was terri ed to be seen expressing legitimate sexual interest in other women. I had male friends who were
notorious rubberneckers and slack-jawed gawkers; one of my former employers had an awful habit of leering at attractive women
when we were out to lunch, which made me very uncomfortable to be seen with him.

I could not stand to be associated with that male gaze. Even around the most beautiful women, I would avoid even looking at them,
because I did not want to be seen as the kind of person that stares at women. I did not want to be seen as a predator.
This is the coercive male gaze: compulsory heterosexuality placed upon closeted trans women due to heteronormative ideologies. A
cognitive dissonance that causes intense guilt and shame surrounding appreciation of ones peers and gendered interests.

Once you remove this male framework – once one is able to perceive themselves as female and accept these interests and
observations are valid – that shame and guilt completely evaporates. Even when the interest is sapphic in nature and genuinely
includes sexual desire, it is no longer tainted with this layer of objecti cation. I am able to appreciate the femininity and the beauty
of my female peers without judgments, I can compliment them without fearing being perceived as a creep, or having my intentions
misinterpreted.

It was a dysphoria I could not possibly have put into words until after it had nally been relieved. I was even more relieved as I began
to integrate into queer women’s spaces and came to realize that women are exactly as thirsty as men are, we’re just (usually) much
more respectful about it. It was a release of guilt that I didn’t even know I was carrying.
Presentational Dysphoria
Clothes. Hair. Makeup. Jewelry. Glasses. Piercings and other body modi cations. Even personal hygiene can be a factor of
presentation, such as the shaving of body hair, or how you take care of your skin. All of these things are gendered in society, clothing
and hair especially.

While the sexual revolution of the 1960s and the business fashion craze of the 80s did wonders for blurring the gap between
masculine and feminine presentation (largely by normalizing masc fashion as androgynous), there are still enormous pressures to
conform to traditional gender norms. Gender Non-Conforming dress is so instantly marked as queer that any time a woman wears a
tailored suit she is marked as a lesbian, and a dad who puts on an Elsa costume because his son wants to have a Frozen party is
labeled as subversive and abusing his child.

Long hair on men has been seen as an act of rocker rebellion for decades, and men with long hair get discriminated against as being
layabouts and bums. Short hair on women is often read as queer or butch (unless they’re old, then it’s expected), and women are
often pressured to keep their hair long. Pierced ears on men became somewhat more normalized in the 90s, but are still seen as an
act of rebellion, and some employers won’t allow men to wear earrings. Makeup on men is so stigmatized by toxic masculinity that
even men who like makeup feel pressured to avoid it.

Like it or not, presentation is gendered, and it is extremely common for trans people to want to present themselves in the fashion of
their true gender, and a desire to be free of the shackles of gendered presentation is common among all trans people, regardless of
where they sit on the gender spectrum. For AMAB individuals they may manifest as a wish to incorporate more feminine elements,
for AFABs it may manifest as a want for more masculine appearance. This may come as a full push towards the opposite of their
assigned gender, or a desire to seek a middle-ground in pursuit of androgyny. It may even simply be a wish to not present as your
assigned gender.

Not all transfems present feminine, not all transmascs present masculine, not all non-binary people seek androgyny. Butch
AMAB trans people are valid, femme AFAB trans people are valid. Presentation is not gender, gender is not presentation.

Presentational Dysphoria typically appears early on in the form of a fascination with the styling of another gender, and a wish to be
able to present as people of that gender do. That desire may be ful lled somewhat by seeking out styling that is unisex, but typically
that wish is self-gatekept by statements of “I’m not con dent enough to attempt that.” AMABs often run into issue here where this
desire often gets trapped behind heteronormative expectations, causing an interest in feminine presentation to be misinterpreted
as sexual desire.

Post-transition Presentational Dysphoria is usually simply a case of high discomfort when attempt to present as one’s assigned
gender. It may not even be about how one looks, but just the way the clothing makes you feel. For the rst year and a half of my own
transition I could not bear to wear unisex t-shirts because they just made me feel more masculine. Even now I have to cut the collars
out of them, because the close neck makes me feel dysphoric.

Presentation’s Affect on Physical Dysphoria.

Clothing can also play a major role in the level of physical dysphoria a person experiences. Men’s clothing is always cut very boxy,
straight up and down on the vertical and very square in the horizontal. Women’s clothing is cut for more curves, accentuating
waistlines and hip shape. Men’s pants feature a lower crotch to make room for external genitals, and no tting for curves, where
women’s bottoms are the opposite. Women’s clothing is often form tting, where men’s clothing is rarely form tting at all. Men’s
clothing is often made of sturdier and thicker materials, meant to be worn as a single layer. Women’s clothing is often made of
thinner and stretchier materials, expected to be layered together.

Because these structures are meant to t the masculine or feminine forms, they tend to amplify the sensation of wrongness. A
classic effect is the way that the difference between men’s and women’s jeans can have a radical affect on a trans person’s comfort
level. Unfortunately this works both ways, as even af rming clothing can reveal how your shape is a mismatch.

I, myself am very feminine in my preferred presentation, and I had a longing to wear dresses from when I was just ve years old. I
abhorred wearing suits, hating the way they t on my body, since they always tugged in ways that felt very incorrect for what my
body needed. I refused to wear any denim for most of my life because
men’s jeans always felt so incorrect (women’s jeans and leggings, however, Nightling Bug
@NightlingBug
feel amazing). Then as I entered into transition and began to present more
When you get ready to go, you just roll out of bed and throw
female, my dysphoria struck again in the ways my body did not conform to on whatever. You don't really do any self-grooming, or care
what women’s clothing was expecting (too much in the crotch, too wide about what's on your body. You're a little proud of your lack of
vanity, your deeper, non-appearance-level existence.
and bulky in the shoulders, too large in the waist, not large enough in the
Your clothes are chosen almost entirely for comfort. And
chest). It wasn’t until the second year that I had experienced enough
for you, comfortable means loose and baggy. You can't
change in my shape to where women’s clothing was properly af rming of stand wearing clothes (that others claim are flattering!)
my shape. that are close-fitting in the wrong places, that draw your
own attention to certain parts of your body.

What does this look like? Well, it looks a lot like other common body Clothes shopping for yourself is a hassle at best and a
source of stress and anxiety at worst. When you do find
image issues. A tendency to avoid anything form tting, leaning towards clothes that fit and look okay, they don't make you
softer fabrics and baggier clothes. A classic gender dysphoria trope is the *happy*. You don't feel more confident in them. You're
just relieved you can go home.
kid who wears nothing but sweatpants and hoodies. Clothes will be
Occasions where you *must* dress up, like weddings and
oversized in order to keep them from hugging the body. AFABs may prefer
funerals and job interviews, are the worst. Even after all of the
to wear compressing sports bras in order to minimize their chests, and grooming and wardrobing, you feel self-conscious and
avoid anything with a tight waistline. awkward in formalwear. It makes you feel *fake,* like a lump of
sludge pretending to be a fancy person.

Internally it most often manifests as intense jealousy of the people you 11:26 AM - Jan 10th, 2020

wish you could be. Jealousy over an in uencer’s body shape, a strong
desire for the out t of a person on the street, and most especially envy of
other trans people. This feeling often persists well into transition, because
this sensation of wanting to be other people of your gender is actually Princess Sea Foam
completely natural, even for cis people. @DameKraft

Feeling envious of other girls for being pretty is a thing that many
Presentation’s Affect on Social Dysphoria. many women feel. Dysphoria is a real headfuck of a layer on top
of that feeling, yet I just wanna say that if you’re a trans woman
Presentation can be important for avoiding misgendering, especially early feeling envious of another trans woman, that’s you being a actual
in transition. A lot of trans people feel a need to perform their gender in woman.

order to be accepted for who they are, leaning in to feminine or masculine 7:17 PM - Nov 4th, 2019

presentation more than they actually would like in order to make up for
their body and ensure that people gender them correctly. Those pursuing
medical transition may nd this need becomes less important as their bodies change and they become able to be gendered correctly
without all of the performance.

Performative Presentation was practically required prior to the reformation of WPATH in 2011; anyone who showed up to a
doctors appointment without extreme feminine or masculine presentation risked be labeled a fake and losing their treatment under
the Harry Benjamin Scale. Trans women actually would lose their estrogen simply for wearing jeans and a blouse instead of a dress,
or for not putting on enough makeup. This is one of the reasons why transmedicalist ideology is so dangerous: it would see us
returning to this system, labeling anyone who doesn’t meet stereotypical views of femininity and masculinity as not actually
transgender.

Presentation is especially important among prepubescent children, as they lack any signi cant secondary sexual characteristics.
Clothing and hair are the only ways we have to show the gender of a child, so much so that if a baby simply wears a pink shirt,
strangers assume it is a girl. Even unisex clothing for kids is strongly gendered by way of colors and graphics. For trans children it
can be extremely distressing to be either forced to cut their hair, or required to grow it out. Denying dresses to a trans girl or
transfeminine non-binary child, or forcing them onto a trans boy or transmasculine non-binary child, can be debilitating to their
morale.
Existential Dysphoria
When you grow up as the wrong assigned gender, you are going to miss out on a lot of things that should have been available to you
if only people had known. Sleepovers, camping trips, girl/boy scouts, shopping trips, cheerleading or sports. Events that are co-ed
may have very different feelings attached to them based on how you engage with them, like going to prom, religious ceremonies
(such as having a bat mitzvah instead of a bar mitzvah), and even just the act of courtship. This dysphoria may also be biological in
origin, such as a sorrow over having not given birth to or breastfed your children.

These missed opportunities can manifest as feelings of loss and hurt. Furthermore, the memories of things you did have access to
but wouldn’t have otherwise, or events that were performed in the wrong gender, can also be a sour point, as these may have
awkward attachments. Imagine having to be a groom at your wedding when you know you should have been a bride; growing up
dreaming about your perfect wedding, and then playing the wrong role in it.

Sometimes existential dysphoria can manifest existentially, hitting you with all the grief of the youth lost. All the dating, the teenage
antics, the parties, even just having been able to be sexual with the correct parts while your body was young and you had no
responsibilities. It is time that can never be gained back.

Many trans people attempt to recapture some of these lost events, hosting or attending queer proms, organizing sleepovers,
performing vow renewals with their spouses, and engaging in common puberty rites of passage like having a mother gure help
them shop for their rst bra, or having a father gure teach them to shave. However, ultimately, existential dysphoria is something
that can never be relieved. You can make new experiences to replace the ones you lost, but you can never turn back the clock.

This is one of many reasons why af rming trans youth is so important. Boys want to do common boy things, girls want to do
common girl things, and non-binary children want to do whatever feels correct to them, and when they miss out they will not forget.
Managed Dysphoria
Growing up in the closet, even when you don’t know you’re in the closet, becomes an existence built on top of coping mechanisms
intended to alleviate dysphoria. The following are ways a closeted trans person may nd to alleviate the dysphoria they experience
in their day to day lives:

When a video game gives you the option of choosing your gender, you tend to choose differently than your assigned gender.
This may be accompanied with excuses to defend that choice. “It defaulted to male and I didn’t care.” “I don’t want to stare at a
guy’s butt for hours.”

