LGBTQ/LGBTQIA/Mental Health/transgender

Medically Transitioning is Not a Walk in the Park. (Sometimes, it Actually Sucks.)

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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.

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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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Sam Dylan Finch is a writer and daydreamer leveraging the power of digital media to inspire hope and challenge stigma. He is a recognized and trusted voice within mental health and queer media, having reached millions of readers worldwide after his first of many viral articles back in 2014. Sam's career has spanned many roles, including work as a writer, editor, social media strategist, and content marketer for platforms like Alma, Healthline, Psych Central, Teen Vogue, Huffington Post, Oar Health, and countless others. You can learn more about him at his website, SamDylanFinch.com.

25 comments

  2. Ah, Sam, it never occurred to me that the combo of transitioning and mental illness (and, really, how many people who come to that decision haven’t already been whipped around to some large degree) would be such a rough ride, but now that you put it out there it totally makes sense. And, your concern for those without adequate resources and support is well founded. So, while I thank my ancestors that trans is not one of my personal issues, I thank you too for sharing and making this so clear. I’m wishing you that the hurricanes will subside and you can get on to a calm sea and a prosperous voyage. Re-blogging

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  4. I’m sorry for the pain you’re going through, and grateful for your generosity in sharing it. There is so much ignorance about the reality of hormones, not only among cis people but also in the trans community. Hormone therapy can greatly enhance quality of life, but like all medical interventions, it is not risk-free. We need to fight for more comprehensive education, research, insurance coverage, and trans healthcare that is inclusive of non-binary and neurodivergent people.

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  5. One of my teachers, Sarah Yehudit Schneider, teaches that only when we learn to hold paradox do we become whole people. You are in the process of learning to hold paradox. Neither is true and both are true. Learning to surf on that is the key to feeling the pain and not going crazy. Or going crazy and hanging on. As an ultradian cycler, I have to constantly remind myself that none of this is absolute, that there is always room to move. Yes, I get morbidly depressed, and often can’t see out of the hole I fall into. Fortunately my meds and my mutt have so far kept me out of the grave. But I really don’t know if I could throw testosterone on that fire and expect to live, nowadays. I took testosterone for a year, and cycled so badly I had to give it up. I really almost died. You’re right, the best things hurt, they take a lot of work and a great deal of faith that everything will come out right, a huge amount of determination. And of course we must have a sense of when to tread water, take a break, ask for help, or even change direction. I’m rooting for you, SDF.

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  6. Pingback: Medically Transitioning Is Not A Walk In The Park (Sometimes, It Actually Sucks). | drugssexpolitics

  7. I want you to know, No, I need you to know, how very important your words and stories are to so many. I run an LBGTQ nonprofit and we are just starting an Initiative to do outreach and support for trans folks. I am just beginning to hear stories like yours. I also know from personal experience how much hormones can alter your brain chemistry. I also know about depression, so this is so VERY important for people to hear. Many of the people I hear from also suffer from mental illness…again, so VERY important to hear your words. Thank you! And, I am so sorry that no one told you about hormones and their possible side effects. One more thing-I don’t read many blogs- mostly due to time contraints-but a trusted friend sent me yours and I now read regularly because your voice is so important. Again, thank you!

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  8. That was an important article. This was my fear before HRT. I’m autistic and have a rare tumour disease. I was super worried if I can take T. Even my therapist told me that it might let become my autism worse. Gladly nothing happened and I’m fine, but it could have come otherwise. All good for the future Sam. That you can stay on T and your mental illnesses get treated well. Stay strong!

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  10. Pingback: Testosterone: Panacea or Pandora? | Dawn to Don

  11. Reblogged this on life writ large and commented:
    So turns out I’m not alone in my experience at the intersection of being transgender on testosterone and living with mental illness. Transitioning is hard, regardless of your mental health background, and it’s important to be aware of the worst case scenarios as well as the dream stories.

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  12. Oh Sam, I’m so sorry. You are absolutely not alone. I also deal with bipolar and anxiety, and after being on hormones for about six months, I ended up back in the psych ward for the first time in almost two years. I’m pretty sure the hormones had something to do with it. It is a hell of a struggle to both simultaneously having hormones be both a curse and a blessing, and trying to hold both those understandings in your mind at one time.
    I’m so glad you wrote about this, because it does feel very lonely, and like you, I’ve absolutely felt like I’m the only one going through this mix of problems.
    You are a beautiful writer and a beautiful person Sam, and I’m very glad to have found your blog. There are so many parallels to my life that I’ve read, and while I feel for you for hurting, it’s also comforting to know that I’m not alone in travelling this path. I do hope that your swings calm down for you soon.
    Have a beautiful day sunshine, and take gentle care of yourself

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  13. Hello Sam,

    Thank you Sam for being so transparent about your struggles with mental illness while being on “T.”

    As a transman who’ve struggled with depression and bipolar issues I can truly understand.

    It may not be the hormones thats affecting your psychological health it just could be an underlying health concern such as your thyroid maybe not fuctioning as it should.

    I was living in a psychological nightmare until I was diagnosed with hypothyroidism (low thyroid function).

    So I began researching hypothyroidism and found that one of its most glaring symptoms is rapid cycling, depression … and the “medication” a synthetic thyroid hormone that was prescribed for me only excerbated my symptoms.

