Dysphoria, it should be said, is not a precondition of being trans. According to some research, as many as 10 per cent of those who positively identify as trans men, trans women, non-binary people and various other terms do so without any feelings of dysphoria. It is sometimes incorrectly assumed that trans men and women experience dysphoria and non-binary people do not, when in fact some non-binary people feel themselves to be in great need of medical assistance, and some trans men and women seek none at all. Nevertheless, most trans people experience dysphoria to some degree.

Gender dysphoria is a rare experience in society as a whole, affecting about 0.4 per cent of the population, which can make it hard to explain to the vast majority of people, who have not experienced it. To get around this, we often rely on metaphors. The clumsy phrase ‘born in the wrong body’ has become the favoured soundbite in popular media. Clumsy because – and this must be stressed – many trans people do not think this describes dysphoria at all well. To my mind, the trans writer expresses it more accurately: ‘Dysphoria,’ she says, ‘can feel like heartbreak.’ Heartbreak, its incapacitating grief and the sense of absence and loss which activate the same parts of the brain as physical pain, can be so all-consuming it interferes with your everyday life. So, too, dysphoria. For me, at least, this is a much richer way of describing how many trans people experience distress with their bodies – indeed, how I felt until I medically transitioned.

Gender-non-conforming behaviour is something to be celebrated, rather than the basis for teaching children that they may have been born in the wrong body, as some schools now do. There are many reasons why children and young people may experience gender dysphoria: it may be a sign that a child will go on to have a fixed trans identity in adulthood, but can also be associated with discomfort about puberty, grappling with same-sex attraction and childhood trauma. There is a coincidence with autism.
Yet the NHS has ignored this in embracing gender ideology's unevidenced affirmative model and has put growing numbers of young people on the path of irreversible medical treatment that can make them infertile and has potentially significant risks for their brain and physical development, without adequately exploring the reasons for their gender dysphoria.

Trans healthcare, then, is part of a wider political struggle for bodily autonomy that women, LGBTQ+ people, disabled people and ethnic minorities have all been fighting – a struggle that intensified during the decade of austerity that was the 2010s. This political struggle has primarily focused on trans adults, growing societal awareness of whom has allowed for more robust advocacy and rebuttal of the myths about medical transition. Even transphobes and reactionaries in the media and in politics, uneasy and disapproving though they remain, have come to begrudgingly tolerate adult medical transition as a matter of personal autonomy. After all, as trans people have successfully argued, adults are entitled to do whatever they want with their own bodies.

The majority of these kids who go through this gender dysphoria grow out of it, so why would you recommend a drug or surgery that’s irreversible or can have harmful consequences? It’s just kind of common sense, but sometimes common sense just doesn’t happen. It’s kind of silly that you have to legislate this sort of thing.

“Transgender” is a fashionable mental disorder being presented to kids as a legitimate medical condition. Shameful.

We've got it locked into this focus on medical interventions. And certainly some of the young adults said to us, they wish they'd known when they were younger, that there were more ways of being trans than just a binary medical transition.

Trans healthcare must be revolutionized urgently: it was created not to help us but to conceal that which is unpalatable to cisgender people and to erase the implications of our existence for the rest of society. That is why we were not permitted families in so many cultures and why authoritarian governments always attack our access to care. Yet in this we are not unique. Cisgender women, disabled people, fat people, black people, HIV-positive people and trans people are all groups that experience high degrees of medical discrimination and abuse, historically and currently. Our struggle is, then, a shared one – and it should not be left to us alone. In the wake of the coronavirus pandemic especially, the 2020s and beyond will see us all struggle in a new era of recession and growing about who deserves healthcare investment. This is a daunting, frightening time, but solidarity between all of us who are pushed to the margins may yield new health activist movements and resistance.

When we talk about trans people, we’re usually referring to individuals who were either recorded as male at birth but who understand themselves to be women (trans women) or, vice versa, were recorded as female at birth but who understand themselves to be men (). Not all trans people, however, find simply moving between the pre-existing categories of man and woman satisfactory, accurate or desirable. Such trans people, who are less well understood, generally unsettle mainstream society more than trans men and women, because they challenge not only the prevailing idea that birth genitals and gender are inseparable, but also the idea that there are just two gender categories. Often, these people are accused of making up their experience out of a need for attention or a desire to feel special – though in reality the political, economic and social costs for such ‘non-binary’ trans people (who don’t straightforwardly see themselves as men or women) can be immense.

Being trans is not something to be feared. It’s just an aspect of a human being, the same way being gay is just an aspect of who I am. [...] The only place as far as I’m concerned that my sex matters, as opposed to my gender, is in a medical setting. That's between me and a doctor.

Trans women do not transition out of a desire to be feminine; we transition out of a self-understanding that we are or should be female (commonly referred to as gender identity).

Psychiatrists and other mental health professionals should employ modes of assessment that encourage the pursuit of truth. They must view this pursuit as central to their commitment to responsibility and remain skeptical of cultural idioms that come and go, such as the adolescent’s plaintive cry in transgender cases: “I am a boy trapped in a girl’s body!” This cry is never a factual report about the reality of her or his sex, but usually a cry for help, seizing upon a newly coined “idiom of distress”: “I’m so fearful and unsure of myself and my future, I must, as others claim, be living in the wrong body, trapped in the wrong sex.” Psychiatrists help not by “affirming” the bizarre conclusion but by seeking and treating the source of the generating fears.

Hope is part of the human condition and trans people’s hope is our proof that we are fully human. We are not an ‘issue’ to be debated and derided. We are symbols of hope for many non-trans people, too, who see in our lives the possibility of living more fully and freely. That is why some people hate us: they are frightened by the gleaming opulence of our freedom. Our existence enriches this world.

And yet scientists continue to study the brain in hopes of understanding whether a sense of the gendered self can, at least in part, be the result of neurology. A study described by author Francine Russo in Scientific American examined the brains of 39 prepubertal and 41 adolescent boys and girls with gender dysphoria. The experiment examined how these children responded to androstadienone, a pungent substance similar to pheromones, that is known to cause a different response in the brains of men and women. The study found that adolescent boys and girls who described themselves as trans responded like the peers of their perceived gender. (The results were less clear with prepubescent children.)