Is it possible to be born in the wrong body – that somehow biology and/or anatomy have played a cruel trick and left you destined to live a life in one role when it's always felt like you should be the other? The answer is most definitely yes – and the solutions are becoming much more achievable and possible than ever before. 

Increasing acceptance of gay and lesbian identities, over the past two decades and the introduction of new legislation, is creating much greater opportunity for individuals to 'come out' as transgender and find ways to live more authentically. In this section we will cover some of the theory whilst also offering some practical advice to help you understand more about the options that are available.

 

What is gender dysphoria?

Gender dysphoria is a medical term used by psychiatrists to diagnose patients who have severe and persistent distress about being the wrong gender and who express a strong desire to live as the other gender. It replaces old terms like transsexualism and gender identity disorder and refers to the chronic sense of unhappiness that arises when the inner experience of gender is other than that ascribed at birth (“you're a boy/you're a girl”).

Whilst gender dysphoria is the official medical vocabulary, many individuals feel more comfortable using the term transgender instead.  The social expectations about conforming to our birth gender are immense and all encompassing, and come to determine so much of what is to come in our lives.

From the colour of the nursery paint and the toys that fill it, through to the friends we make, the relationships we develop and which behaviours we are encouraged to have - all can seem pre-determined and regulated within our culture on the basis of our reproductive anatomy.

In Western culture, young children quickly fall into pre-set patterns of behaviour and by around the age of four or five have been taught that there are significant differences between boys and girls and that they belong in one group, not the other. Many young children however, unaware of the implications of anatomy just know that they identify most strongly with the opposite group.

Whilst girls can generally explore the 'tomboy' identity up to early teens without arousing much parental disapproval (if any), for many boys, any transgression away from stereotypical 'boy’' behaviour can be met with disapproval: for the gender questioning child, surviving childhood can require the performance of a false self.

However, things are changing for the better, and increasingly we are seeing children and young people who recognise this mismatch in their gender identity being given the opportunity to explore possibilities beyond male-or-female, with some starting a formal gender transition whilst still at school. 

 

Despite these positive steps in the right direction, these changes are very recent and more commonly we see people seeking to transition as adults – often in mid or even later life. The challenges for this older group can seem bigger as more is at stake – particularly when one has built a successful career and has the impact on family life to consider.

How common is gender dysphoria?

Statistics are very difficult to state with accuracy because many trans people have lived in secrecy and few surveys have offered the option to declare a transgender identity. The Gender Identity Clinics, UK, however, have seen numbers steadily increase as awareness has spread – particularly since the advent of the Internet which has allowed people to find out more about being transgender.

Numbers continue to grow at an increasing rate with over 1300 referrals at Charing Cross Gender Identity Clinic in 2012. Most intriguing perhaps, was a recent survey by the Scottish Law Society which discovered that four per cent of their members identified as 'living in a gender other than ascribed at birth' – and since it is recognised that some transsexuals reserve the right to not disclose a transgender past, the figures could have been higher. As indicated above, prior to this few organisations have asked the question – and when the only options are “tick male or female” you won't find any transsexuals or transgender people.

Indian Census has never recognized third gender i.e. Transgender while collecting census data for years. But in 2011, data of Transgenders were collected with details related to their employment, Literacy and Caste etc. In India, total population of transgender is around 4.88 Lakh as per 2011 census. The data of Transgender has been cubbed inside "Males" in the primary data released by Census Department. For educational purpose, separate data of Transgender has been curved out from that. 

The signs

In many cases, the signs of gender dysphoria are there from an early age –  however, social pressure will lead many children to suppress this aspect of themselves leading to underlying unhappiness and anxiety as children pretend to be the 'boy' or 'girl' that is expected of them. However, despite their best efforts to fit in, many transgender children will be seen as somehow different by their peer group and many will experience rejection and bullying which can lead to low self -Esteem and a lack of confidence.

Peer group bullying for gender non-conformity is particularly common in schools and is often mistakenly seen as 'homophobic' bullying despite it being at an age when sexual-orientation (which is quite distinct from gender identity) has yet to emerge. A supportive school and supportive family which allows young people to develop in their own unique way can mitigate these effects and increasingly we are seeing such schools and such communities supporting transgender youngsters to live much happier and more fulfilled lives while they work out an authentic way to define themselves and live as people.

The biggest challenge for adults and/or children who recognise themselves as being gender dysphoric is a sense of isolation – it's easy to imagine you are the only person who feels like this; however, as Internet communities increasingly show, there are many others out there and often quite a few within your local neighbourhood.