    Often time people with thyroid issues are misdiagnosed with a whole host of makadie including depression and bipolar, which has lead to them being “passed around” from one specialist to another including mental health professionals, and being placed on dangerous psych “meds”

    Please have your primary health provider do lab work to check your thyroid. And don’t let them just order the TSH (thyroid stimulating hormone) test alone. They MUST order the following Thyroid Function tests: TSH, FT3, FT4, T3, T4, rT3, anti-TPO, and anti-TG.

    To learn more about thyroid issues, there is a very comprehensive site ran by patients called; stopthethyroidmadness.com. It is a tremendous help to me.

    Please forgive me if I am being too forward. But because many people especially female-bodied people both transmen and women have been misdiagnosed by the patriarchal antiquated medical establishment. Hence, we end up paying the cost with entire our health or our lives.

    I am not a medical professional. I am someone who cares. When one of us hurts we all hurt.

    I hope this information will be of some help to you.

    Thank you for reading.

    HarloweRayne🌀

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      1. Unfornately they rely on only the TSH test alone, which is only a starting point. Please obtain copies of your last three lab reports. Doing so will enable you to establish a baseline and to see it there have been changes in your TSH levels. Sam there are other lab numbers which must be looked at; ACTH (pituitary gland hormone level) If you can find the time, once you’ve obtained your lab reports if your TSH levels is above 0.5 – 1.0 then your thyroid needs help. If your levels are not within range; and your hair has become like straw and is falling out, your skin is usually dry, etc … please check out stopthethyroidmadness.com

        I wish you the best in your healing.

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  14. Sam: I too had difficulty with testosterone treatment and chose to stop using it for periods of time. One of the misconceptions is that you have to be on HRT all the time, every day, in the exact same dose. This was not true for me. I was on a full dose of T for 3 months, then cut it to half the dose for 3 months, then 1/3 the dose for about a year. I also had periods where I went off it altogether for one to 3 months.

    There were many reasons why I chose to go off it, and then back on it again. First, like you, I am mentally divergent. I have Aspergers, and I found that testosterone made that much worse, especially in high doses. After a four month run on T, even at low doses, I would become completely non-responsive to my environment. I felt dull, shut down, emotionally and physically unresponsive. I lost any sense of focus or desire to do anything constructive. As soon as I went off the T for a week, I felt like myself again. I started making to-do lists and getting things done. I had normal responses to people, events, sensations, the world around me. I felt connected and tuned in. I could focus and get things done that were meaningful to me.

    Sometimes that connectedness meant pain, emotional and physical pain, but I would rather feel that pain than feel like a dull block of wood. When I was on T, I also had trouble with controlling rage, with emotional responses that seemed over-reactive. So I would either be non-responsive, or sometimes I would become completely unglued and totally lose it. Since I’ve been off T, I have a range of emotional responses that feel healthy and normal.

    Currently I am off T because it also made me gain huge amounts of weight. I gained 50 pounds in one year. I am getting ready for top surgery so I went off T to lose weight. I have been off T for four months and I lost 25 pounds with no effort whatsoever. It’s clear the T was making me gain weight. Once I have the surgery, I may choose to go back on T again, but at an even lower dose, .0.5 g per day. If I still have the effects that bothered me before (unresponsiveness, weight gain) I may go off it again.

    My goal for using T was to lower my voice, and I accomplished that. The first time I went off T (after 9 months, I went off it for four months), my voice went all the way back to where it was before I started T. That was a huge bummer. So I went back on the T at a lower dose, to lower my voice again. After another year on T at 1/3 the dose, I went off it again. I’m happy to say that after four months off T, my voice has stayed down where I wanted it.

    So you don’t have to be on HRT all the time, and you don’t have to be on the highest dose. Low-dose T does work for physical transitioning, it just takes longer. It’s your body and and it’s up to you. Do what feels right for you.

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  15. I’m schizoaffective bipolar type, and before getting stabilized was rapid cycling so I understand what you mean by switching so fast and it’s hard to get a handle on because before you know it, you’re on the other side.
    My mental illness started at 10 with a diagnosis of depression. At 15, I’m female, when I hit puberty they put me on constant birth control in hopes to regulate my hormones and stop my periods. I was “moody”. But didn’t get the bipolar diagnosis added till my early 20s. I’m now 33, I don’t identify as trans, but not quite female either. I guess I’m still trying to figure things out. This may be tmi but now taking the birth control medication regularly along with my many psych Meds I rarely get my period. My case manager suggested I see an endocrinologist because my sex drive is off and some other stuff that might be evident of hormones being off. Anyways. Being non-binary and mentally ill I have a little experience. And I have issues my psych Meds have brought but I don’t have the option to not take them.

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  19. Thanks so much for writing about this. Also trans and bipolar here, and I have been struggling with rapid cycling for the 5+ years since I started T. I just wanted to say that I totally understand what you’re going through, especially feeling like “the best thing that has ever happened to me is becoming my worst nightmare”…witnessing and feeling your pain.

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  21. Talked to someone about your chemistry who understands how it works, why it affects bipolar. She sounded optimistic that you might be able to balance better after hysterectomy-oophorectomy because of how estrogen-progesterone work to balance each other and ovaries sometimes respond to T by upping estrogen. It’s hard to live with either way. That’d also shut the door to biological fatherhood or make it a crazy risk.

    I sound ignorant, but tonight I’m fighting fibromyalgia and have only a half dose of my pain meds, which do as much for me as the right meds do for mental illness. I can’t remember something I understood completely five minutes ago, or the terms. Only that it sounded hopeful that getting surgery could reduce the problem. That was the gist of it. Good luck.

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  22. Pingback: What Being Institutionalized As A Trans Person Made Me Realize | Let's Queer Things Up!

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