Introduction: The Importance of Challenging Your Own Views on All Matters Related to Transgender Health
Look, I’ll be the first to admit it – I’ve spent a fair bit of time being skeptical about transition as the go-to solution for gender dysphoria (caveat: I’m talking here about adults, especially ones with a history of cross dreaming. I’m not talking about kids because I just don’t know anything about that and I don’t talk about stuff I don’t know nothing about. Unless I’m drunk which is quite often, but I’m not drunk now). But you know what? Sometimes you need to challenge your own views and look at things from another angle. That’s what intellectual honesty is all about, right? So today, instead of focusing on the potential pitfalls of transition (which I’ve done plenty of times before), let’s flip the script and examine what happens when people who experience severe gender dysphoria don’t transition.
What the Research Tells Us
Let’s get into the meat of it. Here’s what studies and expert observations tell us about untreated gender dysphoria in adults:
Mental Health Impacts
- Persistent and often severe depression that tends to worsen over time if gender dysphoria remains unaddressed
- Elevated anxiety levels, particularly in social situations where gender expression is restricted
- Higher rates of substance abuse as a coping mechanism for emotional pain
- Increased risk of self-harm and suicidal ideation compared to the general population
The landmark study by Dhejne et al. (2011) in PLoS ONE, “Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden”, while primarily about post-transition outcomes, included crucial data about untreated gender dysphoria and showed significantly higher rates of mental health issues and suicidal behavior in individuals with untreated gender dysphoria compared to the general population.
Social and Personal Consequences
- Difficulty maintaining intimate relationships due to discomfort with assigned gender role
- Workplace challenges, including decreased productivity and career satisfaction
- Withdrawal from social activities and family events
- Development of compensatory behaviors that might temporarily mask but don’t resolve the underlying distress
A comprehensive review by Hughto et al. (2015) published in The Lancet Public Health, “Transgender Stigma and Health: A Critical Review of Stigma Determinants, Mechanisms, and Interventions”, documented the severe social and personal impacts of untreated gender dysphoria, including workplace discrimination, relationship difficulties, and social isolation.
Physical Health Effects
- Stress-related health issues, including sleep disorders and cardiovascular problems
- Potential for unsafe self-medication or other risky behaviors
- Psychosomatic symptoms like chronic pain or digestive issues
The American Journal of Public Health published research by Meyer (2003), “Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence”, which, while not exclusively about gender dysphoria, provided substantial evidence for the physical health impacts of minority stress, including specific data about transgender individuals who were unable to access appropriate care.
A Thought Experiment: Meet David
Let’s imagine David (not his real name, because, well, he doesn’t exist – but bear with me). He’s 45, successful in his career, married with two kids, and has been struggling with gender dysphoria since puberty. On paper, everything looks perfect – good job, loving family, nice house in the suburbs. But inside? That’s a different story.
David spends hours each day managing an internal war. He throws himself into work, hoping the distraction will help. He’s tried therapy (the kind that focuses on acceptance, not transition), meditation, sports, you name it. But the dysphoria persists. It’s like living with a constant background noise that sometimes becomes a deafening roar.
The likely trajectory? Based on what we know from research and countless personal accounts, David might:
- Become increasingly withdrawn from his family
- Experience deepening depression as he watches his body continue to age in a male direction
- Develop unhealthy coping mechanisms
- Eventually reach a crisis point where the pain of not transitioning exceeds the fear of its consequences
The Evidence Can’t Be Ignored
Here’s the thing that’s been getting to me lately: while I still have questions about transition as a universal solution, the evidence about untreated severe gender dysphoria is pretty stark. Multiple studies show that when people with severe gender dysphoria don’t have access to transition-related care, their mental health outcomes are significantly worse than those who do receive appropriate care.
A Personal Reflection – Getting Brutally Honest
Right, let’s get real here – and when I say real, I mean the kind of honest that makes your hands shake a bit as you type it. As someone who’s made a conscious choice not to transition, I have to acknowledge something uncomfortable: I recognize far too many of those symptoms we just discussed in myself.
The drinking? Yeah, let’s start there because it’s the obvious one. I’m a heavy drinker. And while I’m going to keep some of the other symptoms private (even I have my limits on public vulnerability), let’s just say the list above reads less like a research paper and more like a personal diary entry.
But here’s where it gets complicated – and isn’t that just always the way with gender stuff? How do I know these issues stem from gender dysphoria? Life isn’t neat and tidy; it doesn’t package trauma and struggles with convenient labels. I’ve had my fair share of other challenges that could explain these patterns. Maybe it’s a combination. Maybe it’s something else entirely.
And here’s the real kicker, the thought that keeps me up at night (well, one of them): What if transition would make everything worse? What if, in trying to fix one set of problems, I create an even bigger mess? Success and failure in transition aren’t binary outcomes – they’re as complex and nuanced as gender itself.
The Final Paradox
So where does this leave someone like me? Someone who prides themselves on being empirical and evidence-based, who can see clear clinical evidence of the consequences of non-transition, but whose same critical thinking has led them to believe transition isn’t their best path?
The answer, I’ve come to believe, is that there is no universal answer. And maybe that’s exactly what the future of transgender healthcare needs to embrace. Every person who walks into a clinic with gender dysphoria isn’t just another data point – they’re an island unto themselves, with their own unique geography of needs, fears, and possibilities.
What if instead of approaching treatment with preconceived notions – whether pro-transition or transition-skeptical – we treated each person as genuinely unique? No gender theory, no ideological framework, just pure discovery of who this person is and what path might work best for them?
Because here’s what I know: my truth isn’t your truth. My solution might not be your solution. And that’s okay. The real failure in transgender healthcare isn’t in choosing to transition or not to transition – it’s in pretending there’s a one-size-fits-all answer to one of the most complex aspects of human experience.
So here I am, sitting with my paradox: aware of the costs of my choice, but still believing it’s the right one for me. Sometimes the most evidence-based conclusion is that there is no clear conclusion at all – just the continuous process of trying to find our own way through the fog.
Further Reading
- An Introduction to the Transition Test
- Is This All a Fetish or Am I Really Transgender?
- I’m Transgendered, Should I Transition?
