My parents and I survived my ‘Rapid Onset Gender Dysphoria.’ This is our story.

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Yes, it’s true.

I am a survivor of Rapid Onset Gender Dysphoria, otherwise known as ROGD.

And if you’d talked to my mother back then, you would’ve gotten a very panicked account of how abrupt my coming out was.

But my story isn’t hers to tell.

(She, by the way, would totally agree with that statement. This is why she isn’t posting about me in online forums or participating in “studies.” Also: Hi Mom, love you.)

And while I wish I had the Perfect Transgender Narrative™ to convince you of my validity, I don’t. I didn’t always know I was transgender. I’m not even sure exactly when my dysphoria really started.

But if you knew my story, you might realize why that makes sense.

I was a sheltered kid growing up in suburban Michigan. And while I’d been bullied for being “weird,” and always felt like the “black sheep” wherever I went, I knew literally nothing about queer or transgender people… much less “gender dysphoria.”

There was no context to place that sense of isolation into. It never occurred to me that gender was a thing I could have feelings about, and I certainly didn’t know that I didn’t have to identify as a girl if it didn’t exactly fit.

Having an older brother that was so close to me in age, my androgyny wasn’t exactly odd, either.

I figured it was a natural product of being so close to him. We shared our toys as kids, played video games for hours, and my many interests — ranging from the stereotypically “feminine” to “masculine” — made me gender-ambivalent at best.

If you’d asked me how I felt about my body as I got older, I would’ve said I “felt ugly.” When asked to describe myself? “I’m just weird.” There was no other vocabulary available to me, because my world was incredibly, incredibly tiny.

Even if I did have some sense of dysphoria, I didn’t have the ability to place where it was coming from.

I was a kid with obsessive-compulsive disorder and ADHD. As such, I was in a constant state of anxiety and agitation growing up. When it became unmanageable, I would get really depressed.

In other words, emotional overwhelm was a constant in my life. Teasing apart where any of it came from wasn’t a simple process.

It only became more complicated as I got older. When I was a teenager, I developed an eating disorder and then found myself in an abusive relationship. The disconnect from my own body from there only became more intense. I was numb to it in so many ways.

Gender was not my concern at that time — simply surviving my mental illness and that relationship was all I could muster.

But thoughts about it started to surface, slowly but surely. When I began considering taking on a more androgynous appearance, and started questioning gender in my late teens, my abuser told me that I “wouldn’t be attractive anymore.”

My self-esteem was already so diminished. His comment made me feel so deeply ashamed for ever having considered being anything other than hyperfeminine and cisgender.

So I didn’t just tiptoe back into the closet… I leapt back in.

At first, I put any kind of gender-related thoughts on the highest shelf in a locked box. I couldn’t handle the idea of destabilizing my life in the way that transition — and by extension, ending that relationship — would’ve triggered.

There just wasn’t room for questioning my identity at that time in my life.

Between my OCD and my traumatic relationship, I was repressing the hell out of any gender-questioning thoughts. I didn’t have the emotional capacity, resources, and support to work through it.

It wasn’t until I got out of that relationship and started therapy that I could begin to untangle everything.

As I started to better manage my OCD and heal from the relationship that had destroyed my self-esteem, those questions about gender start to find their way to the surface again. I begin to wonder.

And I started searching online.

That’s when I really began questioning if some of my earlier feelings about being out of place — especially among girls my age — meant something.

I wondered if being disconnected from my body might be connected. I wondered if being drawn to androgyny (and the little things, like enjoying playing as “boy” characters on my favorite video games) might have meaning, too.

And I’ll be honest, I didn’t know for certain if those aspects of my earlier experiences did or didn’t have a gendered significance. Very few of us do in actuality, because identity is complicated, and gender is, too.

Not to mention, my history was very complex and painful. The thing about dysphoria is that so much of it is very abstract. Feelings aren’t as crystal clear as a lot of cisgender people seem to suggest.

Dysphoria isn’t this obvious neon sign that appears from the minute you exit the womb, especially in a society that does everything it can to make transgender people totally invisible to begin with.

We often don’t know where our feelings are coming from, especially if our backgrounds include trauma.

Which is why changing circumstances externally — our clothes, our pronouns, our names — can be so important. We do it to see how our feelings change so we can better understand what caused them, and more importantly, what we can do about them.

So I came out as genderqueer when I was 19 years old. I felt uncomfortable continuing to identify as a “girl” when I was having all these questions about my identity and my body.

I cut my hair, started changing how I dressed, started binding my chest, and began to imagine what my future might look like. I wanted to see if I would be happier or more comfortable in doing so.

For my parents, though, we’d never really had a conversation about my gender. What they saw was their teenager going off to college and catching something quite an awful lot like “rapid onset gender dysphoria.”

Except instead of the internet, it was that dang liberal arts school corrupting me.

But it became obvious, with each step of my social transition, that something magical was happening — I was coming out of my shell. I was happier. I felt a little more adventurous. I felt a little more at home.

I sat with myself and I said, “Okay. There’s something here.” I knew there was because with every change I made, I felt a little lighter in a way I never had before.

I soon learned that a disconnect from your body or self, disordered eating, anxiety, and a sense of isolation can all be a part of the transgender experience we call “dysphoria.”

It seems to be something a lot of us share. And more importantly, when some people transition, those experiences improve or even go away entirely.

When I finally understood that a gender transition was making me feel better and brighter… I was thrilled. But I was also hit with waves of very acute, very new gender dysphoria.

My internal reality was solidifying, but my experiences as I moved through the world weren’t aligning at the same time. That gap became more and more stark — and much more painful.

This was the “rapid onset.”

And if you talk to transgender people, a lot of us have the same story — we know our truth, but it also magnifies our pain. There’s the new distress of realizing that no one else sees it but us. The pain of invisibility.

While you are becoming the person you are meant to be, you simultaneously become invisible to the rest of the world — even to the people you love.

That is traumatic — and it can come on gradually for some people, and quickly for others, depending on when you came to understand your identity.

I knew who I was and I wanted that to be recognized. But it wasn’t. And the more erased I felt, the more pain I experienced.

I found myself focusing more and more about the aspects of my body that kept me from feeling seen. I’d never felt comfortable in my own skin, but now I had a better understanding as to why — and I had a clearer idea of what needed to change.

That’s when I started considering hormones.

At 22 years old, I was now growing impatient and miserable. I didn’t share these things with my parents at first, though, out of a fear of being rejected. They were your typical Midwest “ranch dressing” kind of parents — they knew very little about what any of this gender stuff meant.

But I came out to them anyway.

They were, in the deepest sense of the word, confused.

But more than that, they were terrified, because they’d never once heard me talk about questioning my gender. For them, the pain I was describing was sudden and life-altering.

And, yes, “rapid.”

But it wasn’t the dysphoric feelings that were necessarily new. It was the urgency to address them that was new — because I learned there was a solution, a path I could finally take.

That urgency made the dysphoria feel stronger. But in all likelihood, it may have been there in some form all along.

But either way, it hardly seemed to matter when it began. I just needed to know if testosterone could help me. And if it didn’t? I could always stop.

So I held my breath, emailed my parents, and told them what I was prepared to do. And my mother especially — while she was terrified about what would happen next — did what every parent of a trans youth should be doing: she stood by me.

Rather than looking to change who I was, or digging for evidence that I was delusional, or blaming somebody else in my life… she pumped the brakes. She moved through her fears and came out on the other side of that as my biggest supporter.

And being supportive didn’t mean that she wasn’t afraid. It didn’t mean that she didn’t have questions, doubts, or worries. It didn’t mean that she understood everything that I was talking about.

What it meant was that she had the courage to walk through those fears with me, and do everything she could to support my own happiness, even if the path was totally unknown and even scary to her.

My mom didn’t see my coming out as a fluke, nor did she see my transition as a threat. She saw it as an opportunity for her to grow.

And while she stumbled and wasn’t always graceful, she did everything she could to be there for me, no matter what.

