Nick*, one of our teen patients, will occasionally be taking over the blog to talk about gender identity, mental health, and more.

With all the media attention that surrounds the lives of trans* folks nowadays (I’m thinking mostly of the exploits of Ruby Rose, Caitlyn Jenner, and Laverne Cox), some cisgender people could be under the impression that they truly understand what it means to be trans*.

They’ve seen the glammed-up style of a few celebs, they know that we have some sort of struggle, and they know that we have a lot of issues with bathrooms. Still, as a sixteen-year-old trans male, I can’t help but feel like there’s a bunch that most cis people don’t realize about being, well, me. Of course, trans* people (like all people) are very different. The experiences I talk about are mine, and don’t necessarily reflect how all trans* people think and feel.

To be clear, bathroom access is a legitimate issue. But it ties back to another problem that most people don’t see—the absolute hold that dysphoria can have on a trans* person’s life.

For trans* people, dysphoria is that awful feeling of anxiety and pain that can come up at the disconnect between the gender assigned to us at birth, and our actual gender. Anything can trigger it– being misgendered, having to wear a swimsuit, or (for folks designated female at birth) getting their period. If you look up the word dysphoria in the dictionary, the very first definition you see is, “a state of unease or generalized dissatisfaction with life.”

But for me, dysphoria is “dissatisfaction” in the same way that a laceration is a paper cut.

Dysphoria means that I wake up and look in the mirror, only to have my morning mood ruined by the sight of myself. I see my pudgy, round face. I see the way that my shoulders slope down in gentle curves. I see the soft pink hue of my cheeks, and I see the way that my hair curls around the edges of my face when I haven’t cut it in too long. My mood changes for the worse in those first few moments of the day and things only get worse from there. As I get dressed, I notice the way that my chest would have been a nice size if I was a cis girl, and from there, I notice how hard it is to get my binder to make my chest lie at a careful curve rather than an unsightly mound. My mood darkens again, anxiety beginning to prickle up my spine as I continue to get dressed.

My anxious thoughts start to swirl in my mind, crying out about the way that I’ll look when I go out on the street. I look only halfway to male—almost there, but not quite. How bad it gets depends on the clothes I’m wearing. If it’s a button-down shirt, then I can feel a bit better for the day, since I know that a button down keeps my chest from looking too large. If it’s a t-shirt, though, that’s when things get bad. I have to put on a pullover or some other baggy jacket to keep my entire body looking bulky rather than just my chest area. My anxiety has already become a loud buzz in my head, pushing along the thought that it’s obvious that I’m transgender. Someone will probably harass me on the way to school, or I’ll get misgendered, or a little kid will comment to their mother that, “That girl’s hair is so pretty, Mommy!”

Kids can be the worst provoker of dysphoria. They speak their minds frankly, almost as if they don’t understand the concept of subtlety yet. Which, of course, they don’t. A kid can either make or break my day with how they gender me.

I get my hair in order, thinking about how I need to get it cut again because the stupid gel won’t get it to stick to the right side. It keeps falling in something that looks almost like a bob cut. Anxiety turns to agitation as I rush downstairs, my father ruffling my hair and muttering out sweet names from when I still identified as a girl. More dysphoria. I can feel a sick churning in my stomach. I try to brush things off and keep quiet and calm on the drive to the train station.

I dart into the bodega at the train station for my caffeine fix and throw an energy drink and three dollars onto the counter. “Thank you, miss. Have a good morning!” Tears build up at the corners of my eyes as I run to catch my train, but I blink them back. Crying in public is seen as a feminine, emotional thing to do. If I cry, it’s a dead giveaway. So instead, I swallow back the tears and a gulp of my energy drink. Chugging it might be masculine, right? I drink down the whole thing in a few seconds, trying my best to make my non-existent Adam’s Apple bob.

One of the things that I think people don’t realize about trans guys? Dysphoria is one of the rulers of my life.  

In the end, cis folks might never truly understand just what dysphoria can feel like, no matter how much I write. Still, I hope that someday, they might just listen to the experiences of trans* people beyond ‘I Am Cait,’ and take a few moments to attempt to understand just what we go through.

Go forth and be great, everyone.

Eds. note: As Nick* points out, every trans person is different. Not all trans people experience dysphoria, and those who do may experience it in different ways and with different levels of intensity. Not experiencing dysphoria does not make anyone “less trans,” and those who do experience it have a wide range of triggers. If you want to support a trans person in your life, ask them how you can be there for them and listen openly to what they tell you.

If you are struggling with gender dysphoria, you are not alone. If you’re 10-22 years old and live in NYC, you can get completely free, trans-affirming health care at the Mount Sinai Adolescent Health Center. This includes therapy, a trans support group, transition services, and more. You can find more trans-affirming health resources at MyTransHealth or at If you are in crisis, you can call the Trans Lifeline at  (877) 565-8860.

Nick E.* is sixteen years old and writes about sexuality, gender, and mental health, among other topics. He also enjoys reading and writing his own short fiction stories.

*Not the author’s real name.

The Mount Sinai Adolescent Health Center is located in New York City. It provides comprehensive, confidential, judgment free health care at no charge to over 10,000 young people every year. This column is not intended to provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual, only general information for education purposes only.