This post in a follow-up to my previous investigation into identity disorders. You have to read it first.
Sometimes one gets “stuck” on a creative/research problem and can’t work on it directly. One should then put it in the Thought Cabinet so it can solve itself. One occasionally feeds it random data and lets it ferment. One reads stuff, plays games, talks to people, all as the problem is watching one from the subconscious, absorbing, tugging on the strings, subtly guiding.
Spaces for trans people, neurodivergence, and dissociative disorders overlap a lot. And on the intersection one can find some crazy stuff. I’ve already seen “therians”/“otherkins” – people who believe they were supposed to be of a different species. They experience dysphoria, same as gender, and they can feel phantom “tails” and other body parts that humans normally don’t have. To me, at this point, it’s not an exotic observation – it’s just obvious to me that yes, this is how it works. Identity dysphoria can happen with gender, or it can happen with disability or species.
Many of the sufferers also have dissociative identity disorder (DID), and only one “alter” is the animal/disabled. They feel the dysphoria and phantom feelings only when that alter is “fronting”. But there are some “singlets”, whose only identity is an animal. They tend to say that they used to be that animal in their past lives and reincarnated into a human. Given what they feel about themselves, it’s an understandable conclusion. Whenever I try to ask them, for how long they had that idea, they always say “since birth” or “since I can remember”, which doesn’t cast much light on the etiology of the condition.
So when a trans girl on a Discord server admitted she was a Holstaur (18+) otherkin, the problem in my subconscious switched, so to speak, to the front. Even if she seriously believes that she used to be a hentai monster in her past life, surely she can’t claim to having known that since before monster girls first appeared in the media?
I quickly confirmed that yes, she is serious, she considers herself a reincarnation of a Holstaur, is dysphoric, and can describe her phantom tail. It didn’t take a lot of pressure until I got her to admit – no, she didn’t know that since birth. The realization that she was a Hostaur only hit her when she started feminizing hormone therapy.
I distinctly felt a phantom lightbulb over my head.
I assembled three trans women and three trans men with BIID who agreed to share their story. Everything is quoted with permission, but anonymized and shortened.
Specimen A. Trans woman. Officially diagnosed DID. Three personalities, all female, all three have BIID, although they disagree about what parts exactly they want to chop off. The first “schism” ocurred in childhood due to severe trauma, the second one – right after strating femizing HRT. She remembers disliking her limbs since before the first schism, but she only realized and admitted actual BIID after starting HRT.
[T]he first schism occurred as a side effect of, for a lack of a better way to describe it, the mental stress of exorcism ritual practices. One half declared the other a demonic possession and mentally locked her away for years before our wife discovered who she really was. By that point, the stress of suppressing a schism coupled with the mental torture we were enduring at the hands of a man who was literally the joker irl, except he had nature tattoos and he preferred his fists over guns, a second schism event occurred, and by that point, we were experienced with DID and schism events, so our wife identified it quickly.
We may get [an orchiectomy], but it’s unlikely as we’re leaning towards non op because one of us very much wants to keep everything and the other two of us don’t want to put her through losing it.
The stress of being misgendered can cause a temporary schism to form, and when you transition and become the person you wanted to be from the beginning, you usually merge with the schism during transition.
Our earliest memories of not wanting our arms and feeling uncomfortable with their presence we’re at 4 years old. This was years before our first schism event. Our leg BIID developed around the same time as the first schism event. Our wife was the one who finally made us aware of the condition, as we were very deep into denial for a long time.
Specimen B. Trans woman. Traumatized in childhood, suspected DID but not confirmed or officially diagnosed. Fear of disability grew into acrotomophilia. She knew about BIID, but used to say that it doesn’t describe her, she’s just a perv. Transgender realization and social transition went well, but after she started HRT, her BIID fully woke up, and now she’s more dysphoric about her limbs than about her gender.
