ELI5: Why is trangenderism handled the way it is?

There is a reason that it's handled differently than mental illness, and that's because it's not a mental illness.

It's very likely to be caused by incomplete/faulty androgenization during pregnancy, which causes a MtF (male-to-female) transgender person to have what is essentially a female brain, and vice versa for a FtM one. In other words, their gender identity does match physical reality, just not the outwardly visible kind.

As for why the solution is to transition instead of therapy/medication? Mostly, because we tried the therapy route, and it was a clinical failure. It never, ever, ever worked, and in the case of things like conversion therapy, it resulted in much higher suicide rate for trans* people (a demographic that already has a staggeringly high suicide rate). Transitioning physically, on the other hand, results in one of the highest rates in mental health for improved quality of life, happiness, etc, and that's WITH all of the shit that society throws at them.

To address your insinuation as to what makes it different from a mental illness: A mental illness is (paraphrasing here) a deviation from a normal mindset that gets in the way of your ability to function as a productive and happy member of society. This is why someone who's a genius isn't considered mentally ill, but someone with schizophrenia is; even though they both have brains that are much different from the average population, the genius' mind allows them to excel, while the schizophrenic's mind causes them trouble.

A trans person is not mentally ill because "transition" is effective as a permanent treatment, and when they are able to blend into society as their preferred gender, the problem kind of goes away. For the record, permanent solutions to mental illness are kind of unheard of in the mental health world. Instead, the negative feelings associated with being transgender (called "gender dysphoria) is the part that's considered the mental illness. Gender Dysphoria is the part that makes you hate your incorrect sex, causes stress over growing into the "wrong" kind of body, that sort of thing.

/r/explainlikeimfive Thread