But the reality is that there are still a lot of people out there who don't understand what it means to be gender-fluid. And for a person who identifies as such, communicating with people who don't get it can be one of the most difficult aspects of being gender-fluid, says sex therapist Kelly Wise , PhD, who is transgender. Dealing with gender dysphoria (anxiety or pain over "a marked incongruence between one's experienced/expressed gender and assigned gender," according to the DSM-V ) is one of the main issues Dr. Wise helps his patients manage. "If it’s unmanageable to walk in the world, where people see you one way, and you don’t see it [that] way, to the point that you don’t want to go and interact with the world, it’s important that we talk about it with the people who matter to you," Dr. Wise says.