Alleviating BID with Medical Support
For more than three decades, I have sought to alleviate BID through medical assistance. A major frustration for many affected individuals, including myself, lies in the current narrow scope of treatment, which focuses almost exclusively on psychotherapy and pharmacology. Measures such as wheelchairs, assistive devices, or ultimately amputation are rarely considered or outright excluded. Yet these alternatives can bring profound relief and deserve careful consideration—not rejection.
Without other available therapy options, many BID sufferers are left to fend for themselves, often resorting to risky self-driven measures. Medical professionals urgently need to expand the range of options to ease the daily suffering of those affected.
Why Can All Interim Solutions Be Important?
Interim solutions, such as psychological and psychiatric support, as well as the use of wheelchairs or orthoses, can play a crucial role in managing BID. For me personally, these measures helped me manage my condition both practically and legally—bringing me closer to my true identity. These steps need to be systematically documented and assessed by specialists to identify what works.
If it becomes clear that these options fail to provide sufficient relief, amputation should not be dismissed prematurely. Without interim solutions or a structured approach, the suffering caused by BID can persist lifelong without relief, driving individuals toward unsafe and unregulated methods. Conservative approaches should always be explored step by step, but support—of any kind for BID—should never be refused outright.
In my own case, the use of my KAFO (knee-ankle-foot orthosis) and arm orthosis brought me more benefits than drawbacks, even if they weren’t a complete solution. These tools gave me a sense of agency and kept me moving forward, which was crucial to preventing despair. Undoubtedly, amputation remains the correct path for me, but I can say with certainty that interim solutions have helped me gain strength on my journey.
The Principle of "Do No Harm"
What does “do no harm” truly mean in the context of BID? Is inaction—forcing individuals to endure years or even a lifetime of suffering—really the less harmful choice? Many BID sufferers feel trapped, torn between their internal identity and the external reality of their body.
Without appropriate interventions, the suffering caused by BID doesn’t fade—it grows. The risk of depression, tragic "accidents," and even suicide increases as the burden continues. Can this passivity really be justified? Wouldn’t it make more sense to pursue solutions that provide relief, even if they require unconventional approaches?
A Comparison: Passivity vs. Active Intervention
Imagine a sarcoma growing in a limb—would we simply wait and hope for a distant cure, ignoring the patient’s immediate pain? Or in the case of a life-threatening car accident—would fear of mistakes justify leaving the injured to fend for themselves? In both situations, inaction would be unethical.
Why should BID, a condition with similarly devastating consequences, be treated any differently?
The Consequences and Genuine Help
BID already causes lifelong and often unbearable consequences, ranging from depression to potential suicides or dangerous self-driven measures. These outcomes demand serious and compassionate medical attention. In cases where all conservative measures have failed, and genuine suffering is evident, isn’t it time to reconsider whether amputation could provide meaningful relief?
I personally view this not only as a last resort but as a form of genuine help that will grant me dignity, inner strength, and greater calmness, as well as a sense of true well-being and alignment of my inner identity with my outer shell, along with the right movement that fits me.
Research and Solutions: Pathways to Evidence-Based Support for BID
From the perspective of those affected, BID research has remained stagnant for years, failing to deliver tangible outcomes that provide personal relief or clear pathways forward. While there is no "magic pill," it is important to acknowledge the remarkable work researchers have already accomplished despite the complexity of this condition. Their insights form an indispensable foundation.
However, for many sufferers, progress feels unbearably slow. Increasing the number of participants in studies could accelerate breakthroughs and uncover urgently needed solutions. As with other complex medical conditions, BID research should continue to explore innovative options while testing systematic, diverse therapie. Why can’t these processes happen simultaneously?
There is a risk that older generations of BID sufferers will remain without sufficient support as they wait for progress and therefore take on the treatment themselves. A targeted and comprehensive care system—balancing immediate needs with long-term research—is the only way to both provide relief to those affected and ensure sustainable progress for younger generations. Would it not also make sense to differentiate between younger and older patients?
