Alternative explanations

Among young people presenting with gender dysphoria, up to 35% have autism or clear traits of it — a multiple of the general population. With autism, the body often feels strange: sensorially overstimulated, socially out of step, hormonal puberty as chaos. Gender then becomes an explanation for something with a different cause.

Someone who learns to understand that they are autistic sees the difference between "I don't belong with my sex" and "I don't fit social expectations that happen to be tied to sex."

Rapidly shifting, intense feelings; impulsivity; identification with the latest TikTok that came in. With ADHD, every new lens on yourself gains full conviction within hours — until the next one. Stable self-knowledge requires a calm that ADHD doesn't naturally provide.

Abuse, boundary-crossing behaviour, an experience with a perpetrator, or being raised in structurally unsafe conditions — that changes how you inhabit your body. Many girls and women who want to hide their breasts or femininity do so because their body, in their experience, has become a target.

A masculine appearance or mastectomy may increase the feeling of safety at first — but it doesn't address the cause. It shifts the problem and makes later treatment much harder.

"I was born in the wrong body" is a tidy explanation for: I feel awful. In about 80% of young people with gender dysphoria, depression or anxiety disorders are present at the same time.

The question is which underlies which. What's certain: transition doesn't improve depression rates, and in long-term studies, mental health complaints after transition are about as high as they were before.

Both revolve around disgust with one's own body — especially with what makes the body female: hips, breasts, menstruation. Among girls with anorexia or bulimia, the percentage with gender doubt is far higher than among their peers. The overlap is not a coincidence.

General discomfort with your body — your nose, weight, skin — is common in puberty. In body dysmorphic disorder, that discomfort becomes an obsession. When it fixates on sex characteristics, it resembles gender dysphoria, but the treatment is different.

A large proportion of children with gender dysphoria turn out — if not medically treated — to be gay or lesbian. Classic follow-up studies (Drummond 2008, Wallien & Cohen-Kettenis 2008, Singh/Bradley/Zucker 2021) showed that 70-90% of dysphoric children were no longer dysphoric after puberty; most were homosexual.

For a lesbian girl who feels attracted to girls, "so I must be a boy" feels like a logical conclusion. It's the opposite of what it is: a girl who loves girls.

Suddenly arising gender doubt in teenagers without a prior history of dysphoria as a child — usually girls, often in clusters (classmates, friend groups, one Discord server). The pattern is consistent with social contagion, a mechanism also known from anorexia and non-suicidal self-harm.

The term is contested by activists, but the patterns are real. Litman, Diaz, and the research by Lisa Littman documented them first.

In men who first present at adult age with the wish to be a woman, in the majority of cases a sexual paraphilia underlies it: becoming aroused by the idea of seeing oneself as a woman. This pattern was described by Ray Blanchard and has a name: autogynephilia.

It is not an identity and not a gender — it is a sexual preference of which the man himself is the object. Denying its existence helps no one; recognising it does.

The feeling of being outside your body, or that your body isn't yours, is a dissociative symptom. It occurs in severe stress, trauma, some depressions, and autism. It can feel like "wrong body" — but it is a neurological reaction, not a sign of gender.

A boy who doesn't like football and does like drawing; a girl who plays rough and isn't interested in dresses. It used to be called "tomboy" or "sensitive boy". Now it gets translated lightning-fast to "then you're trans". But deviating from the stereotype isn't proof that you belong in a different body.