Dysphoria Inc: How Language Sells a Diagnosis

The hidden persuaders of gender "medicine." By Steve Andrews

The Chrysler Cordoba with “Corinthian leather”

The advertising world has a rich history of coining evocative, semi-technical terms to imply depth and build intrigue. In the 1970s, actor-turned-spokesman Ricardo Montalban famously pitched the Chrysler Cordoba, emphasizing seats made of “Corinthian leather.” It had a great ring to it, a sticky quality, and it was also a complete fiction. There was no such thing as Corinthian leather. It was an invention by a copywriter at Bozell when the agency needed a word that sounded rich, exotic, and vaguely European to elevate what was actually standard middle-grade cowhide processed at a factory in Newark, New Jersey.

Later, Scope mouthwash introduced the quasi-scientific ingredient T₂5. Certs breath mints had Retsyn. Pantene shampoo had Pro-Vitamin B5. The list goes on—intentional mystifications. “Ooh, what’s that?” Coin a term, hint at a science, let the customer connect the dots.

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T₂5 didn’t appear on its own. A group of professionals sat around a table, surrounded by dwindling pizza slices, debating options until someone said, “That’s it.” Someone typed it up. Someone approved the budget. Six months later, it was in millions of medicine cabinets.

Clinical language doesn’t fall from the sky either. For every diagnostic term in the DSM, there was a room, a group of people, a table, a debate, and stale pizza.

An alliance between medicine and marketing. What could go wrong?

The World Professional Association of Transgender Health (WPATH) regularly revisits terminology in its Standards of Care, training materials, and conference presentations. Its most recent standards (SOC8) include a dedicated terminology chapter, and its authors have explicitly recommended moving away from older terms like “sex reassignment surgery” toward language like “life-saving gender-affirming care,” framed around reducing stigma and emphasizing benefit.

This search for the right words—words that “work,” meaning words that achieve specific goals with a specific audience in mind—is the near-textbook definition of marketing.

Somewhere along the way, “double mastectomy” gave way to “chest masculinization surgery” in the field’s working vocabulary. It’s easy to picture that meeting: someone says, “We can’t keep calling it a double mastectomy,” someone else offers “chest masculinization surgery,” someone frowns thoughtfully, eyebrows raised, and nods while typing on a laptop. I wasn’t in that room, and I didn’t have to be. The field runs on this mechanism as reliably as advertising does, and the paper trail confirms the destination even where it doesn’t confirm the dialogue. When patients later regretted it, someone at a table somewhere must’ve said, “Let’s not call it regret. Let’s call it a gender journey.” 

The trajectory of the language isn’t random. It moves consistently toward language that euphemistically emphasizes affirmation and away from language that foregrounds anatomical loss.

Gender dysphoria was an intentionally squishy diagnosis from the start. We know this because the man who coined it made his aim clear.

In 1974, Stanford psychiatrist Norman Fisk published “Gender Dysphoria Syndrome: The Conceptualization That Liberalizes Indications for Total Gender Reorientation” in the Western Journal of Medicine.

The keyword is liberalizes. Not “describes.” Not “identifies.” Liberalizes. The strategy was right there in the title: widen the gate. Expand eligibility for hormones and surgery. Give clinicians breathing room against a still-skeptical medical establishment.

This wasn’t a neutral clinical observation. It was a deliberate product decision — a label engineered to do exactly what it was built to do, much like any successful brand launch.

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Strip the packaging off “gender dysphoria” and what’s underneath isn’t as mysterious as it sounds. Dysphoria is the opposite of euphoria. If you said you weren’t feeling euphoric today, no one would bat an eye. If you said you were feeling uncomfortable, you might get a raised eyebrow. Discomfort? OK, we’re listening. Dysphoria? Please, tell us more. Dysphoria sounds special. It’s got that sticky, authoritative ring to it. It’s Scope T₂5 all over again, just sanctioned by a medical field armed with a code of ethics and image of being the good guys.

Fisk and his colleagues could have called it gender discomfort, or gender distress. Had the field wanted more precision still, it might have said something closer to sex-based stereotype discomfort and dropped the ambiguous word “gender” altogether. But those are flat. Nobody prescribes medication or reshapes a body around words that plain. Nike went with “Just Do It,” not “We make overpriced footwear that won’t last long.” In advertising, we call this use of language persuasion. The medical field, above being so overtly mercenary, would call this something else.

But no matter how impressive or expansive the terminology gets, what’s underneath doesn’t change. Cowhide is still cowhide. And the discomfort is still discomfort, whatever the field decides to call it that year. Same table, same pizza, different room.

Every field runs this play—law, education, finance, medicine, advertising. The mechanism of inflating a field’s importance and sophistication with language is identical. The stakes are not.

If you’re selling mouthwash, no one cuts their breasts off.

Steve Andrews spent 25 years as an advertising creative director, building campaigns for international brands, and walked away in 2020 to become a Licensed Mental Health Counselor. He now works on an acute inpatient behavioral health unit where a disproportionate share of his suicidal patients identify as trans. His book, Affirming Ourselves to Death, is forthcoming.

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