A preference for literature and lm with characters of your true gender, or with characters who break gender norms (Mulan,
Little Women).

Pornographic outlets which satisfy strong desires or feel more relatable, such as a draw towards gay/lesbian porn, bridal kink,
or transformation sequences.

Crossdressing or performing drag.

Finding excuses to cut hair short, or to grow it out.

Shaving of body hair, or a refusal to shave hair you’re expected to.

Wearing loose and baggy clothing that hides the shape of your body.

Avoiding social gatherings whenever possible, seeking isolation.

Becoming intimately educated about some gender-associated topic, such as men’s or women’s clothing design.

Obsessively working out (AFABs).

Helping cis partners to shop in order to live vicariously through their presentation.

Because so much abuse is handed down onto gender non-conforming

children, many trans people grow up learning to hide their natural
Nightling Bug
personalities out of sheer necessity. Many trans people speak about @NightlingBug
having a phase of life where they attempted to “buy-in” on their assigned You're worried that you might be homophobic, even though you
gender, performing masculinity or femininity to extremes in order to try to believe in gay rights, because "LGBT+ stuff" fills you with a deep
discomfort. It all seems so flamboyant and overtly sexual. It
“ x” themselves. This leads to repression tendencies which may even
makes you want to shrink down and disappear, before you die of
super cially appear toxic, but are simply the results of trying to hide every secondhand embarrassment.

scrap of their true selves. Later, when you meet real queer people, or your friends come out
of the closet, you start to idolize them. But you're also jealous.
Growing and meticulously grooming facial hair (the so-called “denial They're *free* and *real* in a way that seems impossible for
beard”). straight people, like you. They have huge, *real person* worries
and desires and lives.
Taking up makeup artistry in order to perfect a high femme look. 1:38 PM - Jan 10th, 2020

Presenting extremely masculine or hyper feminine.

Avoiding any conversation about fashion for any gender. Dissociating

whenever fashion conversations or activities occur.

Obsessively working out (AMABs).

Assuming a strongly stereotyped gender role in a relationship (e.g. the dutifully modest housewife).

Marrying and having kids in anticipation that it will “ x” what’s wrong with you.

Buying in to ultra-conservative attitudes towards gender and sexuality.

Expressing Homophobia and Transphobia in self defense to ward off suspicion.

Aggressively passive engagement in anything connected to one’s true gender.

Finally, another very common coping mechanism is to nd means of escape or mental engagement in order to forget your own
feelings.

Intensely investing large amounts of time into hobbies.

Long hours spent at work.

Chain binging movies, TV shows or books.

Spending all idle time playing video games or on social media.

Obsessively cleaning one’s living space.

Sleeping. Lots and lots of sleeping.

Impostor Syndrome
“ Impostor syndrome (also known as impostor phenomenon,
impostorism, fraud syndrome or the impostor experience) is a Nightling Bug
psychological pattern in which an individual doubts their @NightlingBug
accomplishments and has a persistent internalized fear of being @TorgHacker You don't need dysphoria to be trans!
exposed as a “fraud”. But also, I've seen "angst over not being dysphoric enough"
described as a sort of meta-dysphoria? Because it's distress you
experience when you're worried you aren't _____ enough to be
Society in general is very good about making trans people doubt your gender.
themselves. We receive tons and tons of subliminal messages through out 4:42 AM - Jan 22nd, 2020
our lives saying that being trans isn’t normal and that anyone who is has to
be exceptionally special. Cis media’s obsession with the “born in the wrong
body” narrative has led to a lot of false information being internalized by trans youth. Many, many trans kids grow up thinking they
aren’t actually trans because they don’t know that they are a different gender, they just wish they were. Many non-binary children
grow up knowing something is wrong, but not believing they’re trans because they don’t feel like a binary trans person.

On top of this, messages saying that trans people hate their bodies or hate their genitalia have polluted the awareness landscape, so
that many people who either do not experience physical dysphoria (or simply think theirs isn’t very strong) go around believing they
aren’t “trans enough”.

YES, YOU ARE TRANS ENOUGH

On top of this, the constant messaging from transphobic media that trans
people are not actually their true genders and are simply trying to trick
Faith Naff
people into believing otherwise gets internalized like a virus. This creates @FaithNaff
a lot of self doubt about the authenticity of one’s gender, especially in the Gay people 2 decades ago: *exist*
face of so many gender stereotypes. Seeing oneself fail to meet those Bigots: "They're trying to turn our children gay! We must protect
stereotypes can make it very easy to convince yourself that you do not live our children!"

up to your own gender (note: cis men and women get this too, far too Trans people now: *exist*

Bigots: "They're trying to convince our gay kids they're the wrong
often).
gender! We must protect our gay children!"

Furthermore, due to a history of transphobic abuse, many trans people 5:36 PM - Jan 27th, 2020

suffer from damaged self-esteems, and often already have dif culty with
self doubts. Gender Dysphoria also causes depression, which further
contributes to and reinforces those doubts. This all leads into a massive cluster of self invalidation that can lead someone to
struggle over and over again to accept their own gender identity.

But here’s the thing… only trans people are worried about if they are actually transgender! A cisgender person does not have this
obsession with their identity, they think about it, they process it, they move on. If you keep returning to these thoughts over and
over again, this is your brain telling you that you took a wrong turn.

The world is full of in uences put in place to ll us with doubt and keep us from breaking outside of the established social order.
These are some of the systems and ideologies that seek to invalidate trans people and keep us from self-actualizing.

Autogynephilia
This pattern was strongly reinforced during the late 1980s when the Autogynephelia (AGP) theory of Ray Blanchard gained a lot of
traction as trans awareness was just starting to escalate. AGP is a pseudo-scienti c explanation intended to “explain” the source of
trans women’s identities using paraphilias. Blanchard separated trans women according to if they were attracted to men or to
women, while simultaneously invalidating their womanhood. His work completely ignored transgender men, and he dismisses non-
binary identities outright.
Autogynephelia attests that straight trans women are actually just gay
men who seek a feminine appearance to draw desire from straight men, 𝓙𝓸𝓬𝓮𝓵𝔂𝓷

@TwippingVanilla
and that trans lesbians are actually straight men who have become so
A friend of mine who just started her transition this week asked
obsessed with their desire for women that they wish to become a woman me yesterday if I ever got turned on by seeing myself. I knew
in order to gain sexual grati cation from themselves. immediately what she was actually asking, so this is a PSA for
all those trans femmes out there feeling invalidated by their
own bodies.
Blanchard’s theory largely hinged on the way that presenting feminine
Im gonna be blunt: Your gender is not invalid because
often resulted in sexual arousal within newly transitioning women. You
you get an erection when seeing yourself dressed as
see, most of his study subjects were patients who were trying to seek feminine. We’ve all gotten it. It doesn’t mean you’re
hormone therapy for the rst time, and as such were still very new to fetishizing. It doesn’t mean you’re not actually trans.

presenting female. All it means is that you feel good about how you look.

Gender Euphoria is sexy. Being comfortable in your

Yes, it boggles the mind, but this was actually considered a valid theory of clothes is sexy. Liking the way you look is sexy. *Feeling
sexy is sexy!!*
psychology for years. It even appeared in college textbooks. Blanchard’s
That triggers a turn on, the body reacts to sexy things.
research studies did not meet scienti c rigor, and his data was found to be
Here’s the kicker: Cis Women get this too!!! It’s literally just a
extremely awed (he manipulated his patients, and simply just threw out lady boner!
any data that didn’t t his hypothesis). A lot of his theories are based in Over time this reaction happens less and less as you get
misogynistic views of womanhood, and the man never actually involved more used to preseting as yourself. Eventually most
clothes are just clothes, it’s just your new normal.
any cisgender women in his study to function as a control group. You can
But that special outfit that makes you feel really hot? That
read more about how awed the theory is in Julia Serano’s excellent essay
new dress that you try on for the first time and feel really
The Case Against Autogynephilia. cute in? That lingerie that you bought specifically to feel
sexy in?
AGP had been thoroughly dismissed by modern psychology by the late Yes, that triggers it. All it means is thst you’re happy.
2000s, but the damage has been done. In the public’s eye, trans women Let me tell you, the massive relief my friend displayed at
learning that this was completely normal was palpable. The
were all perverted fetishists. Media portrayals of trans women mirrored
poor girl had been stressing about that so hard.
this attitude, further spreading negative imagery into the public
She didn’t even know about AGP, but she knew the stigmas
consciousness. and was terrified that this meant she was fake.

6:46 AM - Jul 22nd, 2019

Transfeminine individuals then internalize these messages, and come to
the conclusion that they are not actually transgender, just fetishists. It
happened to me, it’s happened to nearly every millennial trans woman I
know who gured themselves out as a teen.

You are not a fetishist, the feeling you get from thinking of yourself as a woman is gender euphoria.

Patriarchal Oppression
A common source of invalidation for AFABs is the con ation of gender with the systemic oppression of women, particularly among
non-medically-transitioning non-binary people. The message of “oh you just don’t want to be a woman because of how women are
treated” is far too often heard, and it can deeply infest your subconscious to the point of self doubt. But this doesn’t make much
sense, because if you’re AFAB and not a woman, that makes you transgender. And on average, society treats transgender folks
worse than women. So transitioning to escape systemic oppression is a dumb concept (and I personally have never met a trans
person who has done this).

Radical Feminism’s messaging of abandoning female gender roles can also make parsing your own feelings harder. “Am I actually
non-binary, or am I just a feminist?” “Am I actually a man, or am I just a very butch lesbian?”. For this, I encourage you to talk to cis
woman feminists, especially lesbians. They’ll complain about systems of oppression and the patriarchy, but the problems are all
external, and they want to be women. Even very butch lesbians want to be women, just in a different way from mainstream
femininity.

Then you have the problem of people believing that to be non-binary is to be androgynous, and to be androgynous is to be less
feminine. Feminine enbies are valid! It is okay if you do not want to remove your breasts. It is okay if you enjoy your curves. It is okay
if you do not mind being called “she” and “her”. That does not make you any less transgender.
If you feel like you are not a binary woman, than you are not a binary woman. Cis women do not experience that detachment.

Toxic Masculinity
Male-assigned kids grow up positively drenched in messaging of what it is to “be a man”. There are so few examples of positive
masculinity in popular media, and AMAB Masculine Enbies are also so commonly erased in trans representation that being a
genderqueer male can feel very lonely. AMAB Enbies are often either grouped in with gay cis men or treated like trans women.

You can just be genderqueer! Your identity is valid!

