“Passing”, Puberty, and More: Body Dissatisfaction in Gender Minorities

Written by CCTC Staff Writer

There’s an old saying about your body being a house. In a way, it’s where your thoughts and hopes and experiences are stored. But what if you don’t feel quite at home in your body? What if — like many individuals who struggle with gender identity and expression — you don’t feel at home in your own body? What makes someone who does not identify with the gender they were assigned at birth feel so much body dissatisfaction?

Read on for:

The definitions of gender identity and gender expression (they are not the same thing)
What body dissatisfaction means for transgender and nonbinary individuals
Causes of body dissatisfaction in gender minorities
Unique issues for youth who struggle with gender identity
How body dissatisfaction can elevate to gender dysphoria
Consequences of feeling like you’re not in the “right body”

While some parts of the world are really making strides in terms of gender acceptance and support, there are still daily struggles that can take a serious toll on one’s mental health.

But first, if you are a trans or nonbinary person in crisis:

You may be struggling and feel like you have no one to safely confide in — but that’s not true.

There are teams of dedicated volunteers who provide confidential support to gender minorities in need. These individuals are all within the LGBT community (in the first two resources, all volunteers identify as transgender.)

Your calls, chats, and emails are confidential and are not shared with parents or other authority figures in your life.

The Trevor Project: a crisis phone and chat hotline for transgender youth

Trans Lifeline: a phone crisis hotline run by and for anyone in the trans community

LGBT National Hotline: a phone, chat, and email peer-support hotline

LGBT National Senior Hotline: a phone hotline specifically geared towards seniors in the LGBT community

Someone is out there and willing to listen to you. You are not alone in this.

Defining Gender Identity and Gender Expression

Before we get into the specifics, let’s just first separate sex and gender. Rejecting the idea that there are only two genders is the absolute best way to start understanding gender identity and expression.

Many people think of gender as being “male” or “female”, much like you are assigned “male” or “female” sex at birth. But there are huge differences between sex and gender.

Your sex is assigned to you by a doctor when you are born based solely on biological factors like your body parts and your chromosomes.

Gender is much more complex. It is a social and legal status, and built within genders is a set of roles and expectations about how you “should:”

Speak and respond to others
Dress and otherwise present yourself
Behave within your culture
Embody the “standard” characteristics of a gender

Sex and gender are not the same: your sex is decided for you, at birth, based solely on your anatomy. Your gender, on the other hand, is decided by you and how you feel within your body.

Gender Identity Definition

According to the Human Rights Campaign:

“Gender identity is one's innermost concept of self as male, female, a blend of both or neither – how individuals perceive themselves and what they call themselves. One's gender identity can be the same or different from their sex assigned at birth.”

When one’s gender identity does not match the sex they were assigned at birth, they may identify as transgender.

For example, someone may be assigned male at birth, but perceive themselves as female. Their sex assigned at birth is “male” but they identify as female. This person would be a transgender female — but is just as much “female” as anyone who was assigned female at birth.

People who identify as nonbinary do not perceive themselves as either completely male or completely female. They may identify with both male and female characteristics, or neither.

Nonbinary people may use pronouns such as they/them, as she/her or he/his pronouns might not accurately reflect their gender identity.

Gender Expression Definition

From the Human Rights Campaign:

“Gender expression is the external appearance of one's gender identity, usually expressed through behavior, clothing, haircut or voice, and which may or may not conform to socially defined behaviors and characteristics typically associated with being either masculine or feminine.”

A person who is assigned male at birth, but identifies as a woman, may choose to express themselves in a traditionally feminine way — they choose to be gender conforming. But someone can also identify as a woman and not wear dresses, makeup, or appear in any other “stereotypically feminine” way — they can choose to be gender nonconforming and be no less of a woman because of it.

Some people prefer not to express themselves according to any gender.

What is Body Dissatisfaction?

Body dissatisfaction is defined as a negative attitude towards one’s own physical appearance. It seems to result from a perceived discrepancy — an unacceptable difference — between the actual physical appearance (actual body image) and the desired ideal state of the body (ideal body image).

Negative perception of the body is a common experience for gender minorities. In fact, in one study measuring the relationship between gender identity and body satisfaction, 70% of transgender participants reported experiencing some form of body dissatisfaction.

