Living with Gender Dysphoria: Tips for Transgender People’s Friends, Allies, and Partners

A quick note: This blog post uses some terms that might be unfamiliar. We’ve used links to define them in parentheses.

What is dysphoria?

Many, but not all, transgender people  experience dysphoria. Here is a formal definition of dysphoria from the UK’s National Health Service: “Gender dysphoria is a condition where a person experiences discomfort or distress because there is a mismatch between their biological sex and gender identity. Gender dysphoria is a recognized medical condition, for which treatment is sometimes appropriate. It is not a mental illness.” In that definition, treatment commonly refers to transition that can change the body, such as hormones and surgery, which are supervised by a medical professional. Because everyone experiences dysphoria differently, medical transition may not be right for some trans people, and it’s important that all trans people take transition at their own pace. This comic discusses how one trans person found the right pace for their transition. Gender dysphoria is not something that is necessarily “fixed” or “cured” by medical interventions. Additionally, medical interventions for dysphoria are not considered necessary by many health insurance providers. So, due to their high costs, these options are financially out-of-reach for many trans people who need them.

“Clothing Dolls,” by Mi Mitrika. Courtesy of Flickr Creative Commons.

Some trans people don’t experience dysphoria at all, and for some trans people, dysphoria is more about the discrepancy between their identities and other’s perceptions.  Here is one trans person’s account of what dysphoria is like: “Body dysphoria feels like the worst-fitting outfit you’ve ever put together, but you can never take it off. Or sometimes it’s more like a pebble in your shoe, or a belt that digs into your side, or a tiny thing that is just noticeable enough to throw your day off. Some days I wake up and it’s just there. Some days it’s because I tried to fit my not-so-masculine body into my masculine clothes, and the parts that didn’t fit made me want to scream and disappear and puke up all my guts at the same time. It can grow into a scary place where I don’t know if my body belongs to me, and I feel e I’ve been detached from something essential and am about to wash out to sea. Maybe a picture makes me hate and fear the body I don’t have because it’s not the body I wish I had. Maybe I think that the someone I desire won’t desire me because I don’t look like all the handsome cisgendered men they probably grew up loving. (Click here for the definition of cisgender.) Maybe it doesn’t make sense why I feel these things, but I still feel them and they still hurt.”   Dysphoria can create disparate health and wellness outcomes, and therefore personal and academic outcomes for those who experience it. 

How do trans people cope with dysphoria?

Although dysphoria can be challenging and painful, there are many ways trans people have learned to cope. Some trans people with dysphoria seek medical treatment to make their bodies match their identities, some seek mental health services to help cope with dysphoria, and some use coping skills they’ve learned. One recent study found that transmen’s mental health was improved by chest-binding, which helps transmen’s chests appear flatter and more masculine. Here are 25 ways that the author of the quote above copes. For a lot of trans folks, one of the most valuable tools to cope with challenges like dysphoria is friendship. In one survey of MTF trans youth, ninety-eight percent of respondents stated that friends were “somewhat” or a “great deal” helpful for emotional support. (Here is the definition of MTF.)

…Support from people like you!

You’ve probably heard a lot about trans people’s struggles with mental health. What we don’t talk about enough is that support from family, friends, and partners can greatly reduce the risk of trans people’s poor health outcomes. For example, among trans people, “social support has been linked with lower levels of both depression and anxiety and fewer suicidal behaviors.” It’s also been positively associated with self-esteem and quality of life. That’s because social rejection is the cause of a lot of trans people’s poor health outcomes in the first place.  Creating a campus atmosphere of understanding, inclusion and acceptance can go a long way in supporting our trans peers.

So how do you support a trans person dealing with dysphoria?

anole-2Because dysphoria is about the discrepancy between someone’s sense of self and their body or other people’s perception of their gender, the best way to support your transgender friend or partner through dysphoria is by (1) seeing their gender the same way they do, and (2) communicating that (as well as your communicating overall care for them, of course!)

Sometimes, cisgender people have to challenge their own assumptions, thoughts, and unconscious beliefs about bodies and identities. For example, we are all socially conditioned to associate certain physical characteristics with maleness and/or femaleness, and these associations are deeply ingrained. However, being supportive to a trans person (particularly one you are intimate with) means actively working to undo those associations. Instead affirm that your friend or partner truly IS the gender they identify as regardless of their voice, mannerisms, or body shape.

That core belief, and your willingness to challenge the thoughts you have that are in conflict with it, is the foundation of supporting any trans person in your life through dysphoria.