Transmedicalism
This one hits everybody. Transmedicalism (aka Truetrans) is a transgender ideology derived from the Harry Benjamin scale (ranks 5
and 6). It seeks to reinforce the pre-WPATH rules, requiring intense physical dysphoria, demanding medical transition, and often
invalidating all non-binary identities. At its core, transmedicalism is a supremacist concept, elevating binary trans people above the
needs of any other gender identity, and a push back against the expansion of the transgender identity. They wish for more
gatekeeping than we have today, rail against enbies using the transgender label, and would prefer to see fewer people receive
treatment for their gender dysphoria.

To put it succinctly, many transmedicalists hate that the newer generation “has it so easy,” despite the fact that many of their ranks
are part of that generation. This ideology started among disgruntled trans elders, but has since spread to other binary individuals,
particularly among young trans men.

If a trans person’s rst exposure to transness is a transmedicalist, this can severely set back their own self-acceptance and push
them even further into the closet. Transmeds are well known to actually tell people “No, you are not trans.”

Do not believe these lies. They are bully tactics explicitly designed to gaslight and dismiss people’s pain for self grati cation.

Trans-Exclusionary Reactionary Feminism / Gender Critical Movement / Gender

Essentialism
Gender Essentialism is the belief that there are an innate attributes to a person’s existence that are derived based on what sex
organs the person is born with. TERF and GC ideology was born out of the lesbian separatist movement of second wave feminism
and fully denies the existence of transgender biology and non-binary identities. The movement has been largely overtaken by right-
wing reactionaries, racists, and homophobes, and is now being bolstered by evangelical Christian organizations.

These people will stop at nothing to invalidate your existence. Do not give them the time of day.

Gender Abolitionism / Postgenderism

Postgenderism is a transhumanist philosophy originating in radical feminism which states that gender causes more harm than good,
and seeks to eradicate it from our society. GAs believe that all gender is a construct and that anyone who feels strongly connected
to a binary gender is either nefariously propagating gender stereotypes or ignorantly following systemic indoctrination.

GAs do not believe in the existence of gender dysphoria, and will attempt to invalidate those who experience it. They’re functionally
the extreme leftist version of the Gender Critical movement.
How is Gender Dysphoria Diagnosed?
This section is going to focus on the diagnostic criteria under the American Psychiatric Association’s Diagnostic and Statistical
Manual of Mental Disorders, version ve (DSM-5). The reason I’m focusing on this standard is because, well, nobody else has one.
The UK’s National Health Service basically mirrors the APA’s DSM. Other countries have their own local standards, but they’re all
either very similar, or a lot more outdated.

The WPATH SoC describes ways that Gender Dysphoria manifests, but does not de ne clear diagnostic criteria, instead leaving it
up to individual mental health professionals to make their own diagnoses. In general it advocates that if the patient is of sound mind
and body and says that they have Gender Dysphoria, then they should be believed. The key piece here is “sound mind and body”, it is
left to the mental health professional to do the due diligence to ensure that there are no other conditions which may be causing the
patient to believe this.

Or to put it bluntly, WPATH says that if you think you’re trans, you’re trans. This has been the attitude that the majority of the
community has adopted as well. As long as you believe your gender does not match what you were assigned at birth, you are
transgender. However, insurance companies aren’t so happy with self-diagnoses, so here are the criteria which are de ned in DSM-
5 for diagnosing someone with Gender Dysphoria.

Note These are the criteria for adolescents and adults. Children have a different set of criteria, which you can nd here. I have also
changed the wording slightly, here, as the of cial criteria are binary-centric.

For an adult to be diagnosed with Gender Dysphoria by a licensed mental health professional they must meet two of these six
criteria, and have experienced those criteria for longer than six months.

A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics

The way the person sees the world and interacts with the world does not align with the way it is typically expected for someone
of the gender they were assigned at birth. There are a very broad number of traits which t into this description. It can be in the
way they interact with others, how they talk, what hobbies they prefer, how they dress, their body language and mannerisms,
what gender(s) they relate to more.

A strong desire to be rid of one’s primary and/or secondary sex characteristics

A strong desire for the primary and/or secondary sex characteristics of another gender

These two are pretty well paired. This is physical dysphoria as previously de ned. The person nds discomfort with aspects of
their body which are a result of their sex at birth.

A strong desire to be of another gender

A strong desire to be treated as another gender

These are the social and societal dysphoria. They are how a person wants to interact with the world, and wants the world to
interact with them.

A strong conviction that one has the typical feelings and reactions of another gender

This is pretty self explanatory.

As I said, only two of these conditions need be met for a formal diagnosis. You may notice that only two of these comprise the
physical body. It is perfectly valid for a trans person to be experiencing Gender Dysphoria without actually hating any part of their
body, or wanting to change any part of their body. Physical Dysphoria is only one fraction of the many ways that lead to being trans.

Now, here is the kicker. If you identify as transgender, meaning that your gender does not align with the binary sex you were
assigned at birth, you already meet two of these criteria! You have a strong enough desire to be of another gender that you are
identifying that you are another gender, and you have a strong conviction of what your gender feels like, and it isn’t what you were
given at birth.
So, it is literally impossible for a person to identify as trans and not experience gender dysphoria. By the WPATH requirements
anyone can identify as trans. Ergo, the statement “you do not have to have dysphoria to be transgender” is a logical paradox.

Then why do we still say it? Because most people don’t know what gender dysphoria actually is, and it is easier to repeat the mantra
than to explain the nuances and subtleties of how Gender Dysphoria manifests. But hey, look, now you’ve got a nice article to link to
that can help people understand that.
How is Gender Dysphoria Treated?
Treatment options vary signi cantly depending on the individual person’s needs. Every single transition is unique, and there is no
one way to transition. This section is a list of possible pathways.

Social Transition
In a phrase: Coming out of the closet. This is simply announcing to the world that you are transgender. You announce that you wish
to use a new name and/or new pronouns – or not, you may just wish for people to know that you are trans and do not actually
identify with your assigned binary gender. For some non-binary people this may not even be a full step away from their assignment,
since gender is a spectrum and there is such as thing as a “non-binary man” and a “non-binary woman”.

A social transition is the act of stepping out of the closet, and it can relieve a lot of stress from suppression of ones self.

Legal Transition
This is the process of changing your legal documents to re ect your true gender. This may be through a legal name and gender
change issued by a court, through a change of gender marker on an of cial ID, or through re-issuing of birth certi cates and
marriage licenses.

Presentational Transition
These are changes to how you style yourself, be it your clothes, your hair, or the use of makeup. Our society heavily genders all of
these things, and switching presentation is both af rming to one’s self and also sends cues to those around them about how they
wish to be addressed.

Medical Transition
For adults this is hormone replacement therapy and surgery. For adolescents this often means puberty blockers until the teen is old
enough to be certain of which gonadal hormone they want to have. For prepubescents, this is nothing. Let me repeat that again,
since transphobes keep getting it wrong.

PREPUBESCENT CHILDREN DO NOT MEDICALLY TRANSITION.

While the American Academy of Pediatrics strongly encourages the validation and acceptance of transgender youth, and the
enabling of all other forms of transition, they explicitly do not support doctors beginning either hormone therapy or puberty
blockers until a child has reached Tanner stage 2.

Furthermore, no surgeon in the United States will perform a gender altering surgery on a minor (excluding intersex “corrections”,
which is a whole other problem outside the scope of this article). Very few children have strong enough features to be read as either
male or female without clues provided through presentation. Allowing a child to change their hair and clothes is all that is needed
for the child to be seen as male or female.

Hormonal Transition
Masculinizing Hormone Therapy (female to male sexual characteristics) consists of the introduction of testosterone, usually via
intramuscular injection or topical gel. The increase in total gonadal hormones typically causes a cessation of ovulation, which is the
source of the majority of estrogen produced in the ovaries.

Femininizing Hormone Therapy (male to female sexual characteristics) consists of the introduction of estrogen, typically estradiol,
via oral pills, patches, or regular injections (intramuscular or subcutaneous). The use of slow dispensing implants is also becoming
more and more common. It is also common practice to prescribe an anti-androgen to block testosterone production or absorption.
In the United States this is usually Spironolactone, a blood pressure medication which has a testosterone blocking side-effect.
Outside of the US the most common drug is Cyproterone Acetate, an androgen receptor blocker, which is not available in the US.
Doctors may also prescribe Bicalutamide, which also blocks androgen receptors. However, some doctors may simply opt to use
larger estradiol doses in order to cause the body to halt testosterone production.
In adolescents, puberty blockers may involve the above androgen blockers, or if it is covered by insurance, the use of an
antigonadtropin (drug which blocks the hormones that cause the production of estrogen and androgen) such as leuprolide acetate
(a shot delivered every few months) or histrelin acetate (an annual implant).

Surgical Transition
Transgender surgeries are typically divided into three separate categories:

Bottom Surgery (modi cations to genitals).

Femininizing:
Orchiectomy (removal of the testicles)
Scrotectomy (removal of scrotal tissue, following orchiectomy)
Vaginoplasty (creation of a vaginal cavity)
Vulvaplasty (creation of a vulva, with or without depth).

Masculinizing:
For Your Information
Hysterectomy (removal of uterus and cervix)
A newly developing area of bottom surgery is in AMAB non-
Oophorectomy (removal of one or both ovaries) binary operations which attempt to perform vaginoplasty without
Vaginectomy (removal of vaginal cavity) the removal of the penis. This particular surgery is extremely
experimental and has been performed less than a dozen times in
Metoidioplasty (a process which increases the size of the clitorus the United States, but the outlook for the future is good.

into a penis) An additional option for non-binary bottom surgery is genital

Phalloplasty (construction of a penis from skin grafting) nullification surgery, which aims to completely remove the
external genitalia, leaving only a urethral opening.
Urethroplasty (extension of the urethral canal through the
phallus)
Scrotoplasty (use of labia majora and false testicles to construct a scrotum).

Top Surgery (modi cations to the chest)

Feminizing:
Breast Augmentation via fat transfer or implants.

Masculinizing:
Bilateral Mastectomy (breast tissue removal) with chest reconstruction.

Facial Feminization / Masculinization Surgery (modi cations to the skull, cartilage, and skin on the face).

The younger a person is, the less they will need these surgeries, especially if they medically transition prior to the age of 20.

Feminizing:
Forehead recontouring
Eye socket recontouring
Brow lift
Hairline correction
Blepharoplasty (lifting of eye bags)
Rhinoplasty (reshaping of the nose)
Cheek implants
Lip lift
Lip lling
Jaw recontouring
Tracheal shave (adam’s apple reduction)
Rhytidectomy (face lift)

Masculinizing:
Forehead augmentation
 Jaw augmentation
Chin augmentation
Tracheal augmentation (adam’s apple enlargement)

Other Trans Feminine Surgeries:

Brazilian Butt Lift. Fat from the belly is transplanted into the butt in order to increase hip to waist ratio.
Voice Feminization Surgery. An incision is performed in the vocal chords in order to permanently raise the pitch.
Cinderella Surgery. Bones in the foot are shortened in order to reduce foot size. EXTREMELY RISKY
Shoulder Reduction. The collar bone is shortened to reduce the width of the shoulders. EXTREMELY RISKY
What is the Cause of Gender Incongruence?
To put it bluntly: We don’t know, not rmly. Science and modern psychology has proven that it is not caused by nurture; no one
becomes transgender, gender identity is congenital, solidifying before we even exit the womb. It also appears to sometimes be
hereditary; transgender parents have a higher likelihood of having transgender children, and many times they realize this in reverse.
The child comes out to the parent, and that helps the parent realize they can come out as well.

