Peeling the Onion

Why "new" dysphorias surface in transition

In the summer of 2021, about eight months after I’d come out publicly, COVID rates were way down, the vaccine was out, and my wife and I decided to take a big roadtrip to re-meet the whole family. We love to camp, and had an absolute blast wanding our way through the Great Plains, the Rockies, and back. The trip was wonderful. I’d been doing my best to revel in being, if not a willowy elf maiden, then to embrace the meagre curves that a year of hormones had given me.

In our return swing through North Dakota, the summer temperatures climbed so high that our campground for the evening closed while we were driving right up to it, for safety. B— and I had to scramble, but we found a motel with an available room.

The air conditioning, after a month of July and August camping, was heavenly. I turned it up high, sank into the plush bed, connected to the wi-fi, and got ready to turn off my brain and scroll some social media after eight hours in the car. I’d joined what-was-then-Twitter a few months before, so after reading through some Reddit threads, I spun up the blue bird app to see how some friends were doing there. I scrolled a few times, and there was one of those quote-tweet-with-a-picture memes that Trans what-was-then-Twitter loved to do going round. Dead nerd / trans tsunami, if you saw it, in response to an absurdly transphobic opinion piece that’d been published recently.

And I saw, quote-tweeted, a woman I had never seen before. Zeni, was her internet pseudonym. On the left, a picture of a blonde guy with a scruffy beard. On the right? A beautiful woman with enormous breasts (in fairness, at the time, she was a “mere” 1800cc’s).

Zeni Zounds, as she is today—a heck of a lot larger up top than she was when I first saw her.

My heart lurched in my chest. Hard. A surge of envy and desire and hope, that a trans girl could just have a body like that and be a normal dork. Like me. She was about my age, about my build—I could see, in her, something that I instinctively did not want to see. I put my phone down. Fear. Managed panic. Ohhhh, no. No no no no no, this felt all too familiar. I was out of the closet. I couldn’t be feeling the hatching-panic again. I did my best to gather the bits and pieces of myself back in, to push down my racing heartbeat, my panic, the tears that threatened to spill out.

B— noticed immediately, of course. She sat down on the bed next to me, hugged me, and asked me what was wrong. At a loss for words, I opened what-was-then-Twitter and just showed her Zeni’s picture.

“Oh,” she said. I nodded. “You want to be like her?” she asked.

“I don’t know,” I said, small-voiced. She held me, and a few hours later, we went out and bought a bag of rice, a pair of pantyhose, and a cheap measuring cup. The rice sizers seemed absurdly large in my sports bra at the time. I felt ridiculous. Embarassed. Ashamed.

“Come on,” B— said, and beckoned me over to the motel room’s full-length mirror. Slowly, I walked over, eyes screwed shut. She turned me. I opened them and looked.

I melted into tears of relief and joy.

From the depths

One of the most common pieces of advice I see given to new-hatched or new-in-transition trans folks is that their needs might change as they move through transition. Seemingly-obvious or long-settled things might change, and change dramatically. Your sexuality might shift. Bottom dysphoria has a weird habit of showing up 6-18 months into transition. The way you feel about your chest or waist or hips could change. Hell, it’s common for someone who thought they were binary to discover that they’re actually nonbinary, or vice versa—the very first, most foundational discovery, often, is not quite right. Even if you figured everything out right the first time, which is a minor miracle in and of itself, the intensity of your dysphorias can change and, very often, grow dramatically over time, forcing people to resolve something that they thought they could just live with.

It’s really good advice. Almost everyone I know who’s been in transition for long enough has stumbled into at least one of these.

But it begs an incredibly important pair of questions: if this is so common, why does it happen? And where do these feelings come from?

It’s a little tricky to answer these questions directly, because psychology has not really engaged with what dysphoria is on a research level yet, now that the keystone of a trans identity has shifted to gender incongruance. To describe the problem in other words, if gender dysphoria is not what makes a person transgender, we currently don’t have a good alternative explanation for what it is or what it does. We know it’s there. We know it’s serving some sort of psychological function. But we don’t know why.

And before we can answer the questions we’re really after—why do new dysphorias appear over time—we need to try to grapple with what dysphoria itself is.

Symptomatic

Rather than looking at dysphoria as an end-point, something that exists in and of itself, what if we looked at it as a symptom? This is a shift that’s happening a lot in psychology right now—for instance, depression, the single most common diagnosis in the entire field, is currently being moved from a diagnosis to a symptom of some different problem. If you’re depressed, the argument goes, the problem probably isn’t that there’s some chemical imbalance in your brain or such nonsense, but rather that you’re living in an economically tenuous situation, or you’re a member of an oppressed minority, or you have insomnia or diabetes or hypothyroidism.

Emotional pain, the argument goes, doesn’t exist in a vacuum. Like physical pain, something else causes it, and because traditional psychology has focused on changing your thinking or strengthening coping mechanisms, it hasn’t been especially effective at treating emotional pain. There are a lot of clear, physical effects of emotional pain. And, like many other chronic pain conditions, taking action can relieve that pain decisively.

So, let’s reframe things. What if we thought of gender dysphoria as a chronic pain condition that was caused by being unable to meet the fundamental human need. In this case, the need to live an authentic life? This sort of emotional trauma is actually really common. Kids who are neglected by their parents are a tragic but good example here, because that witholding of love can, and often does, cause lifelong trauma, and teaches their kids that it’s not safe to be themselves. In other words, if gender dysphoria was a symptom instead of a diagnosis, the way childhood trauma is—specifically, the way childhood trauma from unmet needs works—would what we know about it fit?

