Note: Even though the DSM-5 lists "Gender Identity Disorder" (GID) as "Gender Dysphoria" (GD), after talking with and interviewing a number of people, it is my conclusion that "Gender Dysphoria" even though renamed over the years, contains within it too simular wording as "Gender Identity Disorder" (GID), therefore, in this article GID is synonymous to a degree, with that of GD. It is then up to the genderqueer, pansexual, LGBTQ community and scientists to decide what stays in the DSM and what does not.

IEET Contributor Wes Strong wrote a follow up to this essay from a social constructivist point of view.

The following is an updated version of a 2010 article "Will gender exist 100 years from now, or does it already not exist?"

Introduction

It has been claimed by biologists that the brains of females and males are different in obscure ways. However physical differences in adults may be due to psychological and sociological pressures on the brains of each gender, because cultures and societies probably exaggerate roles and stereotypes, having an impact on brain plasticity. On top of society’s role in forming gender identity, we can see in current biological data of brains and their relation to gender identity due to “molecular and hormonal mechanisms.” (Rosario, 276-278)

It has been shown that the structure of brains in Homo sapiens can take on either a male or female form from a variety of factors during critical postnatal periods.  The biology of sexual identity is reveling important data which points to diversity in sexual orientation, leading us to accept that looking at gender in a binary fashion is unacceptable; gender identity in Homo sapiens is probably much more ambiguous and diverse then we once thought. (Rosario, 276-279)

From this we can conclude that the gender identity listing in the current Diagnostic and Statistical Manual of Mental Disorders should be eliminated. Genetic engineering of the brain will only increase the ambiguity if we choose. A post gender-binary society is possible, not only in the future, but as we will see it may already be here naturally.

Genetics

Humans have 23 pairs of chromosomes within each cell; twenty-two of these are alike in both males and females. A female has two X chromosomes and a male has one X and one Y within their cells. It is with this Y chromosome that the differences in males and females begin. This combination of XX or XY does make a female “female” and a male “male”, but it does not have a direct effect on gender identity or sexual orientation. “Rather, the influence is indirect and derived through determination of the nature of the embryonic gonadal anlagen and their hormonal products”. (Gooren, 593)

All humans start out as “females”. If “male” sex hormones and the appropriate receptors are present, the male genital phenotype will develop, and if sufficient male sex hormones or functioning receptors are not present, the female genital phenotype will develop. (Knickmeyer, Cohen, 826)

It was standard practice through the 1980’s and 90’s that children born with ambiguous genitalia could be raised as members of either sex because a person’s body image was considered a function of socialization. (Diamond, 623) It was believed that one’s sexual behavior was controlled by nurture not nature. People had surgery so that they would be of one “sex” or “gender”, leaving the nurture part of development as a leading factor of identity.

It wasn’t until the late 90’s that it became evident that sexual behavior was determined prenatally and it did not matter how a child was raised. “It appears that the extent of androgen (i.e., testosterone) exposure of the brain in utero, during the early postnatal period, and at puberty, has more of an effect determining male gender identity than does sex of rearing and sociocultural influences.” (Diamond 625)

A concept that emerged from the 1998 American Association of Pediatrics conference was that since the human brain can be either male or female, there is a possibility that someone would not want to be the gender which they were given from birth. (Diamond, 626) Genetics, along with other factors, such as hormones, social constructs, to even pheromones show that adults may want to change their gender because they feel that they are not the gender they grew up with.

Our DNA contains four nucleotides; Adenine, Guanine, Cytosine, and Thymine. Genes are made up of these four nucleotides, ATGC, and are arranged in different sequences which yield a variety of different kinds of proteins that make up the human body. The phenotype is the resulting expression of the genotype which is what the organism looks like, functions, and in some cases how the organism acts.

This article is dealing with gender identity within humans, instead of the obvious differences we may find in mice when dealing with gender. (Rosario, 275-278)  The genotype is supposed to explain what the phenotype will look like, but that is not always the case. For example take someone who has been cut badly and their body then has a scar. The genotype and the phenotype are different, and the scar doesn’t represent what the genotype was originally programmed for, respectfully. It was originally programmed so that the area of skin would be smooth and tough, not scarred, but had within it the ability to heal the initial cut.

I would hesitate however to explain gender identity as a scar. Certain types of phenotypic brains are a result not of thier parent's genotype, or observable phenotype, but rather because the human had “mutated genes” or was exposed to certain chemicals, including hormones during prenatal critical periods.