There are so many reasons behind body satisfaction in gender minorities.

Related: Read this if you want to stop obsessively looking in mirrors and windows, or any other forms of body checking.

Causes of Body Dissatisfaction Related to Gender Identity and Gender Expression

Gender Stereotyping

Gender stereotyping is reinforcing the gender “norms” that society considers acceptable. Stereotypes are usually rooted in traditional concepts of masculinity and femininity.

Individuals who identify as trans often feel the need to align with these stereotypes to “prove” their gender. Otherwise, others may misgender them, or worse — others may not accept their gender identity at all.

They may also want to embody these stereotypes as a way to feel closer to their authentic selves — they want the outside to reflect the inside.

But the thin ideals associated with femininity, and the muscular aesthetic associated with masculinity, are difficult to attain, no matter your sex assigned at birth.

Related: These are body image issues that males experience, and what to do about them. Note: This article is for anyone and everyone who identifies as male. or knows a man or boy who is struggling.

Distress Around Unwanted Body Parts

A person does not need to change any external bodily features to be considered male, female, somewhere in between, or outside the gender spectrum altogether.

But many people feel extreme distress around unwanted body parts that can with their sex assigned at birth, including reproductive organs, facial/body hair, vocal range, and muscle build.

These unwanted body parts often make a person feel a huge, painful disconnect between their internal identity and external body, which is the exact definition of body dissatisfaction.

Inability to Access Transgender Healthcare

Most public and private healthcare providers are behind the times, viewing the full range of trans-related healthcare as cosmetic, experimental, or just plain unnecessary.

But this is completely untrue.

Treatments such as hormonal therapy and gender confirmation surgery are necessary for some to feel at home in their body, and decrease the intense distress and trauma that some people feel due to body dissatisfaction.

Again, it is critical to note that you do not need medical treatment if you want to transition to the gender you most align with. But for some people, medical interventions are necessary and can be lifesaving.

“Passing” vs. Being Outed

A lot of transgender individuals are routinely harrassed and even assaulted when others identify them as trans. Others may simply feel distress when someone references their sex assigned at birth.

So they may try to “pass”. Passing refers to the ability of a transgender person to be correctly perceived as the gender they identify with, and not as a transgender person.

It’s easier for a lot of trans people to receive the rights they deserve when they pass in the eyes of the public — simply because it makes it easier for the public to understand their gender identity.

However, a lot of people do not have passing privileges.

Trans and nonbinary people without passing privileges may live in constant fear of being outed, which leads to body dissatisfaction and constant worries around appearance.

Lack of Gender Affirming Supports

As a great deal of the world ignores or denies the legitimacy of genders outside of the gender binary, a strong, gender affirming support system can make a huge difference.

However, if a person has no one they are comfortable enough with to disclose their true gender to (aka come out to), they may feel like:

Their gender isn’t valid
They are not seen
They are alone in a body that does not reflect who they really are

All of these add up to body dissatisfaction, stress, loneliness, and in some cases, psychological problems such as anxiety and depression.

Unique Risk Factors for Youth Who Identify as Transgender or Nonbinary

When you are an adult, you have a bit more freedom in terms of the people you surround yourself with and the way you choose to present yourself to the world.

Now, just because someone is an adult, it doesn’t mean that the process of coming out is easy, or even safe.

But there are certain struggles that are unique to children and teens whose gender identity is not what their family and friends assumed.

The Onset of Puberty

Puberty is the time when the physical body starts developing the features that may or may not align with your gender identity.

This includes hormonal shifts and growth spurts that can, depending on the body’s anatomy, bring on:

Facial hair
Voice changes
Breasts or curves
Menstruation
Muscular development

These features, which may not at all align with one’s true gender, can be incredibly distressing. Before puberty, a child could start transitioning with name and pronoun changes, changing the way they dress, and changing their mannerisms.

Transgender youth may experience body dissatisfaction due to unwanted body parts, but their outward appearance is not as gendered yet.

For transgender youth, there are puberty blockers that repress or stop one’s hormone development so that these physical features do not develop, or stop developing if a transgender youth has already started puberty.

Puberty blockers are entirely reversible and allow youth to explore their gender identity before their outward appearance drastically changes.

