If you follow me basically anywhere on social media (like this Facebook, that Facebook, my Twitter, or my recent fave, Instagram), you probably already know that my mental health has been garbage recently.
You may have also figured this out when I wrote my last blog entry about my friends helping me through some pretty scary depressive episodes.
What I’m saying, y’all, is that it’s an established fact that the universe is giving me a lot of shit lately (and you know, I couldn’t resist the opportunity to plug my social media #shameless).
I’ve been running back and forth between doctors, all of whom want to know why, after about two years of relative stability on my medication regimen and a life that I am really content with, I would suddenly be rapid cycling and spiraling down so quickly.
If I haven’t been locked in my bathroom, pondering why in the hell I am still alive and how it’s possible to feel this depth of emotional pain, I’ve been hypomanic and convinced I am the singular most important being that has ever walked the earth.
If you’ve never rapid cycled before, take it from me: Neither of these states of mind are particularly fun, especially when they happen in rapid succession.
We thought it was fluctuations in my hormone levels, but after a shift in medications and a stable dose of testosterone, this is starting to seem less and less likely.
And now the doctors are wondering if testosterone is simply a trigger for my bipolar disorder, if it’s my sensitivity to hormones overall, or if it’s severe PMS that necessitates a hysterectomy.
In other words, the hormones are fucking me up.
And I want to talk about this because no one – and I mean no one – prepared me for what hormone replacement therapy can mean for a transgender person with mental illness.
Not just the mood swings that have been the equivalent of a hurricane raging through my life, but the realization that the best thing that has ever happened to me is becoming my worst nightmare.
I still don’t know how to hold space for these two coexisting realities.
Sometimes the very thing that brings you total affirmation and joy can also be the thing that drives you so close to the edge that you almost tumble right over it. Sometimes the very thing you cannot live without is also the thing that leaves you feeling like you can’t continue living.
This contradiction – that these hormones can be both life-giving and life-threatening – is impossibly hard to negotiate and is a testimony to just how complex this intersection of transness and mental illness can really be.
The emotional turmoil of knowing you cannot go back, and yet realizing that it is terrifying and even dangerous to move forward, is not an experience that I was ready for.
Somehow I thought that hormonally transitioning, even with my bipolar disorder and anxiety, could not devastate me the way that it has. I didn’t know that throwing testosterone into the mix could distort my mind so deeply.
But it did.
I didn’t realize hormones could seep into my psyche this way, rattling my brain in ways that I haven’t experienced in many years.
Some days it has felt like the universe is just punishing me for being transgender. Some days I have just blamed myself for all this, as if I had any other option than to start HRT.
This experience has been profoundly lonely, and with it, there have been a lot of emotions and contradictions that I still haven’t been able to process.
And I can’t help but wonder what happens for neurodivergent trans people who do not have competent care and are left struggling – either being given more psychiatric medications to no avail, or being advised to stop HRT altogether, neither of which are real solutions.
I wonder how many folks who occupy this intersection are rendered completely helpless, faced with impossible decisions about whether or not hormones are safe for them, whether or not it’s worth the risk, whether or not the options available to them (like hysterectomy) are even feasible.
I was supposed to increase my testosterone dosage today. I walked away from the clinic being told that it wasn’t yet safe to do so. Because it’s not – not now.
I would be lying if I said I wasn’t grieving that, even if I understand and know that this is the right thing to do.
I would be lying if I said I didn’t walk out of that clinic, turn to my partner and say, “I wish someone had told me this might have happened.”
I wish someone had said that HRT can make you lose your mind. Even if that’s not what we want to hear, sometimes it’s what we need to hear.
But I’m not saying that HRT is the wrong choice for trans folks with mental illness, or that we’re doomed.
If I had known the road would be this difficult, would I have chosen differently?
No. Absolutely not.
I’ve written extensively about all the joy that it’s brought into my life, joy I wouldn’t trade for anything.
Even on my worst days, being able to look in the mirror and see the self I was meant to be is indescribably beautiful. And I would rather endure this than never know what it was like to come home, to fill my own shoes, to be at peace with myself.
HRT was never a “choice.” It was, in many ways, inevitable. And it’s ridiculous to suggest that we should will ourselves to be content without it if it’s what we need.
But no one said testosterone would be this difficult. No one said it could set off a catastrophic episode. No one said that I should be ready for anything.
Nowhere in the literature or in the conversations did they say “psychiatric breakdown.” They said “mood swings, maybe, but it’s uncommon.”
The honest truth is that HRT can be the best decision we make for our mental health. But for a small but still important minority, it can be absolute hell before we get there.
As a part of that minority, I’m left mourning the revelatory experience I had hoped for and even, in the beginning, had. But it has been replaced with an ecstatic turmoil, conflicting emotions that seem impossible to navigate or negotiate.
I’m scrambling to find a space to just affirm that, yes, this is the best thing I’ve ever done and it’s also the hardest thing I’ve ever been through.
I’m left wondering if I’m the only person to fight with my own body like this.
I have to believe that I am not the only person whose body said, “What you need will save you and destroy you all at once.”
Here’s what I know for certain: Sometimes the most worthwhile things that we do will hurt. Sometimes they’ll hurt like hell. Sometimes they’ll sneak up on us when we are least prepared, when we aren’t ready, when we’ve just gotten comfortable.
I still believe that it is worth it just the same.
I also believe that there are trans people who struggle with their mental health and are afraid to get help. Afraid that it will simply “prove” that transitioning was a mistake, or lend legitimacy to the idea that trans people should be denied care, especially those of us with preexisting disorders.
I worry about those folks. I was almost one of them this week.
I’m recognizing that we need to create a larger conversation about the complexity of being a trans person with mental illness, especially when it comes to both accessing care (an astonishing number of us lie to our providers so that we won’t be denied hormones or surgery) and as we go through our transitions (during which there are countless triggers, biochemically and emotionally and socially).
Can we just pause for one fucking second and acknowledge that transition is HARD?
Like, y’all, can we take a minute and admit that transition, whether it’s medical or just social, is not always beautiful or magical?
Or that sometimes it is everything at once – sometimes it is both beautiful and awful, affirming and destroying, everything we needed and yet not at all what we hoped for?
Sometimes it’s just a mess of contradictions and that’s okay, too.
And that’s true for those of us with mental health struggles (which, hell, sometimes feels like it’s most of us, right?) but also true of those without.
Transition. Is. Hard.
So I’m writing this now to just hold some space for those of us who are so there, who are so done, so exhausted, so depleted.
Those of us who look in the mirror and say, “I’m happy with what I see but I’m not happy with how I feel.” Those of us who are fighting within themselves to know what the “right thing” to do is. Those of us who feel like there’s no easy choice.
I’m here for those of us who are tripping over obstacles we didn’t know would be there.
I’m pushing back against the reductive narrative that tells us that hormones solve everything, as if it is quick and easy and simple – the be-all and end-all – because while it may be true for some, it is far too simplistic to make room for everyone’s experiences.
And yes, at this messy intersection of queerness and mental illness, I’m here to say that sometimes shit is complicated.
I’m also here to say that we’re gonna get through it.
You and I? We’re in this together.
A note on labels: Like many people with mental health struggles, I’ve experienced my fair share of misdiagnoses. Since writing this piece, I’ve finally been correctly diagnosed with obsessive-compulsive disorder and complex PTSD, which have been life-changing realizations for me. That said, I hope that the resources I created in the past can still be helpful. (Jan 2019)
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