There has been plenty of research into the etiology of gender dysphoria, but the current science considers gender identity as fixed and biological, which makes sense of why conversion therapies have been so unsuccessful (otherwise the conservative medical establishment would be more likely to recommend conversion therapy to solve the “problem” of trans people, as talk therapy is much less intervention, much cheaper, and much more socially acceptable than medical transition).

Here is a relatively accessible paper on the topic by esteemed endocrinologist Joshua Safer: https://pubmed.ncbi.nlm.nih.gov/31027542/

It’s behind a paywall, but that can be circumvented if you know how.

More interesting than whether mental illness is more common in trans people because of how they are treated by society (which seems almost obvious, though worth confirming empirically) is whether mental illness might be more common for trans people because of the biology, such as from having the “wrong” sex hormones in their body.

Gay men who were forced to take estrogen in the UK experienced symptoms like depression and suicidal ideation, and lots of the same things trans people report (there is speculation whether Alan Turing being forced to take estrogen may have contributed to his suicide).

There is also the famous case of David Reimer whose penis was accidentally amputated during circumcision as a baby. Under the direction of the psychologist John Money, who believed gender was entirely determined by environment / social programming, was raised as a girl. Reimer consistently struggled being raised as a girl, eventually decided he was a man, and struggled immensely with mental health struggles before his suicide.

Suicide seems to be a common thread among those suffering from gender dysphoria, with over 40% of trans people reporting having previously attempted suicide and over 80% having considered attempting suicide (source), and it’s not surprising cis people when forced to take cross-sex hormones also seem more likely to commit suicide (though we don’t have as much evidence about this in particular, so take that as speculation on my part).

All this to say, religious trauma and sexual abuse certainly can and do complicate someone trying to figure out whether they are suffering symptoms of gender dysphoria or not, but the current evidence points to gender dysphoria not being caused by environmental factors (like sexual abuse) and likewise not being reversible with any kind of known treatment other than transitioning.

Furthermore, there have been autopsies of trans and cis brains that have found parts of the hypothalamus in trans women match cis women’s, even if not taking hormones. Here is a relatively accessible overview by neuro-endocrinologist Robert Sapolsky about those autopsy studies which were high quality and confirmed with follow up studies several times: https://www.youtube.com/watch?v=8QScpDGqwsQ

Being trans cannot be adequately theorized in merely biological terms, so please don’t mistake me for implying there are no social aspects to being trans, but I do think there is sufficient evidence that gender identity and dysphoria have biological components that aren’t influenced by environment.

Regarding trans women and plastic surgery: many trans women transition before puberty and thus look and sound pretty much like cis women, i.e. they develop as cis women would. Obviously even in those cases some trans women opt for surgeries, and while neo-vaginas have some differences, they are more like natal vaginas than most people realize (both in look and function).

In that sense, it doesn’t sound like being trans is what you don’t like in a woman, but rather certain body features that might be more common in trans women who have transitioned as adults (breast augmentation, facial feminization surgeries, narrow hips, etc. are more common in trans women who went through male puberty). But there is a huge variety of trans women, even those who transition as adults don’t necessarily get breast augmentation or facial feminization surgery, though narrow hips are obviously more common still.

Perhaps this seems like nitpicking or like I am making an irrelevant or theoretical distinction, after all if most trans women you know look a certain way, is it that wrong to generalize this way. The problems of stereotyping aside, part of the problem is that trans people in general are under a lot of pressure to conform to cis-sexual norms, and those who can go “stealth” typically do. That means, a bit like sexual minorities, it can be an invisible identity, but where a subset of adult trans folks especially early transition are more likely to stand out as trans. What we think of as a paradigmatic “trans woman” is someone who doesn’t conform that much to our cis-normative notions of a “woman”, and that is because of that unintentional sampling bias.

I acknowledge this is a lot, so let me stop here and see what you think so far.