For a long time, the mainstream of the trans community generally understood the condition of gender dysphoria in terms of biological science. This understanding has encouraged scientific research into gender dysphoria, and also gradually increased the public’s understanding.
However, in recent years, this foundation has been increasingly shaken, from attacks of two main types. Firstly, there are the reactionary forces which argue for the invalidity of gender dysphoria, using oversimplified and often outdated models of biological science. And then, there are those who seek to justify the trans phenomenon from a place of radical philosophy and postmodernism, rather than science. These radical philosophers are effectively willing to concede the scientific ground to the reactionaries, because they themselves believe that the scientific method is oppressive, because of influence from postmodernists like Michel Foucault. In turn, the reactionaries are more than happy to paint all trans people with the irrational, postmodernist brush. Therefore, these two factions effectively reinforce the views of each other, eroding the scientific foundation for understanding gender dysphoria every time they trade blows.
In this short film, we will seek to re-establish the biological scientific understanding of gender dysphoria. We will examine the evidence supporting the scientific validity of gender dysphoria. We will also discuss and dispel the misconceptions that underlie the most common lines of attack from the reactionaries. Finally, I hope that the evidence presented here will be enough to convince trans people and their allies that they do not need to resort to postmodern philosophy to validate trans people.
In recent years, there has been much debate about the preliminary findings that parts of trans people’s brains are more similar to the opposite sex, which could provide support for the brain-body mismatch hypothesis. However, given that the findings are still rather limited, their validity is not yet universally accepted. This, in turn, has led some to falsely conclude that there is no firm scientific evidence for the validity of trans people.
What we need to remember is, the human body is a complex thing, and there are many things about the way it operates that we still don’t understand, even in this day and age. It is therefore unrealistic and counter-productive to require solid proof of the underlying mechanisms for everything before we accept their validity. Indeed, this would paralyze many important parts of clinical medicine. There are still many medical conditions across many specialties where the precise underlying mechanism remains poorly understood. If we were to refuse to accept the existence of these conditions, however, many people would suffer or even die.
Which is why clinical medicine sometimes relies on what are called ‘syndromes’. Basically, syndromes are a collection of symptoms that often run together, where the underlying cause for the symptoms is not entirely clear. The repeated observation of the pattern of symptoms appearing again and again in many patients, as observed by many different doctors, forms the basis to establish the syndrome. After all, if many patients are presenting to different doctors, at different times, with the same thing, we can be pretty confident that something real is happening, and that there is likely to be a condition that is affecting these patients in common. Gender dysphoria is such a syndrome. Since it was first described many decades ago, many people across the world have presented with symptoms consistent with the syndrome of gender dysphoria, providing very solid evidence for its clinical validity. This is why trolls who compare being transgender with made-up concepts like ‘transrace’ or ‘transage’ or ‘identifying as an attack helicopter’ are simply making a fool of themselves.
Some people have raised the idea that those presenting with symptoms of gender dysphoria are really suffering from mental illnesses such as schizophrenia or body dismorphic disorder. However, we need to remember that syndromes are defined by the set of symptoms that run together, as repeatedly observed in a large number of patients. It has been clearly observed, with a very large sample size, that patients with gender dysphoria do not exhibit symptoms that are normally required to give the diagnosis of mental illnesses like schizophrenia or BDD. For example, gender dysphoria patients do not have things like hallucinations, disorganized speech, social withdrawal, generally disordered thinking or paranoid thoughts that are characteristic of schizophrenia. This provides clear evidence that gender dysphoria is not related to schizophrenia at all.
While the exact underlying cause of syndromes are unknown, their treatment should still be based on evidence. What kind of evidence? Of course, the evidence that it works to alleviate symptoms and reduce suffering. After all, clinical medicine is in the business of relieving people’s suffering. The reason why gender transition is a valid treatment for gender dysphoria is because it has been demonstrated to be effective in relieving the dysphoria of trans people. Even in some cases, where the dysphoria doesn’t completely go away, there is substantial relief, which allows people to go on with their lives. Furthermore, whether conservative cultural warriors or gender abolitionist radical feminists like it or not, gender transition is the only known treatment that is most often effective in relieving gender dysphoria; there is no other approach that has been demonstrated to be anywhere nearly as effective so far.
As we have seen, the validity of gender dysphoria is well established, by its long history of clinical cases, as well as the effectiveness of treatment via gender transition. These things alone are sufficient to prove the validity of gender dysphoria, and we do not, and should not, need to wait for what could be decades, for firm understandings of molecular and cellular level science to be available, to affirm its validity.
