Serious Pain

Distress should be at the core of transsexual care.  It must be constantly monitored.  A high level of distress requires emergency intervention. The goal of treatment is to minimize distress.

Each of the three types of distress must be monitored separately.  ...Because the treatment for each type is completely different.

The sum of the 3 types of distress is a measure of risk.  High levels of total distress lead to suicide, self-mutilation, or self-destructive acts.  The goal of intervention is to reduce the distress, thereby reducing the risk.  The relative contribution of each distress type indicates which interventions will be most effective in the shortest amount of time. 

Wrong-gender distress is the most dangerous.  Shifting Type 1 distress to Type 2 is helpful, even if the total distress remains the same.

Body Image Distress is a measure of how important surgery will be, how soon surgery should be done, and which surgical procedures will be needed.


EXAMPLE:  If an individual is experiencing a high level of Type 2 Distress, transitioning -- especially medical transitioning -- will only make things worse.  This kind of person is known as a "Regretter".  The situation is commonly encountered while working with Androgynous people.

Many transgender people expect to wake up distress-free after transitioning.  ...And they're surprised by the tidal wave of Type 2 Distress that hits them.  They may question whether the surgery was worth it -- Why do they still feel pain?    Understanding the differences between the various types of distress can be encouraging.

Similarly, several years after transitioning some may forget how bad the Type 1 distress used to be.  The persistence of Type 2 Distress may make an individual wonder whether they made a mistake.  Rarely, they may even undergo reversal -- another regretter!  Only to wake up afterward with a mountain of Type 1 Distress:  "Oh yeah, now I remember."

To a great extent, transsexual treatment is distress management.

              © Cassandra Branch MD  (2015)

The distress that a transsexual endures has three distinct and measurable sources:

Type 1.  Wrong-Gender Distress

Everyone experiences distress whenever their outward appearance (ie, their gender expression) doesn't match their inner voice (their gender identity).  If you doubt it, put on a dress (if you're a man) and go to the mall.  A mismatch between inner self and outward appearance is know as Wrong-Gender Expression.  Most men would rather die than be seen wearing a dress.  And Transsexual men feel exactly the same way.

          Wrong-gender Expression ALWAYS causes Type 1 Distress


A transsexual woman is born fully aware that she's female.  In fact, the first sentence she speaks at 18 months is:  Me girl, mama.   But her parents look at her genitals and say, "You're wrong.  You're a boy."  They force her into pants and order her to like trucks.  ...That's when the distress begins.

       Wrong-gender Expression is imposed on trans people because of a misunderstanding about sexual biology.

The trans youth will resist, she'll struggle, she'll cry.  ...And so she'll be punished.  Punishment can't change her inner self (No one can change Gender!) -- it merely drives the behavior underground (secrecy).  ...Only to be discovered and punished. 

So it goes for year after year.  Her persistence is the measure of her distress.  She CAN'T give up.  Every fiber of her body screams, I'm a girl!   A forced Wrong-gender life cuts to the bone, like fingernails scratching a chalkboard.  It feels like chilli pepper has been poured under your skin.  (Note:  transmen experience the same distress in their need to become a man.  See HERE.)

Fortunately, it's simple to relieve Wrong-Gender Distress:  Transition to be who you really are.  ...Of course, that's easier said than done.  But Wrong-Gender Distress is so intense, EVERY transsexual will ultimately transition.  Or they'll die trying.

Body Image

Wrong-gender expression encompasses more than clothes & pronouns.  Even a transsexual's body parts are wrong.  Every time they look in the mirror or use the restroom, they're confronted with anatomic structures that shouldn't be there.  

So what?  people might wonder.  Sexual anatomy is hidden under clothes.  Why the big obsession with self-mutilation? 

Remember that wrong body parts were the reason for society's assault from the beginning.  The First Grade Teacher taught that Genitals are Destiny.   Of course today's trans people demand to change their biology.

However, individuals differ in how much distress their body parts cause -- in some cases, 5-year old children have been so distressed, they cut things off with a kitchen knife.  Others are able to reluctantly bear the pain while waiting for surgery. 

How much surgery? also varies from one trans person to the next.  Many trans people need a total remodeling, while a few might only be bothered by one area in particular.  Breast modification is a certainty for almost everyone. 

Body Image is the basis for anatomic correction.  What does it take to be a Man?  For some transmen, male genitals are an essential part of Masculinity, so they'll accept the expense & risk of genital surgery.  Other transmen don't feel that the outcome justifies the risk -- male genitals have less importance in their Body Image

Similarly, transsexual women vary in how much importance they attach to each area of female anatomy.