Screen Shot 2018-09-08 at 11.46.18 AMWith my family’s support, I began my medical transition. I won’t lie — I was scared, too, at first. I wondered if I could be mistaken. I wondered if it was my OCD playing tricks on me. I worried that maybe trauma had led me astray.

But after years in therapy, and multiple gender specialists weighing in, this was the conclusion we had all reached. It was worth a try.

I’m grateful every single day that I took the chance. And I’m just as grateful that my parents were by my side, supporting me through it.

I started hormones, I got top surgery, and with each step, there was a light in my eyes that wasn’t there before. I came alive. I was happier, more confident, and the emotional overwhelm that seemed to buzz around me my whole life slowly began to fade.

As my parents saw this unfolding, even they couldn’t deny what was happening. I was finally calm. I was optimistic. And most importantly, I was ecstatic.

And one of the greatest, most unexpected gifts of my transition?

My mom (who I will freely admit, like most teenagers, was not my favorite person growing up) became one of my best friends.

Even as my mom struggled to understand me (and still does sometimes), that has never once been an obstacle in her loving and supporting me.

My parents are proud of their gay, transgender son. I know this because they don’t hesitate to remind me.

And looking at their example — two people who really couldn’t have been more unprepared for a trans kid — is what still gives me hope, even as proponents of this pseudoscience try to undermine and invalidate trans youth.

Hope even for the parents that participated in the Rapid Onset Gender Dysphoria “study,” who may someday learn that their fear is worth embracing — that it’s an opportunity to grow, to love, and to listen.

An opportunity to better know this wonderful person that they brought into the world — to see, for the very first time, what lies in their heart, and to prove to them that they’re still worthy of love exactly as they are.

My parents embraced that opportunity despite all the grief that came with it. And when I ask them why, their answer to me is always simple: “Because we love you.”

We didn’t always know that I was transgender or that I even had gender dysphoria. But when my parents look at me today — and they see a happier, healthier adult — none of that really seems to matter anymore.

I hope that one day, we’ll live in a world where parents of transgender youth, no matter how “rapid” their coming out, will get to experience that same joy, too.

That moment when they look at their kids, brighter than ever, and finally understand that the journey is absolutely worth it.

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If you’re suicidal, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386, or reach the Crisis Text Line by texting “START” to 741741.

 

Hey, friend! Before you go…

cropped-heartThis blog is not sponsored by any fancy pants investors that are trying to sell you stuff.

It’s funded by readers like you via Patreon!

Every donation counts. Help keep resources like these accessible to everyone that needs them! And help buy me a cup of coffee, because I write a lot of these blogs after work, late at night, so I could definitely use the caffeine.

If your ‘suicide prevention’ isn’t talking about the mental health system, you’re missing the point.

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As both a suicide attempt and loss survivor, I need to climb up onto my soapbox for a minute.

Suicide attempts, from a “preventative” standpoint, are rarely, if ever, as easily prevented as calling a hotline or a loved one. “Reaching out” — while incredibly important — is not the be-all-end-all of preventative strategies.

Especially considering the fact that many of us have a history of asking for help, and not getting the care that we needed.

I understand the impulse to ask, “Didn’t they know they could call me?” I asked myself that many times when I lost one of my best friends earlier this year. But this shows a very big misunderstanding of the emotional experience that many suicide attempt survivors have described.

Speaking from my own experience, when you are in a very acute amount of emotional distress, your thought process is not as linear or composed as you might assume.

The pain in that moment can eclipse everything else — past, present, future. It’s a sort of tunnel vision in which the pain becomes too great; in those moments, I’m cognitively incapable of stepping back to get the kind of perspective I might otherwise have.

This is why I always try to remind folks that suicide attempts don’t necessarily reflect a person’s overall state, as much as it does their level of pain in that particular moment.

To put it as a metaphor, suicide attempts remind me quite a bit of heart attacks, in the emotional sense.

After a certain point, the body’s resources can no longer fend off a very acute and painful event. It is so pronounced that your brain’s reaction is to scramble and do whatever is necessary to combat that pain, as immediately as possible.

We have some autonomy when we’re in that kind of pain. But so many of our actions are ultimately driven by the visceral agony we’re in. Our systems are flooded and overwhelmed, made worse by the adrenaline, the stress hormones, and for many of us, whatever substances we might be abusing — like alcohol — in a misguided attempt to cope.

But more often than not, unlike a heart attack, it’s also a pain that’s been building for weeks, months, or even years.

When we talk about “suicide prevention,” we focus too much on trying to understand the actual attempt, and not enough on accessibility of care.

We don’t do much to ensure that the pain doesn’t become that acute in the first place. We don’t focus enough on quality of life afterward. And most importantly, we rarely interrogate the systems in place that have failed to support them long before they reached this place.

It’s as though we’ve seen someone having a heart attack, but we start asking what they had for dinner the night before, or kicking ourselves for not offering them aspirin that morning.

When we talk about addressing heart disease, we’re not just trying to intervene in the mere moments before they happen — we know that isn’t enough, which seems like common sense in this context.

We talk about the whole person, and all of the ways in which their wellbeing needs to be prioritized well before they reach a crisis point.

But suicidality is still not viewed this way. We treat suicide attempts as very deliberate choices, rather than complex reactions that we know are better addressed sooner, not just puzzled over later.

The problem is, our mental health system isn’t set up to intervene at the moment when it’s needed.

Therapists and psychiatrists are still wildly inaccessible. And if you can find one that has availability and is covered by your insurance (assuming you have insurance), it often takes weeks, even months before you can actually see them.

If that clinician isn’t competent or a good fit? That’s additional weeks, months, and even years until you find someone who meets your needs. Which doesn’t include the months it takes for those treatments to start yielding real results.

I recently wrote a reported piece about a veteran with PTSD, for whom the nearest mental health provider that took his insurance was a staggering four hours away by car. And if he hadn’t had access to a vehicle? I’m not sure he would still be alive right now.

And all this assumes that mental health care isn’t so stigmatized in your community that you feel empowered to get help sooner rather than later, which is simply not the culture we live in.

This bureaucratic nightmare, combined with stigma, is why many people with mental health struggles often don’t seek help for nearly a decade (or more) after their symptoms set in, if they seek help at all.

And that’s why I bristle at the questions I so often hear after a suicide attempt. “Why didn’t they ask for help?” is the wrong question to ask. “What were they thinking?” is the wrong question to ask.

“What did WE do to help them, as a society?” is the question here. And more specifically, what were WE thinking, when we set up our mental health system to be so inaccessible?

I want to challenge us to think about what we’re doing to change this on a substantive, systemic level. This isn’t about reaching out. This is a call-to-action.

My own suicide note years ago simply read, “I’m sorry. I just can’t do this anymore.”

Not, “I don’t want to do this.”

Not, “I don’t have any other options.”

Not, “I don’t care about my loved ones.”

I simply said, “I just can’t.” I had reached a point at which I truly believed that I could no longer physically withstand the pain that I was in.

This led me to the emergency room and, even there, I saw people desperately trying to harm themselves by any means they could, being stopped only because they were restrained by hospital staff.

And this was not because they didn’t have “help” or “options.” It wasn’t even because they weren’t asking for support. They were in the hospital — they were surrounded by people who, in theory anyway, wanted to help them.

But their pain was that unbearable, that all-consuming.

How do you bring someone back from that? And more importantly, how do you make sure they don’t return to that place?

Beyond preventing the act of attempting suicide, I want to know how we can assure them that the life they’re returning to is one in which they are truly supported.

No one should ever get to a point of experiencing that much pain. And if they do, there should be no question of what resources are in place to guide them through recovery. But our system isn’t built to intervene sooner rather than later. Our system isn’t built to create a reliable, consistent safety net afterward.

It’s certainly not interested in establishing any real quality of life, so much as it focuses on simply preventing death.

We have a “worst case scenario” mental health system, and it’s failing. Its efficacy is a game of luck at best, a roll of the dice.

If you have insurance; access to transportation; the right combination of clinicians, inpatient or outpatient programs, and/or medications; the time to commit to recovery; the persistence to keep following up with providers; the support system around you to help you when this becomes overwhelming; and the sheer energy to navigate the system that is already overburdened — maybe, just maybe you’ll survive.

