Realizing that you are transgender male to female can begin in early childhood, but it can also begin at later stages in life. For those who identified as transgender female as young children, the sad part is that they have never lived a single day without feeling something between confusion and shame about their bodies. For other people, the decision to change from a man to a woman starts at a later point, as in puberty or even in early adulthood. Some people make the discovery about themselves even later in adult life.
One misconception that many transgender male to female patients feel is that they are alone in their identification as transgender. While it is true that the transgender segment of the population is a small minority, current estimates of the transgender population in the United States range between 700,000 and 1.3 million people. While not all of these people will go through surgery in order to complete a transition, the majority of people do explore their options, ranging from psychotherapy alone to a regimen that includes hormone replacement therapy (HRT) and sexual reassignment surgery options that do everything from change the way a patient’s face looks to the shape of her body and the primary and secondary genital areas and sex characteristics.
Not everyone who identifies as a different gender from their birth sex has gender dysphoria, and not everyone who feels like a woman trapped inside a man’s body goes through hormone replacement or surgery. In some cases, the situation involves a different condition that has not yet been diagnosed, such as bipolar disorder or schizophrenia. In those situations, diagnosis and treatment of the correct condition end up resolving the patient’s symptoms. This is why the World Professional Association for Transgender Health (WPATH) has set up such a rigorous set of conditions that patients must meet before qualifying for surgical procedures as part of the transition.
It hasn’t been that long since transgender male to female patients were thought to have a form of mental illness. In 1980, researchers first identified gender identity disorder (GID), but they labeled it as a psychiatric problem rather than a simple difference of sexual identity. It was not until 2013 that scientists took a second look at GID and classified it as a biological phenomenon rather than a mental condition, and so they renamed it gender dysphoria. Because gender dysphoria is technically a medical condition rather than a psychiatric disorder, it lacks the stigma that it had once had. It also protects both people with gender dysphoria and people who believe they have gender dysphoria but actually have a different condition, because it ensures that only people who will benefit from the series of regimens will actually receive them.
A transgender male to female patient gets a diagnosis of gender dysphoria when she expresses an ongoing desire to live as a woman. This can show up in a number of different ways, ranging from a disgust for the external signs of one’s biological gender (including the clothes, reproductive organs and other outward indicators of given gender) to a desire to live with recognition as a member of a different gender. The purpose of the therapy leading up to that diagnosis is to make sure that it is authentic and will stand the test of time; patients must express that desire for a minimum of six months before the therapist will make a diagnosis of the disorder. Within therapy sessions, the patients need regular meetings to understand that their gender identity is authentic and to prepare themselves for the dramatic changes ahead.