Gender Identity Disorder is a recognized medical condition by the American Medical Association and the American Psychiatric Association.  It is considered a birth defect, which occurs about five weeks after conception. The brain does not match the physical sex of the body.  This is also known as Transsexualism. There are males with female brains and females with male brains.  The true incidence is unknown but is estimated to be one in one hundred thousand births.  The reason for it is unknown but it is thought to be a biochemical mistake in the formation of the brain.   The result is that the individual has the psychological and chemical brain of one gender but the body of the other.  Persons with this disorder know from an age of 5 or 6, that they are different from other individuals of the same physical sex.  Early on, they learn to hide it from all others, even their parents and siblings.  They learn the skills and mannerisms of the gender that their body is but are aware that they think and feel different.  They want to be of the opposite gender and often characteristically go to bed at night praying they wake up in the body that matches their mind.  Many do not understand the difference until they see the anatomic difference between girls and boys.  Puberty is very difficult because the body changes away from the way the mind expects. 


Most individuals learn to cope and often act in a way that exaggerates their physical gender to compensate.   Males with a female brain join the military or take up hazardous activities.   All learn to hide it and never speak of it to another living soul for fear they will be considered crazy.   Many internalize their feelings and eventually become moody, withdrawn, and despondent.  No one else knows what he or she is going through.    They are terrified others will find out about their secret.


At some point, the defense mechanisms and barriers that let the Transsexual function break down and it is impossible for the person to reestablish the shell that they have projected to others.  This usually happens about ages 30 to 45.  They develop what is termed Gender Identity Dysphoria.  The term Dysphoria is Greek for “difficult to bear”. The discrepancy between what their mind and soul is and what they see in the mirror produces the Dysphoria.  The symptoms are physical pain, agitation, and debilitating depression.  Things that used to be meaningful diminish to extinction.   The pain is like what is felt when a loved one dies.  Eventually, the individual has to address the problem or become nonfunctional.   Twenty percent attempt suicide.  It is clearly not a choice one makes or wants.   Many are angry they have the disease and can speak of it to no one.  Often they do not understand the reason for their terrible feelings until they go through extensive psychotherapy.  Not uncommonly, many therapists do not recognize what is happening to their clients, who are afraid to reveal their innermost feelings, for fear of rejection.






There is no cure, therapy, or medication to cure the Dysphoria once it breaks into the open.   Treatment is directed towards options.  The brain cannot be changed so the body image has to be altered.  Some live part time in the gender of their mind and that may be sufficient.  For most, about 99%, treatment is directed towards changing the body to match the mind.  This involves hormonal therapy to match the brain, psychotherapy to deal with the stresses of transitioning from one gender to another, and eventually sex reassignment surgery.  The Harry S. Benjamin Institute determines the standards and protocols for treatment.  It is a worldwide illness.


It is a difficult disease to have because others view it as a choice or an expression of homosexuality.  The illness is about what your gender identity is, not who you love, which is a separate issue.   Patients often lose their spouses, families, relatives, and employment at a time when they are most vulnerable and need support the most.  Those that have the resources transition to their new life and if their employer is knowledgeable, succeed in returning to a productive life.  In some cases, if the individual can, they “disappear” leaving family and friends behind to start a new life always with the fear they will be discovered.  Those without resources end up alone on the street, or unable to face the pain and the loss of all they hold dear, take their lives sometimes with no one knowing why.  It is an illness that with a single stroke cuts the person off from their identity, their family, and their economic security.  Only one in a hundred who starts the process completes it. The rest are caught in a type of purgatory neither fish nor fowl.   Insurance does not pay for the treatment.    The most common cause of death is suicide followed by murder, usually brutal.


Little is know about what happens to Transsexuals after they complete their transition to the gender of their mind because they want to blend into society and be accepted in their natural gender.   More is known about the dark side of the moon than what happens to Transsexuals long term. 


Some resources are True Selves by Mildred Brown, and Chloe Ann Rounsley

                                   Brain Sex by Ann Moir, PhD, and David Jessel





Sara Kristine Becker, MD

May 21, 1999


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