Introduction to Gender Dysphoria

Gender Dysphoria is the experience of distress associated with lack of congruence between a person’s gender identity and biological sex. The classic example might be captured in the experience of being “a woman trapped in the body of a man.” The current diagnostic nomenclature extends this discussion from a cross-gender identity concern to the experience of distress when there is lack of congruence, which could include non-binary gender identities as well, such as genderfluid, genderqueer, bigender, and so on.

In our previous work, Understanding Gender Dysphoria, (Yarhouse, 2015), we discussed how gender dysphoria resides along a continuum of severity and only a subset of individuals will meet criteria for the formal diagnosis of Gender Dysphoria. Also, only a subset of these individuals appear to pursue medical interventions, which we define as either taking cross-sex hormones or undergoing one of many surgeries associated with sex reassignment (or gender affirmation).

Mental health fields and popular culture today are moving toward an emphasis on transitioning. What we have found to be true is captured in the words of a transgender Christian who described her understanding of the landscape, ”Transitioning is the main secular response; healing through counseling is the main Christian response. Dealing with it daily is the reality for most of us.” (Yarhouse & Houp, 2016, p. 59).

We agree with the transgender Christian that, not only is there a cultural emphasis on transitioning, but there is also a Christian emphasis on healing. That is, many Christians hold out an expectation that the person who suffers from gender dysphoria should simply pursue “healing” to restore their gender identity so it is congruent with their biological sex. Yet psychological or emotional healing often does not occur; the gender dysphoria typically remains and is painful for the person living in that reality. What we would like to do in these articles is explore further the reality of living with an enduring condition like this: that is, dealing with gender dysphoria daily.

Most of what we see in the realm of “coping” with an enduring condition of gender dysphoria are the use of adaptive coping strategies, such as deep breathing, progressive muscle relaxation, and so on. When these are insufficient, people often turn to gender-symbolic coping strategies, such as how they wear their hair, the clothing they choose, the use of preferred names and pronouns, and so on. Still others use low-dose or clinical dose cross-sex hormones or consider sex reassignment surgery. These coping strategies can be thought of as residing along a continuum from least invasive to most invasive. The World Professional Association for Transgender Health (WPATH) organizes interventions as reversible, partially reversible, and irreversible. These are all “on the table” in the sense that such interventions are readily available to people who meet criteria for Gender Dysphoria, and our understanding of treatment options might shift as we learn more both about the etiology of gender dysphoria and about outcomes to various treatment approaches over time.

Now, what are some distinctly Christian contributions to the discussion of adaptive coping? Some of these involve integrating religious elements into existing coping strategies. For example, the person who adapts a meditation practice by meditating on a scene from the Bible is integrating Christian elements into a widely practiced relaxation approach. Something similar happens when people incorporate spiritual words into breathing exercises, so that, in deep breathing, they say “Amen” or “Peace” quietly to themselves as they exhale.

Without detracting from these adaptive coping strategies, it should be noted that people with more severe gender dysphoria often find that such strategies, while somewhat helpful, do not relieve gender dysphoria. In some cases, then, the failure of the adaptive coping strategies above may lead them to consider other coping or management strategies.

So, if even the integration of Christian elements into adaptive coping doesn’t work for a dysphoric individual, what else does Christianity potentially bring to the discussion of coping? In the next article, we will discuss the unique gifts God offers those within the Christian faith to support themselves and others in the midst of navigating these troubled waters in daily life.