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)