No one’s livelihood or quality of life should be left to chance.

I’m not trying to paint a bleak picture. People can and do thrive, and I’m absolutely an example of that.

But not because our system is actually successful at what it does — it’s because I am one of the lucky ones that eventually, after many years, found my way through it.

I can tell you why I attempted suicide years ago, and it’s simple: the amount of time it took to “recover” exceeded the amount of resources I had to cope.

It took eight years to get the proper diagnoses for my mental health conditions from the time I started therapy at age 17.

Which means it took eight years to find the right medications to treat my OCD, PTSD, and ADHD. And it took eight years to find a therapist that specialized in those areas — a therapist that I had to pay out-of-pocket for, because my insurance wasn’t taken by any therapists in the area who had openings for new clients.

I’m less interested in preventing the act of suicide itself, and more interested in knowing why our system is doing such a terrible job of caring for people who are struggling before, during, and after.

When we know earlier and more compassionate interventions are so critical, and when we know quality of life is exceedingly more important than simply keeping someone alive, we need to start asking why our system is set up the way it is.

We need to start demanding that something change — because our lives depend on it.

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Hey there, friend. Before you go, I want to share some resources with you.

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If you’re suicidal, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386, or reach the Crisis Text Line by texting “START” to 741741.

This isn’t just a generic “here are some numbers” plug, I promise. This is a “I want you to stay, we need you here, please don’t go just yet” plea.

Are you a loved one that wants to reach out to someone you think is struggling? Incredible. You totally should.

I have a guide here for how you can offer support in concrete ways.

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One more thing: I created this resource totally for free, but your donations help keep this labor of love going.

This blog is not sponsored by any fancy pants investors that are trying to sell you stuff.

It’s funded by readers like you via Patreon!

Every donation counts. Help keep resources like these accessible to everyone that needs them! And help buy me a cup of coffee, because I write a lot of these blogs after work, late at night, so I could definitely use the caffeine.

 

Some credits & gratitude go to… Photo by rawpixel on Unsplash. Artwork by Jessica Krcmarik.

An open letter to anyone else he’s hurt.

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Seven years.

It’s taken me seven years to understand that what happened wasn’t my fault. To admit to myself that this person I trusted was never who he appeared to be. To look at that time in my life and see it for what it truly was: traumatic.

It’s been seven years, but when I see someone on the street that looks like him, it still feels like it was yesterday. My stomach drops. My vision blurs. My entire body tenses. And for a split second, I feel just as small and powerless as I did all those years ago.

I’m thousands of miles away from him but I forget that, sometimes.

I’m living my domestic life with a spouse, two cats, and the sweet little downtown flat. Sometimes I repeat the address like a mantra, just to remind myself of where I am. I keep a map of San Francisco in my kitchen. I collect tattoos to irrevocably mark the passage of time, a reminder that my body is my own, now more than ever.

But sometimes, he is the fear that still exists in the in-betweens spaces.

When someone walks too quickly toward me, when there’s a loud noise I’m not expecting, or when someone touches me and the word “no” is on the tip of my tongue, but I’ve forgotten how to say it — he still lives there, quietly.

It’s a word I didn’t learn how to say until long after he was already gone, when the acronym “PTSD” was passed down to me like a generational hand-me-down that I never asked for, when a psychologist gently said to me, “Sam, that was abuse.”

Seven years.

It took me seven years to finally feel angry. In hindsight, I’m astonished that I was ever kind (“it’s called a trauma bond,” they say). But when the rage finally kicked in, it was a fiery force, a beautiful blaze to behold. It was the perfectly scrawled signature at the bottom of my body’s manifesto — I am mine.

I imagined the smoke billowing out, an ominous warning that could be seen all those miles away: never again will any man’s entitlement grant him access to any part of me.

I am the surface of the sun and my rage turns predators into ash.

I smother every lie beneath my heel as it falls from his mouth. The pedestal I built him is nothing more than dust now, a pitiful reminder of what it felt like when he came toppling down, when I told him, “I don’t need you.”

Seven years.

Pain is an extraordinary teacher. It comes in waves, but as it passes over me, the darkness is replaced with clarity.

I’ve found the courage to dive underneath, even in the face of something so remarkably vast. I’ve learned to appreciate my breath, and to trust the buoyancy and resilience of my body.

And I know now the compass of my own heart. I come back to the surface each and every time — like a magnet that’s unquestioningly pulled to survival, to life — no matter how far I drift or sink.

No narcissist’s hunger (I imagine it as a mosquito drawn to ruby red blood) has ever taken away that instinct, however quiet it became.

I still have the inner wisdom that moves me when I am fixed in place.

It was once the raft that carried me back to myself; it is now the fleet that I call on, with every ounce of dignity, earnestness, and vulnerability, all at my command. What he took from me, I replaced with unwavering loyalty to everything I am and will become. He cut me at the stem, but my roots were always strong.

Seven years.

I still bloomed.

The path has been messy, but beautifully wild, and I love it all the more for that. To be whole and hurting, I think, is better than being a shell or a vessel or a hungry ghost.

He was a void that we mistook for depth, depth which he sold us as romance — but in truth, his soul was hollowed out long before he found us.

Ego has an appetite, and his will never be full, no matter how many ways he rewrites the story and casts the play. The truth about control and manipulation is that, so long as you need it, your power can never come from within.

That’s why he will never have what we have, whether he knows it or not.

We can cultivate our own power. We can tend to the garden within ourselves, basking in the light of our own courage.

Pain is a teacher, and persistence is our secret wisdom that we cultivate each day that we choose to live. With time, I’ve found new ways of growing, new ways of loving. While I’m not grateful for the violation that brought me here, I cherish the resilience that has unfolded in its place.

When I see our pain replaced with collective possibility, I am in awe of us and everything we can be.

And when the darkness washes over me again, I’ll look to this light to bring me back.

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This blog is not sponsored by any fancy pants investors that are trying to sell you stuff.

It’s funded by readers like you via Patreon!

Every donation counts. Help keep resources like these accessible to everyone that needs them!

Photo by Tim Marshall on Unsplash.

11 important ways my loved ones supported me during a mental health crisis.

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A few months ago, I wrote an article encouraging folks with mental health struggles to reach out, offering some concrete suggestions on how to do so.

And don’t get me wrong, I still think it’s a critical conversation! So many of us want to ask for help, but we don’t know exactly what to say.

Yet… there’s another conversation that we need to have about reaching out. More specifically, we need to talk about how our loved ones can do better in reaching out to us.

In a perfect world, anyone who was having a hard time could issue the “bat signal” and get every ounce of love and support they deserve. But it rarely works that way, because mental illness is so stigmatized to begin with. Many of us are simply too afraid to reach out.

I’ve been lucky to have some loving people in my life who, in many ways, have modeled the kind of compassion that is so critical during a mental health crisis.

And I want to share what they did — because I think we all have something to learn from them.

If you have a loved one that’s struggling with a mental health crisis, there’s so much you can do to help, whether you realize it or not.

Here are 11 things that my loved ones did for me that made a difference — and why it was so important.

1. They did a lot more listening than talking.

I know this is cheesy, but it’s worth repeating: some of the most meaningful moments I had when I was struggling were when my loved ones just… listened.

There was so much to process during that time. Having a hot cup of tea and being able to talk about all the messy things I was feeling meant the world to me.

They didn’t pry, they didn’t lecture — they followed my lead and let me share what was on my heart. Sometimes, being there for someone really isn’t any more complicated than just, well… being there.

2. They were sure to ask what I needed instead of assuming.

No two people will cope with a mental health struggle in the exact same way. This sounds like it would be obvious, but so often, we don’t take this into account.

What helps one person isn’t always going to be helpful to someone else — and figuring out how to best show up starts with asking the right questions.

Some of my favorite things that people have asked me during a rough time:

“Is there a particular activity we could do together that might take your mind off of things?”
The goal here isn’t necessarily to make someone feel better, since they might not be in a headspace for that. Instead, offer up a distraction or an escape. And if they don’t know what to do? Suggest a few activities!