If you are struggling with any of the issues mentioned above you don’t need to struggle on your own. Without help, symptoms may lead to feelings such as depression, anxiety and in some cases suicidal thoughts – but with greater social acceptability and recognition of transgender identities emerging, with appropriate help new doors could be opened for you to a much more positive and authentic future.

Coming out as transgender

Deciding to come out as transgender can be an emotionally challenging time and the biggest worry for many is more often than not how others will react to the news.

Occasionally, coming out as transgender can lead to you becoming estranged from friends and family members who may struggle to accept you as you really are - sometimes due to prejudice and sometimes due to a lack of understanding. Hopefully however, in time they will realise that you can live successfully and happily in your true gender and it will be easier for them to accept you: this is why patience is important.

 

The process of coming out needs to be considered carefully and those who are coming out for the first time are advised to tell just one person at first who they trust and who they feel will support them.  Here are some further tips:

• If you tell someone you love and are faced with a negative reaction, don’t be too despondent – give him or her space (be patient). It is sometimes difficult for people to immediately move beyond the traditional gender labels they have grown up with. Try to put yourself in their position, your coming out may impact their own feeling about themselves and their sexuality as well as their feelings towards you.
• Don't apologise for being transgender, present it in a positive way and ask for their support and acceptance.
• Don’t tell the whole world at once; tell people one by one, starting with those who are the closest and most trusted. Draw on the support of other transgender people locally to help you deal with any adverse reactions.
• Prepare yourself for questions and try to have as much information as possible ready so that you can answer them.

 

The next steps

Many, but not all people who identify as transgender and/or transsexual, will wish to seek out medical intervention to give them a body which is more readily accepted within society as identifying them as the correct gender. Unfortunately such facilities and provisions are not readily available in India as are in western countries.  For example, the route to accessing medical intervention in the UK is most commonly via the National Health Service (NHS).

This can be a challenging route and individuals taking this route should be aware that not all Doctors will have training or awareness in this specialism.

Initially, a transgender patient who visits a Doctor surgery with gender dysphoria will be referred to a psychiatrist to ensure that a diagnosis of gender dysphoria is appropriate and that there is no underlying psychosis or other condition which could lead to harmful treatment being administered inappropriately. This can feel like a frustrating hoop to jump through but it is there to protect a small but important number of people for whom gender reassignment surgery is not appropriate.

The process of gender transition will involve not only a medical transition (for those that opt for it and for whom it is appropriate) but also a social transition which is known as the Real Life Experience (RLE). 

Preparing for life post-surgery means learning to live in the acquired gender and becoming accustomed to the norms of life in the true gender role. This takes time and will involve a process of 'coming out' to family, friends and at work. It's important to handle this process carefully as emotions can run high and it can take people time to adjust to news that may come as a surprise to them.

From an employment perspective, once you announce your intention to transition, it is advisable to read upon law and seek support to manage that process carefully since many employers are unaware of their responsibilities under the law.

Treatment options

Firstly, anyone with gender dysphoria will need to try and prepare themselves for what is likely to be a long and at times frustrating process, but once you have decided to take action the following are among your options:

Hormonal therapy

Cross-sex hormone therapy is a form of gender dysphoria treatment that involves taking the hormones of the preferred gender. For example, a female wishing to become a male would be prescribed testosterone and a male becoming a female would take oestrogen.

The primary aim of hormonal therapy is to help individuals to feel more comfortable within them – both mentally and physically – and to begin the process of altering the body so that it is more in sync with their gender identity.

 

For some, this may be all that is needed in order to enable them to live with gender dysphoria. A percentage of individuals who do have cross-sex hormonal therapy experience such a change in the way they feel that they do not need to have surgery.

 

Be aware that buying hormones over the internet may seem like a shortcut to transition but there are inherent dangers and hormones in particular should be monitored by a specialist in endocrinology.   

Gender reassignment surgery

If you decide that a medical transition will help you to feel more comfortable in your body then you will need to approach your doctor for a formal consultation and referral. However, having emotional and psychological support while you navigate the medical profession can be beneficial in many cases. The things most transgender people will tell you about transition is that if its right for you then the journey is worth the work – getting there will take courage and persistence; in the meantime you will find benefit in the following tips:

• Build a support network – Identify the friends and family members most likely to support you first and draw on their support where appropriate. It can also be particularly useful to try and find other transgender people local to you from whom you can draw additional support. Check out appropriate LGBT support networks for advice, guidance and tips.  There are many avenues for LGBTQ community in various metro cities for meeting and socialising, although not very openly. Some of them are GayBombay, Good As You, HarmlessHugs. Recently a queer dating platform Amour Queer Dating (http://amourqueerdating.blogspot.in/) also has been launched to help LGBTIQ find long term partners.

