What is Gender Dysphoria?: A meta-narrative review.

The 2nd EPATH conference, Belgrade, 6-8th of April 2017

2017-03-30 What is Gender Dysphoria slides

Presented with Michael Toze


In the DSM-5 (APA, 2013), the authors have changed the diagnosis for trans people of all ages from Gender Identity Disorder (GID) to Gender Dysphoria (GD). They have also broadened the diagnosis to include intersex. The (contested) GD diagnosis is argued to better describe the distress that some trans and intersex people experience when their gender identity feels incongruent to their assigned sex (Davy, 2015). Critics have suggested however that the previous GID and current GD diagnoses are both stigmatizing and lacking in scientific rigor (Hegarty, 2009; Davy, 2015), and that the distress from experiencing gender identity differently to that assigned at birth does not necessarily emerge from gender incongruence per se, but from numerous psychosocial sources, including transphobia, familial and friendship rejection and bodily discontent. Moreover, the author has studied gender and sexuality for many years, and particularly trans gender and sexualities, and noticed that the term Gender Dysphoria was being used in particular ways in the literature, often differently from the diagnostic criterion. The present study is a meta-narrative review of the characterization of Gender Dysphoria.


In this paper, we determine what GD is (in the literature), and then make some recommendations to journals’ editorial teams about characterizations of GD regarding consistency of use, descriptions of participants in the methodology sections of articles, and referencing in order to inform the rigor of publications in the area of trans people and intersex people who continue to be stigmatized, pathologized and misrepresented in academic fora.


The present study is a meta-narrative review, which identified 598 papers, and asks simply: What is Gender Dysphoria? We searched multiple journal databases from all disciplines. The terms we used were Gender Dysphoria and Gender Dysphoric inclusive of the dates April 2013 and June 2016.

Main Outcome Measures



We coded the literature inductively resulting in a number of substantive narrative themes. We have developed an analysis, which tells the stories of how GD is characterized in sexological, medical, sociological and the humanities literature. The major themes we will be drawing on in this paper are: 1. Gender dysphoria as identity, which includes sub-themes of identity (mis)characterizations, identity management and research samples. 2. Gender dysphoria as distress, which includes sub-themes of body, social and sexual distress, clinical thresholds and etiological stories. 3. Gender Dysphoria and Health Policies will include sub-themes of Gender Dysphoria and Teamwork and Guiding Principles.


We will draw together the narrative characterization of Gender Dysphoria, the implications and limitations of the eclectic array of usage in academic literature. We will make some recommendations about how best to make more rigorous the use of the diagnostic concept across the disciplines, attest its misuse and clarify what Gender Dysphoria is.

Trans Social Movements and Mental Health Issues

In the first sections of this paper I explored some of the discourses from trans social movements which have utilized the available science and knowledges in the area to contest the pathologization of trans people. They are asking in what ways changing Gender Identity Disorder to Gender Dysphoria (GD) in the DSM-5 lessens the stigmatization of trans people, and also how the different strands of the trans depathologization movement challenge the GD classification in the DSM-5. To examine these points, I will describe some of the strategies, political praxis, and claims from transgender community organizations’ and advocates’ websites, forums, and blogs (which are by nature international in their scope). I wish to post a methodological caveat: I will not have reached all the internet sources available. Indeed, it is not my intention to be exhaustive. Notwithstanding these limitations, my internet source analysis arguably reaches a fair representation of the various discourses that are circulating within the trans depathologization movement, particularly in relation to contestations surrounding the newly formed diagnosis in the DSM-5. This will then lead to an overview of why the latter depathologization of trans people is important for approaching mental health concerns of some trans people.




School Cultures and Gender Variant Children: Parents’ and Guardians’ Perspectives

Jennifer Pellinen Transgender Flag.jpgA TransGender-Symbol Plain3.png

We are looking for volunteers to take part in a study about parents and guardians who support their gender variant or transgender children at school.
As a participant in this study, you will be interviewed by an experienced researcher about both the limits and positive aspects of school culture in relation to your child.
Your participation would involve an interview at a place that you feel comfortable with and will last about 1 hour. In gratitude for your time, you will receive a £10 Gift Card.

For more information about this study, or to volunteer for this study, please contact:

Dr Zowie Davy, School of Applied Social Science, De Montfort University, Leicester, LE1 9BH


tel. no 0116 257 7844

This study has been reviewed by De Montfort University Research Ethics Committee and received ethics clearance.

School Cultures and Gender Variant Children: Parents’ and Guardians’ Perspectives


Participant Information Sheet

We would like to invite you to take part in a research study. Before you decide, we would like you to understand why the research is being done and what it would involve for you.

