Back in the days just before I started testosterone, I used to say, “If HRT were to start causing problems with my bipolar disorder, there’s no question – I’d stop the hormones.”

I swore, over and over again, that I would never sacrifice my sanity for my transition. But this is not what I said in the psych ward, when the psychiatrist asked me, “Would you be willing to stop testosterone?”

Repeatedly, day after day, doctors would ask me about stopping HRT and my answer was the same every time.

“That’s not an option.”

My self of six months ago would have been aghast if he knew I was refusing to stop HRT despite being institutionalized.

But it wasn’t six months before. It was present day.

Present day, under a 5150 – wishing I weren’t alive, hearing voices that told me I was better off dead, and drinking more than my fair share to cope with both – the Sam that had hair on the back of his hands where there wasn’t any before, the Sam that was losing his curvy shape by the day, the Sam that looked in the mirror and felt whole for the first time, went against medical advice and insisted that they find another way to help him.

And I think that if you aren’t trans – and maybe even if you are – you might think that’s absolutely crazy.

But in my mind, I would’ve rather struggled to find medications that allowed my transness and bipolar to coexist than give up on my transition for the indefinite future, losing any hope of being in a body and inhabiting a self that felt right.

It would’ve been trading one kind of anguish for another. Which, to me, didn’t feel like a real solution at all.

For the cisgender medical providers around me though, they couldn’t wrap their heads around why I would refuse to stop HRT.

They couldn’t comprehend why I was willing to sit in an institution for however long it took to find a medication regimen that stabilized my bipolar disorder without denying me my transition.

And I say this not because I’m taking pride in being stubborn, but because cisgender people in general don’t know or understand the lengths trans people go to – the sacrifices we make, the trauma we endure – just to be who we are.

Cisgender people don’t understand that even in spaces that are supposed to be “safe,” trans people are subjected to harm that cis people will never endure.

I didn’t expect my hospitalization to be one in which my transness was understood, but I was blown away by just how little support there really was available to me.

If we aren’t suffering at the hands of someone else, we’re suffering the emotional trauma of being trans in a system that does not yet know how to affirm us, help us, or treat us.

In my case, there wasn’t a single doctor that could tell me if I would be allowed to continue on testosterone – because there’s simply not enough research around treating mentally ill trans people.

I had to sit in a psych ward, my mind eating itself alive, waiting helplessly to see if it was lithium that would win this fight or if I would be denied hormones because it was considered too risky to continue.

I had to wait, day after day, knowing that the hospital could take my hormones away at any time.

Thankfully, it was lithium that won out, this time.

But I quickly learned that even the best psychiatrists struggle to know what to do with transgender patients.

And when you’re locked in the psych ward, being treated like a medical mystery is not reassuring when your life and your transition are on the line.

This doesn’t even begin to capture the utter incompetence I experienced in the hospital, from staff members who did not know how to talk about trans people to the rampant misgendering despite my files clearly being marked “FEMALE TO MALE.”

I went there to heal but instead, panicked doctors and nurses encouraged me to stop HRT, they unapologetically misgendered me despite being repeatedly called on to do better, and a facility that assured me it was trans-competent turned out to be more invalidating of my gender than any mental health facility I’d ever been in before.

I was supposed to be a patient. But I was forced into the role of advocate and educator, at a time when I barely had the energy to care for myself, let alone teach an entire (rotating) staff how to treat transgender people.

In the San Francisco Bay Area, of all places, in a psych ward where suicide attempt survivors and suicidal trans people – of which there are many – will be going to receive care and begin their healing.

In a hotbed of insensitivity, cluelessness, and even violence.

It begs the question: For a community that is in dire need of mental health support, where do we go when we’re in crisis?

For me, I had no choice but to go to the ER when my breakdown happened. And I fear for other trans people who are similarly left without viable options, and are subjected to transphobia that wears them down during a time when they should be healing.

And I fear for the number of mentally ill trans folks that were denied hormones before they were ever given a chance to find an alternative.

I was released from the hospital yesterday, now very stable on both lithium and testosterone.

But I’m alarmed by the number of professionals that told me stopping HRT was my only solution, the amount of transphobic microaggressions I experienced in a hospital of all places, the number of battles I had to fight in a place I should’ve been cared for.

I’m outraged for my community, and the trauma they’ll endure in psychiatric facilities that are supposed to be for healing – not for harm.

There’s a glaring deficit in research, treatment, and care of transgender people, especially those with mental illness.

Until we acknowledge this, transgender people will continue to be failed by the mental health system – and will continue to end their lives instead of getting help. And facilities like the one where I stayed aren’t just responsible for doing better. They’re complicit in this epidemic of lost trans lives.

“Don’t transition” is not a solution. “Don’t be in crisis” is not a solution.

Transgender people with mental illness need and deserve better.