However, I believe we should continue to be interested in finding out more about the mechanisms behind gender dysphoria. After all, knowing the exact science behind things tend to greatly improve our understanding, and our ability to relieve pain and suffering. Therefore, further research into gender dysphoria should be encouraged.
Now, many trans people describe their condition as one of mind-body mismatch. To use an analogy, it’s sort of like the wrong kind of software has been installed, that doesn’t match the hardware. Sometimes, it literally feels like the mind has an expectation of what the body should be like, and that physical mismatch is what causes the dysphoria. This is called physical dysphoria. Besides physical dysphoria, however, many trans people also report what is called social dysphoria, that is, dysphoria that arises from being seen as the wrong gender in social situations. In the next two segments, we will examine whether the hypothesis of mind-body mismatch is scientifically plausible, and whether the hypothesis is also plausible for both physical and social dysphoria.
I think one reason why some people are so insistent that gender must align with genetic sex, is because they don’t quite understand the way genetics work. If you think about it, DNA, on its own, are only a bunch of biochemical molecules. Their importance lie in when they get expressed, as real world observable characteristics. In biology, the inherited genes, the DNA a living thing has, is called the genotype, and the real world observable characteristics that these genes ultimately give rise to is called the phenotype. The phenotype includes both physical properties and behavioral and developmental properties.
In many cases, the relationship between genotype and phenotype can be quite complicated, even unpredictable. This is because the translation of genes into observable characteristics goes through a complex cascade of steps, any of which also depends on a variety of factors, like environmental factors, and also other innate biological factors like hormone receptors and other regulatory mechanisms. These factors can lead to certain genes having more or less of an effect on the observable characteristics, or even no effect at all on the observable characteristics. The presence of these regulatory factors is essential, because it allows the effect of genes to be turned up or down by the body’s own regulatory mechanisms, so that the biochemical environment is adaptive to the body’s needs.
Anyway, the fact that the translation of genotype into phenotype is a messy and sometimes unpredictable process means that genetic sex may not always align with observed characteristics around sex and gender. The most extreme example of this would be complete androgen insensitivity syndrome, also known as CAIS. In this condition, genetically male individuals are completely insensitive to the effects of male hormones. Such individuals appear to be physically female, and you would generally not be able to tell them apart from genetic women without a medical examination. The existence of conditions like CAIS is solid proof that, in terms of sex and gender, the relationship between genotype and phenotype is complex and not always straightforward.
While physical intersex conditions are the most clearly visible forms of genotype-phenotype mismatch in terms of sex and gender, it has long been hypothesized that gender dysphoria could also arise from similar mechanisms. For example, one of the most well-known hypotheses for the underlying mechanism of gender dysphoria is that of a brain-body mismatch, that trans people’s brains are somewhat more similar to that of the opposite genetic sex in some way. This hypothesis is popular because it lines up with the way many trans people describe their own condition. Moreover, there has been preliminary evidence from brain scan studies to support this hypothesis. Another factor in favor of this hypothesis is that it is very scientifically plausible. The fact is, various conditions like the aforementioned CAIS have proven that the translation of genotype to phenotype in terms of sex and gender is not always straightforward. Male genes do not always produce a male phenotype. It is therefore plausible, for example, that a more partial form of androgen insensitivity could produce the result of a predominantly male phenotype when it comes to certain things, like physical characteristics, and a predominantly female phenotype when it comes to other things, like certain parts of the brain’s wiring. This would effectively produce a trans individual. Of course, this is only one hypothesis among many when it comes to the underlying cause of gender dysphoria. Other hypotheses include genetic imprinting errors, immune-mediated pre-natal development alterations, and more.
Given the complexity of the systems involved in translating genotype to phenotype, and given our still limited understanding in this area of science, it is very likely that it could take a long time before we fully understand the underlying cause of gender dysphoria right down to the genetic and molecular level. However, the take away message from all this is that, it is very scientifically plausible that an individual who is genetically male could have a female gender identity and feminine gendered behavior. It is also very plausible that, as a result of feminine wiring, such an individual’s brain would expect to reside in a female body, which would create physical dysphoria. Of course, it is equally plausible for the opposite to happen in genetically female individuals. It is therefore, in fact, those who think that genetic sex must always be predictive of the gender of an individual, who are ignorant of the complicated science here.