If a human embryo was exposed to certain chemicals, usually endogens, androgens, and sometimes certain vitamins and minerals during pregnancy which permanently changed the brain to go one way or the other, or perhaps a little bit of both genders, we can call that sexual dimorphism, but only on the ground that we accept that size, shape, density, and structure of certain brain areas suggest “femininity” or “masculinity”. This article leans toward Rosario’s idea of diversity and ambiguity in relation to the human brain concerning gender identity and even the way one might act, or wish to act.

As it turns out neuroscience and genetics is showing how the brains of LGBTQ people are really ambiguous. There’s more then 20 or 30 ways the brain could be "feminized" or "masculinized" in that the brains between men and women are a little different dimorphicly on a macro scale. (Rosario, 276-278)  You can identify a male by his brain and a female by her brain, but the thing is some of that may also be due to sociological pressures on brain plasticity, making the gender even more ambiguous in a gender neutral / genderqueer / pansexual society. A male who has a phenotype and genotype of a male can have a women's brain, and a woman who has a genotype and phenotype of a woman can have a male’s brain, respectfully.

 

Gender Identity and the DSM

“The phenomenology, nosology, and even the very name and pathological status of gender variance have been particularly heated topics recently because of revisions in the DSM with the planned publication of the DSM-5 in 2013. While all the sexual disorders have long been controversial, debate about [Gender identity disorder in children] (GIDC) has been particularly fiery. As Jack Drescher (2010), a member of the Work Group on Sexual and Gender Identity Disorders, summarizes, lesbian, gay, bisexual, and transgender (LGBTQ) activists criticized the Work Group and the APA more broadly of pathologizing transgender people. Some activists erroneously claimed that GIDC was a Trojan horse aimed at repathologizing homosexuality. Furthermore, therapies aimed at coaxing gender dysphoric children to accept their natal sex were likened by these advocates to “reparative therapy” of homosexuality. While some transgender activists argued for the complete elimination of GID and GIDC from the DSM, others feared that expunging GID would allow insurers to drop coverage of transgender medical care and instead view it as an elective or cosmetic. The articles by individual members of the Work Group point out that these researchers thoughtfully grappled with the scientific, political, and sociological ramifications of having GID in a psychiatric nosology (Cohen-Kettenis & Pfafflin, 2010; Drescher, 2010; Meyer-Bahlburg, 2010; Zucker, 2010). The Working Group's proposed revision of the very term GID to “Gender Incongruence was partly to mitigate the social stigma of a psychiatric “disorder” as well as to more accurately portray a psychological phenomenon that benefits from identification and therapy: a lasting, “marked incongruence between one's experienced/expressed gender and assigned gender” (APA, 2010). Readers should review the “Rationale” section of the GIDC draft revision as well as the aforementioned articles to appreciate the reasons for retaining a diagnosis as well as the changes in criteria according to newly accumulated psychometric data.”(Rosario, 2013)

There has been a lot of controversy over the Diagnostic and Statistical Manual of Mental Disorders III’s and (DSM-V - 2013) listing of Gender Identity Disorder (GID) as "Gender Dysphoria" (GD) since the beginning of its formation. The DSM is a book which lists and describes psychiatric disorders considered official by the American Psychiatric Association. The current DSM version is DSM-V(yr2013).

The APA doesn’t list disorders in this influential book by any layperson standards, in fact it uses committees to review the science behind each listing and as the years go on the DSM evolves into a more precise book for doctors and psychiatrists. But this same review process, which was responsible for the removal of “homosexuality” from the DSM is now under attack by the LGBTQ community, especially by transsexual / transgender / genderqueer peoples.

Some researchers are also supporting the removal or revision of GID out of the DSM based on recent science which suggests that gender identity is not as simple as recognizing ones phenotype, but instead complex reasons have been found, from hormonal, sexual dimorphism, pheromones, or the density of neuron structures in the brain of the third interstitial nucleus of the anterior hypothalamus (INAH-3) to genes outside of the X and Y chromosomes. (Kohl, 344-345; Rosario, 267-284; Hill,8-9)

The controversy around the DSM listing is vast in scope. “There is often a moral tone to much of the discourse, reflecting conflicting ideologies and deeply held values, perhaps protecting vested interests or reflecting gender politics.”(Hill, 10) Part of the criticism of the GID lays in the fact that cultural trends may be different. As Hill suggests in America we have expectations for young people when it comes to gender roles, but relax these same expectations for adults.

