Managing body dysphoria and puberty-related pressures

Body dysphoria is a term used to describe the experience of discomfort or distress that a trans or gender diverse person might feel because there is a mismatch between the sex assigned at birth on the basis of genital appearance (usually male or female), and the gender identity (usually boy or girl). Not all trans or gender diverse people experience body dysphoria, but many do.

Whilst on the waiting list to the Gender Identity Development Service (GIDS), Oonagh worries that GIDS gives a lot of weight to body dysphoria as a requirement to be trans.

Parents we spoke to talked about how their trans, or gender diverse children felt about their bodies. Many spoke about feelings of discomfort and distress that their children experienced and how puberty accelerated feelings of body dysphoria for their children. Alongside getting psychological support, there were practical things that helped with body dysphoria.
Parents discussed practical strategies they or their children had found useful for managing feelings of body dysphoria for instance, in those assigned female at birth:
  • Binding to reduce the appearance of breasts;
  • Packing to give appearance of a penis;
  • Contraceptive pill to stop periods.
Some adult trans and gender diverse people choose to have surgery to alter their bodies. This is only an option for those over the age of 16. No genital surgeries are done until adulthood 18 or older, however, a 16 year old might have chest surgery. You can read more about parents talking about surgery here. You can also read more about Jan’s experience of her daughter having facial feminisation surgery below.
Hormone blockers were a very common and a very important way to manage puberty that parents discussed. Parents of young adults also talked about gender affirming hormone therapy.

Body dysphoria and puberty related pressure

In our interviews, younger children were less likely to experience distress relating to their body, even though some were aware of the differences between boys’ and girls’ bodies. For example, talking about her son around the age of four Georgina observed that he used to ask her when he could go to the doctors and ‘get his boy bits, his boys bum.’ Some parents of younger children worried that the way their child will feel about her body in the future will be negatively impacted by society’s ‘expectations of what a body should look like for a certain gender.’

Interview 1 worried that the existing healthcare model could contribute to feelings of dysphoria for her daughter, leaving no room for being a girl with a different type of body.

Puberty related changes such as starting periods, facial and body hair, growth of breasts, deepening of the voice, changes to facial features etc., were often a huge source of discomfort for young trans and gender diverse people. The uncertainty or anticipation of puberty even before any changes occurred also caused worry and stress for the young person. Georgina reflected that her teenage son didn’t like his body and that he didn’t like ‘what’s going to happen at puberty.’ She emphasised that ‘luckily so far there’s nothing to make him look feminine, because puberty has started. It’s just that it’s in the form of hairiness first, which is lucky for him.’
Bodily changes during puberty could seem sudden. Elijah said about his child that puberty had hit ‘like a rock.’ When puberty started, Teresa’s daughter ‘was getting taller, her voice was breaking. She started to grow a beard. Testosterone was just raging.’ The family decided to access private care to stop some of the changes.
For some young people body dysphoria contributed to depression and anxiety.

Having a female sounding voice has caused anxiety for Ross’s child, who won’t talk to people on the phone.

Talking about their bodies and puberty can be difficult for young people, in particular when they find the changes that are happening distressing.

Talking about bodily changes in early puberty could be challenging, and Georgina used a tick box exercise to help her son express his wishes.

Parents whose children had not yet entered puberty sometimes worried about how the experience of puberty would be for their trans, or gender diverse children. For those waiting to start hormone blockers there could be additional concerns about how far into puberty their son or daughter would be before the treatment started.

For Mel waiting for hormone blockers felt almost like a time bomb. She also worried about her stepdaughter not going through puberty at the same time and in the same way as her peers.

Managing body dysphoria: binding, packing, the contraceptive pill and surgery

Parents we spoke to talked about things that helped their children with body dysphoria. Some of the things they discussed were going on a contraceptive pill to stop periods, binding and packing, and surgery.
Binding refers to compressing breast tissue to flatten the chest in those assigned female. The type of materials and methods used for binding vary. Binding can alleviate the dysphoria related to having breasts that trans men can experience. Lesley said about her son: ‘he’s got a few binders and that helps him feel less dysphoric.’ Ross said that for his child, who was ‘so far through puberty’, with a fully developed chest, wearing the binder was ‘the only option.’
Leigh, Lesley and Kate all talked about the importance of binders for their sons. Kate also discussed how to choose the right binder and how to use it safely. Lesley said she found out about binders from Mermaids and from reading about experiences of adult who were trans men online. She felt that for her son, CAMHS recommendations not to bind when he was an inpatient were unhelpful, as she felt binding was ‘crucial’ for reducing her son’s body dysphoria. Leigh said her foster son ‘will not leave the house unless he has a binder on.’ But binding also could have its challenges and frustrations: Ross said although using binders was helpful for later puberty, it’s ‘not healthy and its not been great’.

Binders made Kate’s son feel better. She also had some advice on how to wear them safely.

Leigh talks about her foster son feeling very self-conscious about his chest and binding being uncomfortable in hot weather.

Packing refers to wearing padding or a penis shaped object in the front of the pants or underwear to give the appearance of having a penis.

Lesley talked about her son’s dysphoria around periods, binding and packing. She said binding and packing made her son feel better about his body.

Getting the contraceptive pill prescribed to stop periods can help young people assigned female, identifying as boys/ men deal with feelings of body dysphoria brought about by menstruation. However, not all pills are equally suitable and some might have unwanted side effects. For example, Lesley felt that although her son’s GP was very helpful and offered to put him on the pill, the pill itself ‘made things a bit worse for a while.’ Choosing the right contraceptive pill could help.

Ross suggested the contraceptive pill to manage his child’s periods. He said the GP was very supportive and found a pill that was low in oestrogen.

A few parents and carers with children over the age of 16 had considered how surgery might address changes brought about by puberty. Chest reconstruction is only available to people who are 16 or older for genital surgery they must be 18 or older (see Resources).
Jan said her daughter’s receding hairline and prominent masculine facial features were a concern for her daughter and that she was ‘very keen for facial feminisation surgery.’ The family decided to pay for the surgery privately. Ali thought it was a shame that laser facial hair removal wasn’t available on the NHS for young trans women. Other parents spoke about their young person getting gender affirming surgery on the NHS. You can find out more about gender affirming surgery here.

Hormone therapy

Hormone therapy in young people, gender affirming hormone treatment to masculinise with testosterone or feminise with oestrogen, is, where possible, preceded by hormone blockers in...