The Diagnostic and Statistical Manual of Mental Disorders has precise diagnostic criteria for Gender Dysphoria. The previous one had slightly different diagnostic criteria for Gender Identity Disorder. In small cell lung carcinoma, there are clear ways to diagnose the condition and a clear treatment pathway once it has been diagnosed, depending on its stage; it would be lovely to imagine that were possible for the thing some people wanted to call Harry Benjamin Syndrome; and the DSM might make it appear that it is. You visit your doctor, you say what your symptoms are, you answer questions, and get a diagnosis.
Diagnosis of GD/GID- you will transition, you will be happy and fulfilled ever after.
No diagnosis of GD/GID- you are not trans.
The DSM omits to mention many things that will affect the success of your transition- what is your family and work situation, how well do you pass, what is your personality like. Some of these are not quantifiable. People attempt transition on a wing and a prayer, and some of them succeed. “Do you want to transition?” is the main question. Some assessment of whether the desire is likely to persist, or whether you can succeed, may be useful, but that is not subject to precise scientific measurement, and may not be knowable.
There are also theories of the cause of GID, such as Autogynephilia, which is complete rubbish. There is a great deal of research about differences in trans folk’s brains, or DNA. This is reassuring. “I have a woman’s brain,” you say, because that justifies your decision to transition in your eyes, and this should be precisely measurable, ever since the BSTc was found to be female sized in a small sample of trans women.
I don’t feel scientific theories explain something this human. It is worthwhile attempting to explain scientifically, but also to recognise the limitations and incompleteness of the hypotheses.
I would rather use myth to explain my actions. “I have a woman’s brain” is refutable; “I am two-spirited” is not a statement of scientific fact but a myth, a story which justifies what I did. I transitioned. If you want a reason for that, “I got a diagnosis from a psychiatrist” would work, or “I wanted to,” but “I am two-spirited” is emotionally satisfying. Rationally, as a scientific theory, I am a materialist, but emotionally, when I consult what I feel about it, I am a theist, a believer in God. If I attempt a scientific, rigorous explanation of God or transition it is refutable and may be ridiculous, but “I am two-spirited” is not. It’s not a scientific theory, it is a story I tell. Stories guide us through life.
And then there is reality. I am faced with a choice. What do I want to do? Stories, or using pseudo science like a story, might justify my decision, or alternatively I might decide according to the story or the pseudo-science, and find my decision so unbearable that I decided the other way. Some things are irreducibly uncertain.
I can be the Rational Man, even now. I will put my feelings to one side, and work out in a rational way what is going on. I will behave sensibly. Then I cannot bear it any more, and break down in tears, unable to speak coherently, possibly curled on the floor. If I accept that state and pass through it, I become-
I love it. That is who I want to be. I just respond in the moment, though the crying may have exhausted me: I have clear access to my feelings and I can express my essence in words and action. I wish I could find a way to get to that state less traumatically, and earn money while in it.