Tips to communicate respect for trans folks and help alleviate dysphoria:

  • Use the name and pronoun the trans person prefers.
  • Don’t disclose someone’s trans identity to others without their consent.
  • Respect trans people’s decisions about if, when, and how to transition.
  • When you’re with others who know the trans person’s identity, correct them if they get names and pronouns wrong.
  • If you’re dating someone, ask what words they want to use to talk about their bodies (for example, chest vs. breasts).
  • Use compliments and descriptors that reflect your friend’s or partner’s gender identity. For example, if your partner identifies as a masculine person, they might prefer to be called  “handsome” rather than “pretty.” Luckily, “fabulous” and “smart” are gender-neutral.  
  • When you are struggling to see your friend or partner the way they want to be seen, it can be best to process this with a cisgender ally rather than the trans person. But be sure to do this in a way that respects the trans person’s privacy. For example, check in with them first about who to process with.
  • If dating a trans person (or anyone really,) practice consent consistently and carefully. Consent is important in all relationships, but it’s especially important in trans relationships because, as we’ve discussed here, trans people’s relationships with their bodies can be complicated.

More resources

Here’s more information on how to support trans folks.

For more content on healthy relationships in the LGBTQ community, check out this online course offered here at UNC.

If you are transgender and are struggling with dysphoria, social support, or anything else, contact the LGBT Center here on-campus or Trans Lifeline.

Anole Halper is a graduate intern with Student Wellness. They are getting a dual Masters in social work and public health. Their research interests include sexual violence prevention and LGBTQ health equity issues.

When a Friend Comes Out: Dos and Don’ts

The decision to “come out,” or disclose one’s sexual orientation, is an important part of an LGBTQ person’s path to self-acceptance. When a friend comes out to you, it shows they trust you and value your relationship. For heterosexual people who haven’t had the personal experience of coming out, it isn’t always easy to know what to say or do when a person comes out to you. Here are some dos and don’ts to help you respond in a supportive, loving way. While this list is not definitive, it is a good starting place. The UNC LGBTQ Center can provide additional resources, both online and in person.


  • Practice active listening. Respect the importance of the conversation, and be engaged.
  • Keep their confidence. Coming out can be a difficult process, and your friend has the right to control who they are out to and when. Sharing this information with you is a sign of trust – respect that. This does not mean you have to be burdened. If you need someone to talk to, Counseling and Psychological Services staff can provide a good outlet.
  • Respect your friend’s romantic relationships as legitimate. Their partner is not their “special friend.”
  • Support your friend’s decisions.
  • Assure your friend that you love them and that your friendship is not going to change.
  • Attend a Safe Zone training to educate yourself on issues facing LGBTQ communities and build skills to help you become a better ally.
  • Practice self-care. Hearing this news can bring up any number of feelings and it is perfectly okay to seek help, or do what you need to take care of yourself.


  • Offer unsolicited advice.
  • Expect your friend to conform to your idea of what constitutes proper sexuality.
  • Insist your moral stance regarding sexuality is the only valid one.
  • Assume your friend is interested in you romantically.
  • Ask prying questions about their sex life or HIV status.
  • Let your friend feel isolated. Include them in more of your plans to counteract any lost support.
  • Feel offended that your friend took so long to tell you.
  • Feel offended that your friend told other people before you.
  • Rush the conversation. Give your friend as much time as he/she/ze needs.
  • Tell them you always knew they weren’t heterosexual.
  • Minimize the importance of this step.
  • Make this a one-time conversation. Make it explicit that your door is always open for him/her/hir.

Keep in mind that it is never too late to apologize for something you said or did when a friend came out to you in the past. If you reacted poorly, you can still apologize and begin to rebuild the relationship.

Adapted from resources from PFLAG and Youth Pride Rhode Island

Fighting Fair & Healthy Communication in Relationships

Real talk. Couples argue. Even if you really like each other 98% of the time, every couple gets into a snafu or disagreement every now and then. How can you survive the fights and keep your relationship happy and healthy overall?

Here are a few things to avoid:

Criticism. While no partner is perfect, it’s important to keep in mind the difference between a complaint and a criticism. A complaint addresses a specific action of a partner(s). A criticism is more global — it incorporates or implies a negative judgment about a person’s character or personality.

Contempt. Contempt can be communicated through sarcasm, name-calling, eye-rolling, sneering, mockery, and hostile humor. Contempt is harmful to a relationship because it is virtually impossible to resolve a problem when your partner is getting the message that their partner is disgusted with them.

Defensiveness. When a disagreement escalates and becomes negative and critical, it’s not surprising that someone may feel attacked and thus become defensive. While this is a natural response, becoming defensive keeps a person from taking responsibility for your part in the conflict and essentially blames one partner as solely responsible.

Stonewalling. In relationships where criticism and contempt lead to defensiveness, which leads to more contempt and more defensiveness, eventually one partner tunes out. This stonewalling involves acting as though they could not care less about what the other is saying or feeling, and often looks like refusing to engage in conflict resolution or touch conversations altogether.


And some healthy communication tips for tough conversations:

Validate and affirm the importance of the relationship and your partner to you.  Express your hope that you can have an authentic, respectful conversation. Agree on whether you’re okay with taking a break from the conversation if you or your partner get frustrated or feel overwhelmed.

Stay focused on the main theme(s) you want to discuss.

Make sure that your verbal and non-verbal communications are in alignment.  Body language, facial expressions, eye contact, and body posture can have a huge impact on the meaning of words. The tone of our voice and the volume you speak in can all change the meaning of your message as well.