Girls and boys can participate in activities that are stereotypical for the other gender and not be uncomfortable being a boy or a girl at the same time. (Hill, 11) Some modern parents are affected by transgender kids to the point of being distressed because their children want to go against the norms of society and act differently then their phenotype, creating problems for them in school and in general social life because the United States has particular gender roles which males and females are supposed to live up to, especially in their youth.

Going against the norm and claiming that they are really a member of the opposite sex, or somewhere in between, some children seek operations. However these operations are rare and, here doctors and parents run into problems. There is more success in operations before puberty according to some researchers and doctors who may just be trigger happy, playing around with simplifications of the complexities of role theory. Young people may change their minds when they get older so caution should be taken. One limited and possibly biased study showed that adolescents who had their sex changed had very positive outcomes and where happy with their decision. However some children grow out of their “GID” and become happy with their untouched phenotype. (Hill, 25-29)

I disagree with Robert L. Spitzer, the author of Sexual and Gender Identity Disorders or "Gender Dysphoria" as in the DSM-V:

Discussion of Questions for DSM-V stated that GID can be compared to the eyes of blind people. The goal of his paper is to remain calling gender identity outside the norm a “disorder.” I would have to agree with the growing number of LGBTQ people that it shouldn’t be called a disorder because “identity” within the human brain and mind is so diverse that trying to pin down something like this as a disorder is a waste of time, especially given the scientific evidence that homosexuality may even have a role in evolutionary processes, never mind the science which is talked about within this particularly influential article. The meaning behind identity when it comes to sexual attraction is very important to people in our society, hence some claims that sexual identity and discrimination is socially constructed. This importance (to both the queer individual and the ignorant homophobic) has led to many deaths resulting from hate crimes, discrimination within cultures, and prejudice. Hate and discrimination tends to be learned from ignorance, clearly having strong cultural-societal roots of violence.

How many people have been killed by others in the recent because they are blind? How many people have to suffer everyday in utter confusion because they are blind? Blind people in the western world have at their advantage a number of tools designed for their condition to help them live within society. Some people may make fun of them, and many blind people would love to be able to see, to be able to use the original evolved function of their eyes, but looking at gender and sexual identity purely from an evolutionary view, relating the biological function of eyes to sexual identity as Spitzer tries to do by attacking Hill, becomes rather problematic.

However, many homosexuals and transgendered people do not want help and the last thing they want is to be discriminated against because they fall under what society refers to as LGBTQ. It seems that when it comes to gender identity people want to be who they think they are and don’t want to have to conform to a certain stereotype of the binary sex which has been valued so greatly by conservative Christians and the like who believe in a “God” (who happens to be male) and has a binary view of gender. I would argue that fundamentalist viewpoints about gender identity are reminiscent of racism.

In response to Spitzer’s article, I would have to conclude that gender identity discrimination can be more correlated to racism than blindness. It would be disgraceful if scientists told African Americans/black/people of color that they have a genetic disorder, or an identity disorder, that they are really “white” and should be converted to a white person. Science (and sociological studies) have shown that race is not a ground for discrimination or grounds for any particular way of looking at people. The same applies to gender identity. Spitzer should rethink his views on gender identity and help eliminate it from the DSM-V. It is clear that the transsexual community does not want GID and GD as a listing in the DSM, just like how homosexuals didn’t want homosexuality listed in the DSM-III. The DSM-IV-TR states under “Gender Identity Disorder” many guidelines which fit the criteria for the listing, including;

“In adolescents and adults, the disturbance is manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics (e.g., request for hormones, surgery, or other procedures to physically alter sexual characteristics to simulate the other sex) or belief that he or she was born the wrong sex.” and “The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.”(DSM-IV-TR, 302.85)

According to the actual wording adults with “GID” are under “significant distress”, and I believe it to be the case that it will one day be very clear that most of these people suffering from this problem lies in how their culture reacts to their identity and how they view themselves through the eyes of other people and even the eyes of themselves yearning to be who they truly are, probably because of the chemistry of their brains and bodies, and not because they can just change if they want to. Many doctors are working on ways to help people change sexes and become the person who they want to be, but this I suggest only be done post-puberty (DSM-IV-TR, 302.85 )

However I think that in our society with sex roles so explicitly clear in the media, in our families and in the work place that the yearning to be Genderqueer, Pansexual, male, female, etc is intensified within these individuals, through societal conditioning. They look at society and think about the ways they should look and act, but the ways that society has formed gender roles may be very skewed in itself, so any LGBTQ person has extra pressure to act and look a certain way, because society exaggerates gender roles.

