Gender dysphoria, formerly known as gender identity disorder, is a condition defined by a disconnect between a person’s assigned gender at birth versus their expressed gender, or the gender in which they identify or feel a sense of belonging. 

While 0.6% of U.S. adults identify as transgender, the prevalence of gender dysphoria may differ for individuals that are males but identify as female and people who are females yet identify as male. For instance, a study conducted in the Netherlands found approximately 0.6% of the male population identifies as female, while 0.2% of the female population identifies as male. 

There are several popular myths and misconceptions surrounding gender dysphoria despite this condition being documented or expressed throughout human history. However, until recently, gender dysphoria has not been well understood nor unanimously accepted by the medical community. Therefore, it is critical to have an unbiased and scientific understanding of gender dysphoria and transgender facts

1. Myth: Children aren’t old enough to know their gender identity.

Fact: Many children are capable of making decisions about their gender identity.

Based on current understanding of gender dysphoria, the period before an individual hits puberty is critical. During this time, an adolescent goes through different stages of discovery and begins to develop a sense of identity-based on gender and other characteristics. Children with gender dysphoria generally know whether their diagnosis is still accurate by the time they reach 10-13 years of age. Children can also develop gender dysphoria at even earlier ages, and have a firm conviction before they hit puberty whether they still identify with their expressed rather than assigned (biological) gender. 

2. Myth: Being transgender is a choice.

Fact: Being transgender is not simply “a choice.”

First, gender dysphoria is classified as a legitimate mental health condition by the newest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) version issued in 2013. The DSM-5 was devised by hundreds of experts in psychiatry and medicine and took over ten years to develop. The diagnoses and evidence-based treatments for gender dysphoria are based on scientific research conducted in the recent past. 

Second, gender dysphoria is a complex condition that cannot be distilled down to a simple choice between an assigned gender and an expressed gender. The concept of identity, without even considering gender is staggeringly complex. Being transgender is not a ploy for attention, to be different or to confuse more traditional people. For transgender people, acknowledging their expressed gender allows them to be their true selves. Although gender dysphoria may be misunderstood by the population at large, open communication is necessary for a mutual understanding between cisgender (individuals whose assigned gender aligns with their expressed gender) and transgender communities. 

3. Myth: Sexual orientation is the same as gender identity.

Fact: A person’s sexual orientation cannot be deduced from their gender identity.

Sexual orientation, by definition, is not the same as gender identity. Gender identity is defined as the particular gender an individual associates or does not associate with (e.g. female, male, an alternative gender or lack thereof) vs sexual orientation, which is defined as a general pattern of attraction and sexual arousal to other people (or lack thereof). 

Just because a transgender individual identifies with their expressed gender does not mean that they must follow conventional sexual orientations for their expressed gender, though this is typical. For instance, a biological male that has transitioned to a female may have a sexual preference for males (following suit with their expressed female gender). Conversely, they may still have a preference for females (following their biologically assigned male gender).

4. Myth: All transgender people medically transition.

Fact: It is a transgender individual’s choice whether or not to medically transition.

All transgender or gender dysphoric individuals cannot be grouped together when it comes to medical or life decisions. There are various reasons why a transgender person chooses or abstains from medical procedures, which range from hormone therapy to surgery. A person is still considered transgender if they elect against an operation, cosmetic procedures or hormone therapy. 

In a study conducted in 2011, transgender and gender non-conforming individuals were asked if they medically transitioned. Over 60% of respondents reported medically transitioning in some capacity, with 33% reporting that they received surgery to transition. Interestingly, the same study noted striking differences in opinion about full genital reconstruction surgery. Transgender women were more likely to want a full reconstruction surgery over transgender men, indicating that medical transitioning is an extremely personal and intimate choice. 

5. Myth: Transgender people are mentally ill.

Fact: Being transgender is not a mental illness.

Though gender dysphoria is a mental health condition, this does not mean it is a mental “illness.” The original name for gender dysphoria, gender identity disorder was officially changed in the most recent DSM-5 to remove any negative stigma attached to the word “disorder.” Medical professionals also wanted to distinguish gender dysphoria as a mental health condition rather than a mental illness like schizophrenia

Currently, there is no known genetic or biological basis for gender dysphoria. However, in the future, there may be new discoveries about how and why individuals develop the condition.  Despite the lack of a clear scientific understanding of gender dysphoria, transgender individuals deserve respect, compassion, and support regardless. Patients with gender dysphoria suffer psychologically just as people diagnosed with personality, dissociative or psychotic disorders — all of which are recognized disorders not well-understood conditions by scientific standards. 

6. Myth: Transitioning is as simple as one surgery.

Fact: There are many complexities involved in transitioning besides surgery.

Transitioning involves physical, mental and emotional changes that go beyond gender confirmation surgery. Besides personal changes, a transgender person may encounter legal and social changes based on their expressed gender identity. To better align with their expressed gender identity, individuals may want to change their legal names, marriage and birth certificates, drivers licenses, tax, and medical information, among many other changes. 

Additionally, each state in the United States has specific rules and requirements about changing gender on state-issued identification. In many cases, making a full legal, physical, emotional and mental transition will take years — not merely one surgery. 

7. Myth: Transgender-inclusive healthcare is expensive.

Fact: The cost of health plans does not increase much, if at all, to include transgender-inclusive benefits and they are not prohibitively expensive, especially for large providers.

There are many issues surrounding healthcare for transgender individuals, particularly those seeking hormone therapy and gender confirmation surgery. One might think that transgender healthcare costs would be staggering, but according to the Human Rights Campaign, total care costs for one individual range from $25,000-$75,000 which are less than or comparable to costs for defibrillator implants ($68,000 – 102,000) and much less costly than the drugs required for colon cancer treatment (approximately $250,000). 

Additionally, since the prevalence of gender dysphoria is very small, the amount of individuals receiving this type of treatment would be unremarkable in the context of healthcare in the United States, representing less than 0.1 percent of overall medical costs. In some cases, governments and insurance companies would save money by covering transgender healthcare costs, as this would decrease mental health issues and high-stress levels of individuals with gender dysphoria. 

If you or a loved one is struggling with substance abuse and untreated gender dysphoria, The Recovery Village can help. Individuals with gender dysphoria that use drugs or alcohol to cope can speak with one of our caring representatives to discuss treatment options. 

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