In this month’s Ask a Therapist, we’re joined by The Expansive Group therapist and coach Serena Martinez, LMSW (They/Them). Please note that the responses on our blog segment “Ask A Therapist” are not therapy, medical advice, or crisis management.  

Gender dysphoria doesn't always look like staring in the mirror and feeling disconnected from your body. Sometimes it's feeling uncomfortable in certain clothes, hearing someone refer to you in a way that doesn't feel right, or struggling to feel present during sex. It can show up in ways you might not immediately recognize as dysphoria, and what feels difficult one day might barely bother you the next.

Understanding how dysphoria shows up for you can be an important part of figuring out what helps. And while gender-affirming care, changes in presentation, or a more supportive environment can make a meaningful difference, those options aren't always accessible or possible. That doesn't mean there aren't smaller ways to find comfort, feel more connected to yourself, or make difficult moments a little easier.

Serena, a staff therapist at The Expansive Group, breaks down four ways gender dysphoria can show up—physically, socially, aesthetically, and sexually—and shares practical tools for coping with dysphoria, even when you can't change what's causing it.

What Does Gender Dysphoria Feel Like?

There isn’t one universal experience of gender dysphoria, and it doesn’t necessarily happen all the time. Serena explains that experiences can range “from intense dissatisfaction with one’s body to passive almost annoyance.” For some people, dysphoria can become so overwhelming that concentrating on everyday tasks feels difficult. For others, it may only appear in particular situations.

You might notice it when you get dressed in certain clothes, see yourself in a photograph, hear someone use a particular gendered term for you, or take a shower and become more aware of your body.

Dysphoria can fluctuate based on context and environment. You may feel relatively comfortable in your body one day and then experience a particular trigger that makes that comfort disappear. This doesn’t mean your identity has changed or that your previous experience of yourself wasn't real.

Let’s dive into four ways dysphoria can commonly show up. 

Physical Gender Dysphoria: Signs and Symptoms

Physical dysphoria can involve distress about specific body parts, changes associated with puberty, the way clothing fits, or the overall shape or appearance of your body. It isn’t always intense or noticeable. Sometimes it's more like a persistent irritation: wishing something were different, avoiding looking at a particular part of your body, or feeling vaguely uncomfortable. It might be hard to find words to describe the discomfort; it just is.

For some people, certain activities can make this more noticeable. Showering, changing clothes, exercising, having sex, or seeing yourself naked might bring your attention to aspects of your body that you would rather not think about.

Not every trans person experiences physical dysphoria. As Serena emphasizes, “Dysphoria isn’t what makes someone trans.” Someone can know their gender, explore their gender, or pursue gender-affirming care without experiencing significant distress about their body.

Social Gender Dysphoria: What It Is and How It Shows Up

Dysphoria can come up through other people's perceptions of you. You might feel comfortable with your own understanding of your gender and become distressed when someone calls you a gendered term that doesn't align with how you see yourself. You may feel ignored or misunderstood when someone uses the incorrect pronouns to describe you.

We don’t experience gender in isolation. If anything… you might notice your gender even more when you’re around other people. As Serena puts it, gender involves both “how we internally feel and experience ourselves” and “how others perceive us.” You can feel deeply grounded in who you are and still be affected when someone else perceives you differently.

Aesthetic Gender Dysphoria: How Clothing and Appearance Can Affect You

Sometimes dysphoria isn't exactly about your body. It can be about what your body or clothing communicates to other people. You might love a particular shirt but feel uncomfortable wearing it because of the way it emphasizes a body part. You might enjoy makeup but dislike the way other people interpret your gender when you wear it. You might feel good about your appearance in private but become uncomfortable when you imagine how strangers will gender you. 

Even well-intentioned compliments can occasionally land badly. Serena gives the example of someone moving away from a more feminine gender presentation receiving the compliment, “you look beautiful, girl!” The person offering the compliment may mean it lovingly, but the gendered language can reinforce a perception that doesn't feel affirming.

The issue isn't necessarily the compliment itself. It's the mismatch between how someone is being perceived and how they want to be perceived.

Sexual Gender Dysphoria: How Dysphoria Can Affect Sex and Intimacy

There isn't a single “trans experience” of sexuality. What feels affirming, neutral, or dysphoric can vary depending on the person, partner, context, and day. For some people, being touched in certain places, seeing their body during sex, being naked with another person, or being referred to with particular gendered or body-related language can intensify dysphoria. Others might find that sex temporarily provides a way to connect with their body in a positive or affirming way. And some people may experience little or no dysphoria during sex.

Sex is a place where communication really matters. You can use your words to get closer to the sex you want to be having! You can tell a partner what words feel good, what words don't, which parts of your body you do or don't want touched, or whether you want certain parts of your body covered during sex.

How to Cope With Gender Dysphoria: 3 Therapist-Recommended Tips

When you're actively experiencing dysphoria, the goal doesn't necessarily have to be making yourself suddenly love your body or feel completely comfortable. Sometimes the more realistic goal is simply getting through the moment with less stress.

1. Try Gender-Affirming Clothing and Accessories

Gender-affirming aids can create an immediate sense of alignment between how you experience yourself and how your body or appearance feels.

Depending on what feels affirming to you, this might include:

• A binder
• A packer
• Makeup
• Clothing
• Accessories
• A particular hairstyle
• Gender-affirming underwear
• Anything else that helps you feel more like yourself

Serena recommends experimenting with these kinds of tools as one way to alleviate dysphoria.

2. Use Sensory Tools to Ease Gender Dysphoria

Gender affirmation doesn't have to happen through your appearance. Serena suggests using positive sensory experiences to shift your relationship with the moment. You might create a playlist that makes you feel connected to your gender or identity, wear a perfume or cologne that feels affirming, wrap yourself in a favorite blanket, or engage with another sensation that helps you feel grounded.

The goal isn't necessarily to distract yourself from being trans or gender-nonconforming. It can be about giving your nervous system another experience to focus on—one that feels good, neutral, or affirming.

3. Make Your Environment More Gender-Affirming

Sometimes the most helpful intervention is reducing exposure to something that is making dysphoria worse. That might mean covering a mirror, changing into different clothes, taking a bath, using a loofah in the shower, or cuddling a pillow while you sleep.

These might sound like small changes, but small changes are often what we have access to in the moment. You don't have to solve your relationship with your body every time you experience dysphoria. You can simply make the next ten minutes gentler.

Find an LGBTQ+ Affirming Therapist

If you’re looking for extra support, we’ve got a team of therapists and coaches who can provide the tools and space to explore this further. All of our offerings are affirming of neurodiversity and multicultural identities, are affirming of sex and non-traditional relationship structures, and are supportive of queer and trans identities.

You can connect with one of our therapists or coaches using our intake form. We offer individual and relationship support. In addition, check back regularly for support group openings where you can be in community while healing. 

Picture Credit: Heartstopper