Minds who do not have “GID” also struggle to just live up to what the media, friends, family, etc are putting out there. In a post-gender society minds will have the opportunity to escape gender roles. People who currently don’t look a certain way, who don’t fit a certain stereotype have problems coping. A person who wants to be the opposite sex must have those same problems, but more intensely, in my opinion. After reviewing websites, books, and journal articles it became clear to me that the reasons for homosexuality, pansexualism, genderqueer transsexualism are so vast, and so complicated, one can use occam's razor, and make the connection that biology and society, nature and nurture are so diverse, so indecisive, that the possibilities are simply infinite like in a rainbow of diversity.

We can see how genetics may play a role, how prenatal exposure to certain chemicals may play a role, how society may play a role that the only conclusion to be drawn right now is that identity concerning gender should not be considered a disorder. One day the science will be so fined tuned that it will be possible to test people for certain gender and sexual identities just by looking at their genome and a sophisticated brain scan, and/or hormonal levels.

Some people are worried such things will increase discrimination in societies that view gender identity outside heterosexism a disorder. Fetuses may be tested, and gene therapy may be used to “correct” such conditions, or some other type of hormonal balancing may be used. I think it should be up to the LGBTQ community, in a democratically way to decide if their identity is a "disorder" and if they would rather fit into the heterosexual matrix of domination. This I highly doubt will become reality, and instead the opposite will happen: diversity will prevail. Though biological reductionism in some cases (levels of reality), if not all can conclude ones gender/sex, society should be prepared for boys wearing dresses and girls playing with toy trucks, etc.

Gender Differences and Sexual Reproduction

There are of course non-controversial differences between genders, in fact, I just implied one of them; that “gender” exists and is a word that describes something, but what does it describe? Biologists have identified differences between members of the same species which can increase the likelihood of sexual reproduction, the difference in each species is known as gender or sex, which usually comes in the form of “male” and “female.” Sexual dimorphism is used to describe the phenotypical difference between males and females of the same species. An example of sexual dimorphism in gorillas is the fact that males tend to be twice the size of females.

Homo sapiens however have less distinctive sexual dimorphic characteristics than many other animals. (Campell, 277) There are also organisms that are asexual, like the sea anemone and the desert-grassland whiptail lizard. Natural selection has also produced many species which are purely hermaphrodites such as the earthworm. Sexual dimorphism and reproduction vary greatly on our planet, both in the plant and animal kingdoms.

Some animals also reproduce by an “external” mechanism where the eggs are fertilized outside the body, for example, typical frogs. (Campell, 534-535) Sexual reproduction as it is in Homo sapiens is just one way for an organism to reproduce. In the future we might actually find it healthier for humans, transhumans/posthumans to reproduce in artificial wombs, rendering human sexual reproduction useless, and perhaps even harmful.

Maybe when people/minds learn about the variety of sexual reproduction and sexual dimorphism in other species, and also grasp the concept that we, as humans, share a lot of DNA with these other animals, one starts to understand that nature does not go by the bible, social constructions, or even just biology, that it is a fantastic mixture of everything from biological-reductionism to sociological constructs that simply play roles in the gift of neural plasticity AND genetic expression.

One notable condition in humans is partial androgen insensitivity syndrome where males with XY chromosomes, but on the X chromosome there is a “defective” androgen receptor gene. People with this condition are mostly biologically male, but have all female characteristics and tend to take on female “gender roles.”

A person with this condition shows how androgen creation is important in gender identity. Studies have also pinned down that androgen production for gender identity is important in prenatal periods and during prepubertal periods. (Tsuyoshi, 1011-1016) Conditions like these help scientists understand the roles of genetics and androgens on the human body, and can even help with understanding gender identity. As the years go on androgen production and genetic markers for gender identity will show why even within the biology of people, and not just in their mind’s, that identity comes in many forms that should be respected.

Gender Identity

Anyone who knows something about biology knows that almost anything can happen in the diversity of problems that can arise in human and animal reproduction. However this article is concerned with gender identity, which in healthy children and adults is very complicated and we do not want to refer to gender identity as a “problem.” The kinds of discrimination and prejudice people come up with is amazing, to say the least.