Look at treatment for gender dysphoria. Like chronic pain or trauma from neglect, it does not go away on its own. When people who feel gender dysphoria take action to resolve the causes of their pain, the pain they feel from it is dramatically and permanently reduced, or even eliminated. Typical psychological management strategies for chronic pain, such as dissociation and depersonalization, are extremely common among people coping with gender dysphoria. Perhaps most importantly, depersonalization and dissasociation (among other coping mechanisms you see a lot among both people living with chronic pain, neglect trauma, and/or unresolved gender dysphoria) are typically dramatically improved or resolved entirely when a person is able to meet their goals in transition. And, like chronic pain, dysphoria can’t be improved by mindfulness or embodiment treatments—they actually only make peoples’ hurts worse.

In short, if gender dysphoria isn’t a chronic pain condition, it sure as hell acts like one.

Now, I suspect that the answer here is more complex than something as simple as chronic pain. Some very smart people have suggested that dysphoria might be a very specific form of chronic post-traumatic stress disorder, which would fit the general Maslowian model of emotional pain from long-term, unmet needs; that, in turn, would make gender dysphoria a chronic emotional pain condition caused by ongoing complex emotional trauma, the causes of which must be resolved for healing to be possible. I’m pretty persuaded by that argument, but a dive that deep into trauma and recovery is a much more complex article.

We’ll get there. Just not today.

How much can you bear?

When we’re talking about chronic pain, we need to get two really useful tools out of our toolkit. The first, pain threshold, is the point at which a pain becomes painful enough for us to become aware of it. If you’ve ever noticed a bruise on your body and wondered to yourself where you got it, that’s a great example of how you can take a minor injury and not even feel it, because it fell underneath your pain threshold. The second, pain tolerance, it the maximum amount of pain a person can bear at one time. The easy way to think of this is that a person’s pain threshold and tolerance are the bottom and top ends of a gauge, like a spedometer. Below the bottom, and the pain might as well not be there. Over the top, and you can’t even feel the difference.

This is a basic evolutionary response, because the whole point of pain is to give a person a heads up when they’re in danger. It’s the central part of our threat response system, and how we stay alive—and that threat response system includes emotional pain, like fear and anxiety. It all runs under the same basic rules, so to speak. The pain threshold exists so that we’re not constantly alerted to minor, irrelevant dangers, while pain tolerance exists so that we can still act, and therefore save our lives, without being completely immobilized by the pain we’re feeling. After all, if you’re hurting, it’s usually because the place you’re in is really dangerous to you, and the best thing to do is to get as far away from it as you can. Natural selection.

So, if gender dysphoria is a type of chronic pain, that means that there’s a hard ceiling for each of us for what our brains will physically allow us to perceive before it starts shutting down other pain inputs to protect us.

Read that again. If you feel gender dysphoria, and especially if you feel a lot of it, it’s really likely that there’s more that you can’t feel right now because your brain is shutting off your ability to notice it.

But that means that, as you resolve the biggest sources of your dysphoria? Suddenly there’s going to be room underneath your pain threshold again.

Peeling the onion

When I talk to people who are in the thick of all this about the seemingly-strange appearance of new dysphorias to other trans people, I have a metaphor that I like to use. Resolving dysphoria is like peeling an onion. You can only ever see the outermost layer at any given time, and as you peel one layer off, another, smaller layer comes into view. And there’s no way to know when you’ll be done. You just have to keep peeling.

When we think about the seeming appearance of “new” dysphorias, go back to that good advice that elder trans folks give. 6-18 months into transition, bottom dysphoria often appears. Your gender identity might not be what you thought it was when you came out to yourself. Your sexuality might shift. Or, as was my case, you might realize, all of a sudden and out of nowhere, that you needed to be rather busty.

At these points, what has actually happened? You’re in transition, presenting as your proper gender, quite possibly full time. In other words, you don’t have to suffer the pain of pretending to be someone else all the time. Maybe you’ve started HRT. In other words, you’re not coping with the pain of biochemical dysphoria. You’re probably out, meaning that you don’t have to live with being called by a name you hate. Maybe early changes from HRT are really starting to kick in, and you can finally start to see your face in the mirror, and not a stranger’s. Maybe you’re further on, and have had a gender-affirming surgery to help you with something that’s been dragging on you constantly your whole life.

In short, those sources of constant, moment-by-moment pain? They’re either gone or dramatically reduced.

Which means that your brain can stop shutting off lesser, but still significant, sources of pain.

When we start noticing “new” dysphorias, the truth is that they were always there. Once I finally dug into my own truth months later and embraced the reality of needing the body I needed, it was impossible for me to miss all of the little ways my need to be curvy had leaked out over my lifetime. Sure, before the moment I first saw Zeni and was able to put an image on what I needed, I had never felt that need as a pain or a longing, but I can see a hundred, a thousand little ways that it had made itself known to me over the decades.

It sure is frustrating, though. You finally chop off the head of your dysphoria, only to discover that it’s a hydra, and two more rise.

But unlike the hydra, there’s an end-point for dysphoria. Just keep peeling.