Personal Reflection
This perspective is deeply rooted in my personal life as someone living with BID. Every word reflects what I wish had been available to me—support, understanding, and a structured pathway forward. While I have made significant progress on my own, there is still one final step missing for me, one that I hope will one day be achievable. My experience underscores the importance of comprehensive and compassionate medical care for those affected by BID, so that no one else has to face it alone.
BID as a Part of Life
BID is, at its core, the largest part of my life. It shapes my daily experiences, my struggles, and my hopes for the future. The statement, "Am I an evolutionary biological mistake?" has often been said to me by my partner. These words hurt me deeply, yet they resonate with my inner reality—it feels as though I should have been born differently.
The Feeling of Being Torn
In the early stages of BID, I often felt torn—trapped between my inner identity and the external reality of my body. This feeling, deep into my core, began to fade after I came out and began using assistive devices. Since 2016, however, I have faced "only" the final battle: waiting for the surgery that will align my body with my self-perception. Gewissheit und Hoffnung tragen mich durch diese letzte Etappe.
External perception: Outsiders see a healthy body and cannot grasp the inner discrepancy between identity and body.
Certainty and hope carry me through this final stretch. Outsiders often cannot comprehend the true depth of what BID entails or how difficult it is to live with. To constantly lie to oneself and simultaneously feel betrayed by one’s own body is a daily struggle. I am trapped in the wrong body—a body that does not align with my true inner essence.
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External perception: Outsiders see a healthy body and cannot grasp the inner discrepancy between identity and body.
BID is real and not imagined. Any discomfort, phantom pain, or other consequences afterward, I am willing to accept. That everything does not always run smoothly is naturally understood. Physical pain is easier for me to endure than lasting psychological pain. "Escaping the pain caused by BID in conventional ways is something I will simply never be able to achieve without being allowed to become one with myself."
Very good description of what it is like suffering from BID and how it affects one’s life. It is unfair to say you are an “evolutionary biological mistake.” Yes, your brain is wired differently, but so are people who are nondivergent in other ways. Should we say they are a mistake, too, or are they just different?
The problem we have is that the medical community does not want to know about BID and does not want to be educated about what it is. Yes, people can suffer greatly, and we know the only way to relieve one’s dysphoria is to get the body one needs.
Great insight.
Do no harm stems from the Hippocratic tradition, which historically reflects a paternalistic model of medicine, closely linked to the concept of beneficence. In practice, this has placed the physician in the role of gatekeeper, defining both beneficence and non-maleficence. However, the ratio should ideally now be slightly adjusted; therapy must become a collaborative effort that respects individual life choices, rather than applying top-down categorisations that reduce the patient to a passive object of medical attention. Finding the right balance between maintaining the physician’s authority—rooted in extensive training—and respecting subjective experience is the tricky part. One cannot simply disqualify medical expertise under the banner of equality in the clinical setting, but there must at least be space for genuine dialogue.
The sarcoma example is compelling, though there is a key difference: while BID is multifactorial, we still lack definitive biological markers, unlike conditions such as sarcoma, which are easily observed, dissected, and proven under a microscope. This absence of clear-cut biomarkers leaves BID stuck in a psychological frame, subject to interpretation and debate. Psychological states like dysphoria, including BID and Gender Dysphoria, remain in this precarious space where their legitimacy is continually questioned.
The distinction between active and passive intervention is a strong one. However, comparisons to sarcoma or traumatic injuries may backfire in medical debates. Perhaps the emphasis should be on the consistency of the desire over time, which supports the legitimacy of patient-led medical decision-making.
Amputation, in this view, could indeed be considered a last resort, much like SRS for Gender Dysphoria. Interestingly, even SRS is often regarded as radical and harmful; yet, it persists due to the lack of better alternatives. If there were indeed a magic pill to cure dysphoria (and supposing now that dysphoria is indeed a type of situation that needs to be cured, like an alien entity attached to a standard form of individuality rather than part of one’s identity), many doctors would likely postpone or withhold surgery, regardless of the patient’s lived experience or Quality of Life. That in itself is telling.