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)



  1. Sam. This may be one of the most important pieces you’ve ever written.

    I am so so so sorry that they did not do better. I am so sorry for the times that I have not done better. I am so happy you stuck it out and were successful in finding something to help that did not require you to compromise yourself. You are amazing.

    Liked by 2 people

  2. Sam, I’m so proud of you for fighting to stay true to yourself, even under the greatest adversities. You’re strong and you’re amazing and I’m so happy that you are continuing with HRT and you have medication that works. And much gratitude not only for your courage but also for writing about it. Hugs and much love.

    Liked by 1 person

  3. Reblogged this on drugssexpolitics and commented:
    I was saying to a friend today that I am completely disillusioned and wary of psychiatry as psychiatrists don’t know how to treat my mental illness and not my gender.

    In a world where being trans is still seen as pathology, I have been stuggling through mental illness alone and unsupported. I still think I’m safer as I am than experiencing the violence and ignorance that trying to access healthcare has exposed me to.

    It’s a pretty messed up world.

    Liked by 1 person

  4. Sam, on behalf of my former (i.e., retired from) profession, I apologize for how you, and without doubt, very many other trans folk are treated or, more properly, mistreated. Its true, I cannot but very vaguely and probably incorrectly at that, imagine how it feels to be trans and trapped in a wrong body. I’m some better at imagining what it is to have voices or deep pit black depression, after all, I’ve had nightmares. But that is no excuse for professionals actively involved in treating trans people in crisis to be so ignorant. Yes, much more research is needed. It is only going to happen if voices such as yours are raised to demand it and they are supported. Thank you, as always for sharing your story and insights. reblogging

    Liked by 1 person

  5. Thank you for writing this. It made me feel so much less alone in my situation. I’m a genderqueer who uses non-binary pronouns. I’m also receiving electroconvulsive therapy which requires me to be checked into an outpatient procedure ward to do. I’m constantly referred to as “she” and so is my trans partner who accompanies me there each appointment. I am in a severe depressive episode and just don’t have the strength to advocate and educate. Your post gives me strength. Maybe next time I’ll be able to speak up when they call me “she” and “lady” so that I can be treated with the respect and care I deserve.

    Liked by 1 person

  6. Whoa, I’m sorry you had to go through that. Hope the Vitamin L does the trick for your brain….I know I wouldn’t be alive if not for Vitamin L.

    In Judaism we say that everything has a purpose, and that opportunities often arise from adversity. Often we are shown something, up close and very personal, that needs to change. You were shown this.

    Believe it or not, there is a mechanism for change in the medical culture. For doctors it’s called a “rounds” or a “case conference,” maybe other terms now. For nurses there’s a “clinical ladder,” very useful because it’s a way for them to advance their careers.

    It’s not at all hard to organize these things. A few emails to administrators saying “I was a patient in your facility, I found that there was a knowledge gap about transgender people. This issue caused both me and the staff a good deal of confusion, and because of this I felt my care was compromised. Because there is clear evidence that trans people are at higher risk of suicide than the general population of people with mental illness, it’s imperative that psychiatric hospital staff be educated about transgender people and surrounding issues. I would be happy to help set up an educational program for both medical and nursing/ancillary staff about transgender, what it is, and what issues your staff are likely to encounter, and how to care for transgender people in a way that makes us feel safe and valued as people.” Sample email to the administrator.

    I know that you are agoraphobic, wish that wasn’t the case because I know you could knock ’em dead with your wonderful eloquence. If you yourself can’t appear in public, certainly there must be someone else in the trans community who could. In fact, this would be a great moment to spearhead a task force, which you could do by computer and phone.

    I really think that this is the only way real change is going to happen, and it would save lives. To have actual real trans people in a conference room answering questions that the psych staff are full of but can’t really ask patients….to talk to them face to face so they get to see that trans people are actually people and not freaks…this could be transformational, it would certainly increase the compassion quotient. Wish I was there, I’d organize ity for you in a flash. That used to be my job as a working medical administrator. So if this speaks to you, feel free to use me as a resource.

    Wishing you abundant good health in every way!


    Liked by 3 people

  7. Sam – I am glad you found a solution which allowed you to remain on HRT. A friend of mine was not as fortunate and I often wonder how things would be different had he encountered medical professionals who provided competent care.

    Liked by 1 person

  8. I haven’t been following you long, but in that time I’ve come to realize how strong you are. I can’t even imagine the struggle you’re dealing with. I’m cis, but I struggle with mental illness. I’m stable at the moment, but I haven’t always been, and I would do anything to remain in a healthy mindset. Even though, I’m cis, I understand how heavily identity affects mental health. I don’t understand how professionals could see your struggles and prioritize one over the other when they are so obviously and inexplicably intertwined.

    I’m glad you’re currently stable, and I’m so proud and thankful that you write about your struggles so others can understand. Also, I don’t know if you’ve ever had your tarot read, but I know that helped me immensely when I was struggling.

    I wish you the best of luck.

