Can Nonbinary People Experience Gender Dysphoria?

Gender nonbinary people—who often call themselves enby—do not identify with the male-female gender binary. There are a wide range of gender expressions and identities under the enby umbrella, including agender, gender outlaw, genderqueer, and genderfluid. Gender nonbinary people are not a monolith. Some see gender as a problematic concept to be rejected and fought. Others do not object to gender yet feel they personally do not fit into a specific gender identity. Many enbies identify as trans.

Trans people often report a feeling of gender dysphoria. This is stress, anxiety, and frustration associated with being labeled as a gender with which one does not identify. For example, a trans boy whose parents force him to wear dresses may feel intense gender dysphoria that affects his self-esteem and mental health. Gender dysphoria is highly prevalent among people who are not allowed to express their gender identity.

A person does not have to identify with either the male or female gender to experience dysphoria. Enbies can feel dysphoria, too.

What Gender Dysphoria Looks Like in Nonbinary People

Some of the DSM-5’s diagnostic criteria for gender dysphoria are inclusive of enbies. Common symptoms include:

• Inconsistencies between one’s lived gender identity and assigned gender identity
• Wanting to be treated as a member of a different or alternative gender
• Dislike of or frustration with gender signifiers

However, the DSM-5 also focuses heavily on gender dysphoria as the desire to be the “opposite” gender. Because gender nonbinary people do not wish to be the “opposite” gender, they may not feel included in traditional diagnostic criteria.

Gender dysphoria in nonbinary people may manifest in slightly different ways, including:

• A shifting attitude toward gender signifiers. For example, a person might dislike their breasts one day but feel fine with them on another day.
• Feeling troubled by some gender signifiers but not others. For instance, a person might want to be rid of their chest hair but like their penis.
• Feeling pressured to defend their gender identity. Some enbies report being told that they are adopting a trend, not expressing their identity and lived experience.
• Facing pressure to conform to multiple gender roles. Some enbies present in androgynous ways or embrace signifiers of two or more gender identities. They may face pressure to conform to conflicting gender identities.

Gender Dysphoria in Nonbinary Youth

Binary trans people—those who identify as male or female—and enbies generally report developing gender dysphoria around the same time. For most people dysphoria sets in around puberty, getting progressively more intense as puberty changes the body.

John Sovec, LMFT, a California therapist who works with LGBT clients, says, “Gender dysphoria is often discussed in the treatment of adult nonbinary clients, but it is important to also note its influence on the development of nonbinary adolescents. When you reflect on the pressures to fit in that already exist in a teen’s world, imagine the distress and anxiety that can manifest when gender dysphoria is present.

Adolescents are already experiencing the myriad changes that are occurring during the onset of puberty, and these changes in the body can magnify the feelings of dysphoria. “Adolescents are already experiencing the myriad changes that are occurring during the onset of puberty, and these changes in the body can magnify the feelings of dysphoria. What was once a generalized feeling of being uncomfortable with their physical sex and/or gender role can be heightened with the onset of puberty and manifest in feelings of depression, anxiety, shame, and self-hatred.

“It is important to assist adolescents in establishing their identity by actively exploring identity-related choices and encouraging identity development in their affirmed identity in a safe and supportive environment.”

Research suggests enbies face significant difficulty accessing gender-affirming health care. This may be because traditional notions of gender dysphoria take the gender binary for granted. A 2018 study of more than 800 trans youth found that just 13% of nonbinary youth sought hormone therapy, compared to 52% of binary trans youth. They were also more likely report encountering barriers to accessing hormone therapy.

The study also found that older enbies (aged 19-25) were significantly more likely than older binary youth to avoid necessary health care. However, younger enbies and binary trans people (aged 14-18) saw no differences in foregoing primary health care. Cultural shifts in attitudes regarding gender may play a role in this. As awareness of enbies increases, so too may the willingness of younger enbies to identify as nonbinary and demand gender-affirming health care.

When Nonbinary People Seek Treatment for Gender Dysphoria

Gender nonbinary people are sometimes reluctant to seek health care for gender dysphoria, as well as for unrelated issues. This may be because doctors commonly believe inaccurate stereotypes about enbies or are unaware of their existence.

A 2017 study of enbies seeking health care found that they often feel misunderstood, stigmatized, disrespected, or pigeonholed into the incorrect gender. Even when enbies seek care at gender-affirming clinics, they may encounter clinicians who are accustomed to relying on a strict gender binary. According to the study, nonbinary people may feel pressure to conform to the gender binary in health care settings.

In some cases, a health care provider may trigger feelings of dysphoria. For example, a doctor might call a chest binder a bra. This can deter enbies from seeking appropriate medical care and make it more difficult to access hormonal therapies and other treatments for dysphoria.

Research consistently shows significant health care disparities between trans and cis individuals. There may be similar disparities between binary and nonbinary trans people. This could affect access to all forms of health care, including potentially life-saving treatments that are unrelated to gender.

How Therapy Can Help Nonbinary People with Gender Dysphoria

The right therapist can provide a supportive, affirming environment for enbies with gender dysphoria. In therapy, a nonbinary person can discuss their feelings about gender in general, as well as their own gender identity. Therapy that supports these feelings instead of stigmatizing them can be a powerful antidote to the pressure many nonbinary people face to conform to a gender binary.

A therapist may also:

• Support a nonbinary person in accessing dysphoria treatment options, finding a supportive health care provider, and choosing the treatment most consistent with their identity.
• Help a nonbinary person discuss their identity with friends or family. Not all nonbinary people present as obviously nonbinary. They may need help coming out, discussing their identity, and educating loved ones about what it means to be nonbinary.
• Discuss issues such as self-esteem, body image, depression, and anxiety.
• Help a nonbinary person understand that being nonbinary is not a mental health condition or a personal failing.

In therapy, a nonbinary person can better understand their own identity, become a stronger advocate for their needs, and tackle internalized dysphoria and transphobia.

References:

1. Clark, B. A., Veale, J. F., Townsend, M., Frohard-Dourlent, H., & Saewyc, E. (2018). Non-binary youth: Access to gender-affirming primary health care. International Journal of Transgenderism, 19(2), 158-169. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/15532739.2017.1394954
2. LGBTQ 101: terminology and tips. (n.d.) Retrieved from https://www.kenyon.edu/about-kenyon/diversity-at-kenyon/lgbtq-plus/terminology
3. Lykens, J. E., Leblanc, A. J., & Bockting, W. O. (2018). Healthcare experiences among young adults who identify as genderqueer or nonbinary. LGBT Health, 5(3), 191-196. Retrieved from https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC6016091&blobtype=pdf
4. Mamone, T. (2017, October 19). Yes, non-binary people experience gender dysphoria. Retrieved from https://theestablishment.co/yes-non-binary-people-experience-gender-dysphoria-c056eb3df3c9
5. Providing affirmative care for patients with non-binary gender identities. (n.d.). Retrieved from https://www.lgbthealtheducation.org/publication/providing-affirmative-care-patients-non-binary-gender-identities

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