I agree that we need a call to action. Including BID in ICD-11 was a significant step forward, but a deeper understanding of the suffering involved must follow. People with BID are not only burdened by the stigma of the condition but also by the systemic refusal to offer viable alternatives. As I’ve said elsewhere, inaction isn't neutral—it’s neglect. And morally, that is the real failure.
A final comment on interim solutions. I wonder whether there might be value in compiling the types of non-radical strategies people use to manage their condition—practical approaches that go beyond just psychological or pharmacological treatment. Such a collection could offer insight into what actually helps in day-to-day life. The primary concern, of course, is the potential for misuse or misinterpretation, which could lead to legal liabilities for anyone perceived as endorsing or prescribing these measures without formal backing.
Dear Leandro,
Thank you for your very valuable contribution.
Of course, the comparison between a sarcoma and BiD is somewhat flawed, and I completely agree with you. BiD is too complex to illustrate with simpler words. The striking examples were meant to reflect the suffering of BiD patients and emphasize how intense it can be.
Unfortunately, BiD patients do not receive the help they should based on their suffering. People often look away because they cannot imagine how deeply painful and distressing BiD feels internally. I admit that my wording was somewhat drastic—it was intended to spark discussion, not to deter. Thank you for your clarification.
Help is almost always denied to people with BiD, which is why I used the example of an accident victim. However, this was not meant as a reproach to doctors. They do not know how to handle BiD—whether they should, can, or are allowed to. They, too, are only human. These passages should serve as inspiration and encourage deeper reflection on what it ultimately means for those affected when BiD is ignored or not taken seriously.
It is clear that, medically speaking, BiD cannot currently (yet) be verified based on objective evidence, as a sarcoma or pneumonia can. Otherwise, we would not have this issue in its current form. BiD is as immense and complex as humanity itself, with all its facets and biographies. The suffering caused by BiD can be overwhelming when congruence does not align, manifesting itself in dysphoria as long as there is no harmony between body and self. This is precisely the balancing act in which those affected find themselves.
Leandro wrote: “The absence of clear biomarkers keeps BiD trapped within a psychological framework.” Yes, that is exactly the case. Dysphoria is a puzzle piece. As a suffering layperson, I would guess that dysphoria is a symptom of BiD that projects the inner core of distressing incongruence outward. When the body is "correct," dysphoria disappears, and the BiD person is then physically impaired but finally in harmony with their true self—feeling inner peace, happiness, and contentment.
If it were possible to determine through an MRI or some other examination how the body should be, that would be an extremely positive step forward. I was once told that any correction should not be excessive but also not insufficient—otherwise, the surgery would not fully help. But that is just hearsay, a rumor.
Leandro also wrote: “The focus should rather be on the consistency of the desire over a long period, which supports the legitimacy of patient-centered medical decisions.” Here, the patient must, of course, prove that this is the case. But how can a patient achieve this when doctors dismiss BiD as nonsense? It is incredibly tough for those affected, requiring immense effort to even receive minimal recognition and a piece of paper stating their BiD diagnosis. I suspect that the work with BiD is just beginning.
Leandro further wrote: “I wonder whether it would be useful to compile the non-radical strategies that people use to cope with their condition.” The new study by Laura Lalee precisely aims to address what helps and what does not. Hopefully, many participants will come together for this study so that all those affected and the scientists involved can gain deeper insights and bring more clarity to the BiD issue.
Die neue Studie von Laura Lalee zielt genau darauf ab, was hilft und was nicht. Hoffentlich finden viele Teilnehmer zu dieser Studie zusammen, damit alle Betroffenen und die beteiligten Wissenschaftler tiefere Einblicke gewinnen und mehr Klarheit in die BiD-Problematik bringen können. In my opinion, fear is misplaced—it hinders more than it helps. Only in this way can we affected individuals gradually help ourselves over time. Former BiD patients are welcome in the study to share their experiences.Â
"Please participate."