This projects aims to explore parents’ and guardians’ experiences of supporting their gender variant children. The study is particularly interested in the school context, school interactions and school policies.

What is the purpose of the study?

We would like to identify how different aspects of schooling advantages and disadvantages gender variant children at school. We would like to explore your feelings about any advantages or disadvantages the school system has on your child’s schooling. We would also like to know your thoughts on how schools could be improved for gender variant and trans children. This study is funded by De Montfort University.

Why have I been invited?

You have been invited to contribute to the study because you are a parent or guardian who is supporting a gender variant child at school.

Do I have to take part?

Participation is entirely voluntary. You can withdraw at any stage of the interview without giving a reason. It should be noted, however, that following the interview you will have 48 hours to tell the researcher that you do not want what you have said in the interview to be used in the study. If this happens, the researcher will erase the audio recording and destroy any anonymised transcript.

What will I have to do?

You will be invited to answer questions about:

  • your experiences of supporting your gender variant (trans) child at school, the behaviors of others around you, and what effects you think this has on you and your child.
  • any school restrictions placed on your child or good practices and how you think they affect them.
  • any school policies and training that employees at the school may have or need

You can say as much as you wish, but usually interviews will take-up about 1 hour of your time.

As a token of appreciation, you will be offered a £10 gift card.

Will my contribution to the study be kept confidential?

Yes. We will follow ethical and legal practice and all information about you, or that you contribute, will be anonymised and handled in confidence. Your name, where you live, or the name of the school will not be recorded in the study. All recordings will be made using digital media files and transcriptions will also be held on electronic password protected files. All files will be held in a password accessible file on a computer for seven years and then be destroyed.


What if I have a complaint or concern?

If you have a concern about any aspect of this study, you write or email the principal researcher who will do their best to answer your concern/complaints.

Dr Zowie Davy

H017B Hawthorn Building

Centre for LGBTQ Research

Health and Life Sciences

De Montfort University




If you are still not happy, you can contact the Chair of the Ethics Committee, at De Montfort University:

Chair of the Ethics Committee

Research & Commercial Office,

1.25 Edith Murphy House

The Gateway


LE1 9BH.

Trans Rights, Medicine, and Law @ The Leicester Human Rights Arts and Film Festival

The doctors and psychiatrists treating trans people in primary care through to transitioning health services in Gender Clinics are often influenced by a pervasive trans narrative of moving from one gender to another as if this is representative of all trans people and understood equally by all concerned. This narrative is of course how some trans people feel and how they often express their transitioning experiences. The narrative articulated by many transpeople in Western contexts consist mainly of the ways in which the original body through the trope of the ‘wrong body,’ distresses them for many years, and which prior to transition they are compelled to live a gender that is not truly them. Following, often many years of ‘living a lie’ the body is sometimes refashioned to align better with their gender identities. What this simplistic narrative may imply to different healthcare, and other professionals, providing care and services to transpeople, is that trans people all desire the same things in relation to their bodies, that they experience their transition equally, and that the transitioning technologies required are the same. Transitioning technologies here refers to hormone therapies and surgical interventions…….



Keynote: Research assemblages and epistemological commitments


I provided a keynote address at University of Strathclyde: TransForming Research Practice: Towards ‘Best Practice’ in Transgender and Non-binary Inclusive Social Research.

My paper started with a practical recognition that is required of researchers is to be able to choose the best form of methodology for the job at hand. Or for researchers to understand by choosing one methodology over another will inevitable produce different results. I want to draw on Fox and Alldred’s recent paper by paraphrasing their understanding of ‘doing and producing research.’ I think their concept of research machines as part of a ‘research-assemblage’ allows us to begin to recognize research as a process of territorialization. Research territorialization is the often momentary settling of all the research’s constituent parts into a whole that shapes knowledge production. The knowledge that research produces manifests according to the particular flows of affect produced by any researcher’s methodology and methods, analysis and write-up and the people involved. This materialist analysis of research-as assemblage is pivotal to my more recent understanding of research integrity, and will form the basis for a critical framework for this talk around qualitative and indeed it’s often quoted nemesis quantitative social inquiry surrounding trans and non-binary people.

to see PowerPoint click Trans and Non-binary

Davy, Z. (2015). Trans Intelligentsia: A Western Pictorial? TSQ: Transgender Studies Quarterly, 2(4), 676-678.


Katie Herzog’s Transtextuality (Senate Bill 48), an installation “depicting 48 portraits of transgender men and women of letters,” took on the mammoth task of displaying portraits of trans pioneers who represent transgender intelligentsia. The celebration of her Western “sitters” is an impressive display, and their academic work has no doubt contributed vast and wide-reaching insights into mine and the lives of some of my trans sisters, brothers, and others. However, her wall of fame, while potentially innocent in its creation, neglects the class, ethnicity/race, sexuality, and other situational aspects of trans writers’ lives that may have impacted the performative aspects of knowledge production about (trans) gender beyond the Western imaginary. Although this trans celebration may feel subversive because it challenges the status quo of those whose knowledge counts vis-à-vis cisgender people, we must be constantly drawn to ask, does the subversion suppress others?

