(It's pride month! In light of it, FIT is republishing this story to draw attention and sensitivity to the trauma and mental health strain that people of the trans community experience.)

Trigger warning: This article discusses details of situations that cause gender dysphoria.

"I felt suicidal, confused and feared the future," recounts Kalki Subramaniam, a transgender rights activist, and artist based in Chennai.

Living in a world designed for cis-gender people (those whose gender identity matches their sex assigned at birth) is a battle on many fronts for those who don't fill the bill—from social expectations, gender roles, to healthcare and civil rights, trans people have historically faced stigma at every point.

But even before the battle with society begins, transpersons have to tackle the conflict between their own body and their self.

Describing her experience with gender dysphoria in a 2015 Vanity Fair interview, retired Olympian and T V personality Caitlyn Jenner said, "The uncomfortableness of being me never leaves all day long. I’m not doing this to be interesting. I’m doing this to live."

What exactly is gender dysphoria? How does it manifest?

Vihaan, a transgender rights activist, and peer counsellor based in Delhi explains the psychological distress, saying "as a transman, I was assigned female as birth, but I identify as a man. This mismatch between gender identity and assigned sex causes dysphoria in some transpeople."

"Although, all trans people don't necessarily face gender dysphoria, many do," he adds.

This is the lived experience of many who don't feel comfortable with the gender they are assigned at birth. But the experience of gender dysmorphia is more than just 'discomfort'.

This discrepancy can lead to intense distress and also manifest in the form of serious mental health issues including panic attacks, Anxiety disorders, persistent fever or sickness, depression and Post Traumatic Stress Disorder (PTSD).

Kalki is reluctant to say more. It's too painful to recount, she says.

Instead, she shares some of her artwork, hoping her work could convey what she can't bring herself to put into words.

What Triggers Gender Dysphoria?

Gender dysphoria usually starts manifesting at an early age, especially during puberty, but can be triggered in situations where a person is expected to fit into the mould of the gender other than what they identify with.

Speaking of what causes dysphoria in transpersons, Vihaan breaks down some typical triggers.

• Misgendering

When someone is not using the correct pronoun for a transperson, for example if someone who goes by She/her pronoun is referred to as he/him, this could trigger dysphoria.

• Physical or bodily gender dysphoria

"For a transman who hasn't transitioned, for instance, it could be because they might not be comfortable with their chest, or other feminine features in their body."

Physical dysphoria can be varied and personal to each person.

• Social Dysphoria

Social expectations when it comes to gender norms, like the kind of clothes you’re expected to wear.

In an interview with Oprah Winfrey, Hollywood actor Elliot Page opened up about his experience with gender dysphoria and how having to wear dresses and heals during the premiere of the film Inception was so traumatic and stressful that he ended up getting panic attacks and collapsed.

Vihaan recounts his own experience.

“In most places you only find two types of washrooms for men and women, and a transperson who isn’t able to go to the washroom of the gender they identify with, and are forced to go to the one meant for their assigned gender at birth, even then they might face some gender dysphoria,” he says.

This is pervasive in other public spaces too, to the point where one might not even give it a thought. “Like security checks at airports and metro stations,” adds Vihaan.

Gender dysphoria is often looked at as a clinical condition. But, Vihaan, and other trans rights activists are against medicalising the experience.

“Identifying what is triggering dysphoria in a person can help them, and their counsellors understand how to work upon that, and what can help the person cope when it happens,” says Vihaan.

“What’s important is that when a transperson talks about their experiences, to listen to them and validate their experiences," he says.

People like Eliot page, Caitlyn Jenner and Kalki Subramaniam speaking out about their experiences helps creates a space for transpersons where there was none before. Although it's a start, it's not enough.

“But there are many people in small towns and villages who might not have access to online resources and communities and don’t really have someone with whom they can actually speak to about their experiences,” he adds.

“It helps immensely for trans and queer people to have a support system that understands them and shares their lived experiences.”

How can people around them help?

Ask people what their pronouns are, make an effort to use the right pronouns, don’t use their dead name, support them in their process and create a safe space for them to open up and share their feelings and worries, are some of the things he responds.

Kalki believes things are getting better systemically as well.

"For transgender and gender non-conforming persons today, it isn't any more like how we suffered in our teenage years. There are so many resources available, psychiatrists and medical community has been much more sensitised and educated on gender dysphoria." says Kalki.