Here is the science that is believed to in uence gender identity. This does not mean that it de nes gender identity, nor does it fully
encapsulate one’s gender, as so many aspects of gender are cultural and social. None of this is prescriptive of a person’s identity,
none of it is cast in stone.

If you’ve seen Jurassic Park then you may remember this scene:

This isn't science fiction, although it is very simplified.

The gonads in human fetuses initially develop in a bi-potential state, meaning they can become either ovaries or testes. The SRY
gene on the Y chromosome releases a protein called Testis Determining Factor (TDF). This protein then starts a chain reaction with
SOX9 production (another protein), which causes the gonadal cells to form into the Sertoli and Leydig cells that make up the testes.
If TDF is never produced or is interfered with then the gonad cells form into the Theca cells and Follicles which comprise the
ovaries.

Once formed, the testes then begin producing a testosterone surge which typically starts in the 8th week of gestation and
continues until the 24th week. This surge, combined with another hormone from the placenta, is responsible for the development of
the penis and scrotum. Genitalia formation starts around week 9 and becomes identi able by the 11th week. If the surge does not
occur, or the body does not respond to it (such as in the case of Androgen Insensitivity Syndrome) then the genitalia form into the
vulva, vagina and uterus instead.

If there is an interference in this process then you can end up with the wrong bits, and this is the result of many intersex conditions.
Often times this is a partial development, where the external genitalia only partially form, but functional gonads still exist.
Sometimes the child comes out with fully functional male or female genitalia, but mismatched gonads. Sometimes the TDF protein
fails to release and the fetus grows completely functional female reproductive organs, despite the presence of a Y chromosome.
This is known as Swyer Syndrome, and an unknown number of women may have
this condition. In 2015 an XY woman with Swyer Syndrome who was born without
ovaries successfully carried and gave birth to a child via IVF. Usually Swyer
Syndrome results in completely non-functional ovaries, but in 2008 a woman was
found with Swyer Syndrome who had gone through puberty, menstruated normally,
and had two unassisted pregnancies. Her condition went undiscovered until her
daughter was found to also have it.

The fact is, the vast majority of the population has never been tested for genetic
karyotype, so we don’t know how common these cases actually are. Where does
this come into affect for gender identity? Well, the exact same process that causes
the external genitals to differentiate also occurs for the brain.

Brain Split
The prenatal brain doesn’t really start to develop until between week 12 and 24.
The cerebral cortex, the thin outer layer of the brain that contains most of what we
think of as consciousness, grows substantially during those periods of time. Prior to
that, the structure present is more like a scaffolding, the basic parts of the nervous
system necessary for bodily function. The primary sulci (the wrinkles in the cerebral
cortex that allow for more surface area) start to form at week 14, well after the
genitals have developed.

It has been con rmed multiple times via MRI studies that there are small but
signi cant differences between cis male and cis female brains, differences which
align with the gender identities of trans people in the study. Note, this does not
mean that anyone with those differences will have that gender, because gender
identity isn’t that simple, but it provides evidence that there is a clear difference in
masculine and feminine brains. There is also evidence that brains can have mosaic
combinations of these differences, which may be the case in non-binary people.

A change in the testosterone levels in the fetus after the 11th week can directly
impact the masculinization of the cerebral cortex, as well as changes in other parts
of the brain structure. This has been examined over and over again in studies of
female assigned children with CAH (congenital adrenal hyperplasia) and CAIS
(complete androgen insensitivity syndrome).

“ We found a significant relationship between fetal testosterone and sexually

differentiated play behavior in both girls and boys.

— Fetal Testosterone Predicts Sexually Differentiated Childhood Behavior in Girls Source

and in Boys

An excess of testosterone in the mother’s body during the second trimester can (and does) cause masculinization of the brain in an
externally female fetus, and an interference in testosterone production or uptake can (and does) cause feminization of the brain in
an externally male fetus. This interference does not have to be external in origin, either. Any number of genetic traits can cause the
brain to respond differently to testosterone.

A fairly large study of transgender individuals released in 2018 found several key genes which were statistically more likely to be
longer among trans women (longer, as in having more repeated fragments). Individually these genes may not have an impact strong
enough to cause a malfunction of masculinization, but collectively they absolutely could reduce the ability for the fetal brain to
masculinize. These genes are all passed from parent to child, giving credence to a tendency for trans parents to have trans children.
Gender is Biological And it gets even weirder!
Sadly, western society has actively prevented a deeper understanding of
gender. Ancient civilizations understood it well, but colonialism wiped
Lisa T Mullin
them off the map. 100 years ago, scientists in Germany were actively @LisaTMullin
studying transgender medicine and made extraordinary advancements, Normally the Y chromosome carries 27 genes, only 4 are
until the Nazis burned it all in 1933. Conservative and fascist pressures in related to sex. One, the SRY, determines (via the SOX9 gene)
whether testes or ovaries form in the early fetus. Another 3
the modern day have hindered advancements in transgender healthcare
determine sperm production if testes form.
whenever possible.
The SRY is just a signaler to 3 dark DNA areas to
produce more SOX9 genes, above a certain threshold
Yet, progress continues, and every few years we learn a little bit more. testes form, below that ovaries.

But that is just the start of the story. If ovaries form then
What we know for certain is that it is not a psychological condition, it is another gene, FOXL2, keeps them as ovaries.
not something caused by trauma or by any external in uence, nothing can FOXL2 works with estrogen receptors to keep the ovary
make a person transgender. It happens in the womb, and is not something as an ovary without which it would turn into testes and
start producing testosterone by inhibiting SOX9
that a person can choose to be, any more than they could choose their
production.
race or their eye color. It has nothing to do with sexual orientation, it has Male and female mammals produce SOX9 as far as I
nothing to do with kinks or fetishes, and it has nothing to do with social know all their lives (I need to check up on that) and even
if there are already ovaries if the level becomes high
in uences from their parents or from their peers. Transgender children
enough then the ovaries will turn into testes.
are as rm in their identities as cisgender children are.
But FOXL2 production depends on enough estrogen
and/or the estrogen receptors working correctly. If
something goes wrong with either then SOX9 production
increases and existing ovaries will turn into testes and
produce testosterone.
So there is a feedback loop: No SRY means less SOX9, thus
ovaries form. They produce estrogen which causes FOXL2
production which suppresses SOX9 production to keep the
ovaries as ovaries. Is something goes wrong and SOX9 levels
climb enough then those ovaries will become testes

11:00 AM - Feb 2nd, 2020

But the Chromosomes!!!
There are dozens of ways that chromosomes can be much more complex
than XX and XY. Medically these are referred to as DSDs (Disorders of Sex
⚢ TransEthics™ #ProtectTra…
Development). Not all result in an intersex condition, and many only @TransEthics
manifest at the onset of puberty. I'm going to regret paying the co-pay for this test eventually
because it was pretty pricey… but I had my karyotype done. Just
De la Chapelle Syndrome (46,XX Male) occurs when the SRY gene got the results.

from the sperm parent crosses over into a non-Y-bearing sperm I –a trans woman– have XX chromosomes.

during spermatogenesis. When the egg and sperm merge, it results in the GC crowd can g[REDACTED]k themselves

an XX embryo with an SRY gene, creating a phenotypical male child 4:13 AM - Feb 2nd, 2020

with two X chromosomes.

Swyer Syndrome (46,XY Female) produces a phenotypically female

child with an XY chromosome. This results from a dozen different genetic conditions, including:
Absence or defect of an SRY gene
Absence or defect of DHH synthesis
Absence of the SF-1 protein due to adrenal failure
Absence of or defect the CBX2 gene, preventing TDF cascade

XX Gonadal Dysgenesis is very similar to Swyer Syndrome, except occurs in XX children and results in nonfunctional ovaries.

Turner Syndrome (45,X) produces a phenotypically female child with numerous abnormalities. It occurs when neither an X or Y
chromosome crosses over from the sperm.

Klinefelter Syndrome (47,XXY) results in a phenotypically male child with more feminine traits. In extremely rare cases it
appears in female assigned children as well, resulting in feminized testicles instead of ovaries.

49,XXXXY Klinefelter Syndrome is often fatal, but when it isn’t, it will always results in a sterile child.

Trisomy X (47,XXX), Tetrasomy X (48,XXXX), and Pentasomy X (49,XXXXX) all result in a female child, but with progressively
more intense health issues.

XXYY Syndrome results in male children (due to two SRY genes) which often experience hypogonadism, needing testosterone
supplements, but otherwise seeming like a typical male

Mosaicism results when some cells in the body have one set of chromosomes and other cells have another due to a mutation of
the genome during gestation. This may be XX/XY (resulting in a dual set of genitalia), X/XY (a milder form of Swyer or Turner
syndromes) or XX/XXY (a milder form of Klinefelter syndrome).

Chimerism occurs when two fertilized embryos merge together into one zygote, causing half of the child to contain one set of
DNA and the other half to contain another. This can result in an otherwise completely typical human being of either male or
female phenotype, even capable of producing offspring, but which comes back on a kareotype test as not matching their
phenotype based on where the sample was taken on their body. In extremely rare cases this can result in two full sets of
reproductive organs.

Congenital Adrenal Hyperplasia(CAH) is masculinization of the female genitals in an XX child due to overactive adrenal glands.

Androgen Insensitivity Syndrome(AIS) is a total or partial resistance to all androgens, preventing masculinization of all organs,
save for the testicles, in an XY child. AIS subjects typically develop a female gender identity, but some partial cases may be
male.

5-alpha-reductase de ciency(5ARD) is a failure in the body’s ability to metabolize testosterone into dihydrotestosterone
(DHT), preventing masculinization of the genitalia until the onset of puberty, when the child suddenly grows a penis.

Aromatase De ciency causes masculinization of an otherwise female child due to excess levels of testosterone (and can bleed-
over into the mother during gestation).

Aromatase Excess causes feminization in an otherwise male child, as all testosterone is converted into estrogen.
 Open Ocean Exploration
@RebeccaRHelm

Friendly neighborhood biologist here. I see a lot of people are talking about biological sexes and gender right now.
Lots of folks make biological sex sex seem really simple. Well, since it’s so simple, let’s find the biological roots,
shall we? Let’s talk about sex...[a thread]

If you know a bit about biology you will probably say that biological sex is caused by chromosomes, XX and
you’re female, XY and you’re male. This is “chromosomal sex” but is it “biological sex”? Well...