The Basics Portal

Here's a quote from an acclaimed Mental Health "Expert" who openly advocates anti-trans violence, harassment, & discrimination:

“Imagine that we could create a world in which very feminine boys were not persecuted by other children and their parents allowed them to play however they wanted. Do we really think that boys with GID would have the same low rate of transsexual outcome that they do in our crueler, less tolerant world?  As much as I would like to arrange such a world, I think that it might well come with the cost of more transsexual adults.”

     J Michael Bailey  (for more, go HERE)

"Bailey's respect for the people he describes serves as a role model for others who still struggle to accept and appreciate homosexuality and transsexuality in society."
-- Comment from American Psychological Association

Type 3 Distress:  Collateral Damage

Enduring Type 1 & Type 2 distress, 24/7, week after week, year after year is wearing.  Secrecy, guilt, and unending fear lead to emotional scarring and valid psychiatric conditions, such as depression, paranoia, narcissism, post-traumatic stress disorder (PTSD) and so on.  These conditions in a transsexual are the same as the psychological injuries sustained in other instances of severe, long-lasting emotional trauma.  The diagnosis and treatment are the same for trans people as it is for anyone else.  The problems are best treated by Mental Health Professionals.

NOTE:  An important part of treating Type 3 Distress is to relieve the Type 1 & Type 2 distress that caused the trauma in the first place.

BEWARE:  Mental Health professionals often consider healthy trans women to really be seriously ill men.   Transphobic docs sometimes automatically diagnose trans people as suffering from some major psychological disorder, such as Bipolar Disorder, Schizophrenia, Delusional Disorder, Body Dysmorphic Disorder, etc.  Youth in particular may be diagnosed with Oppositional Defiant Disorder, because they stubbornly resist society's efforts to change their gender. 

Any real major psychiatric problem will be accompanied with an objective (measurable) difficulty with mental processing, such as: faulty reality testing, problems with interpreting sensory input, loss of impulse control, etc.

Type 2.  Harassment Distress

Harassment distress is injury intentionally inflicted by parents, teachers, healthcare professionals, and so on.  The intent is to force a transsexual to adopt Wrong-Gender Expression; to become who they're not. 

In a way, Harassment Distress is the opposite of Wrong-Gender Distress.  Type 1 Distress compels a transsexual to transition from Wrong-Gender Expression to Right-Gender Expression.  In order to counteract that basic ingrained need, society must design punishments and tortures severe enough to keep the trans person in Wrong-Gender Expression. 

The tools of Type 2 Distress are:  teasing, taunting, public humiliation, rejection, exclusion, discrimination, unemployment, violence, physical restraint...  with the occasional murder for good measure.

Transitioning may relieve Wrong-Gender Distress, but it triggers Harassment Distress.  ...Out of the frying pan, into the fire.


However, transsexuals have a sort-of "advantage" in the struggle.  Social leaders always underestimate the intensity of Type 1 Distress -- it's infinite.  There's no torture severe enough to stop transsexuals from transitioning.

If a person is enduring a high level of Harassment Distress, the solution is to move to a different, more accepting location -- such as San Francisco, Seattle, New York, and London.  Harassment is never a reason not to transition or to retreat to wrong-gender expression.

"Gender Dysphoria"  doesn't Exist

Mental health professionals often use the term, "Gender Dysphoria" in reference to trans people.  Since "Dysphoria" is the Greek word for distress, one might think that the psych docs are referring to the same distress that has been discussed above.    In fact, the two terms have almost opposite meanings:

A trans woman is Really a Woman who suffers distress from being forced by society (including psych docs) to pretend to be a man.

The Gender Dysphoria myth claims that she's Really a Man who decided to hate (have dysphoria from) being a man, due to some mental defect. 

Wrong-gender distress refers to a healthy woman with a normal reaction to society's misguided policies.  The problem is resolved by educating the general population about sex & gender.

The Gender Dysphoria myth claims that the woman is mentally ill.  The problem is supposedly resolved by "curing" the paitient through psychotherapy.  After almost 70 years of trying, the mental health profession has never had a successful outcome.

Transsexuality is far more than, "Oh hum, I think I'll be a woman, today...."  Transsexuality is a scream of agony from the innermost soul:  "I'm not the person you're forcing me to be!"  It's a yearning for liberation.  It's a need for truth -- no more secrets or pretenses.


The distress that transsexuals endure is real and it's intense -- so intense that many are driven to suicide or self-mulilation just to stop the pain.  It's the motivation for transitioning.  It can lead to such panicked desperation that a trans person will take dangerous risks (eg risk being recognized by a friend or someone from the workplace), just to soothe the pain for a few hours.  Trans people in agony are willing to cash in the family's college or retirement funds.  They're willing to make any sacrifice or sever any relationship, if there is any possibility that it might bring temporary relief.  

The New Gender Paradigm

Psychiatrists are the people who are suffering from "Gender Dysphoria":  They're unhappy (dysphoric) about the Gender trans people are born with.  They're obsessed with punishing others for their own inadequacies.