“Do you need help with anything around the house?”
That stack of dishes in the sink has a bigger mental health cost than you might expect.

“Have you been eating? Drinking water? Talking to people? Taking your medications? Sleeping okay? Would it be helpful if I…”
Can you send them their favorite takeout meal or a cute, reusable water bottle? What about a text every morning to say hello, or every evening to make sure they’ve taken their medications? Could you pay for a monthly or yearly subscription to a meditation app to help with sleep?

Whenever possible, pay attention to where someone is struggling, and tailor your support accordingly!

3. They learned more about my disorder.

In my experience, obsessive-compulsive disorder is a very complicated thing — a lot more complicated than people realize. And rather than asking me twenty million questions when I was diagnosed, my loved ones took it upon themselves to do a little research of their own.

This helped them not only better understand what I was going through, but it ensured that they didn’t unintentionally make things worse.

4. They sent me thoughtful gifts that I could hold onto.

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The necklace that my parents sent me. 🙂

I’ve saved every card, every letter, every care package (except for the chocolate, which I obviously ate), and every keepsake that my loved ones sent me to let me know that they cared. While it obviously didn’t magically lift me out of a crisis, it did make me feel loved and cared for.

One of my favorite things I received was actually from my parents.

They sent me a mental health awareness necklace when I was first diagnosed with OCD that I really cherish. They put a lot of thought into it, too — the pearl they chose was teal, the color that represents OCD awareness.

It was their way of letting me know that they supported me, and that they were with me every step of the way. It means so much to me to have a tangible reminder of that to this day.

5. They took a team approach.

One person can’t do it alone, which is why I appreciated my loved ones’ efforts to connect with each other, and at the very least, make sure that there was a healthy network of support around me.

If you’re not sure how to get that ball moving, here are some of the questions they asked me that could be helpful:

“Who else is supporting you through this and how can I get in touch with them if something comes up?”
Having some names and contact information means that, if there’s a crisis you’re not prepared for, there are others you can call on.

“Who do you live with currently and how can I reach them if I’m concerned about your safety?”
It’s often dangerous to call the police during a psychiatric crisis, so if there’s an emergency, make sure you know who that person is living with and how to connect with them if needed.

“Do you mind if I reached out to (mutual friend) if I need support?”
The buddy system is critical to make sure you have a safe space to process your own fears and frustrations, too.

“Can we compile a list of phone numbers that you can text or call if I’m not available to support you?”
Hotlines, local clinics, friends, a therapist — create a shared spreadsheet that’s easy to access, so that your friend knows there’s always someone available whether you’re there or not.

During any kind of crisis, the more support, the better. So if your loved one doesn’t seem to have a lot of support, that’s priority #1 — it’s time to figure out how to build out that network, whether that network is in the real world, or simply online.

6. They didn’t lecture me about what ‘treatment’ was best.

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I genuinely adore my friends.

No lectures about “have you tried yoga,” no misguided rants about antidepressants being overprescribed, and no recommendations for fad diets that would supposedly “cure” me. They just offered compassionate, gentle support as I did my very best to make the decisions that I felt were best for me.

When it comes to dealing with mental health — or any kind of health — that’s a decision that’s made between that person, their health providers, and whoever else they choose to consult.

Unsolicited advice is never appropriate, especially when dealing with something so personal.

7. They helped me navigate the mental health system.

The mental health system is a monstrous, complex, and frustrating thing. It can take months to secure proper support, even years — and when you’re already at the end of your rope, it can be discouraging enough to make you give up entirely.

I can’t describe how helpful it was to have loved ones who were willing to help me track down a therapist, drive me to appointments or clinics, pick up my prescriptions, stay with me in the emergency room, or connect me with support groups.

If your loved one is struggling with the system, ask if there’s a way you can lighten the load — chances are, they’ll be glad that you offered.

8. They worked hard to keep my trust, even when they didn’t approve of my choices.

Like quite a lot of people with mental health struggles, I have a history of substance abuse. Back then, it would’ve been easy (and pretty justified) to look at some of the decisions I made when I was in crisis, and say to me, “Sam, what the hell is wrong with you?”

But I was fortunate to have people close to me who, instead of criticizing me, did everything they could to make sure I remained honest.

When I wound up making decisions that weren’t in my best interest, my loved ones said a few things that really stood out to me:

“Do you have a plan for what you’ll do differently next time you’re feeling this way? Can I help you come up with one?”
Sometimes we made rash decisions because we felt we didn’t have any other options. Coming up with a plan for next time can make a real difference. I actually talk about some of my favorite “mental health hacks” that can be helpful in those situations in this article.

“I’m not here to judge you. I just want to figure out how we can keep you safe.”
Letting someone know that you’re not judging their behavior is so critical to ensure that they won’t isolate themselves.

“If there’s a next time, can you give me a list of three different people you’ll reach out to before you act?”
Remember the phone list I mentioned above? This is the perfect opportunity to remind them that it exists — and that they can and should use it.

These conversations aren’t easy, because sometimes, the decisions folks make in crisis can be downright frustrating. But the reality is, when a person in crisis is no longer honest because they feel judged, they’re less likely to tell someone the next time they’re in a dangerous situation.

Keep the communication as open as possible. And when needed, reach out to someone else in their support network to ensure you don’t burn out in the process.

9. They kept checking in, even when I seemed ‘better.’

Six days before one of my best friends died by suicide, they used the hashtags “#happytobealive” and “#happytobehappyagain” in an Instagram post.

The honest truth is, just because someone seems to be “better,” it doesn’t actually mean that they are.

In fact, many people who attempt suicide often appear to be at peace or even upbeat when they’ve decided that they’ll end their life — it can actually be a warning sign of something very serious going on.

Appearances are deceiving, which is why I’m so grateful that my loved ones know to check in on me, even if I “seem fine.”

10. They didn’t view me as disposable.

A person with mental illness is not disposable.

Let me repeat that again, with emphasis: People with mental illnesses are not disposable.

As someone who has supported a number of people in crisis, I understand the temptation to “ghost” or cut ties with someone who is in a very difficult place. Burnout is real, and we don’t have an infinite amount of energy and love to offer someone, no matter how much they’re struggling.

But there’s a difference between self-care and abandonment, and sadly, I’ve witnessed all too often that there are people who just don’t know the difference.

If you’re not sure how to take a step back from supporting someone during a crisis, here are some suggestions that were immensely helpful to me, both as the person struggling and as the person offering support:

“My life is getting a little bit hectic right now; I’m not sure how reliable I’ll be the next couple weeks. What other forms of support do you have in place?”
Remember the phone list? Pull it out. Make sure (as best you can) that if you’re taking a step back, there are other forms of support in place.

“I’m starting to struggle with my own mental health. If I hibernate a little bit this weekend, is there someone else that can check in with you?”
It’s okay to take care of yourself. Just make sure that you’ve let your loved one know that you’re taking a step back, and if possible, for how long.

“This isn’t at all a reflection of how much I care about you, but I’m running low on energy lately. I want to make sure you’re okay, though. Who else is supporting you right now and how can I get in touch with them?”
Avoid blame — the last thing a person in crisis wants to hear is that they’re a burden. If possible, connect with someone else in their support network, and let them know that they might need some extra check-ins, if they’re available to offer that.

“If I step back for a little while, can you promise me honestly that you’ll keep yourself safe?”
If someone can’t promise you that, it’s an emergency — and it’s time to call for backup.

“Let’s set up a time to check in on…”
If you set a deadline, it’s less likely to feel as though you’ve disappeared. If you can, set a date and time to check in again, so this person knows that you’ll circle back.

Simply bailing on someone in the midst of a mental health crisis can do real harm, and it’s not okay — unless your own safety is at-risk — to carelessly “drop” someone because you’re overwhelmed.

While there’s no perfect way to step back, it’s important to at least make an effort to do so thoughtfully.

11. They didn’t wait for me to ask for help.

I wish, more than anything, that folks with mental health struggles would feel empowered to reach out. But because of the stigma and emotional toll that mental illness can take, I understand that often times, they won’t.

