Transgender Teen Survival Guide

Lee says:

The majority of transgender people have some feelings/experiences that could be classified as symptoms of gender dysphoria, but there are definitely some trans folks who do not experience any gender dysphoria at all. 

Gender dysphoria is defined in the DSM-V as “the distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender” (DSM-V, page 451).

Gender incongruence means there’s a disconnect between the gender you were assigned at birth and the way you identify- but that disconnect doesn’t necessarily have to cause distress.

It’s like the rectangles and squares thing- all squares are rectangles, but not all rectangles are squares.

If you have gender dysphoria, then you also have gender incongruence- but not all people with gender incongruence also have gender dysphoria. They may experience only gender euphoria, for example. Gender euphoria can be experienced without gender dysphoria.

There are some people who experience gender dysphoria but they don’t label the experience as such because they don’t know the different ways that dysphoria can manifest, or what “counts” as dysphoria. So you may not have dysphoria right now, but you might find yourself getting more dysphoric as you come out and find yourself dealing with transphobia and people invalidating your identity, or you might find yourself getting more dysphoric as you recognize that what you’re experiencing is actually dysphoria. Our Dysphoria page has more info on that! 

And there are folks who experience gender dysphoria symptoms, but they don’t experience enough symptoms to meet the criteria for a formal diagnosis, or they have a more mild experience of gender dysphoria that is not severe enough to meet the criteria for a formal diagnosis. 

And some trans folk experience these things but prefer not to put medical/psychiatric labels on their gender identity and experiences at all, so even if they might have enough symptoms to meet the clinical diagnosis of gender dysphoria, they might not consider that label part of their self-identity or consider their experiences through the lens of “symptoms” at all. 

Other people may experience very severe and debilitating gender dysphoria, which might be a big part of their trangender experience and identity and be the reason why they identify as trans. 

Most trans people are somewhere on the spectrum between the extremes of completely non-dysphoric and severely dysphoric, so they experience a mix of no dysphoria about some things and severe dysphoria about others with an overall moderate dysphoria that fluctuates in intensity over time and typically is reduced as a person transitions. 

So while it’s not common to be transgender and never experience any symptoms of gender dysphoria at all, something being uncommon isn’t the same thing as something not existing at all.

The word “transgender” is an umbrella term that is inclusive of (but not forced upon) anyone who identifies as a gender that they were not assigned at birth. If you’re a demigirl, you fall under the non-binary umbrella; if you’re non-binary, you fall under the transgender umbrella.

Again, if you don’t fully identify as the gender you were assigned at birth 100% of the time, you can call yourself trans. That’s it, there’s no other criteria you need to meet to be trans. You don’t need to have gender dysphoria to be transgender.

This link explains why people might identify as transgender without experiencing gender dysphoria.

So no, the fact that you don't have dysphoria doesn’t mean you’re not a demigirl. 

Delaine says:

Our dysphoria page has some tips and links that might be able to help you.

Lee says:

Hi Delaine <3 It’s lovely to have you back! 

I agree, the dysphoria page has a ton of tips on coping with dysphoria, and it’s definitely the first place you should look!

You might also want to check out the Transfeminine period dysphoria post and the Transfeminine People Can Get Period Symptoms link, if missing a period is what’s causing the bottom dysphoria. 

If it’s how you use your genitals, you may try sitting to pee and looking at the having sex or masturbating post for other things.

You may find tucking worth a try! And even if you don’t tuck, you can often wear women’s underpants, especially the kind with a lot of coverage in the front like women’s boyshorts. 

Non-binary dysphoria is complicated, so tucking and/or wearing feminine underwear might be enough for you.

But some people want surgery, which may or may not apply to you. When people ask about “neutral” genitals they either mean a featureless crotch (sometimes called nullification) or both a penis and a vagina (no term for this exists) because there isn’t really any single way for ambiguous genitals to look.

If you’re amab, genital nullification surgery might be referring to a penectomy and orchiectomy. 

This is a wonderful post about Genital nullification for AMAB non-binary patients by someone who got their nullification surgery done in the US, and if you’re amab and considering nullification, this is a must-read.

I’m not going to get into that further because the post really explains it all!

If you want to have both sets instead of neither, that’s harder for AMAB people. In vaginoplasty, usually the surgeon uses the penis to create the vagina which would mean sacrificing one to create the other.

However, some people also choose not to have a vagina created and opt for a ‘dimple’ that gives the appearance of the entrance to the vagina which means they can’t have penis-in-vagina penetrative sex, but they will have a quicker recovery and no dilation, fewer risks for surgical complications, and it will look like a vagina so they can still pass while naked. And- they can still orgasm. This is sometimes referred to as “minimal depth” or “cosmetic” vaginoplasty. This requires less tissue than creating a vaginal canal, so you may also be able to keep your penis with a minimal-depth vaginoplasty.