 

• Look into your legal rights – In recent years, various laws have been introduced in a bid to protect transgender people from discrimination, which have added significantly to the level of protection for transgender people. The Rights of Transgender Persons Bill, 2014 is a proposed Act of the Parliament of India which seeks to end the discrimination faced by transgender people in India. The Bill was passed by the upper house Rajya Sabha on 24 April 2015.  It was introduced in the lower house Lok Sabha on 26 February 2016.

 

The states Tamil Nadu and Kerala in India were the first states to introduce a transgender (hijra/ aravani) welfare policy. According to the transgender welfare policy transgender people can access free Sex Reassignment Surgery (SRS) in the Government Hospital (only for MTF); free housing program; various citizenship documents; admission in government colleges with full scholarship for higher studies; alternative sources of livelihood through formation of self-help groups (for savings) and initiating income-generation programmes (IGP). Tamil Nadu was also the first state to form a Transgender Welfare Board with representatives from the transgender community. In 2016, Kerala started implementing free SRS through government hospitals. 

 

In India one group of transgender people are called Hijras. They were legally granted voting rights as a third sex in 1994. Due to alleged legal ambiguity of the procedure, Indian transgender individuals do not have access to safe medical facilities for SRS.  On 15 April 2014, Supreme Court of India declared transgender people as a socially and economically backward class entitled to reservations in Education and Job, and also directed union and state governments to frame welfare schemes for them. 

 

The Rights of Transgender Persons Bill, 2014 guarantees rights and entitlements, reservations in education and jobs (2% reservation in government jobs), legal aid, pensions, unemployment allowances and skill development for transgender people. It also contains provisions to prohibit discrimination in employment, prevent abuse, violence and exploitation of transgender people. The Bill also provides for the establishment of welfare boards at the Centre and State level, and for Transgender Rights Courts. The Bill was introduced by DMK MP Tiruchi Siva, and marked the first time the House had passed a private member's bill in 45 years. The Bill was passed unanimously by the House. However, the Bill contains several anomalies and a lack of clarity on how various ministries will co-ordinate to implement its provisions.  Social Justice and Empowerment Minister Thawar Chand Gehlot stated on 11 June 2015 that the Government would introduce a comprehensive Bill for transgender rights in the Monsoon session of Parliament. The Bill will be based on the study on transgender issues conducted by a committee appointed on 27 January 2014. According to Gehlot, the Government intends to provide transgender people with all rights and entitlements currently enjoyed by Scheduled Castes and Scheduled Tribes. 

 

• Be patient – it can take time for people who have known you in the old gender to acclimatise and become at ease with the change. Be ready to politely educate some people – if someone mis-genders you (addresses you with the wrong pronoun or title) then be prepared to explain that it is courteous to respect the presented gender. Some people may be unfamiliar with gender dysphoria and transgender – be prepared to be an ambassador to help them feel less threatened.

Counselling

If you have been wondering if you might be transgender and whether gender transition or gender reassignment surgery might be appropriate for you the first thing to do is to seek out more information and look for appropriate help. A specialist gender-identity counsellor will have done additional training in transgender and gender and sexuality diversity issues.

Living in your true gender will take courage and a fair degree of experimentation – finding a congruent look, exploring ways to present your body that will be more easily read as relating to your true gender and exploring exactly what you want to communicate in terms of gender identity takes time and patience.

Many people successfully live in a gender other than ascribed at birth – some of whom have had surgical and hormonal intervention, some of whom who have only had partial surgery or hormonal intervention, and some who live successfully in their true gender without any medical intervention at all. The important thing is that you take time to work out what suits you best; and that is where a skilled and experienced therapist can help.

 

What should I look for in a counsellor or psychotherapist?

Since most standard counsellor training does not cover this area it is important to identify someone who has this additional training and expertise to help you decide what course of action might be best for you.

Counsellors best qualified to deal with gender dysphoria will have provided details of their experience on their profiles. When browsing, look out for experience, specialist courses attended and membership with any professional bodies related to gender dysphoria.

Also bear in mind that seeking support via a private counsellor or psychotherapist will be separate from any medical professional or hospital or any other national health body involvement.  Counsellors are not professionally qualified to or authorised to prescribe medication or refer you directly for SRS.