Use “I” statements, feeling statements, and be direct. Passive aggressiveness is not effective and can only escalate situations. “I” statements ensure that you are keeping the conversation focused and remaining honest to your own experiences.

Use active listening skills. Use eye contact and avoid texting, being on your computer, or interrupting during an important conversation or argument. Keep an open mind and try to understand your partner’s experience rather than judge it or get defensive.

Paraphrase and ask questions. Use very brief statements to summarize or reflect what the other person has said. This practice allows an opportunity to clarify any misunderstandings within the conversation before they grow into their own argument altogether.

Be supportive. Even if you disagree, both partners should support each others’ right to share their feelings and thoughts as well.

Make specific requests for behavior changes you need. Perhaps you need to change some of your own behaviors or perhaps you would like to see a change in the behavior of your partner(s). Maybe you would like a change in how you do something as a couple. Look for a compromise. Keep in mind its important in a new relationship to balance trying new things and communicating what you want.

Afterward, do something fun! After a conflict has been resolved or a tough conversation concluded, it can be helpful to do something fun or enjoyable with your partner(s) to end your time together on a positive note.  Although it may feel awkward after you’ve just had a tense conversation, spending some fun time together can remind each other what you like about each other and why sticking it out through tough times and working through disagreements is worth it.

Communication tips taken from Sustaining Healthy Relationships in LGBTQ Communities curriculum.


Enjoyed this post and think more information on healthy relationships would be helpful for you or you and your boo? Check out Sustaining Healthy Relationships, an online workshop created by Carolina students, for Carolina students.

If you’re afraid to communicate your needs or express a disagreement with your partner(s) for fear of what they might do, your relationship may be struggling with more than some problematic communication patterns. Check out the resources at which can help you sort through whether your relationship may be abusive and offer you options of what you can do if it is.

Trans Health Talk

Trans folks are those whose gender identity, expression, or behavior is not traditionally associated with their birth sex. Some trans individuals experience gender identity as incongruent with their anatomical sex and may seek some degree of sex reassignment surgery or hormonal treatments. Others may pursue gender expression through external self-presentation and behavior. In honor of National GLBT Health Awareness Week (March 26th-30th), I give you:

5 Things Trans Persons Should Discuss with their Healthcare Provider

(Compiled from info provided by the Gay and Lesbian Medical Association [GLMA] and the Centers for Disease Control [CDC])


Hormone therapy may give desirable effects for those who are transitioning, but it also carries risks. Estrogen may cause blood clotting, high blood pressure, elevated blood sugar and water retention. Testosterone carries the associated risk of liver damage. Some trans persons bypass the health care system by using injectable silicone, often administered by non-medical persons, instead of injectable estrogen. Silicone used in this manner may actually migrate in the tissues and cause disfigurement years later. Hepatitis may also spread through the use of shared needles. The CDC recommends that hormone use be monitored by the patient and provider. Utilizing the health care system not only ensures safety in hormone therapy use, but also regulates the dosage of hormone use so that the desired effects can be obtained.


Trans men who have not had surgical removal of the uterus, ovaries, or breasts are still at risk to develop cancer of these organs. Trans women are at risk, although low, for cancer of the prostate. Even if your gender identity or expression do not coincide with your internal reproductive organs, it is important not to neglect their health.

STDs and Safe Sex

Risky behaviors may be high among trans persons, according to multiple HIV/AIDS trans needs assessments. Behaviors that may put persons at risk for contracting an STI include having multiple sex partners and irregular barrier method contraceptive use. Trans folks also face stigma and discrimination, which exacerbates their STI/ HIV risk, since the stigma of a trans status is associated with lower self-esteem, increased likelihood of substance abuse and survival sex work in male-to-female trans individuals, and lessened likelihood of safe sex practices.

Alcohol and Tobacco

Due to the social isolation, unemployment and other factors affecting trans folks, feeling of depression and anxiety may lead to alcohol use. Alcohol combined with sex hormone administration increases the risk of liver damage, while risk of heart attack and stroke are increased in those who smoke tobacco and take estrogen or testosterone.

Fitness (Diet & Exercise)

Many trans folks work long hours in order to cover the medical costs of transitions, which insurance often does not cover. Exercise and proper nutrition are important however, especially prior to sex reassignment surgery as they will reduce a person’s operative risk and promote faster recovery.

Some people may be reluctant to share the details of any previous transitioning they have undergone when seeking a new health care provider. The GLMA suggests that trans folks share their medical and health history with their medical providers in order to allow their medical personnel to provide the best possible and most relevant care.

If you identify as trans, intersex or genderqueer and would like to connect with others that do or continue to have discussions relevant to trans health, check out the UNC Chapel Hill LGBTQ Center by stopping by their office in SASB North 3226, and attending their Trans Talk Tuesdays from 6:15-7:15pm at Open Eye in Carrboro on the 2nd and 4th Tuesday of every month.

The UNC Campus Health Services website also has a page specific to health related issues for trans folks. Check it out here.