Explanations of Gender Dysphoria

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A psychosocial explanation, mental illness theory suggests that gender dysphoria is related to mental illness, which is in turn a result of childhood trauma or maladaptive upbringing. Coates et al (1991) carried out a case study of a boy who developed gender dysphoria, claiming that this was his response to his mother’s post-abortion depression. The trauma occurred when the boy was three – a time when children are particularly sensitive to gender issues – and Coates et al suggested that the trauma led to a cross-gender fantasy as a means of resolving anxiety.

Cole et al (1997) studied 435 individuals experiencing gender dysphoria and reported that the range of psychiatric conditions displayed was no greater than found in a non-dysphoric control group; challenging mental illness theory’s suggestion that gender dysphoria is related to trauma or psychological pathology.

Irregularities in mother-son relationship are another factor suggested to contribute to the development of gender dysphoria. Stoller (1975) proposed that GID results from distorted parental attitudes – in clinical interviews with individuals diagnosed with GID, they displayed overly and atypically close mother-son relationships; he suggested that this led to greater female identification and a confused gender identity.

Zucker et al (1996) studied boys with concerns about gender identity and their mothers. Of the boys who were eventually diagnosed with GID, 64% were also diagnosed with separation anxiety disorder, compared to 38% in the boys with subclinical GID symptoms. This supports Stoller’s suggestion of abnormal maternal attachment as a factor in gender dysphoria, but can only explain MtF (Male to Female) transsexuality – it does not suggest an explanation for FtM.

A biological theory of gender dysphoria, the brain-sex theory suggests that male and female brains are structurally different, and the brains of transsexuals do not match their genetic sex. A region of the brain called the BSTc, located in the thalamus, is twice as large in heterosexual men as in heterosexual women, and contains twice the number of neurons – and in transsexuals, BSTc size correlates with psychological gender, rather than biological sex, suggesting a mismatch between the brains and biological sexes of transsexuals.

Two research studies support this theory: Zhou et al (1995) and Krujiver et al (2000) found that the number of neurons in the BSTc of MtF transsexuals was similar to those of biological females, while the number of neurons in the BSTc of FtM transsexuals was similar to those of biological males. This supports the theory’s explanation of gender dysphoria as having a mismatch between chromosomal sex and psychological gender.

However, Chung et al (2002) provided powerful conflicting evidence for this theory – finding that the differences in BSTc volume between males and females do not emerge until adulthood – whereas most transsexuals experience their feelings of gender dysphoria to begin in early childhood. This suggests that the differences in the BSTc reported by Zhou and Krujiver could not be the cause for gender dysphoria, but rather a possible effect.

Additionally, Hulshoff Pol et al (2006) found that transgender hormone therapy does affect the size of the BSTc, and the individuals in Zhou and Krujiver’s studies had been receiving hormone therapy. Therefore, it may be that the hormones caused the finding in transsexuals that their brain sex was closer to their gender identity than their biological sex, challenging the validity of the supporting evidence.

There is other evidence to support the theory of gender dysphoria as a result of neuroanatomical abnormalities – Rametti et al (2011) studied the brains of FtM transsexuals before they started transgender hormone therapy, and found amounts of white matter more closely resembling individuals of their gender identity than of their biological sex.

Environmental effects have also been suggested as a biological factor that can contribute to the development of gender dysphoria – environmental pollutants such as DDT contain oestrogens which may mean that males are exposed to abnormally high levels of female hormones during gestation, causing a mismatch between genetic sex and hormone-influenced gender identity.

A study by Vreugdenhil et al (2002) supports this explanation of gender dysphoria, finding that boys born to mothers exposed to dioxins, a chemical class promoting oestrogen production, displayed more feminised play than a control group, suggesting that environmental chemical factors can lead to a mismatch between gender identity and genetic sex.

Blanchard proposed two distinct subcategories of transsexuality: “homosexual transsexuals”, who wish to change biological sex because they are attracted to their current biological sex (e.g. a homosexual male who wishes to transition to female) and “non-homosexual transsexuals” who wish to change sex because they are “autogynephilic” – attracted to the idea of themselves as the other sex. These groups are so different that it is impossible to presume that the dysphoria has the same root cause – suggesting that there are different explanations for different types of gender dysphoria.

There are ethical issues with research into dysphoria, namely that it is an extremely socially sensitive area of research, with potentially huge social consequences for individuals represented by the research. For example, if a biological cause is identified this might help others to become more accepting of transsexuals, understanding that it is not their fault, or it may cause individuals born with the biological cause present to be harmed or neglected, because it might be incorrectly assumed that future transsexualism is inevitable. Evidence from research suggests that a simple deterministic cause and effect relationship is unlikely – either way, the outcome has important social consequences for sufferers of gender dysphoria.

There is important real-world application of these explanations of gender dysphoria. Colapinto (2000) reports that 1 in 2000 people are born with anomalous genitals that do not match their genetic sex, and research into gender dysphoria is very important in determining the effect of such anomalies and determining the best solutions. Societies such as the “Organisation Intersex International” argue that our society must place less emphasis on biological sex and recognise gender characteristics as a social construction to allow intersex individuals to determine their own gender identity – psychological research is important to supply research evidence to support or challenge such arguments.

Cole (1997) found that MtF transsexuals scored much differently in the masculinity-femininity scale of the MMPI to FtM transsexuals or a control group without GID. Additionally, the incidence of MtF gender dysphoria has been found to be much higher than FtM gender dysphoria. These differences in the way the sexes experience gender dysphoria suggests that it is beta gender bias and an oversimplification to assume equivalence of origin in both genders – current theories don’t explain why biological males experience GID differently and more often than biological females; a more accurate theory should explain these differences.