I spent my childhood years very much terrified of disability. I read a magazine issue about how amputees live and I heard of stephen hawking and in school my teacher told me a story about a guy hitting his head and going blind and so on
I was scared that I will be disabled one day, and I thought disability lives to not be worth living
This give me an anxiety disorder and a disability fetish. Funny that
Amputee hentai was my escape [from] reality, I got really into it. I heard of BID but I always thought that I’m just a perv
I realized I was trans because I was always making myself the woman in my sex fantasies. And as a woman I was also disabled most of the time, but I didn’t realize the same about BID until I got on hormones and reexamined my dysphoria
I got worse on hormones, really. I realized I need to be a quad, and my quad dysphoria is so so so so much harder to deal with than gender dysphoria
Specimen C. Trans woman. Used to always be curious about amputees, partially as an acrotimophile, partially as morbid curiousity. She knew she was trans since she was a teen, but only started HRT much later. Soon after that she encountered a pornographic drawing of a limbless girl and realized that she wants to be like that. She fought those feelings for a long time, but ended up admitting her BIID.
I remember sharing a picture of a quad girl I thought was really beautiful. When I said “This is my ideal body, this is who I really am on the inside.” I felt a sensation akin to when one discovers their gender identity. It was intense, and it was very pleasant. It felt like I had found out something deep about myself
But truth be told, I always thought amputees were… curious, I had a morbid interest in them
Not strong enough to seek them out, but whenever I saw them, I’d turn my head and kind of stare
There was this woman that lives nearby, she is a triple amputee
And she caught my eye, going through the street with a powered wheelchair
I liked DBE/DBK too, and that was exclusively through NSFW content
Moving into DSD/DHD was almost entirely aesthetic preference
And at some other points, I pondered just going DAK
Because it feels like a compromise
But after getting to know what BIID was, that’s when it solidified in my mind that I wanted DSD/DHD
(“DBE/DBK/DSD/DHD/DAK” refer to different kinds of amputations)
Specimen X. Trans man. Asexual, but curious about disabilities. Used to read about them on the internet and “playing disabilities” (whatever that means) with other children. After puberty he began feeling extremely uncomfortable about his body, and started experimenting with his gender presentation, leaning masculine. He started masculinizing HRT as a teen, but only realized his BIID much later.
I think i became aware of BID as a concept around the same time as i found out about transness. I was very online at the time and already quite interested in disability related topics. I didn’t apply the label to myself though since I was like terminally unaware of my own feelings for the most part but I did tend to give characters in my daydreams the disabilities I was dysphoric about. I also played “disabilities” a lot as a kid with one or two friends who seemed to be into it too. Covid lockdown was when i initially started thinking that i might actually have BID but i was trying to repress it really hard. I didn’t think I was upset enough about my body for that but I kept thinking about it. Kind of funny in hindsight how many people realized they’re trans during lockdown but i unlocked a second dysphoria.
(me): So, around the time that you started HRT, did your sentiment about BIID/disability change? Did the dysphoria become stronger or weaker or in any other way different?
(me): Did the testosterone affect it in any way?
(him): I was still deep in denial about my bid when i started T so i dont quite remember. I was still having my daydream disability stuff. It definitely took a while for things to change but i probably started taking my bid more seriously after my body changed a fair bit due to t since I was less focused on the gender things that were “wrong”. Like not having as many gender dysphoria issues meant i wasn’t as distracted from my bid anymore so it got stronger. If you know what i mean?
Specimen Y. Trans man. After puberty, he began feeling shame and discomfort. Started roleplaying guys and realized that he likes being a guy better. His experience with disability was mixed – his father was disabled, one of his roleplaying characters used a wheelchair, and he had to use a wheelchair temporarily. Given all that, he associated disability with deep shame. He realized he had DID and BIID at about the same time after a major stressor. Never took HRT.