It seems many people yearn for precise ways of thinking about sexual reproduction and sexual dimorphism; many Americans would like to think about gender in a strict binary fashion. Some people even believe today that the bible, a book written thousands of years ago which has no relevance to science today, is the way we should look at gender. The phenotype of an individual has many implications on their social status and expected identity (social conditioning). Iran for example has a task force dedicated to tracking down homosexuals to either beat them or imprison them. So obviously gender identity, including LGBTQ can affect people in certain societies in absolutely atrocious ways.

A study was done in 2008 using 48 brains from cadavers. This study provides more evidence that hormones do not necessarily have a direct effect on the gender dimorphism of the INAH-3 region. Instead this study suggests that this region is “masculinized” or “feminized” prior to any operations or hormonal treatment. However this study is also very controversial, and I would rather not focus on it.

Although, it does seem that the anterior hypothalamus (INAH-3) may be one of the areas in a network of neurons which is, in reality, gender dimorphic. It has been shown that the neurons of INAH-3 were “masculinized” in female-to-male transsexuals and “feminized” in male-to-female transsexuals. Studies like these support the claims that “GID” may be rooted more in biological determinants of gender dimorphism which can’t be treated with classical conditioning.

Therefore a mind who is genderqueer, pansexual, LGBTQ should not be listed as having a “disorder” because, in Homo sapiens, there is NO evidence which suggests or is taken seriously by modern science that socially constructed gender roles should have any impact whatsoever on how a person should or shouldn't act. This claim however is not suggesting that serious epistemology of ethical and moral theories is misleading, instead it is simply a claim about modern society's ridiculous notion of "gender roles": hence rendering them obsolete. Social, political, and biological science as of 2013 continues to give us evidence that Homo sapiens more or less socially construct mistaken gender roles from a history of primarily a culturally patriarchal "Matrix of Domination."  In the future, as more data is collected on the social front, the data from genetic testing and phenotype studies like the one mentioned above will help pave the way for transhuman and posthuman sciences of “gender” and "sexual identity."

Conclusion

Geneticists are finding genes outside of the x and y chromosomes that may play a role in gender identity. They are also finding the results of “mutated” nucleotide order within the x and y chromosomes related to gender identity. There are so many possibilities for a gender related gene mutation to occur that many more years of science will be needed to fully understand gender identity, as I stated in 2010.

Traditional values of looking at gender in binary fashion is growing less and less important as scientists show how it is that gender identity is diverse in nature and caused by many biological and social conditions. A post-binary-gender society is not only possible but it seems we are already living in one, if we choose.

As humans take control of their own evolution and as we see a transhuman/posthuman world develop, a vast array of identity, with the so-called notions/concepts of “masculinity” and “femininity” will either fade away or grow into a rainbow of diversity. What do you think?

References

Readers may also be interested in the FAQ provided by genderqueerid.com.

Campbell, Neil, Jane Reece, Lwarence Mitchell and Martha Taylor. Biology: Concepts & Connections. San Francisco: Pearson Education, Inc., 2003.

Check, Erika. Genetics: The X factor. Nature 434 – 7031 (2005) 266-267.

Collins, P. (2000). Black feminist thought knowledge, consciousness, and the politics of empowerment. New York: Routledge.

Diamond, Michael. "Clinical Implications of the Organizational and Activational Effects of Hormones." Hormones and Behavior 5 (2009): 621-632.

DSM-IV-TR, 302.85 Psychiatry Online. “Sexual and Gender Identity Disorders”. 10 July 2009

Ellegren, Hans. "Hen's, Cocks and avian sex determination.” EMBO reports (2001): 192-196.

Gooren, Louis. "The Biology of Human Psychosexual Differentiation." Hormones and Behavior 50 (2006): 589-601.

Hill, Darryl B., Rozanski, Christina, Carfagnini, Jessica and Willoughby, Brian. “Gender Identity Disorders in Childhood and Adolescence” Journal of Psychology & Human Sexuality,17:3 (2006): 7 – 34.

Kimura, Doreen “Are men's and women's brains really different?” Canadian Psychology Vol.28 (2) (1987): 133-147.

Knickmeyer, Rebecca C., and Baron-Cohen. "Fetal Testosterone and Sex Differences in Typical Social Development and in Autism ." Journal of Child Neurology 25 (2005): 825-845.