    Liked by 1 person

  9. Oh Sam. I am not trans and bipolar but I have a trans son & I have had two pschotic/manic episodes (and thus usually get labelled ‘bipolar’) so in some small and incomplete way I can start to fathom what this experience must have been like.
    And ‘agony’ is the word I come up with. Absolute agony. I am so grateful that a. you are so very strong that you are still with us and b. that even in recovery you have the gift of writing like an angel.
    Thankyou for sharing your gift. I think the others are right: this post may initiate some needed changes to mental health care in your area. But, you don’t need to do more: let those that work for & within this system make the right noises.
    Take care Sam. I think you’re amazing! xxx

    Liked by 1 person

  10. Thank you so much for posting this. So many of your posts have connected with me when i felt like no one shared my experience. I was searching for info on transition and mental illness and when your post came up I knew it would be significant. But this was heart-rending. I’m so sorry you had to go through that. You are a strong person to get through that experience while advocating for yourself and not giving in to the ignorant and harmful psychiatric system. No one should have to be in that position though.

    My own fear has always been that no one in the medical community would ever take me seriously as a trans person because I have a serious mental illness. You give me hope that I might be able to take more transition steps one day despite that.

    Liked by 1 person

  11. Hi Sam, I love your blog. I just found it yesterday, and I am a cisgender person who does not understand your struggles but is hearing them and learning about them. I am eternally grateful for people like you who write about what it’s like to be transgender, what it’s like to transition, and what it’s like to be on the receiving end of gender-related microagressions. It’s an experience completely foreign to me, and yet, as your Earthmate, I want to know more about it, so that I can can understand and de-stigmatize these issues and conversations where I can. I just wanted to say you’re a wonderful writer with a strong voice and a lot of courage. I’m happy to know you. I am sure you are inspiring many people. I wish you courage, my friend, through your troubles xoxoxo

    Liked by 1 person

  12. I can only wish that all mental facilities were more understanding and accepting of transgender individuals. I was Baker Acted, which is Florida’s version of a 5150, in December 2015 and despite trying my best to advocate for myself they did not respect my identity. The patients were actually more accepting than the staff was and that says a lot.
    Additionally, I met an agender individual during my stay who said that they just didn’t want to bother with trying to correct the staff, it was too exhausting.
    Later, when I was released, my therapist refused to write the HRT letter she promised me because of the hospitalization.
    It’s really unfair how medical professionals use our mental health as reason to keep transition from us or, in your case, to try to take it away. I’m very fed up with all of the gatekeeping by professionals in the community.

    Anyway, best of luck Sam and I’m glad you’re feeling better.

    Liked by 1 person

  13. Thank you for posting this. I am a trans man in Philadelphia and I have been hospitalized 8 times in a psych ward since 2012. I started T in 2008, so for me there was no discussion of stopping it, because I was already 4 years in at this point. But I totally get what you mean about having to become an advocate and an educator. The very first hospitalization I had was detox from alcohol and drugs. I hadn’t used in about 8 hours and had just arrived and was being taken to my room by one of the techs, who immediately asked me “What’s your birth name?” and “Are you going to have surgery down there?” I had a complete meltdown because I was so far gone out of my head I couldn’t rationalize what he said to me. Each hospitalization except for the last one in September because I raised the issue, they made me remove all my clothes, including underwear, for a “body check”. That was the most invalidating and embarrassing part of my stay. In September I said “I don’t want to take off my underwear” and the nurse actually said “I can’t believe they’ve made you do that, you’re not supposed to.”. Great. Anyways, thanks for writing this, it’s definitely something that needs to be shared within the medical community.

    Liked by 1 person

    1. Ugh, I am so sorry that you’ve been through this and I’m appreciative that you shared your experiences, too. Solidarity from me to you — I hope that our experiences can begin to push back on the status quo!


  14. This brought tears, of, many emotions, to my eyes. The strongest, being, your perseverance. May I send you love and a virtual hug? My first grandchild, who is now a transgender male( I hope that is the correct term..he’s educating me, but, tnt..I may forget..not intentionally) is my heart and soul. I raised him from a baby. I could never fathom not being supportive of his life choices and journey.

    Liked by 1 person

  15. Sam-
    I am also ftm and have bpII. I’m so glad to have come across your blog, because I’ve been feeling so isolated since my last hospital stay.
    I generally blog at
    My first hospital stay about a year ago, I was treated with nothing but transphobia. I got 3 more days for flipping my nametag because it was a huge trigger to see my birthname,, and for asking techs and nurses to be addressed respectfully with my name and male pronouns.
    I am, however, thankful to live in Philadelphia. Our Mazzoni Center is very respectful of me as a transperson with bipolar. Getting off T is not an option, and my psychiatrist gets that.

    It’s such an important part of ourselves as breathing and living beings. I hope you find medical folks who get that.

    Thanks again for sharing your story.

    Liked by 1 person

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