What I appreciated most from my loved ones is that they didn’t wait for an invitation to check in on me, and they didn’t assume that somebody else would.

Lately, I’ve noticed something of a “social media bystander effect,” where we suspect someone is struggling with their mental health, but we assume they have an abundance of support and we disengage.

The sad reality is, though, that “heart reacts” and “hope you’re okay” comments on Facebook, however well-intentioned they are, often aren’t substantive and meaningful enough to carry someone through.

If every one of us is assuming someone else will reach out, chances are, no one will.

Whenever possible, we have to make the active choice to not be a bystander when someone is having a mental health crisis.

And my hope is that, by sharing how others have supported me, we can all feel just a little more empowered to reach out to someone who needs us.

You never know what kind of difference it could make.

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If your goal in therapy is to ‘be happy,’ you might want to rethink that. Here’s why.

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When I first walked into a therapist’s office when I was eighteen years old, I had one goal and one goal only: “I just want to be happy,” I said.

Up until that point, I couldn’t really remember what that felt like. I didn’t know at the time that I had obsessive-compulsive disorder (as it turns out, it runs in the family), and that my near-constant state of guilt, panic, and rumination wasn’t actually the way most brains operate.

I thought happiness was the whole point of this “mental health” thing. So I became something of an emotional hypochondriac — if I wasn’t happy, something was wrong.

Suddenly my very human experiences like sadness, anger, and anxiety were all “problems” that needed to be “fixed.” I had this unreasonable expectation that, if I worked hard enough, I could minimize the presence of every other emotion to become capital-h “Happy.”

That’s not exactly the healthiest mindset, if you really think about it.

Ask anybody what they want out of life, and they’ll probably tell you the same thing I told my therapist all those years ago — it’s about being happy, isn’t it?

But happiness is just one emotion. And humans aren’t built to experience one emotion and one emotion only.

So we set ourselves up for failure. We internalize this idea that life is about sustaining something that can’t actually be sustained… but we pretend that, with the right attitude, it can be.

And then we wonder why we keep getting let down. It just doesn’t leave room for the whole spectrum of emotions every one of us is going to feel.

The thing is, if our goals for therapy (or recovery generally, or even life) are setting us up for failure, they aren’t really serving us. In fact, they’re probably going to discourage us. This becomes doubly true when we’re talking about marginalized people, where societal circumstances basically make it impossible to be happy all of or even most of the time.

And if your goal for therapy is impossible? You might give up before you ever get to the good stuff.

The really paradoxical thing about mental health recovery is that the goals that lend themselves to happiness usually aren’t about happiness at all, at least directly. A lot of people find that the less they focus on “being happy,” the more they’re able to make changes that contribute to their happiness.

Being happy with greater frequency and intensity just becomes this weird (and totally cool) side effect. At least, it was for me.

So if you’re not going to therapy or living life to become happy, what’s the point? I started asking the same thing. And what I learned along the way kind of blew my mind wide open.

If you’re wondering what might be helpful to work towards (whether it’s with a therapist, a life coach, a spiritual guide, in a support group, or even as prompts for your journal), that’s what I’m here for.

Here are five goals that I’ve found to be especially important for therapy — and why ‘being happy’ isn’t one of them.

1. I want to live a life that feels more meaningful.

Arguably every goal on this list circles back to this one. There’s an awesome TED talk by psychologist Emily Esfahani Smith unpacking this exact thing (I highly recommend it — it’s based off of a book she wrote that’s rooted in her work in positive psychology, pulling not just from research, but also from philosophical and spiritual traditions).

We can’t be happy all of the time, but if we can create a greater sense of meaning, it gives us something even better — a life that feels worthwhile. It can motivate us to invest in ourselves, our communities, and our world in a way that doesn’t depend on whether or not we’re happy in a given moment.

In other words, it’s more sustainable. Smith outlines the key pillars of a more meaningful life by breaking it down into four categories: belonging (feeling affirmed by people around you), purpose (serving others in some way that reflects our values), storytelling (which I’ll talk about a little more below), and transcendence (moments that fill us with awe or wonder).

I personally found belonging by joining groups in my local queer community and purpose by volunteering locally around causes I care about. I’ve found transcendence by going to concerts and becoming a drag performer (music and art have always made me feel like I’m a part of something bigger) and traveling a little more.

It’s worth mentioning, I was able to do this after I found the right balance of psychiatric medications to better manage my obsessive-compulsive disorder and ADHD.

So I do recognize that this requires a strong enough foundation on which to build — luckily, a shift in goals can help us determine what exactly we’re working towards which can inform what kind of support we need.

2. I want to create a better narrative for and about myself.

I’ve heard many times before that who we are is just a compilation of the stories we repeatedly tell ourselves — whether we realize that or not.

For the longest time, I’d written myself off as some neurotic, broken person that just needed to be “fixed.” And that deeply impacted how I treated myself and the choices that I made.

Working with a trusted therapist and even blogging about my experiences helped me construct an entirely different story for myself. In processing and unpacking my life experiences, I could see more clearly that I had done my best, learned from my mistakes, and emerged on the other side a stronger and more determined person.

I realized my identity was simply an interpretation of all the events I could remember. And as it turned out, there were many different ways to interpret those events that I’d never thought of.

Up until recently, I chose to interpret difficult events in my life as a reflection of my own inadequacy and failure, rather than a journey of personal growth and new insight. Practicing this reframing of my life, especially with a therapist, helped me construct a new story and a new appreciation for who I am and who I’ve become.

There’s actually plenty of research that backs this up, too; internalized narratives play a big part in our overall satisfaction with life.

The tricky thing is, we’re not always aware of the stories we’re telling ourselves (the fish in the bowl doesn’t always see the water, after all).

But when we uncover these narratives, and start to question where they came from and what we can learn from them, it can make a big difference in how we perceive ourselves (and by extension, how we feel and behave — cognitive-behavioral therapy, anyone?).

I don’t believe for a minute that we “choose” to be happy or unhappy. I do believe, however, that brains are pretty malleable things — and with practice and support, we can find a different story to tell ourselves and learn to believe in it, too.

And if our identities are really just the interpretation of a life story, those interpretations can change our whole selves.

3. I want to cultivate more intimate, fulfilling relationships.

Our relationships play a big part in our day-to-day. I’m constantly amazed, as I do more work with a therapist, at how often I’ve gravitated towards toxic relationships without fully realizing it.

Many of us have patterns in how we engage, the kinds of people we seek out, and in what ways we invest in others (or don’t). Just a few weeks ago, I wrote about one of my worst patterns as a people-pleaser. I suspect we’d be a lot more satisfied in life if we were more aware of these things, but that awareness takes work.

Being more aware of our relational patterns is an awesome goal, and it can wind up making us happier in the long run. It benefits ourselves, the people we care about, and the communities in which we live.

If you’re not sure where to start, there are some questions worth considering:

  • Who are the people I spend my time with? How do I feel before I spend time with them and how do I feel after? I wasn’t able to answer the second question at first, so I had to start being more mindful when I hung out with people. And let me tell you… it was mind-blowing to see how some of the people I invested in most made me feel worse.
  • How do the people closest to me express their care, investment, and affection for me? How do I reciprocate and how often? This helped me to become more grateful for the generosity that I wasn’t always the best at noticing, and also made me aware of the relationships in which I was giving a lot more than I was receiving. (Relationships are rarely an equal transaction, but being mindful can help us make better decisions around where we want to invest our energy.)
  • Who are the people, if any, that hype me up? And how can I find them or connect with them more regularly? I sat down and thought of three people that consistently make me feel good about myself. And no joke, I threw them in a group chat on Facebook and now we get brunch together most weekends. I even have a spreadsheet where I keep track of the relationships I’m nurturing. I can honestly say that my life improved instantly when I did this.

If you don’t have close friends or loved ones that hype you up or make you feel good, that’s also important to know. It might be time to start expanding your social circle, whether that’s online or off!

