The place of desire in gender dysphoria: A qualitative study of transgender people undergoing gender reassignment treatment

Objectives. - The DSM-5 defines gender dysphoria as a significant distress caused by the experience of an incongruence with regard to the person's biological sex. The diagnosis of gender dysphoria, not determined by biological, psychological and cultural elements, relies primarily on the anamnesis and the narrative of the transgender persons. Method. - Individual interviews were conducted with a sample of nine patients consulting a gender dysphoria consultation, who benefited from sexual reassignment treatments. The interviews were analyzed with the Interpretative Phenomenological Analysis (IPA). Results. - Participants describe the development of their transgender identity as a desire to live in a body, which is culturally assigned to the opposite gender, and to be recognized by society as such. This desire - related to affects and not cognitions - is triggered by events, such as the experience of being attracted to persons with the same sex, but without feeling homosexual, or by differences experienced with same-sex peers during socialization. The desire is experienced at various stages of the development and expressed in various ways, depending on the person's biography and his way of being in and relating to the world. When the desire emerges, it is more or less easily welcomed, and at times also repressed; a consequence of this repression may be, that the body as place of this desire may be attacked. In this last situation, the dysphoric state may be caused by the impossibility to accept and to realize the emerging desire. Contextual elements, such as being forced for professional reasons to clarify the transgender issue or the encounter with a key person, move the evolution of this desire. On the contrary, negative attitudes of family members or significant others may impede gender identity formation. Discussion. - The analysis of these narratives allowed to consider the condition of transgender persons not only as dysphoria, and thus situate it in a traditional medical perspective which distinguishes between normal and pathological, but also to conceive it as a ``career'' towards the possible and desirable. While, the term dysphoria relates to a problematic side of the transgender condition, we consider that the perspective of a desire provide a more constructive way to conceive transgender identity. Conclusion. - The challenge for the expert-psychiatrist is to grasp the different expression of this desire and to allow it to freely emerge and evolve, and to express and realize itself. The role of the psychiatrist is thus not limited to be a "gatekeeper'' in the treatments of sexual reassignment, but to accompany transgender persons in their career of gender transition. As such, the psychiatrist adopts a therapeutic stance, which aims-as in other conditions-to help that desires can circulate more freely. (C) 2021 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).