Turns out there is only ONE GENE on the Y chromosome that really matters to sex. It’s called the SRY gene.
During human embryonic development the SRY protein turns on male-associated genes. Having an SRY
gene makes you “genetically male”. But is this “biological sex”?

Sometimes that SRY gene pops off the Y chromosome and over to an X chromosome. Surprise! So now
you’ve got an X with an SRY and a Y without an SRY. What does this mean?

A Y with no SRY means physically you’re female, chromosomally you’re male (XY) and genetically you’re
female (no SRY). An X with an SRY means you’re physically male, chromsomally female (XX) and genetically
male (SRY). But biological sex is simple! There must be another answer...

Sex-related genes ultimately turn on hormones in specifics areas on the body, and reception of those
hormones by cells throughout the body. Is this the root of “biological sex”??

What does this all mean?

It means you may be genetically male or female, chromosomally male or female, hormonally
male/female/non-binary, with cells that may or may not hear the male/female/non-binary call, and all this
leading to a body that can be male/non-binary/female.

Biological sex is complicated. Before you discriminate against someone on the basis of “biological sex” &
identity, ask yourself: have you seen YOUR chromosomes? Do you know the genes of the people you love?
The hormones of the people you work with? The state of their cells?

Of course you could try appealing to the numbers. “Most people are either male or female” you say. Except
that as a biologist professor I will tell you...

The reason I don’t have my students look at their own chromosome in class is because people could learn that
their chromosomal sex doesn’t match their physical sex, and learning that in the middle of a 10-point assignment is
JUST NOT THE TIME.

5:45 PM - Dec 19th, 2019

plant lesbian
@alicemiriel

@RebeccaRHelm As a fellow genetics lab teacher, this is the same reason my department stopped chromosome
testing in lab. A really cool experiment would turn into guys getting freaked out they have XXY, etc.

4:23 PM - Dec 20th, 2019

How Hormones Work
As we described in the Causes of Gender Dysphoria section, every human’s DNA contains the genetic instructions for both male
and female bodies, and which set of instructions gets used is controlled by what hormones your gonads produce. That
differentiation occurs entirely based on whether you happen to have an SRY gene which, in the 6-8th week of gestation, kicks off a
chain reaction that produces testes instead of ovaries. From that point on, every sexual attribute of the human body (primary and
secondary) is a result of the hormones that those gonads produce.

If they produce estrogens (primarily Estradiol) then the genitals form into a vulva, vagina and uterus. If they produce androgens
(primarily Testosterone) then the genitals form into a penis and scrotum, shifting the Skene’s gland downward and enlarging it into a
prostate. Differentiation ends here until the onset of puberty, 9-10 years later, and we all know what puberty does.

So how does this work? Why do the cells differentiate like this? Well, before we can explain that, rst we have to explain the concept
of a Receptor.

Hormone Receptors
In simplest terms, a receptor is like the keyed lock ignition on a car (do new car’s still have keyed ignitions?). Every cell in the body
has a set of locks which activate different functions within that cell. They’re like switches which signal to the cell that it should
activate a different part of its genetic sequence. Each receptor can only accept certain chemical compounds, much like how a lock
can only accept certain keys, and different chemicals have different capabilities at turning the key. Some can completely start the
car, while others only turn it to Accessory Mode.

The ability for a chemical to t into a receptor is called Relational Binding Af nity, and is measured as percentage of how likely a
chemical will bind to a receptor compared to another. So, for example, if Hormone B binds only 10% of the time in relation to
Hormone A, then it is said to have a 10% binding af nity. Similarly, the ability for a chemical to turn the key is called
Transactivational Ability. Compounds which t into a receptor but don’t do anything are called Antagonists, compounds which are
able to turn the key are called Agonists. If it can only turn the key a tiny bit, it’s called a Partial Agonist.

You can think of antagonists like bouncers at a club. They stand in the doorway and prevent anything else from getting through, but
don’t enter the club themselves. Most antagonists are referred to as blockers. This is different from an inhibitor, which is a
compound that slows down a chemical reaction, or an activator, which speeds up a reaction. In receptors, an inhibitor lowers the
ability of the receptor, causing it to respond less effectively to things that bind to the receptor, and an activator increases the ability
of the receptor, making it respond stronger, like a booster.

In some cases a hormone can function as an inhibitor or an activator for a different hormone by slowing down or increasing
behavior in a cell. For example, progesterone increase cell activity, making cells respond more effectively to estrogens and
androgens, and testosterone increases the transaction ability of dopamine receptors, so less dopamine is needed in the brain for the
same effect.

Whats in a Hormone
There are four main kinds of hormones:

Amino Acids such as Melatonin which controls sleep, or Thyroxine which regulates the metabolism.
Peptides, like Oxytocin and Insulin, which are collections of Amino Acids.
Eicosanoids that are formed from lipids and fatty acids and predominantly affect the immune system
Steroids are signaling molecules produced by various internal organs in order to pass messages to other organs within the
body.

For the purposes of transition, this last category is what we care about the most, as all of the sex hormones are steroids. They fall
into seven main categories:

Androgens
 Estrogens
21 22 24 26
20 Mineralocorticoids
18 23 25 O O
12 H (21 carbons)
11
17 HO OH
19 13 27
16

Progestagins
9 14
1 15
2 10
H
8
H Cholesterol Aldosterone
3
4 6 7 O
5
HO
Aldosterone

Glucocorticoids
Cholesterol side-chain
cleavage enzyme OH synthase OH
Deoxy- O O
O Progesterone O corticosterone
HO

Progestagens (21 carbons)

Mineralcorticoids

3-beta-hydroxysteroid dehydrogenase (3β-HSD)

Corticosterone

21-hydroxylase

11β-hydroxylase
O O O
HO Pregnenolone

Neurosteroids
17α-hydroxylase

OH OH

17α-hydroxy O 17α-hydroxy O O O
pregnenolone OH progesterone OH 11-deoxycortisol OH HO OH

Aminosteroids O O O
Cortisol
HO
17,20 lyase
Glucocorticoids
O O O

Androgens (19 carbons)

(21 carbons)

The rst three of these are what we care about most when it comes to Hormone

(liver and placenta)

Dehydroepi- Androste- Estrone OH

Aromatase
HO
androsterone O nedione HO
OH

Therapy. Note: All human beings, regardless of phenotype, have some of every one
17β-HSD
Estriol
OH OH OH
HO

of these hormones in their bodies. The ratios are what affect body shape.
Androstenediol Testosterone Estradiol
HO O HO
)
ns
5α-reductase rbo Cellular location
ca
OH (18 of enzymes
ns
ge
tro Mitochondria
Es

Androgens
Dihydrotestosterone Smooth endoplasmic
O reticulum
H

There are nearly a dozen different androgens, but the ones we care about the most
are Testosterone and Dihydrotestosterone.

Testosterone is the primary masculinizing hormone for the human body and is
produced in the adrenal glands, the testes, and in the ovaries (where it is All steroids are formed from cholesterols (top left)
and are derived from other steroids. Progestins form
immediately converted into estrone and estradiol). It tells both muscle and bone into Androgens which form into Estrogens. This is a
cells to grow and in higher concentrations encourages larger muscle mass and one-way exchange, and does not reverse, so don't
believe it when someone tells you that too much
thicker skeletal structure. This also means that Testosterone is critical for bone estrogen will turn it into testosterone.
health, as it affects calcium distribution within the skeletal structure. Thus, severe
depletion of testosterone can result in osteoperosis and fragile bones. Testosterone also plays a major role in sex drive and libido,
encouraging mating behavior within the cerebral cortex.

Dihydrotestosterone (DHT), which is converted from Testosterone in the prostate, skin and liver, plays a major role in the
development of the male genitalia during puberty by inducing random erections, and the growth of facial and body hair.
Paradoxically, DHT is also what causes male pattern baldness, as it chokes off blood circulation to the follicles on the top of the scalp
(sorry, trans guys, it’s a double edged sword). DHT binds to androgen receptors ten times more strongly than testosterone, which is
why it is critical to eliminate it for feminizing transition.

Estrogens
There are four estrogens: Estradiol, Estrone, Estriol and Estetrol. The latter two are only produced during pregnancy and are
important for fetal health, but have no bearing on transition.

Estradiol is the Feminizing hormone, as it is the primary signaling hormone for growth in the mammary glands (breast tissue), and
because it encourages fat deposits in the thighs, hips, butt, chest and arms, while discouraging fat deposits in the abdomen, thus
producing a curvier gure. Estradiol also promote increased collagen production, resulting in softer skin and more exible tendons
& ligaments.

Estrone’s role in the body has been something of a puzzle in medical research, as it has signi cantly lower binding af nity compared
to estradiol (0.6%) and very low transactivational ability (4%). The hormone doesn’t appear to do anything, it just sits in the blood
stream. However it has a unique ability to convert to and from Estradiol via an enzyme group called 17β-HSD, making it ideally
suited to function like an estrogen battery within the body.

New research is starting to suggest that the body may regulate total estradiol levels by releasing HSD17B1 to turn estradiol into
estrone, and releasing HSD17B2 to convert it back, however this is very early study. Both enzymes are produced in breast tissue,
and may play a role in the presence of cyclical period-like symptoms in estrogenic individuals who do not have ovaries, such as trans
women.

Progestagins
The primary progestogin is progesterone, which plays numerous roles in the body and has been found to be an important
component for feminizing hormone therapy.
One of the largest roles that the progestogin receptor plays is in the
For Your Information
regulation of gonadal function (ovaries and testies). The hypothalamus is
Why aren’t AFAB trans people prescribed estrogen blockers
positively littered with progestogin receptors and responds strongly to alongside testosterone?
their activation, downregulating the production of GnRH, which then
There are two separate sources for estrogens within the female
reduces the production of luteinizing hormone by the pituitary gland. reproductive system. Ovaries contains thousands of follicles, cell
structures which produce eggs. The pituitary gland produces
luteinizing hormone (LH) and follicle-stimulating hormone
LH is what tells the ovaries and testes to produce estrogen and (FSH), which encourages the follicles to grow into luteal cells.
androgens. LH and its sibling hormone FSH both play central roles in Theca cells within the follicle produce testosterone, and
granulosa cells produce the enzyme aromatase, which converts
ovulation, which is another large source of estrogen in ovary-havers. Thus, that testosterone into estradiol. This is the first source of
estrogen, but it is not the largest source.
synthetic progestins, chemicals that t into progestogin receptors, are
often included in birth control in order to prevent ovulation. In AMABs, Note: This is why PCOS causes ovaries to produce testosterone;
the ovarian cysts disrupt the aromatase production, so the
progestogins are a useful tool for blocking testosterone production. testosterone does not get converted.