4. I want to develop resilience and healthy self-reliance.

I’m by no means saying that pursuing happiness is totally futile! It’s important to do things that you love and bring happiness into your life.

But I also think, along with seeking out joy, it’s a good idea to couple it with learning how to cope with the difficult stuff, too.

Being happy is awesome, but being able to roll with the punches becomes really important at those times in which happiness isn’t feasible or possible (because your boss is the worst, or the president tweets again, or life just happens to suck for a while — it happens!).

When there’s a setback, how quickly do you bounce back? Are there ways you’d like to be able to take care of yourself, but find are difficult to do? In other words, how often do you feel helpless or stuck, and are there opportunities to change that?

Rather than becoming unhappy and looking to “fix” it, berating myself for feeling negatively, or getting flustered as I tried to figure out how I got there, I started accepting how I felt in the moment. After all, thoughts and feelings come and go, because that’s kind of how brains work (they are super imperfect meat machines, basically).

So while waiting for the clouds to pass, I started grounding myself in the moment and asking, “What can I do, right now, to make this moment a little better?”

Therapy, for me, has been the best route in learning new coping skills (along with antidepressants, because sometimes our brains need an assist). But I realize not everyone can access super great therapy (a rant for another day).

That’s why I’ve written about mental health apps that can teach you some new skills, shared many of my favorite self-care resources for those that might need it, and am a strong advocate for self-help books, online communities, and support groups. The internet can open up access to a lot of these things. Go forth and educate thyself!

Resilience is an important goal (or process really). It allows us to live in a world that’s constantly changing, and gives our brains permission to be the finicky and unpredictable things that they sometimes are.

5. I want to uncover where I’m making life more difficult for myself.

Everyone on the planet has self-defeating patterns. I mean, I don’t necessarily have any research to back this up, but I have yet to meet someone that doesn’t shoot themselves in the foot with some regularity.

Some people with depression make themselves sad on purpose because it feels “safe,” as an example (I explain more about why in this post).

More often than not, the coping skills we developed when we were younger aren’t so great for the adult world. The rules and environment are completely different (and also, we likely just weren’t as skilled in general at taking care of ourselves — wisdom and experience and all that).

Recently I noticed just how much avoidance makes me miserable. I’d avoid things that stressed me out (like going to the dentist or answering important emails), without fully acknowledging that I was only prolonging my pain.

But here’s a fun discovery: The momentary discomfort of facing what stressed me out was a lot easier than the lengthy, drawn-out anxiety attack that occurred while I put things off.

The more I plugged my nose and walked through the stuff that I hated but needed to face, the easier and easier it became to tackle my stress. Don’t get me wrong — I hated every freaking minute of it with a fiery, burning passion… but that misery was temporary. Never addressing the problem, however, was permanent.

This might seem obvious to you (like, hello Sam, you’re how old and just now getting this?), but when we’re in the midst of it, we don’t always connect the dots.

We might also assume that we’re helpless or powerless despite the circumstances of our lives being very different (read about “learned helplessness theory” at some point, it can be really helpful to know about).

And oftentimes, to notice and break these patterns, we need help — because this stuff is ingrained and most likely exists for a very good reason.

In the past, these patterns might’ve made sense to minimize your immediate stress as much as possible. But I think most of us reach a point when those old tricks start to interfere with the longer term stability we’re trying to achieve.

Learning more about these patterns, then, is what can help us start to unlearn them. And honestly? Every single person on the planet could benefit from working on that.

Yes, this is all easier said than done. But that’s why it’s a process!

Remember, the stuff on this list is meant to give you a sense of direction as you work towards mental wellness. They aren’t destinations or achievements — they’re simply part of a larger process that some of us call “personal growth” and others simply call “life.”

It’s ongoing, but in therapy especially, it’s always good to set up some goalposts where you can.

My goalpost of “be happy” wasn’t working for me. But the moment I stopped expecting myself to be happy all the time, my life got a whole lot better (and calmer, really) in ways I didn’t expect. Things like purpose, growth, intimacy, and resilience made a bigger impact than “happiness” ever could.

We live in a world in which happiness is fleeting. It comes and goes. But the good news is, we can have meaningful lives — lives in which we grow and connect with others in meaningful ways — without being constantly happy.

Besides… no one needs that kind of pressure!

When we start thinking about happiness as the awesome byproduct of personal growth, rather than making happiness itself the goal that we chase, we wind up with a much stronger foundation for mental health.

And weirdly enough, when we’re not obsessed with happiness and so terrified of losing it, it becomes a lot easier to be happy — and appreciate it, too — than it ever was before.

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Beard hacks, finasteride hell, and 5 other things ‘trans masc’ folks might not know about.

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Every so often — especially in transitioning — I’ll have one of those “why didn’t someone tell me this sooner?” moments. Because we’re in the age of information, I think a lot of folks in the transgender community just assume we already have the information we need.

But in actuality? Many of us don’t.

I’ve found that when I share some of what’s surprised me, there’s always a decent number of trans people who are also hearing it for the first time. While transition is a process of discovery, I can’t help but feel that life would be a hell of a lot easier if we did a better job of sharing what we’ve learned with others.

This article, then, is a mishmash of some of the clever, enlightening, or flat-out surprising things that I would’ve appreciated being told at the beginning of my transition.

As someone who is genderqueer — and more or less moves through the world as a “trans guy” — a lot of what I’m sharing here will be more relevant to folks on the “trans masc” end of the spectrum, though I do think there’s a little something here for everyone.

Not everything here will be life-changing information by any means, but I hope that at least a few things here will be helpful to someone who needs it.

1. There are (sneaky) ways to make your facial hair look less weird.

If Oprah gets to have her own “favorite things,” so do I, right?

If you read literally any guide about how to “pass” as a trans guy, they’ll tell you to shave your face. And as someone who had the misfortune of having much of their facial hair grow in thick but blonde (thanks, Dad), I get the impulse — my facial hair isn’t exactly uh, impressive.

The problem is, that little bit of facial hair? It’s often the deciding factor in whether or not my barista is going to misgender me, you know? So as counterintuitive as it may be, my beard has to stay, no matter how ridiculous and patchy it may look. Whenever I’m without it, I’m more dysphoric, and misgendered a lot more often.

We live in the age of makeup though, my friends. Drag kings have got this down to science, and I was fortunate enough to learn that there are ways to make your facial hair a little more… cohesive.

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Glossier’s “boy brow,” aka beard magic.

Drag kings often use mascara to create something of an imitation beard, but there’s actually an even better option for those of us who already have some facial hair and just need it to, you know, make itself known.

The brand Glossier (who hasn’t asked me to plug this or paid me to promote it in any way at all — I’m just eternally grateful that it exists) has a brow pomade called “boy brow” that helps make facial hair appear fuller, darker, and more filled in.

It’s subtle, but for the blonde hair on my face that refuses to show up, this has been a miraculous discovery.

I am never misgendered when I apply this to my face. It’s intended for brows, but it clearly has some benefits for trans folks like myself who need a little more “oomph” with their facial hair.

Observe the magic in action:

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Half of my face without “boy brow” (left), half where it’s used on my facial hair (right).

I’m personally using the brown shade that Glossier offers because it looks more natural on my face, though it does come in black as well!

If you look, you’ll notice that (1) I’m able to connect my sideburn completely, (2) my mustache is darker and has a more noticeable shadow, and (3) my beard has a lot less patchy weirdness to it.

I don’t necessarily apply this to all of my facial hair on a regular basis, but I did it here (apart from the parts of my face, like my cheeks, that I already shave regularly) just to give you an idea of what it would look like on each part of my face.

And it makes a lot more of a difference than you’d expect!

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The full effect, both sides! This is after a night out, so it lasts, I promise.

When I started doing this, a lot of people asked if I’d increased my testosterone dose, and no one was the wiser.

Not to mention, the misgendering really plummeted. All those “passing guides” that told me to go for the clean shave? They might’ve benefitted from knowing that this stuff exists.

But most importantly, I’m more comfortable. There’s this weird idea that using makeup to appear more masculine is somehow an unacceptable thing, but for me, it’s helped with my gender dysphoria and it’s changed the level of confidence I feel when I step out the door.