It might also be possible to use tissue from the peritoneum to create the vaginal cavity which means hypothetically you could still keep the penis, so that possibility is worth discussing with your surgeon. They may also use tissue from your scrotum if you get an orchiectomy which is removal of the gonads/testicles (link and link and link) at the same time. The scrotal tissue should shrink over time, so if you want a vaginoplasty after it’s best to do it within a year or so of your orchiectomy so you can use that scrotal tissue in the formation of the vagina.

There’s also the “Peritoneal Pull Through Procedure” which may be able to allow for preservation of the penis and creation of a vagina.

Here is a post with someone who is post-op from having a vaginoplasty while keeping their penis- it includes a NSFW link showing their new parts. They had a skin graft used to create their new vagina. I’m not sure what the sexual sensation would be like inside a vagina created by a skin graft, like if they’re using microsurgical nerve hook ups or what exactly is going on but it is something that you can look into.

And of course, you could use the typical “penile inversion” vaginoplasty method and use the tissue from your penis to create the vagina, then get phalloplasty to create a new penis using the same phallo procedure that AFAB people go through using a donor site like your arm or thigh to create the penis. More info on those two: Getting a vagina surgery and Getting a penis surgery.

If you’re determined and able to spend the time and money getting consultations with different surgeons until one of them agrees and fighting with insurance, a nullification or both-ification is something you might be able to do. 

But of course, not all non-binary people want that, and honestly I think most probably don’t because it’s a lot of surgery so there are risks and complications and folks might not even want to change what they have if they’re only dysphoric about it sometimes, so I’m only mentioning it because nonbinary medical transitioning is rarely mentioned and I like people to know their options. 

So yeah, I’d start with the dysphoria page that Delaine mentioned! They were right on the mark with that. The dysphoria page gives you more tips on how to cope with the emotional side of things.

Lee says:

Premenstrual dysphoric disorder (PMDD) is a completely different thing from gender dysphoria, even though they both have the word “dysphoria” in there which makes it confusing.

Neither is a symptom of the other, they’re two unrelated things, so having a diagnosis of one of those conditions doesn’t have anything to do with whether you can be diagnosed with the other.

If you’re trans, having a period can make you feel gender dysphoria, but that’s different than PMDD.

How do you tell them apart? Well, when you’re trans, you may have a little PMS before your period, but you usually feel dysphoric while you’re actively bleeding. So before your period you’re ok, then during it you feel bad.

On the other hand, when you have PMDD, the symptoms begin in the late luteal phase of the menstrual cycle (before you’re bleeding) and typically end shortly after menstruation begins. PMDD is essentially like PMS on steroids, so it’s mostly a before-you’re-bleeding experience.

If you have premenstrual dysphoric disorder, you should look into treatment, which usually includes 1) stopping your period 2) taking SSRIs and 3) therapy, although not necessarily in that order. Our Mental health page has some info on getting a therapist and medication.

You may find that Testosterone helps with PMDD because it helps reduce your estrogen and stop your period, and birth control can also help if you don’t want to start T.

Similarly, getting a Hysterectomy and oophorectomy will almost definitely cure PMDD, and that’s a pretty great option if you don’t care about having children. I got a hysterectomy myself and now I never have to worry about having a period, getting pregnant, and it allows me to get any type of lower surgery I want.

Here’s some information about gender dysphoria:

If you have gender dysphoria around your period, check out the Dysphoria and periods post. Similar treatments apply here- you may also want to stop your period with T, birth control, or a hysto, and getting therapy can help you come up with some coping skills to use in the meantime.

So yes, you can have PMDD and gender dysphoria at the same time, but they’re two different conditions with different symptoms. Reach out to a doctor and/or mental health professional if you’re having symptoms! They can help you get a diagnosis & treatment.

Lee says:

I think that dysphoria sometimes gets worse when you try to present yourself in a certain way and feel like the reality of what you look like doesn’t match the expectations of what you thought that you’d look like.

As an example, when I first got top surgery my chest dysphoria went away, but my social dysphoria increased because somewhere in the back of my mind was the thought “after this surgery I’ll pass a lot better!” but in reality I didn’t pass more frequently than I had been pre-surgery. 

When I’m wearing a shirt, a stranger who genders me in a store would think my chest in a binder looks the same as my chest after surgery so I passed at the same rate as I had before when my flat chest was due to binding. So after surgery, my social dysphoria increased a bit because I was sort of panicking like ahh! I tried to pass and I couldn’t, so now I feel worse in some ways than when I wasn’t trying at all!

Similarly, some trans people feel more dysphoric when they come out, sometimes because they become aware of the way people are gendering and misgendering them and they’ve kind of announced to the world that they want to be seen in a particular way but it feels like other people (especially strangers) haven’t gotten the message. 

In cases like yours, some trans people feel less dysphoric when they cut their hair and wear masculine clothing because they’re moving away from the feminine things that caused the dysphoria, but some trans people feel more dysphoric because trying to present masculinely makes them more self-conscious and aware of their appearance and then they realized that even if it’s closer to what they want it still isn’t what they had hoped to see in the mirror.