Two weeks into the period cycle the hypothalamus tells the
Another type of cell that is full of progestogin receptors is mammary pituitary gland to produce an LH and FSH spike three to four
tissue. Progesterone plays a major role in the growth and maturation of times stronger than earlier in the cycle. That surge causes the
follicles to swell until one pops, releasing an egg, at which point
milk ducts within breast tissue. While little formal research has been the remains of the follicle become a structure known as the
corpus luteum. That corpus luteum then begins to produce
conducted into progesterone’s effect on breast development, anecdotally progesterone and significantly more estrogens in order to
it has been seen widely across the transfem community to provide prepare the womb for a fertilized egg. This is the second source.

signi cant improvements in breast fullness. Progesterone has also been Taking testosterone causes the hypothalamus to deactivate the
genes that initiate this LH and FSH spike, so the follicles never
demonstrated to increase blood ow to breast tissue, and encourages fat reach maturity, ovulation never occurs, and the corpus luteum is
deposits in the breasts, both of which increase breast size. never formed, removing a significant source of estrogen within
the ovaries.

Additionally, progesterone promotes better sleep, improves So no, Reddit, it isn’t just “because testosterone is stronger”,
it’s because ovaries are a hell of a lot more complex than testes
cardiovascular health, increases ketogenesis (reducing triglycerides), and are easier to disrupt. Please stop spreading this falsehood.
increases metabolic function, and has been found to reduce breast cancer
risk.

Mineralcorticoids
Mineralcorticoids play no role in transition, but they are worth mentioning because of one major hormone: Aldosterone.

Aldosterone is what instructs the kidneys to stop extracting water from the blood stream. It is produced by the adrenal glands in
order to regulate body hydration. Why is this signi cant?

Because one drug that is very commonly used in trans hormone therapy is an extremely powerful aldosterone antagonist…
Spironolactone. Spiro binds to mineralcorticoid receptors more strongly than aldosterone does, but does not activate the receptor.
It just clogs it, preventing the kidneys from receiving the signal to stop extracting water.

This is why spiro makes people pee so much.

Androgenic Second Puberty 101
What to expect from Masculinizing HRT
This is a compilation of reported medical transition changes collected from testimonials of AFAB trans people taking testosterone
hormone therapy. This information is gathered from social media and chat rooms. Yes, that means this is all anecdotal, but
historically, most of transgender medical study is anecdotal because no one wants to fund transgender medical research.

Note that this is a list of possible changes. There is no guarantee that every person on masculinizing HRT will experience all of
these. Your age, genetics, medical history, degree of feminization from natal puberty, and hormone regimen can all have impacts
on results. There is also just a degree of randomness – every body is different – and some things can take years to appear.

Voice Drop
Androgens cause the tissue that comprises the vocal chords to thicken and harden, permanently lowering the pitch of the voice.
This is not a very fast change, but rather incremental over the rst few years. Some people do not experience any voice change at all,
it varies person to person. The change will not be drastic, if you are a soprano you are not going to become a bass, but it could bring
you down to a contralto or tenor.

This does not mean that your voice will automatically become read as male. Pitch is only a piece of how people gender voice, and the
way you speak plays a much larger role. Vocal training will be needed to amplify resonance and change speaking style.

Changes in Body Temperature Placement

Androgens encourage extra blood ow to the extremities, making them
warmer. Because of this, men have cooler cores but warmer oral and
Adam Fortune
surface level temperatures. You may see your basal body temperature @AFortune69
increase. The net result is that you will feel warmer, and likely will not be Night sweats/being HOT even at normal room temperature. The
able to layer clothing as much as previously possible. If you live in cold night sweats went away after a week or two the being constantly
warm has not gone away it has just become normal.
climates, exposing your calves can help to dissipate heat without chilling
Your scent changes, even the smell of your urine. Like I knew that
you too severely. going in, but it was still weird.

9:46 AM - Mar 22nd, 2021

This change often comes fairly early on; expect night sweats while your
system gets used to it.

Changes in Perspiration
With the above shift in temperature distribution, this also results in a signi cant change in how one sweats. Sweat will pool on the
head, back and armpits. You’ll also likely sweat more often, so keep water handy.

Body Odor
Often one of the rst things to change: sweat and general body odor will become much stronger, especially during exercise. The
smell will take on a sour, muskier smell. Tends to even out over time.

Body Hair, Everywhere

Androgens signi cantly increase the presence of body hair on the legs, groin, buttocks, chest, back and arms. Hair will grow in
thicker, longer and darker. This will likely happen well before facial hair growth, which can take over a year to start. Rogaine /
Monoxidil can help with that, but be careful as it is poisonous if ingested, especially to cats.

Male Pattern Baldness

MPD is caused by Dihydrotestosterone (DHT), an androgen which metabolizes from Testosterone. Having more T in your body
means more DHT can form, and the gene that contributes to MPD causes the hair follicles on the scalp to receive less blood,
choking them out until the follicles die. There will likely be some loss of hair line eventually, no matter what, but if there is a history
of baldness among the men in your family, then you can expect to see that as well. Again, Rogaine can help with this.
The synthetic androgen Nandrolone does not metabolize into DHT and may be a viable alternative in place of direct Testosterone if
hair loss is a concern. However, DHT is important for genital growth, so this is a double-edged sword.

Thicker and Oilier Skin

Testosterone promotes the thickening and toughening of the epidermis, causing skin to become coarser. As estrogen levels fall, the
body will produce less collagen. This causes the skin to become tougher and drier (especially in the knees and elbows). Veins on the
hands, arms, and legs may become more pronounced, but not varicose.

Expect your face and scalp to become oilier. Acne is likely to be a problem, and not just on the face. This tends to be worst
immediately after dosing. This will generally improve after the rst few years.

Larger Hands / Feet

Over long periods of time (3-5 years) the hands may become tougher and more calloused. You may need to increase your ring size
eventually.

Testosterone also causes ligaments and tendons to retain more water, altering their exibility. Over time this can result in an
increase in foot size as the arch of the foot lowers.

Thicker and Stronger Nails

Both ngernails and toenails will grow thicker over time as keratin levels rise due to the presence of androgens.

Increased Muscle Mass

Androgens stimulate muscle growth, which is why anabolic steroids (which are literally testosterone) are so common amongst body
builders. The body will naturally gain more muscle without even having to exercise, but with exercise there can be substantial gains,
particularly in the arms and shoulders. Beware, you won’t know your own strength at rst.

Added lean muscle in the upper body rede nes the shoulder and neck line, creating a more masculine silhouette. It also improves
the body’s ability to process lipids, making weight loss easier.

Fat Redistribution
Where estrogen encourages the body to deposit fats into the thighs, buttocks, and hips, androgens encourage the body to deposit
fats largely into the abdomen. Starting testosterone will encourage your body to follow the androgen pattern, so you can expect
new weight to deposit into your belly, while weight loss will take away from all over. Fat in the breasts, thighs and buttocks will
slowly shift away as muscle builds, but this may take a long time.

Facial Feature Changes

Along with body fat migration, fat in the face also moves. The neck, chin and jaw line will ll out while the lips and upper cheeks
shrink. The color of the eyes may also change and become fainter in the long term, as testosterone causes the pigmentation in the
iris to fade.

This is and extremely subtle and slow moving process that takes years, and it is easy to think nothing is changing at all. The greatest
shifts seem to happen in years 3 and 4. Take sel es to compare.

Increased Tolerance of Caffeine, Alcohol, and/or Psychotropics

More mass means more blood to dilute chemicals into. Increasing testosterone also means a higher metabolic rate, increasing the
speed at which toxins are removed from the blood stream.

Mental Changes
As covered in the Biochemical Dysphoria section, brains can be wired for a certain hormone pro le, and running on the wrong
pro le is like using a laptop with low batteries or an overheated processor. Starting HRT almost universally results in a cessation of
depersonalization and derealization (DPDR) symptoms within the rst two weeks. A mental fog lifts, and it becomes easier to
concentrate on complex concepts (assuming you don’t also have other mental processing dif culties such as ADHD).

ADHD
If you have ADHD, there may be some changes in your symptoms. Androgens amplify dopamine receptor function, so increasing
testosterone can improve the activation potential for dopamine in the brain. Dopamine is a key neurotransmitter in the behavior of
working memory, the short-term memory of the brain. More working memory means you may become less prone to distractions
and have an easier time maintaining cognitive load.

However, estradiol encourages the production of dopamine, so as estrogen levels fall there will be less dopamine for the brain to
work with. Your symptoms worsen, not improve.

Emotional Expansion
The alleviation of DPDR almost universally is accompanied with a much broader capacity for emotion and emotional regulation.
Emotions become somewhat more controllable and suppressible, less likely to overwhelm on the spot. Please note: suppressing
emotions is a very quick way to develop trauma.

However, the ability to express them may become reduced. Some people lose the ability to cry after starting on testosterone, but
this is not a universal experience and may be tied into how strong your T dose is. The reasons behind this aren’t well known,
although some studies have found that androgens alter function in parts of the brain connected to emotional processing. If you do
lose the ability to cry, it may return in time as your brain become more acclimated and you come out of second puberty.

Emotional dis-regulation occurs the most commonly before and

immediately after dosing (injections or gel) and results in reduced
Blotchkat
patience, increased aggression. @blotchkat

I know a lot of people have the effect that they can't cry. But
Increased Appetite / Eating Capacity
honestly, I'm about to cry right now just thinking about crying.
You are going to be hungry. Testosterone cranks the body’s metabolism up I'm extremely sensitive and emotional now in a way that I didn't
signi cantly, and increased muscle mass means there is more to feed, so allow myself before.

you will burn calories faster. I cry a lot, but it's always tears of joy now.

11:10 AM - Mar 22nd, 2021

Sleep
Some people report problems with insomnia and having fewer memorable Missing tweet for 1374070062236246022
dreams. This is far from a universal, however.

Con dence
Testosterone is known to induce a strong sense of self-con dence in
people. Problems seem less signi cant, self-esteem is stronger, fewer
Elijah ★ (He/Him Bug/Bugself)
@crypticenbug
anxieties. Many people report a tendency to be more prone spark
I had a decent sleep schedule before I started T, and afterwards it
arguments, and more willing to speak out in the face of con ict and self basically just flipped
advocate. This does not mean more hostile or argumentative, simply that 12:12 PM - Mar 22nd, 2021
ones tolerance for bullshit is lower.

Extroversion
It’s extremely common for trans people of all types to nd themselves much more sociable post-transition. This may simply be a
result of no longer having to suppress large portions of their personality, but the aforementioned con dence also plays a role.

Genital Changes
All genitalia are constructed from the same tissues, they are merely organized differently during gestation. Much of the behavior of
these tissues is regulated by the hormones ones body runs on. Skin secretions, textures, sensitivity and erectile behavior are all
hormonal expressions. Which means that when you add androgens, these tissues start acting like they are in the shape of a penis
and scrotum, even when they aren’t.