So before you shave your whole face in dismay, please know that this could be an option for you! Drag performers have been using mascara and brow pomade for ages, and it’s worth a try if having facial hair makes you feel more comfortable.

2. If you can’t find an LGBTQ+ therapist, you might be looking in the wrong place.

Real talk, having a therapist that’s in your own community makes a huge difference.

And you might be rolling your eyes and saying, “Well, OBVIOUSLY, Sam.” But I’m reiterating this point because I’m blown away by just how much of an impact this has had in my experiences with therapy.

Healing within your own community is a distinctly different thing from doing this kind of work with someone outside of it.

For the last year, I’ve been doing online therapy with a transgender and queer therapist. And that connection became even more important to me when, at the beginning of this year, one of my close friends (also transgender) died by suicide.

Having a therapist who knew what it was like to lose someone this way, and understood from a place of lived experience what queer grief is really like, became an invaluable part of healing for me.

I do know that therapy isn’t accessible to everyone, and it can be difficult to find a transgender or queer therapist on top of that.

But with the increasing accessibility of trans and queer therapists through online platforms like Talkspace (I wrote about this here), it’s worth investigating if you have the means. Some of these platforms even offer financial support, so click around and see what you can find!

3. Learning self-massage was the smartest thing I could’ve done for top surgery recovery.

Anyone who knows me can tell you that I am not athletic and am, by and large, a very sedentary person (which is a nice way of saying that I’m a couch potato). But when I discovered a local yoga class that used “therapy balls” to teach self-massage, I was uh, intrigued.

Because after top surgery, I was wound so tight that a massage sounded like exactly what I needed.

After top surgery, my body was kind of a mess — more than I’d really expected. A few months out, I still had very little range of motion. I had built up scar tissue and lumps and knots — especially on the sides of my chest, in my pecs, and between my shoulders — that I was convinced would be there forever.

Surgery is bodily trauma, you know? Even if it’s entirely wanted and amazing, we still have to heal after all is said and done.

So I started learning self-massage with therapy balls (my instructor uses the book “The Roll Model: A Step-by-Step Guide to Erase Pain, Improve Mobility, and Live Better in Your Body” by Jill Miller, but I’m sure there are others). My hope was that it would help me recover a little faster after surgery.

It definitely worked.

After a few weeks, I had regained full mobility and range of motion, including in my arms and shoulders. I am now even more flexible than I was prior to surgery. A lot of the built up tissue is entirely gone. The kicker? I’m only six months post-op at this point, and even my surgeon was amazed by how quickly I was able to recover.

A lot of people, as it turns out, use therapy balls and self-massage to manage chronic pain, as many of the exercises can be modified to suit virtually any body. Many of the techniques are exactly what a physical therapist would do with you in recovery — the only difference is that you’re using a tool to apply that pressure to yourself!

Google it, friends! Please! It’s something you can easily do at home, and while everyone’s body is different, finding ways to restore your range of motion after a major surgery is super important.

4. Binding your chest for a long time can affect top surgery results in some people.

Okay, I know, this should be common knowledge by now… but it definitely isn’t.

Apart from the documented (and expected) issues with binding — including pain, shortness of breath, overheating, that sort of thing — I actually didn’t know that binding could impact surgery results.

First of all, a disclaimer: Binding is critical and essential care for trans people, even with all risks taken into account. The relief it provided me from dysphoria isn’t something I would trade, even given all the nonsense I had to put up with during the years that I was binding and after.

But in the interest of transparency, I do want people to know that one of the lesser-discussed effects of binding your chest is the breakdown of breast tissue. Again, many of us know this, but we take on the attitude of, “Well, I’m getting top surgery later, so what does it matter?” (Hi, I thought that, too.)

But what I was surprised to find is that binding my chest impacted my top surgery results later on.

For those of us who go on to get a mastectomy, our tissue being broken down can affect our post-op results. Speaking for myself, as someone who opted to get nipple grafts, it became more difficult to construct them because that tissue was softer and broken down.

This means that some of us might notice that our nips look a little less distinct from the tissue surrounding them (in other words, they can wind up flatter than they might appear on cisgender men).

I am still thrilled with my top surgery results, but I think I would’ve opted for top surgery earlier had I known that the longer I was binding, the more that breakdown could affect the cosmetic results.

I was binding for about six years, so that obviously had a huge impact on the extent to which I experienced this. But it’s helpful to keep in mind if you’re trying to decide how long you should wait for surgery, or how often you should bind!

5. Testosterone exists in other forms besides injections.

I am realizing that not everyone knows this, so I’m including it on this list because I think it’s important. Time and time again, I hear trans folks saying, “I can’t start T because I don’t want to do the shots!” Lucky for you, there are options!

There are pills, though they can be kind of harsh for our bodies. More commonly, folks who are averse to giving themselves shots have the option of getting testosterone as a patch or in gel form.

I personally tried the patches and was allergic to the adhesive (fun times!). I have been using the gel for over two years now, and it’s terrific. It’s basically like hand sanitizer that’s a little thicker and has testosterone in it, and you rub it into your upper-arms and let it dry every day.

Super simple. No needles required!

6. Finasteride isn’t always safe — especially for trans folks with preexisting mental health conditions.

I talked about this quite a bit in this blog post, but it bears repeating. There has been some speculation that finasteride (otherwise known as proscar/propecia) can lead to suicidal thoughts in some people who take it, and some studies are showing that there are elevated risks of self-harm and depression when taking it.

It’s usually prescribed to slow down hair loss, which makes it a pretty common prescription amongst trans folks. But the reality is, its impact on trans people specifically hasn’t been studied much at all.

So, story time.

The only two times I’ve ever been psychiatrically hospitalized for suicidality came a few weeks after starting finasteride, with those episodes subsiding only after I discontinued it. I have never in my life experienced this level of depression and suicidality that I experienced while taking finasteride.

This is anecdotal, but there are many reports of others who experienced similar side effects that the World Health Organization is monitoring at this time.

Because all of these studies have only been done on cisgender men, we don’t actually know how it could impact transgender people, who are already more vulnerable to mental illness and suicidality.

All that said, what this means is that trans folks (or really, anyone) taking finasteride should proceed with a lot of caution! If you notice any increased depression or suicidal ideation, make sure you let your clinician know.

7. You can have gender dysphoria without realizing it.

I wrote about this at a pretty nauseating length in my open letter to truscum, but I’d like to highlight it a little bit here (and speak to, you know, the rest of us who aren’t transmedicalists), because I think it’s important information:

No one else saw me as ugly or ever said I was, but it was a feeling I couldn’t shake. I felt like, no matter what I did, nothing made that feeling go away.

I just thought it was a stupid teenager thing. Except that “stupid teenager thing” didn’t go away and I became a self-hating, uncomfortable, gross-feeling adult.

If you had met me when I came out in 2012, you would’ve said that there was no freaking way I was transgender. I knew I was miserable and I knew I hated how I looked, but “dysphoria” wasn’t a part of my vocabulary yet. While it had always been there on some level, I didn’t have any way to interpret what it meant.

And this isn’t an uncommon experience, trust me. Plenty of trans people come out and are still learning how to describe their experiences. For those folks, it’s sometimes much, much later on that they realize there was some dysphoria happening for them. Sometimes the label comes first — and that’s valid.

I didn’t grasp how severe it was for me until after surgery. Only when my dysphoria was considerably diminished did I understand just how heavy it was to begin with.

. . .

Some people also experience dysphoria only in the form of dissociation, or a state of unreality, numbness, or disconnection. They might not connect this to their gender at all, because it’s not an emotional state they can necessarily identify so quickly in the first place.

For trans people with other mental health challenges, trauma and mental illness might interfere with their understanding of their gender, and dysphoria becomes attributed to other causes (I also wrote about that here).

In other words, our brains work extra hard to try to protect us, which can make self-perception [of dysphoria] as a trans person a little wonky.