Of course, sometimes when people start to transition and their dysphoria increases they find that the dysphoria is a temporary increase that means they haven’t yet reached their target, but with a few people the increased dysphoria means they’re going in the wrong direction after all.

So yes, it can be (and often is) a normal part of early transition to find that your dysphoria has increased- but it can also (in a few cases) be a warning sign. You can sometimes tell the difference by trying to figure out if the increase in Bad Feelings is dysphoria telling you that you need to look more masculine than you current are, or if it’s an urge to return to where you were.

In general though, I’d say that only you can tell what’s going on with your dysphoria- we aren’t in your shoes and we can’t tell you why you’re feeling the way that you’re feeling. But yes, increases in dysphoria can be normal and it doesn’t necessarily mean that you aren’t trans.

Lee says:

You don’t need to be diagnosed with gender dysphoria to tell people that you want to transition. 

Usually people come out as trans and start their social transition before they’re diagnosed with gender dysphoria- getting the diagnosis is usually the start of your medical transition for insurance reasons, but you don’t need it until/unless you want to medically transition.

So just tell your therapist that you want to start HRT/get surgery/etc because you’ve thought about it a lot and you think it’s the right step forward for you and it’ll make you happy and reduce your dysphoria.

Then tell them what you want from them- you need them to diagnose you with gender dysphoria and write the appropriate WPATH Standards of Care-compliant letter so you’ll be able to start your medical transition. An example of that letter is here.

And there’s nothing wrong with being forceful- saying “This is what I need” is pretty important, and so is making sure everyone follows through to help you get what you need.

Lee says:

Yes.

Trans people informally separate gender dysphoria into two categories of symptoms/experiences, “physical dysphoria” and “social dysphoria,” but they both are types of gender dysphoria.

From our Dysphoria page:

Lee says:

I’d start with reading the links in our Dysphoria page! Seeing the “official” symptoms of gender dysphoria, then reading thorough people’s personal experiences of what makes them dysphoric and what it feels like is a good place to start. 

Once you get a good idea of what gender dysphoria is and the different ways it can manifest, you might be able to tell if you relate and if that describes what you’re experiencing.

Some people benefit from Therapists and therapy- if you have a lot of mental health stuff going on, trying to find ways to cope with it can help reduce some of the background noise first so then it’s easier to tell if the other things you’re experiencing are dysphoria or if they’re similar but non-gender dysphoria symptoms. Therapy isn’t required to tell if you have dysphoria, but in some cases it can help.

Lee says:

Gender dysphoria is defined in the DSM-V as “the distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender” (DSM-V, page 451). 

Gender incongruence means there’s a disconnect between the gender you were assigned at birth and the way you identify- but that disconnect doesn’t necessarily have to cause distress.

It’s like the rectangles and squares thing- all squares are rectangles, but not all rectangles are squares.

If you have gender dysphoria, then you also have gender incongruence- but not all people with gender incongruence also have gender dysphoria. They may experience only gender euphoria, for example. 

This link explains why people might identify as transgender without experiencing gender dysphoria.

Lee says:

We have a Dysphoria page with links on what dysphoria can feel like!

Lee says:

Yes! Gender euphoria is a valid part of the trans experience.

The way you experience or interpret your euphoria and/or dysphoria is your business, and doesn’t make you more or less legitimate as a trans person.

Lee says:

Our Dysphoria page has info on what it feels like to have dysphoria, and reading through those links might help you recognize similar feelings in yourself and help you determine if you have dysphoria!

And yes, you can tell you’re experiencing dysphoria without a doctor telling you so.

As the last ask mentioned anxiety, let’s use that as a comparison.

Now let’s simply swap out the word “anxiety” with gender dysphoria:

There’s a lot of discourse around self-diagnosis and whether it’s valid, but it’s possible to say you experience dysphoria even if you don’t have a professional diagnosis of gender dysphoria.

Kii says:

Legally, dysphoria does not count as a disability in any legal circumstances that I’ve seen.

Lee says:

Gender dysphoria is considered a mental illness in the DSM-V, so you may be able to get some sort of support for it but I don’t know what type of accommodations they could give you. 

It’s worth checking into though if you feel you need a particular accomodation for your dysphoria.

Lee says:

If someone is experiencing body dysphoria or social dysphoria, that is gender dysphoria. It isn’t a separate thing. 

Gender dysphoria is a term (and diagnosis) that covers both body/physical dysphoria and social dysphoria, or as you put it, gender presentation dysphoria. 

So saying you can see how cis people can experience the specific components that define gender dysphoria is saying they can experience gender dysphoria.

Our Dysphoria page has more info on what dysphoria is, and we have a post on people identifying as cis while having dysphoria here.

Lee says:

Yes, there are some people who experience gender dysphoria but still identify as cis. 

Gender dysphoria is most commonly experienced by trans people, but it isn’t a trans-exclusive term. Anyone who experiences dysphoria can call it that.

Here’s a similar ask!

Lee says:

Yes, you can have any combo of other mental health disorders in addition to gender dysphoria. 

So you can have gender dysphoria and body dysmorphia at the same time.