Bottom Growth
DHT (mentioned above) plays a critical role in the development of the
erectile tissue within the genitals. As DHT levels rise with the increase in
Testosterone, this will cause the Skene’s Gland (sometimes referred to as
the female prostate) to swell. This will induce random erections within the
clitoris, causing the erectile tissue to grow. The amount of growth varies
from person to person, but 1-3 inches is common.

The clitoral hood and labia will become drier and thicker over time, and
the inner labia may also start to grow hair. Self lubrication may reduce
substantially, and over time penetration may become painful. Use more
lube to avoid tearing and bleeding.

Increased Emissions During Climax

With the swelling of the prostate comes more prostate uid. If you
weren’t a squirter before, you may become one now.

Changes in Sensitivity and Response

Erogenous stimulation may become more focused on the head of the
clitoris and in stroking of the shaft.

Atrophy
Vaginal and uterine atrophy often happens within the rst ve years, and
a hysterectomy may become necessary. Signs of atrophy include a deep
throbbing in the lower abdomen and painful cramping without other
period symptoms, particularly following intercourse. Vaginal atrophy can Aren
be avoided through the use of the same vaginal dilators that AMAB trans @zeghostboy

people use following vaginoplasty. I've been on T for literally a week and a half, and all I will say is
that bottom growth and increased libido starts waaaayyyy quicker
Increased Sex Drive than you might think.

Libido will almost certainly go through the roof for the rst year or two, 1:23 PM - Mar 22nd, 2021

the strongest immediately following dosing. May nd yourself more

assertive during sex and more prone to being dominant and/or a top.

Orgasm Adam Fortune

The “shape” of ones orgasm can change. Rather than a cascade, it strikes @AFortune69

like an explosion from the groin. The jokes about teenage boys always being horny, well, it's a
thing. Not uncontrollably, get yourself in trouble horny, but I'd
Attraction have sex multi times a day...

Testosterone has been shown to increase arousal from visual stimuli. As Also, I find I 'notice' women more now, I still mostly prefer men
but the ratio has adjusted a bit more towards center.
such, you may notice people of your sexual preference much quicker,
9:50 AM - Mar 22nd, 2021
especially if you are gynephilic (attracted to the feminine shape).

Cessation of Menstruation
The increase of androgens within the body causes the hypothalamus to
Blotchkat
down-regulate production of the hormones which control the ovaries. @blotchkat
This will reduce total estrogen available, and may halt ovulation. Without
Orgasms being different was meantioned and I have to second
ovulation and with lower FSH levels, the uterus will be less inclined to this.
build up and release a lining, causing the cessation of blood ow. My clit now really functions like a small penis.
So, before I would have these orgasms that could be very intense,
You may still experience other period symptoms, however, as the yet never satisfying. Now my orgasms are less intense, but it's
hypothalamus can continue to express other aspects of the monthly cycle. like, I actually feel I "finish".

This can even continue following a total hysterectomy, although it is not 10:39 AM - Mar 22nd, 2021

common.
This does not mean that you are infertile, however. Ovulation can still
Moony
occur even if you are not menstruating. Additionally, halting testosterone @MoonyXIV
will make the old orbs wake up, they do not die. cw menstruation: if u take it for a while and then stop taking it for
a bit your period will come back and it will be ANGRY

10:45 AM - Mar 22nd, 2021

Estrogenic Second Puberty 101
What to expect from Feminizing HRT
This is a compilation of reported medical transition changes collected from testimonials of AMAB trans people taking estrogen
based hormone therapy. This information is gathered from social media and chat rooms. Yes, that means this is all anecdotal, but
historically, most of transgender medical study is anecdotal because no one wants to fund transgender medical research.

Note that this is a list of possible changes. There is no guarantee that every person on feminizing HRT will experience all of these.
Your age, genetics, medical history, degree of masculinization from natal puberty, and hormone regimen can all have impacts on
results. There is also just a degree of randomness – every body is different – and some things can take years to appear.

Breast Growth
Despite public perceptions, the majority of transfems do not pursue breast augmentation, as it often isn’t necessary (and for many,
is not within reach). Every human is born with breast tissue, it simply remains inactive without estrogen to make it grow.
Development typically takes 2-5 years, but can continue for more than ten years, just as it does for cisgender women.

Expect aches and pains in the chest, along with lots of tenderness, in the area surrounding and behind the areola. Avoid bumping
into anything, as it will hurt. Nipples and areolas will become much more sensitive while also becoming larger and darker. You’ll
want to invest in some sports bras.

This may be accompanied with lactation. Some secretion is normal and can be expected as milk ducts form and open up, so there is
no cause for alarm. However, signi cant discharge without intentional stimulation may be a sign of a prolactin imbalance, so you
should tell your doctor if this happens.

Skin Softening
Testosterone promotes the thickening and toughening of the epidermis, so removing it makes the skin thinner. Additionally,
estrogen promotes the production of collagen, which causes skin to become softer more iridescent. Expect to see more varicose
veins on your legs. Tattoos that may have faded over time might become bolder and clearer.

The removal of testosterone also causes a severe drop in skin oils, particularly on the face and scalp. This results in a signi cant
reduction of acne and/or dandruff.

Increased Flexibility
Testosterone causes water retention in ligaments and tendons, rendering them less stretchable. Removing androgens from the
body causes the tendons to release those uids and regain their elasticity.

Slimmer Hands and Wrists

As the skin begins to soften and slim down, the hands gradually begin the shrink. Without testosterone, less blood ows to the
hands, causing further reduction in tissue sizes. Ring size will drop as fat and uids move off the ngers. Finger length shortens as
ligaments thin and stretch.

Smaller Feet
Much like hands, the feet also experience changes in shape. Androgens encourage more blood ow to the feet, and encourage water
build up in cartilage. Estrogens allow the ligaments in the foot to stretch more. Collectively this causes the arch of the foot to
increase, shortening its total length by as much as two centimeters. Many people report a drop of one to two shoe sizes.

Thinner & Softer Fingernails

Fingernails are made of keratin, and many keratin genes are activated by androgen receptors, thus causing thicker ngernails. The
loss of testosterone will make the nails thinner and more prone to breakage.
Reduced Body Hair
Do not expect a total cessation of body hair, once the follicles are made
terminal by DHT they remain that way. However, much like ngernails,
hair thickness is an expression of keratin genes activated by androgens.
Removing testosterone causes the body hairs to become thinner and
lighter. Genetics plays a major role in this, however.

Changes in Body Temperature Placement

Androgens encourage extra blood ow to extremities, making them
warmer. Because of this, women tend to have warmer core temperatures
but lower oral and surface level temperatures. You may see your basal
body temperature drop to around 97.6.
The author's hands. This change occurred over the course of
three and a half years.
This unfortunately results in a reduced tolerance to cold, so expect to
need to layer clothing more frequently, especially since many buildings set
their thermostats for male comfort levels.

Changes in Perspiration Patterns

With the above shift in temperature distribution, this also results in a signi cant change in how one sweats. Sweat becomes more of
a full body experience, as opposed to largely centered on the head and armpits. Underboob sweat becomes a thing.

Reduction and/or Change of Body Odor

A major component in male body odor is the presence of the steroid pheromone androstadienone in sweat. Androstadienone is
metabolized directly from testosterone, so halting testosterone removes the source. Without it, sweat takes on a much sweeter
smell, which is often attributed to feminine odors.

People taking spironolactone may experience a total cessation of any body odor, due to the way the drug alters cortisol uptake
within the body.

Reduced Muscle Mass

Androgens stimulate muscle growth, which is why anabolic steroids (which are literally testosterone) are so common amongst body
builders. People running on androgens naturally have more muscle mass, particularly in the upper body, without even having to
work out. Removing androgens causes that muscle mass to atrophy and makes it harder to gain muscle. This is a major contributor
to the feminine shoulder and neck line, as well as the waist line.

With this comes a signi cant loss in strength. Carrying things becomes more dif cult, pickle jars become harder to open.

Fat Redistribution into Feminine Proportions

Androgens encourage the body to deposit fats into the abdomen, while estrogen encourages the body to deposit fats into the
thighs, buttocks, and hips. Switching pro les causes new fats to be deposited according in the estrogen pro le, and fats that were
stored while on androgens break down. This produces the illusion of fat migration as the shape of the body changes. The waist line
shrinks and de nes itself below the ribs, and the belly becomes softer and atter.

Because estrogen deposits weight much lower on the body, and the muscle mass in the upper body is lost, this lowers the center of
gravity, which alters one’s walking gait. It becomes more natural to cantilever the body with the hips while walking, as opposed to
the shoulders.

Facial Feature Changes

Along with body fat migration, fat in the face also migrates. The neck, chin and jaw line thin out while the lips and upper cheeks puff
up. The brow and upper eye lids lift, exposing more of the eyeball. Changes in skin and musculature around the eye can alter the
shape of the eyeball, changing focal depth and altering vision clarity. The color of the eyes may also change and become bolder, as
testosterone causes the pigmentation in the iris to fade.

This is an extremely subtle and slow moving process that takes years, and it is easy to think nothing is changing at all. Take sel es to
compare.

Changes to Scalp Hair

With the removal of androgens, blood ow to the scalp increases. Follicles that had been lost to male pattern baldness may
reactivate, causing some return of the hair line and a lling in of bald spots. Scalp hair becomes thicker and follicles grow stronger,
allowing hair to grow to longer lengths.

With this thickening, curliness may become more pronounced, and a change in hair color may also occur. You might nd your hair
taking on a texture more like your mother’s than your father’s.

Anterior Pelvic Tilt

As musculature atrophies, ligament exibility increases, and weight shifts lower on the body, the orientation of the pelvic bone in
relation to the spine and femurs rotates forward. Not by much, only about 10-20 degrees, but enough to cause a change in the
alignment of the spine and hips, increasing arch of the back and causing the buttocks to jut out more. The added arch to the back
can cause a relative drop in total height, between 1 and 2 inches (2-5cm) depending on pelvic shape.

Note, this is NOT the same as the hip rotation that occurs in AFAB puberty and during pregnancy. That is the result of migration of
bone cells, altering the shape of the pelvic bone itself. However, hip rotation can occur if the person is young enough to still be
within initial puberty, where the body is producing elevated human growth hormone. There have also been examples of hip rotation
happening over long periods of time in trans elders. In 2017 an 80 year old trans woman reported on reddit that over the course of
her 30 years on HRT, her doctor observed changes in her pelvis consistent with female hip rotation.

Reduced Tolerance of Caffeine, Alcohol, and/or Psychotropics

Less body mass means less blood to dilute chemicals into. Losing testosterone also means a slower metabolic rate, decreasing the
speed at which toxins are reduced from the blood stream. Some anti-androgens also put strain on the liver, further reducing how
quickly chemicals are processed.