Davy, Z. (2015). The DSM-5 and the Politics of Diagnosing Transpeople. Archives Of Sexual Behavior, 44(5), 1165-1176.

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In the DSM-5 there has been  a change in the diagnosis for transpeople of all ages from Gender Identity Disorder (GID) to Gender Dysphoria (GD), in part to better indicate the distress that transpeople may experience when their gender identity feels incongruent. The Workgroup for Sexual and Gender Identity Disorders, chaired by Kenneth J. Zucker, was employed by theAmericanPsychiatricAssociation (APA) to update the DSM-5’s GID diagnosis reflecting contemporary scientific knowledge. Additionally, in a pre-publication report to the APA, members of the Workgroup suggested that they would also be concerned with the destigmatization of transpeople while preserving a diagnosis that medical insurance companies would accept for issuing payments for transitioning treatments (Drescher, 2013). The aims of this article are, firstly, to question whether changing the diagnosis lessens the stigmatization of transpeople. I will suggest that the semantic change from GID to GD marks ‘‘inverted’’ gendered expressions as pathological and, thus, continues to stigmatize transpeople. Secondly, the article explores the development of the GD diagnosis, and illustrates how the scientific data this were founded on are contentious. The article then demonstrates how the trans anti-pathologization movement has challenged the perceived pathologizing effects of the DSM-5 classification of GD. The article examines a selection of Western transgender community advocates’ websites, forums, and blogs. From these sources, the article then explores the different narratives of transpeople and political groupswho offer details of their praxis, and evidences how the trans anti-pathologization advocates use the available science and human rights discourses to contest the role of psychiatry in the treatment of transpeople.


Davy, Z., Amsler, S., and Duncombe, K. (2015) Facilitating LGBT Medical, Health and Social Care Content in Higher Education Teaching. Qualitative Research in Education, 4 (2) pp. 134-163


Increasingly, Lesbian, Gay, Bisexual, and Transgender (LGBT) health care is becoming an important quality assurance feature of primary, secondary and tertiary healthcare in Britain. While acknowledging these very positive developments, teaching LGBT curricula content is contingent upon having educators understand the complexity of LGBT lives. The study adopted a qualitative mixed method approach. The study investigated how and in what ways barriers and facilitators of providing LGBT medical, health and social care curricula content figure in the accreditation policies and within undergraduate and postgraduate medical and healthcare teaching. This paper illustrates opposing views about curricula inclusion. The evidence presented suggests that LGBT content teaching is often challenged at various points in its delivery. In this respect, we will focus on a number of resistances that sometimes prevents teachers from engaging with and providing the complexities of LGBT curricula content. These include the lack of collegiate, colleague and student cooperation. By investing some time on these often neglected areas of resistance, the difficulties and good practice met by educators will be explored. This focus will make visible how to support medical, health and social care students become aware and confident in tackling contemporaneous health issues for LGBT patients

A new commentary on my (and colleagues) latest research about LGBT curricula content for medical, health and social care students is available at


For open access of the full article please go to


Davy, Z & Siriwardena, A. N (2012) ‘To be or not to be LGBT in primary health care: health care for lesbian, gay, bisexual, and transgender people.’ British Journal of General Practice. 62(602),

Niro Siriwardena and I will be publishing a Analysis and Comment piece in the British Journal of General Practice concerning LGBT health care.

Lesbian, Gay, Bisexual and Transgender (LGBT) primary healthcare will become a feature of the primary care repertoire.1 Pride in Practice, which is supported by the RCGP,provides a rating system that judges primary care surgeries on a welcoming environment, access, the general practitioner (GP) – patient consultation, staff awareness and training and health promotion for LGB people. For those surgeries signed-up to the initiative, action plans to address shortfalls in GP surgeries or any area of healthcare in need of improvement will be developed in consultation with the Lesbian and Gay Foundation. Another initiative, Transgender Awareness, is attempting to address a number of issues that are important to a phenomenologically diverse group of transgender patients.2 While acknowledging this very positive development, it is important to understand what we mean by ‘LGBT primary healthcare’. In what follows, we will draw on the concept of LGBT healthcare to explore the benefits and potential harms that this term can engender; we will draw on the different ways that the relatively sparse LGBT health literature has addressed and accounted for the different foci of LGBT healthcare over the years; in doing so we will argue for a more nuanced approach to LGBT primary healthcare.