Some people have said that, while they sort of understand the logic behind intersex neurological wiring causing physical dysphoria, that is the feeling of being literally ‘trapped in the wrong body’, they still remain skeptical of so-called social dysphoria, the kind of dysphoria where trans people are uncomfortable being seen as a member of their genetic sex in social relations. They still suspect that this could be due to internalized gender stereotypes. However, social dysphoria is actually just as biologically plausible as physical dysphoria, and the fact that both are usually present in trans individuals to some degree is just to be expected.
I prefer to call so-called social dysphoria ‘relational dysphoria’. After all, social dysphoria is entirely rooted in the role one has to play in interpersonal relationships. And, contrary to the influence of decades of social construction theory, there is scientific ground to believe that these roles could be biologically programmed according to gender. Let’s start with sexual orientation, which is often understood to be simply whether one is attracted to men, women or both. However, many trans people would tell you that they are specifically only interested in a relationship as a woman with a man, or as a woman with a woman, for example. They will tell you that they do not want to be loved by a man as a man, for example. This may sound strange to some people, but it’s really not. If you look across the animal kingdom, in mating rituals, the males and the females often have very clearly defined, and very clearly different, roles to play. And these roles are clearly biologically hardwired. This is a clear demonstration that gendered behavior is intimately intertwined with sexual orientation.
But how about more everyday interactions, between friends, for example? Again, if you look at the way men bond with men, if you look at the way women bond with women, and if you look at the way men and women bond on a friendship level, it’s all qualitatively different. And it’s not just due to culture or socialization. If we look at the animal kingdom, males and females clearly have different ways of bonding, and animals being animals, it’s clearly due to nature rather than nurture. In fact, if you just think about this for a while, you would realize how much of our everyday relationships, even the small details, are gendered. This is universal across all cultures, and remains the case even in cultures where there is a relatively high level of equality between men and women. This would clearly explain why ‘social dysphoria’ can be very debilitating for many trans people.
Furthermore, social situations themselves can also remind trans people of their physical dysphoria in unexpected ways. For example, men are expected to do more of the heavy lifting physical work, because they are physically bigger and stronger on average. If a closeted trans woman, who is being perceived as man, gets asked to do the physical work as ‘one of the guys’, it would remind her of her unfeminine physique, which would worsen the physical dysphoria. Another example is how trans women generally don’t want to be seen as attractive as men, or how trans men generally don’t want to be seen as attractive as women, because that would remind them of their physical dysphoria. These examples show how even regular social interactions can remind trans people of their physical dysphoria, and not just their relational dysphoria.
The fact that physical and social dysphoria most often co-exist in trans individuals is not only scientifically plausible, it actually gives further credence to both phenomenon being rooted in biology. A neurological ‘map of the body’ that does not match the genetic sex of the individual would give rise to the feeling of being trapped in the wrong body. Neurological programming regarding gendered behavior that is incongruent with the genetic sex would give rise to social relational dysphoria in the course of many everyday interactions. Such dysphoria would be particularly acute in the area of intimate relationships. Both of these things can arise from similar biological mechanisms, that cause the phenotype to differ from that predicted by the genotype, as discussed earlier in this short film.
Now, let’s recap the things we have established in the course of this short film. Firstly, gender dysphoria is a real phenomenon. The long history of clinical practice proves that. Even though we don’t know the exact science behind this phenomenon, it is nevertheless well established to be valid, and this situation is not uncommon in clinical medicine either. Secondly, gender dysphoria is not caused by mental illnesses like schizophrenia or BDD. The evidence for this also lies in clinical observation and experience, and it is also very well established. Finally, the commonly held view that gender dysphoria represents a mind-body mismatch, possibly due to genetic or hormonal factors, is scientifically very plausible, and there is indeed preliminary evidence to support this hypothesis. Of course, it’s still a long road ahead in terms of understanding the exact mechanism behind gender dysphoria, and we should remain open to all scientifically plausible hypotheses until then.
All this provides a clear picture of what gender dysphoria is, what it is not, and all rooted in medical and scientific knowledge and reasoning. As we have seen, there is indeed no need to resort to radical philosophy or postmodernism to explain gender dysphoria. Indeed, I believe any attempt to do so would be a distraction at the very least, and could take us further away from developing a broadly accepted understanding of trans people and their issues.
Going forward, I believe it is up to us, who believe in the scientific model of gender dysphoria, to speak up for it, and to counter myths that come from all directions about trans people, which are not scientifically sound. This includes both myths derived from radical philosophy, as well as myths coming from a place of conservative bias. After all, the role of science is to illuminate the truth.