Mental Changes
As covered in the Biochemical Dysphoria section, brains can be wired for a certain hormone pro le, and running on the wrong
pro le is like using a laptop with low batteries or an overheated processor. Starting HRT almost universally results in a cessation of
depersonalization and derealization (DPDR) symptoms within the rst two weeks. A mental fog lifts, and it becomes easier to
concentrate on complex concepts (assuming you don’t also have other mental processing dif culties such as ADHD).

ADHD
If you have ADHD, there may be some changes in your symptoms. Androgens amplify dopamine receptor function, so reducing
testosterone can reduce the activation potential for dopamine in the brain. Dopamine is a key neurotransmitter in the behavior of
working memory, the short-term memory of the brain. Less working memory means you become more prone to distractions and
have more dif culty maintaining cognitive load.

The good news is that estradiol prompts the brain to produce MORE dopamine.

Emotional Expansion
Authors Note:
The alleviation of DPDR almost universally is accompanied with a much
There is a known problem with Spironolactone hampering
broader capacity for emotion and expression. The stoicism and working memory due to it’s affects on mineralcorticoids. This can
dissociation lifts and emotions land with much greater intensity. Highs are significantly worsen ADHD issues and make it much harder to
maintain focus or be aware of your surroundings. I was involved in
higher and lows are lower. Those who may have been unable to cry, before a car accident in 2017 that I blame on spiro fog.
transition, gain it back, both for sadness and for joy.
Unfortunately this also means that if you had trauma from events earlier in life (and who doesn’t), you may start to experience PTSD
episodes. This is why it is good (and in some places, required) to have a therapist.

Mood Swings
As estrogen levels uctuate between doses you may experience noticeable and sometimes dramatic shifts in your mood.
Unexplained crying happens; PMS rage happens; be ready for it.

Appetite
Many people report being unable to eat as much as they could pre-transition. The loss of lean muscle in the arms and shoulders
means that the body has a reduced capacity for burning lipids, and as such the fullness sensation occurs earlier.

However, progesterone increases mitochondrial function within the body, boosting metabolic rate. This can cause an increase in
appetite as the body attempts to replenish calories burned.

That said, you may nd yourself unable to eat as much food as you could before. Many report that they become full/satis ed sooner
than before.

Sleep
Many people report having better sleep patterns after starting HRT. This is likely a factor of the alleviation of DPDR, as it seems to
occur in both AMAB and AFAB trans people. That said, initiating progesterone can signi cantly improve sleep, allowing for deeper
sleep and more dreaming.

Extroversion
It’s extremely common for trans people of all types to nd themselves much more sociable post-transition. This may not actually be
a factor of hormone therapy, however, an simply be a result of no longer having to suppress large portions of their personality.

Sensory Enhancements
Transgender HRT has been shown several times to cause changes in the distribution of gray matter and white matter within the
brain for trans people on both forms of HRT. New structures and neuro-pathways are formed as a result of the shift in hormone
pro les, and this results in changes of sensory perception. These are some of the changes that have been observed and reported,
but it is is not clear if this is a function of the hormones themselves, or a factor of the brain receiving the hormones it is wired for.

Improved sense of smell, especially of other bodies. Human sweat becomes very discernible, even overpowering at times.
Improved color perception. Colors may become bolder, richer.
Improved spatial awareness. Many trans people experience poor proprioception and a tendency towards clumsiness that goes
away after starting HRT.
Changes in perception of taste. Certain foods become more or less palatable; Cilantro, for example, may become more or less
soapy. Increased tolerance of capsaicin (spicy peppers). Chocolate and wine become more avorful.

Users of Spironolactone often develop strong cravings for foods high in salt, such as pickles, olives, or potato products. This is
because Spiro is a potassium sparing diuretic which causes you to pee out all your sodium. The brain creates cravings to encourage
you to replace that sodium.

Spatial Shift, Reduced Con dence

There is a very frequently reported experience of feeling smaller within the world, even when wearing heels. People taller than you
seem to tower over you, and spaces feel larger.

People have also reported a tendency to be less prone to start arguments, an a desire to avoid confrontation rather than create it.
Testosterone has been shown to increase a persons sense of con dence, and removing it has the opposite affect.

Genital Changes
All genitalia are constructed from the same tissues, they are merely organized differently during gestation. Much of the behavior of
these tissues is regulated by the hormones ones body runs on. Skin secretions, textures, sensitivity and erectile behavior are all
hormonal expressions. Which means that when you remove androgens
and add estrogens, these tissues start acting like they are in the shape of a
vulva, even though they aren’t.

Increased Sensitivity
The skin on the glans and shaft becomes much thinner and fragile, more
prone to tearing and irritation, while also becoming signi cantly more
sensitive to touch. The entire organ also becomes much more sensitive to
pressure, and vibration becomes a better form of stimulation over
stroking, which may become painful.

Moisture and Feminine Odor

The skin along the shaft begins to secret the same uids as the vaginal
canal, particularly during arousal (yes, trans girls get wet). These uids
encourage the development of the same microbiome that develops within
the vaginal canal. The combination of these factors means that odor (and
taste) of the penis changes to align more to that of a vulva.

Color and Texture Changes

The scrotum is an analog of the outer and inner labia, and softens to take on a softer, more velvety texture, extending down into the
perineum. The skin along the perineal raphe (the vertical line where the vulva opening had been before the scrotum formed) will
also darken. Some people experience a kind of striping pattern along the scrotum.

Fewer Erections
Without free oating testosterone, the levels of DHT in the bloodstream drop signi cantly. DHT plays a major role in the
stimulation of random erections during sleep through the enlargement of the prostate, and these erections are what is responsible
for the maintenance of the erectile tissue. Without DHT, the prostate shrinks again, and random erections cease (no more morning
wood).

However this means that the erectile tissue will begin to atrophy. Prolonged atrophy will result in shrinkage of the entire organ, for
better or worse. The shape of the penis changes as this occurs, often becoming more conical. The glans is the rst part to shrink and
may lose the ability to become rigid. Penetrative sex may become more dif cult, and erections themselves may become painful.

This can be countered by regularly inducing erections, but that may become more and more dif cult as time goes on.

Clear Ejaculate
The majority of the liquid that makes up ejaculate originates in the prostate. It is a completely clear uid, with a slimy texture. The
white color and stickiness that is usually attributed to male ejaculate is caused by semen and seminal uid from the testicles. The
production of both semen and seminal uid is a product of testicle function, so as the testicles shutdown (either because of anti-
androgens or from estrogen dominance), these uids halt, leaving only the prostate uid.

Some people lose even that, and stop having any emissions at all during orgasm.

Needless to say, this comes with sterility. Contrary to what some sources report, this is NOT permanent, and many people have
been able to restore testicle functionality by halting hormone therapy, either for detransition or for reproductive purposes.

Testicle Atrophy
Once the testes have stopped functioning, the cells start to atrophy, shrinking over time. This atrophy may be accompanied with
pain, sometimes in the form of a soreness or a dull throbbing sensation, or sometimes as registering as little sparks of pain that
travel along the perineal nerve from the testicles down to the rectum.

Sexual Changes
Initial start of HRT may result in a total loss of sex drive as testosterone levels plummet. This can last 3-12 months, and in some
cases doesn’t return at all. Starting progesterone often serves as catalyst for its return. If/when sex drive comes back, the new libido
may be a completely different experience that one may not recognize at rst.

Heightened Erogenous Zones

The entire body becomes more responsive to touch, and with that unlocks
Human Erogenous Zones:
stronger erogenous zones. Breasts, abdomen, inner thighs and neck, in
particular, become more arousal inducing.

Orgasm
Orgasm changes signi cantly, both in the way it builds and how it is
experienced (see link above), but additionally, if one is lucky, they will gain
the ability to become multi-orgasmic with no refractory period. The cost
of this is that orgasm may become harder to achieve, and one has to re-
learn how to reach it. It also becomes easier to reach with a partner, which
may have been the opposite before.

Attraction
It is not at all unheard of for a transgender person to experience a change
in their sexual orientation with transition. This is almost always the result
Source: Topography of Human Erogenous Zones
of the removal of self-imposed mental barriers, but hormone therapy
often plays a role in that removal. In most cases this simply involves an
expansion of ones attraction, from monosexual to bi/pansexual, but some people also discover that their attraction was largely
rooted in self-interest and that their true attraction is reversed.

Cyclical Period-like Symptoms

Obviously, we do not mean blood ow, that would be ludicrous. Symptoms vary greatly (just as they do in cisgender women) and
typically last for 2-4 days, repeating every 26-32 days (though some report experiencing it bi-weekly). This happens independent of
medication dosing schedules. The use of a period tracker app like Clue can reveal the pattern.

Cramping in the intestine and abdominal muscles, ranging from a slight utter in the gut to strong painful spasms.
Bloating and water retention
Gas, diarrhea and other intestinal issues.
Emotional instability, mood swings and irrational thoughts
Heightened depression and dysmorphia
Depersonalization or dissociation.
Increased dysphoria
Irritability (PMS)
Muscle and joint aches and pains
Breast engorgement and nipple tenderness
Acne
Fatigue
Appetite changes, spontaneous cravings (see: chocolate cravings)
Spontaneous shifts in libido
Changes in genital odor

No, there have not yet been studies on this yet, but it is reported by far, far too many individuals to be an anomaly (including by
yours truly), and has been con rmed by multiple people’s own doctors. There is also precedent of this happening with cisgender
women who have had hysterectomies (I personally know two cisgender women who have cycles but do not menstruate, without
any medical intervention).
Running on estrogen and progesterone activates a gene sequence which instructs the hypothalamus to attempt to cycle ovary and
uterine behavior just as it does in female assigned individuals, regardless of the absence of ovaries or a uterus. This cycle affects
numerous organs and subsystems in the body, causing the release of a variety of different hormones and enzymes that can affect
function and even behavior.

A more thorough explanation of this will be coming in a later update to the site.

Conclusion
Every single year we get new studies that show an increase in the size of the transgender population. As awareness continues to
grow, more and more people are realizing what has been wrong with their lives and are coming out of the closet. People who
transitioned decades ago are coming out of stealth. GLAAD estimates as much as 3% of the population could be transgender, and I
have seen numbers as high as 5% or even 10% from more liberal estimations. The more we come to understand about gender, the
more language we gain to describe gender, the more people realize that the rigid Male and Female sexual structure that we have
been forced into is false.

Yet all this change frightens people. It frightens conservatives who see their patriarchal social structures dissolving under the new
understanding of gender. It frightens old-school transgender people who transitioned under the Harry Benjamin rules and now see
so many people easily obtaining what they had to act and lie and manipulate to achieve. They fear that if anyone can be trans, then
the public will stop taking trans people seriously. It frightens the misogynistic trans-exclusionary groups that ght so hard to
invalidate transgender rights, because they think if anyone can be a man or a woman, then their status as a man or a woman is
harmed.

There is no such thing as a “Transtrender”.

There is no such thing as “Rapid Onset Gender Dysphoria”.

There is no such thing as anyone “transing” kids.

These mentalities have to stop.

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