Kohl, James V. 'The Mind's Eyes” Journal of Psychology & Human Sexuality,18:4, (2007): 313 — 369.

Rosario, Vernon A. “Quantum Sex: Intersex and the Molecular Deconstruction of sex. GLQ: A Journal of Lesbian and Gay Studies Vol 15 (2009): 267-284.

Rosario, Vernon A. “Gender Variance: An Ongoing Challenge to Medico-Psychiatric Nosology” 2013

Schmitt, D., Realo, A., Voracek, M., and Allik, J. “Why can't a man be more like a woman? Sex Differences in Big Five Personality Traits Across 55 Cultures.” Journal of Personality and Social Psychology 94 -1 (2008): 168-182.

Spitzer, Robert L “Sexual and Gender Identity Disorders.” Journal of Psychology & Human Sexuality 17:3. (2006): 111 – 116.

Tsuyoshi Baba1, Toshiaki Endo1, Hiroyuki Honnma1, Yoshimitsu Kitajima1, Takuhiro

Hayashi1, Hiroshi Ikeda, Naoya Masumori, Hirofumi Kamiya, Osamu Moriwaka and Tsuyoshi Saito. “Association Between Polycystic Ovary Syndrome and Female-to-Male Transsexuality” Human Reproduction 22:4. (2007) 1011 – 1016.

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Gender - is the range of physical, biological, mental and behavioral characteristics pertaining to, and differentiating between, masculinity and femininity on varying levels, largely narrated and socialized by individual experience. Gender is entirely a social construct, a complex of sex, sex identity, culture, associations and interactions with social gender roles/norms, as well as other factors.

Gender expression - is how people demonstrate a gender. It can be a combination of masc/fem and/or androgyny of various forms. Gender identity is how an individual identifies their gender composition, though this does not always manifest into expression due to social pressures. Individual gender expression does not always match individual gender identity because of patriarchy, heterosexism, etc. For example, androgynous expression often leans towards the masculine, largely due to socialized and internalized patriarchy.

Sex - Defined as a noun refers to reproductive parts (more than just man/woman). Third sexes exist (mixed parts, etc.).

Sex as a verb - is affected by a vast number of socializations and power structures from patriarchy, heterosexism, sexism, gender oppression, even classism through capitalism, etc. Sex as an act is particularly effected by patriarchy, sexism, and heterosexism and narratives constructed by patriarchical porn industry.

Sexual identity - How individuals define their spectrum of sexual attraction based on a fluid combination of gender, gender expression, sex, and certainly other factors. In this sense, gender and sexual identiy can have an interactional relationship and contribute to each other's definition, or place a limit on it.

Femininity- Attributes often associated with females through classical culture and literature

Masculinity - Attributes often associated with males through classical culture and literature

ALL of these, other than sex as a noun, are social constructs defined by an intricate net of interactions between individual experiences, social norms, power structures, etc. etc.

Gender is socialized through various methods, but is a product of those methods more than any biological impulses (sex parts, hormones, etc.) Experience is a BIG part of this which includes an interaction with the contradictions of social norms, rigid male/female gender roles, etc.

Sex acts - follow a very similar path. Gender identity and expression may change over time as individuals interact with these norms in various different ways (It also may stay the same due to these interactions). Same with preferred acts of sexual expression.

Femininity/Masculinity are also defined historically and culturally whose narrative is directed by the ideology of the dominant and powerful classes. Femme/Masc meant different things in the middle ages than they do now. These are socialized characteristics that associate social activity with sex parts, largely reserved to the two dominant sexes (male/female), but in some cultures including third+ sexes in various ways.

Though Gender Dysphoria is in the DSM-5 I would argue that it is not a mental disorder. Gender-assigned-at-birth is problematic from the start as gender is part of a socialized identity and assigned-at-birth conflates sex and gender (which are distinctly different). People diagnosed with GD are no different from anyone else. Social experience narrates and defines individual identity, and individual identity can change over time (or remain the same). There is no universal biological evidence (as far as I know) to indicate GD has a physical cause, but is instead a complex of social interactions, emotion, identity, and other factors.

Gender is inside the normal diversity of human existence while excessive emotional depression and other mental struggles are often the result of social experiences and pressures dictated by power structures and systems of production etc. etc.

So without those structures / with better ones depression wouldn't be as omnipresent in society, but even a good diagnosis and treatment of that disorder requires a social action as to address the systems that manifest these emotions in the individual psyche. - Wes Strong