This is something that we, as a community, aren’t talking about nearly enough! Dysphoria is a very complex experience, and while we might not initially recognize it as such, there could be as many unique experiences of dysphoria as there are trans people.

So if you’re not sure that you’ve experienced dysphoria? That’s okay. Maybe you have and maybe you haven’t — or maybe you’ll understand it a little better with time. Your experiences are valid no matter what.

Transitioning is a learning experience, to be sure. Thankfully, it’s one that we can support each other through.

That’s why I love hearing from all of you in the community.

What are some things you wish you’d known sooner? What has been the most surprising part of transition for you?

Until next time,

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Yes, I have a ‘mental disorder.’ But it’s not being transgender.

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It seems like every other week, some conservative with a podcast and an ax to grind announces that being transgender is a mental disorder — despite having no credentials that would actually, I don’t know, make them qualified to diagnose someone.

And I’ll be honest — it’s frustrating to still hear this.

You don’t have to look very far to get the general medical consensus. The World Health Organization and American Psychiatric Association have both affirmed that being transgender is not, in fact, a mental illness.

And while “gender dysphoria” can be medically diagnosed, this is specifically done to access gender-affirming care — not because being transgender is in itself a disorder.

It’s true that some people really and truly don’t get it. There are some folks that use this kind of language because they don’t know how else to talk about the trans experience.

They don’t know exactly what a “mental disorder” is or what it’s like to be transgender. And they see that we’re suffering and dysphoric — so they don’t know how else to talk about it.

As someone who lives with obsessive-compulsive disorder (OCD) and also happens to be transgender, I can tell you upfront that there’s just no comparison.

Being transgender and having a psychiatric illness aren’t at all the same. Comparing them isn’t just an “apples to oranges” situation — metaphorically speaking, we’re not even in the same food group here.

And why is that? To start, let’s talk about what mental illness is.

The American Psychiatric Association defines mental illness as a health condition that impacts thinking, emotion, and/or behavior in a way that creates distress. More often than not, this leads to difficulty functioning in social, work, and/or family activities.

For people who aren’t transgender, they might look at this definition and come to the conclusion that trans people are mentally ill, because many of us do experience distress, and being transgender absolutely does impact how we think about ourselves and how we behave.

The problem is, it’s not being transgender that, in and of itself, creates distress and dysfunction. It’s the difficulty in trying to be who you are when the society around you is deeply hostile towards you.

It’s not my gender identity that’s caused me distress. It’s moving through the world as a trans person.

If anything, identifying this way has brought me enormous relief and made me a happier person overall.

I started to experience distress because of how others treated me. I was distressed when I experienced invalidation, harassment, and rejection. I was distressed when I was closeted, trying to be something that I wasn’t.

And my functioning was impacted when I couldn’t access care, like hormones and surgery.

When I wasn’t able to be who I was, and when I encountered violence and opposition because of it, that’s when I was distressed.

When someone is suffering as a result of how the outside world treats them, especially when they are part of a group that has historically been marginalized, that’s not a mental disorder.

The word you’re looking for there is “discrimination.”

The more “insane” thing to do would’ve been to keep pretending to be someone I wasn’t, which was a much more agonizing experience for me.

Figuring out my gender wasn’t a problem. In fact, it was a huge relief and it improved my life, so long as society did not interfere with my ability to transition. I’m far more mentally healthy now than I ever was prior to transition… by a long shot.

And that’s why I consider my experiences with obsessive-compulsive disorder and my transgender identity to be — categorically — two very different things.

It’s true that how society treats me because of my OCD, and a lack of accessibility to the therapies and medications I needed to thrive, were both contributing to my distress. Discrimination happens to people with mental illness, too, and it can have a profound impact on our lives.

But there’s a component to my distress that originates outside of that mistreatment.

OCD — and the neurobiology behind it — creates patterns of thought, emotions, and behaviors that are in themselves distressing, even under the very best circumstances.

Labeling those patterns as a disorder is the quickest way to say, “There are aspects of my biology and brain chemistry — mixed in with my environment and genetics and everything that makes me a human — that create specific and unpleasant mental/emotional experiences for me.”

Those patterns have been studied over the years, and they’ve been observed in many people who all respond similarly to particular solutions. The label exists to guide people like myself to the resources and solutions that will help reduce our suffering.

Many of these mental and emotional patterns associated with OCD feel at odds with who I am, and when I don’t work to mitigate their impact, my mental health worsens.

Being transgender, though, feels in alignment with who I am, and when I am able to freely explore and express this part of myself, my mental health improves.

The unpleasant experiences that stem from OCD aren’t reflective of who I understand myself to be; I feel more “myself” in the absence of those experiences.

As a transgender person, though, I feel more “myself” when I am able to embrace my gender identity. The more present I am in that experience, and the safer I feel in expressing that, the more whole I feel.

To call my transgender identity “disordered” implies that I need to minimize this part of my experience, but to be the very best (and healthiest) version of myself? I need the exact opposite.

The key differences here, then, are where that distress is coming from, and under what circumstances it improves.

Those two factors are where being transgender and being mentally ill diverge completely.

I don’t experience distress when I think about being a gender other than what I was assigned at birth, and I don’t experience distress from behaving accordingly. In fact, the more freely I am able to live my life in ways that align with my identity, the healthier I am.

But I do experience distress when I think, behave, and feel things as a result of the neurobiology we call “obsessive-compulsive disorder.” And the more I’m able to minimize and manage the impact of those thoughts, behaviors, and emotions, the healthier I become.

In that way, these are totally opposite scenarios.

When we diagnose someone, we’re essentially saying, “This pattern is present, but if it were less so, this person’s mental health would improve.”

So when you say that being transgender is a mental illness, you’re saying that suppressing or minimizing that identity would then lead to mental health.

But this simply isn’t the case. When trans people are able to be themselves and access gender-affirming care, their mental health outcomes are often better. This is especially true in situations where discrimination or violence is less likely, or in the case of youth, when they are supported by their families.

So by its very nature, being trans cannot be a mental illness — because invalidating and minimizing a trans person’s identity has not been proven to positively affect their wellbeing.

It’s the complete opposite.

If you were to classify being transgender as a mental illness, then, you would be making a recommendation to a clinician to treat us in a way that would not improve our health, which completely defeats the point of making any diagnosis in the first place.

But there are plenty of trans people who continually emphasize how much these attitudes harm us.

We don’t need transgender people to stop being trans, nor do we need to further stigmatize our identities and experiences. Gender diversity is not an illness — a society that is hostile towards it, though, is far more distressing.

If diagnoses are meant to help improve a person’s health, I’m still waiting to see any proof that labelling us mentally ill is actually improving our lives.

The sad reality is, many of the people who still insist that being transgender is a “disorder” don’t actually care about our mental health.

Because let’s be honest, if they did? They’d stop talking and do a much better job of listening.

People who are determined to label transgender people “mentally ill” — those who do so to rile people up on Twitter, not just because they haven’t thought about this much — do so because it’s a way of dehumanizing us.

It’s a way of suggesting that we are delusional and that we aren’t who we say we are. It implies that trans people need to be “cured” or “fixed,” and that we shouldn’t exist. To them, we’re mistakes that never should have happened.

That mentality is used to justify a lot of the emotional and physical violence that wounds and even kills us, and it perpetuates the hostility and self-hatred that drives so many of us to suicide.

But I want to be crystal clear about something: my being transgender was never a mistake.

My path hasn’t been an easy one in a lot of respects. But the strength and determination that I carry in my heart is part of a legacy — it comes from generations of transgender and gender nonconforming people, those who were willing to risk everything for a future they knew they might never see.

They stared down all of the dangers that came with that, showing up for each other and for a better world, so that one day, trans people like me could truly live. It’s a legacy that I now have the privilege of inheriting, and it’s one that I don’t take for granted.

For me, being transgender is an honor — and every single day, I step into my life knowing that from the moment I was born, I arrived with a purpose.

I want a future where every trans person can become who they are with every ounce of safety, love, and affirmation they deserve. And if that’s your definition of “crazy,” it sounds like I have my work cut out for me.

Challenge accepted.

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