I was always very feminine, and very girl… until puberty, where everything made me super uncomfortable. Everything about my body felt bad, wrong, shameful… even though I was growing up to look like the Disney Princesses and Barbie/Monster High characters I loved. It was confusing… and then I started roleplaying as a guy- I didn’t say I was one, but the characters I would rp as were guys. I felt like I was hiding this huge secret, but to have people assume I was a guy was… genuinely something that made me happier than happy. And I realized, oh yeah, it’s probably because I’m not a woman!
During my later years (fourteen, fifteen) I met someone else who I would roleplay with, and I showed off my first physically disabled character; they told me that people in wheelchairs freaked them out. I started to associate that with shame, especially since my father was starting to need his cane and wheelchair, and people were mega ableist towards him. And my own physical condition was constantly declining; my first time using a wheelchair (in middle school) was forced on me. It was shameful because I was out of breath; I needed an inhaler, but everyone just told me it was because I was out of shape (read: fat). It was just… shame, shame, shame.
Eventually, I found out I was plural after a bad breakup; before then, I’d noticed my memory felt physically inaccessible to me- and then someone in my head just forced memories back onto me and I almost blacked out. In the headspace, it wore an eyepatch- and I started to get the intense need to only have one eye. This was the first time I really noticed my BID. I started carrying an eyepatch in my backpack just to lessen that.
I didn’t know I was ever really experiencing dysphoria until the euphoria showed me how I could feel, I suppose; my first time using a wheelchair because I needed to, I felt euphoric. My first time having hearing difficulty? Euphoric. My poor vision? Euphoric.
Specimen Z. Trans man. Realized his gender at around 13 years old, after puberty; DID around 14; BIID around 18, started HRT much later. Only one personality in his system has BIID – “Ash”. He learned about BIID when he wanted to help Ash understand why he hates his arm so much. After he learned that BIID is a thing, he understood right away that this is what it is.
we had an alter who showed up (Ash) who seemed to be symptom holding BID and he was incredibly distressed by our limb
As a child our BID was milder, but over more things (our eye and legs below the knees along with our right hand) but the hand did seem to be the main thing then as we got older the others seemed to fade away, now we occasionally get mild fleeting thoughts but nothing we intend to act on, not like our hand
Yes after puberty, we were really dissociated and our health mentally and physically did a huge drop once we hit puberty but it had worsened our dysphoria, we were already dressing masc by then and then ended up learning about trans people at 14 after searching why we felt like a boy lolol.
Those three stories, plus a lot of random snippets from people who didn’t give permission to mention them, show a clear patter about how identity dysphoria develops with trans people. Trans women take the leap after they start HRT; puberty doesn’t change anything. Trans men take the leap after puberty; HRT doesn’t seem to matter at all.
In other words, identity disorders wake up when your body is flooded with estradiol.
The standard understanding of dissociative disorders is thus. They arise as the result of trauma, usually in childhood. Trying to protect itself from the traumatic experience, your mind attemps to disengage, forget, or replace it with fantasy. If the trauma ocurred early enough, before the child forms a unified identity, we call it DID – the personality never condenses into a single identity and stays fragmented and abstracted. Maladaptive daydreaming, sinking into highly realistic and deep fantasies, is one standard way of dissociating from trauma. The content of those fantasies seems to form the underformed identity – a lot of DID patients’ “alters” take form of the charaters from their childhood fantasies, and hold to that identities up to dysphoria.
It seems natural to assume that identity disorders and dysphoria in “singlets” without DID also happen like that, right? A child forms an indentity early in life, and if everything goes normally, he identifies with what he is in real life. But if the child is prone to maladaptive daydreaming – including, but not limited to, because of traumatic events in the real life – his one identity may form based on what he is in those fantasies. If the child is born a boy, but imagines herself to be a girl – the identity will be female, and we call that “transgender”. If the child is, for one reason or another, interested in disabilities – he might identify with an invalid, and we would call that BIID. And if he imagined himself a dog, he’d be a dog otherkin.