Unsupportive Parents/Guardians

Transgender and nonbinary youth have a higher likelihood of feeling positive about their gender identity with their parents or guardians in their corner, fighting for their rights.

But unfortunately, so many trans children are not taken seriously because they’re just “confused.” And teenagers in gender minorities can feel unseen by their parents and guardians.

Parents and guardians may choose not to use their child’s preferred pronouns and may continue using their deadname (their name given at birth that does not reflect their true gender). They may not fight at all for their child to exist as their authentic selves, and instead repress their identity altogether.

Domestic Instability and Homelessness

In some cases, parents and guardians get so confused and upset about their child transitioning away from their sex assigned at birth, and about them potentially choosing a new name, that they become hostile — violent, even.

They may bully, emotionally or physically abuse, and even disown their transgender children.

So many trans youth end up on the streets, all because they exist in a body that does not reflect who they are inside. In fact, 20-40% of the more than 1.6 million homeless youth identify as LGBTQ, and nearly a third of transgender and nonbinary people experience homelessness during their lifetime.

Gender Dysphoria: A Major Consequence of Feeling Unaligned with Your Body

According to the American Psychiatric Association, gender dysphoria is defined as “a marked incongruence between one’s experienced/expressed gender and their assigned gender, lasting at least 6 months.”

Individuals with this condition experience extreme distress in their own body that can contribute to psychiatric problems such as depression, anxiety, eating disorders, self-injury disorder, suicidal ideation, and suicide. They may also experience impairment in their work or school life, relationships, and/or social life.

Treatments for gender dysphoria include:

Social affirmation: adopting pronouns, names, and various aspects of gender expression that match their gender identity
Legal affirmation: changing name and gender designation on forms of government identification
Medical affirmation: puberty suppressants for adolescents with gender dysphoria and gender affirming hormones like estrogen and testosterone for teenagers and adults
Psychological support: working with a therapist to manage symptoms of anxiety, depression, etc., that may accompany gender dysphoria

Not all transgender people experience gender dysphoria.

But all individuals who experience gender dysphoria are at risk for serious side effects. They deserve gender affirmation, as well as any counselling they need to manage the negative psychological consequences of body dissatisfaction.

Further Considerations About Gender Dysphoria

Until recently, gender dysphoria was called gender identity disorder. The condition was renamed in 2013 due to the negative connotation of the word “disorder.”

Identifying as trans or nonbinary is not a disorder, and not something to be “treated.”

Gender dysphoria has to do with the mismatch between who you are and the body you currently exist in. Therapy can help with the distress of this mismatch, but gender affirmation is key to improving body satisfaction and general wellbeing.

Some researchers argue that gender dysphoria may also not be the most adequate term to express this condition.

They believe that the term, and the connotations that the diagnostic criteria of gender dysphoria, may reinforce the idea that gender can only be binary, rather than a spectrum.

Some also believe that gender dysphoria is not necessarily an individual problem but a reaction to broad social and cultural stigmatization. Researchers in these circles believe that the experience of gender dysphoria may not be a mental condition at all, and should be removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) altogether.

On the other hand, if gender dysphoria is removed from the DSM, individuals seeking treatment for the condition may have a harder time getting insurance companies to cover it.

If you are struggling with body dissatisfaction and/or gender dysphoria:

Try to find small ways to safely affirm your gender identity now:

Surround yourself with gender affirming people, whether that’s in person or online
Find small ways to express your gender, even if that’s just wearing something that aligns with your gender under the clothes you own now or just dressing up at home (when it’s safe to do so)
Create gender affirmations for yourself, such as: “My gender is valid no matter what my body looks like.”
Find a support group in person or online, full of people who understand your feelings
Confide in someone you trust, someone who will let you talk about your problems without judgment

If possible, find a gender affirming doctor. Also look for a therapist who specializes in gender-related issues, as well as any other comorbid illnesses you may experience.

No matter what you identify as, your gender is valid.

And you deserve to be around those who improve your mental health.

If you or a loved one is suffering from an eating disorder, take the first step today and talk to someone about eating disorder recovery or simply learn more about the inclusive, holistic eating disorder treatment programs we offer.

Ai PonoJuly 20, 2021