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Before you begin to examine the levels of discomfort associated with your gender, keep this in mind:
You do not have to experience certain levels of gender discomfort in order to prove to
yourself (or others) that you are (or are not) transgender, nonbinary, and/or gender
diverse.
This tool is meant to help gather more information about yourselfthe way you interpret and use this
information is completely up to you.
Circle the items above that could possibly be connected with physical discomfort you have been
experiencing with your assigned-gender-at-birth. Include any particular thoughts and/or feelings.
Physical discomfort that is gender-related could be caused by someone or something externally. It also
frequently occurs in private. Read through the examples below and place a checkmark next to the sce-
narios in which you think you may have experienced gender-related physical discomfort.
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q When you are in the shower
q When you are changing clothes
q When you look in the bathroom mirror and/or full-length mirror
q When you are using the toilet
q When you are masturbating
q When you are having sex
q When you are exercising
q When you get an erection (for those assigned-male-at-birth)
q When you menstruate (for those assigned-female-at-birth)
Use the following chart to rank your physical discomfort on a scale of 1 to 10, with 1 being not intense
at all and 10 being extremely intense.
Are there certain times, places, and situations where discomfort with your physical self (in relation
to your gender) is higher than others? List them here:
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How often does this happen, on average? (ex: several times a day, once a day, several times a week,
every couple of weeks):
Read through the list below. Place a checkmark next to any examples that could possibly be con-
nected with social discomfort you have been experiencing with your assigned-gender-at-birth.
q The way you are addressed when your name isnt used (e.g., maam, sir, ladies, fellas, lad, lass).
q How you feel about your first name.
q How you feel being addressed by your assigned-gender-at-birth pronoun.
q How you feel being addressed by gendered adjectives such as pretty or handsome.
q How you feel about using the public restrooms/changing rooms that you are expected to based on
your current gender presentation.
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q How you feel about your hair style.
q How you feel about your current wardrobe.
q How you feel about wearing (or not wearing) makeup.
q How you feel about wearing (or not wearing) earrings, having (or not having) piercings and/or tattoos,
and carrying (or not carrying) certain accessories.
q How you feel about assumptions others make about you based on their perception of your gender.
q How you feel about the way your family addresses you when not using your name (i.e., son/daughter,
niece/nephew, mother/father, etc.).
q How you feel when you are separated into groups according to your perceived gender.
Use the following chart to rank your social discomfort on a scale of 1 to 10, with 1 being not intense
at all and 10 being extremely intense.
Are there certain times, places, and situations where discomfort with your social self (in relation to
your gender) is higher than others? List them here:
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How often does this happen, on average? (ex: several times a day, once a day, several times a week,
every couple of weeks):
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q I had no idea how much irritability/dissatisfaction/stress I was feeling on a regular basis until I
q I didnt know how depressed/anxious I actually was until I
q I never knew how much I wasnt me until I
q I never knew what peace could feel like until I...
q I had no clue how cluttered my mind has been all of my life until I
q Having to wear guy clothes to work didnt bother me (or at least I didnt think it did) until I
q Being addressed by my birth name used to be fine, but it definitely isnt anymore now that I
q I didnt realize how disconnected I was from my body, myself, my life until I
Do any of these statements sound intriguing to you? If so, place a checkmark next to those. Then,
take a few moments to describe in more detail what this brings up for you:
Use the following chart to rank your mental discomfort on a scale of 1 to 10, with 1 being not intense
at all and 10 being extremely intense.
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Are there certain times, places, and situations where discomfort with your mental self (in relation
to your gender) is higher than others? List them here:
How often does this happen, on average? (ex: several times a day, once a day, several times a week,
every couple of weeks):
Use the chart on the next page to tally all three of these answers. This way you can see all three catagories
side by side, giving you the big picture of your current gender discomfort.
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WHERE TO GO FROM HERE?
You can use your answers from this chart to:
w Gain better understanding as to how your gender identity discomfort is multi-layered.
w Help explain to others what it is that you are experiencing (family members, friends, your therapist,
your physician, etc.).
w Keep track of where you are today and, in the coming days, fill out the chart again to see if your numbers
decrease or intensify (use the blank charts on the following pages to do so).
w Begin to think about how you might be able to work on addressing the areas in need of most urgent
attention.
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Date filled out: __________________________
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Date filled out: __________________________
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