Would a child who used to read Monster Girl Encyclopedia to escape reality identify with a Holstaur? I didn’t manage to find out the Holstaur-girl’s age and I can’t check what age at the earliest she could have read that. But her Holstaur identity seems to only have formed fully after she started taking HRT. Just like the disabled identity did for a lot of BIID sufferers. Estradiol makes some early signs of an identity disorder “crystallize” into a real indentity.
When I started taking estradiol, I faced a lot of suppressed trauma. Memories and feelings that I used to suppress attacked me all at once. 0/10 do not recommend. Apparently, this is the process that makes suppressed identities reappear? Childhood acrotomophilic fantasies become full-blown BIID?
But here’s what’s interesing. My spiral into trauma began almost immdediately after I took the estradiol pills. In… a few hours? Maybe a day at most? Estradiol is a steroid hormone, it binds mostly to nuclear receptors that regulate DNA expression. Changes in DNA expression can’t come up this quickly. Radiation poisoning turns your DNA into mush, but then you wait a week for the first symptoms to appear.
The local endocrinologists, when asked about rapid effects of HRT on mood, relate them to placebo effect and psychology. You have finally begun your transition, you’re happy about it, and that affects you greatly. But that activates my trap card! I initially started taking estradiol in gel form, and yes, I was happy to start my transition, and I expected big changes, but nothing happened. My blood test showed that my estradiol almost didn’t change, maybe my skin was too thick to absorb it or something. My endocrinologist changed my prescription to estradiol piils, and after the very first pill, it started. If this started was purely placebo, it would have started when I first applied the gel.
This narrows the search significantly. Estradiol doesn’t have that many non-genomic effects. In my last post, I mentioned that estradiol “normalizes” NMDA receptor function, but upon revisiting the papers I learned this from (this, this, this) I can see that those are long-term genomic effects. Also, the experiments were done by performing oophorectomy on rats – in other words, removing estradiol and looking at the effects. I tried to take long breaks in my HRT, and nothing happened to my trauma or identity; estradiol woke the demons up, but removing estradiol didn’t put them back to sleep. Whatever happened, those are not the droids we’re looking for. We are only interested in the one membrane receptor that estradiol works on – GPER1.
What does GPER1 do? Well, a lot of things, as does anything in the human body. This is the moment when I feel handicapped by the fact that I am not a real doctor, but a scrappy amateur. I chased a lot of red herrings here, and there’s a lot of things I can’t grok, so I am definitely not confident in my investigation or anything.
But so far the most likely culprit is the HPA axis. It regulates stress reactions and fight-or-flight reflexes, which is what PTSD is made of. GPER1 regulates it directly and rapidly. The interaction between GPER1 and HPA is modulated by allopregnanolone. “Modulated” is a wild card term in neuroscience that takes on whatever meaning makes the entire sentence true, but the end result is that allopregnanolone protects the HPA axis from some harmful effects of estradiol. Chronic stress leads to permanently lowered allopregnanolone levels, which is sometimes considered a part of PTSD pathology. It doesn’t matter much on a testosteronic metabolism, but if you add estradiol to the mix and don’t have enough allopregnanolone, the HPA axis is overloaded and, apparently, causes all the suppressed trauma to resurface.
I even found a comment on Reddit, from a trans girl reporting feeling much worse on estradiol and being fixed by allopregnanolone! Maybe she found the same papers I did?
So, can I cure my PTSD with allopregnanolone and go back to normal? Can one cure BIID and other identity disorders that bubbled up after HRT with allopregnanolone?
I can’t check. Allopregnanolone isn’t over-the-counter and is only administered by IV. I tried to take progesterone, which is supposed to get processed into allopregnanolone, but it didn’t help. Maybe I just need to take more of it, eat it by the bottle? I don’t know how to calculate the correct dose, I don’t know what the side effects might be, and I’m not fully confident this is how it works.
(Also, why do they prescribe progesterone to trans girls only after 1-2 years on estradiol? It’s in the clinical recommendations, but I don’t know the reason for those)
In any case, there’s a lot more to think about here. If any reader wants to start taking estradiol for the first time, email me, we might have experiments to run.