An open letter to anyone else he’s hurt.

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

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.

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.

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.

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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This is what I wish people who identify as ‘truscum’ would try to understand.

This is an open letter to transmedicalists.

I’m being direct this time, because I don’t want to talk about you as if you are some faraway, distant other. I don’t think that helps anything. You’re real people, and no matter where we differ, I don’t want to forget your humanity.

I’ve talked in the past about harassment that I’d experienced years ago from trans folks who identify as “truscum” (so, for outsiders, transgender people who believe gender dysphoria and medical transition are necessary to identify as trans — otherwise known as transmedicalists).

Most recently, I took to Twitter to vent about it. And, not surprisingly, a lot of you weren’t super happy with me about it.

Your responses got me wondering if I could’ve done things a little differently. Because I’ll be honest — I don’t know that it ever occurred to me before then to speak to you directly.

I’m not going to pretend that I’m not angry or hurt. But I don’t hate you, as some of you suggested. I just really, really want you to stop hurting other trans people.

Based on your responses, though, I wonder if you even realize that you’re harming anyone. I think you’re caught up in some of your own pain, too, and that doesn’t make this conversation easy for anyone.

So I’m taking a deep breath and doing what I should’ve done in the first place — unpacking, very carefully, exactly what I’m struggling with. I’m going to explain as best I can why this “truscum” thing is upsetting for me as a trans person.

And I want to give you the benefit of the doubt, because even if you don’t see me as part of your community, I still believe that you’re part of mine.

Relentless optimist that I am, I like to think that someday trans folks might join hands around a campfire singing “Landslide” by Fleetwood Mac (I swear this song is a transgender anthem — just a personal, unrelated opinion of mine).

But I’d be pleased if we were just nicer to each other as a whole.

This is the longest blog I’ve ever written by far (sorry in advance). But if you’re wondering if I’m coming from a genuine place? Rest assured, I wouldn’t expend this much energy if I didn’t care about this very deeply.

If you’re rolling your eyes about how exhaustingly long it is, you can also bookmark it at any point and come back to it. It’ll still be here. And I’m breaking it up with headers, so hopefully it’ll be easy to find your place again.

So why am I even talking to you in the first place? That’s a valid question.

To understand why, you’ll need to know a little bit of my history.

The first thing you need to know is that I work in digital media. It’s important to mention this upfront, because it’s my public work as a transgender writer that got the attention of transmedicalists in the first place.

Back in 2015, I started receiving emails and tweets from self-identified “truscum” for a blog that I wrote about how much I hated the word “transtrender.”

I didn’t believe that the stance I took was especially controversial — but it drew a lot of attention to me as a trans person, and led to some targeted harassment, which continued for a while throughout my career.

The fact that I hadn’t yet medically transitioned led these folks to start asking invasive questions about my body. They were barging into unrelated conversations on social media to tell folks I was an imposter, contacting my followers with conspiracy theories about my transition (I’d made it all up apparently), and otherwise trying to discredit my work.

And of course, I was misgendered. Just to add a little salt to the wound, I guess.

The reality is, at that point, I’d never said I didn’t want to medically transition. It was that I couldn’t.

Initially, in 2014, I’d had issues with my insurance because I’d moved across the country. After that, it was my mental health status that led clinicians to deny me access to transition-related care (if you’re curious about how this nightmare happens, I interviewed other trans folks with similar experiences, and I wrote about it here).

So while this harassment campaign was happening, I was privately struggling with dysphoria that I could do literally nothing about. You’d hope that other trans people would see this as a rallying cry to demand better access to care. But these folks didn’t.

Instead, transmedicalists told me my lack of medical interventions made me invalid.

In a word? It was traumatic. I felt betrayed by my own community; I thought if anyone was going to understand my struggle, it would be other trans people.

It didn’t stop when I finally accessed hormones, either. Instead, transmedicalists had decided I was lying about that. When I posted a photo of me holding my testosterone gel, they suggested it wasn’t my prescription, and then they decided that because I hadn’t had surgery, I still couldn’t be believed either way.

Never mind the fact that I was desperately trying to access care the entire time.

These were my very first experiences with “truscum.”

I’ll be honest — never in my wildest dreams did I think that the folks harassing me would be other transgender people.

And it wasn’t just me, either. I watched this happen many times to others as well, including some of the advocates that I deeply respect and young trans folks who had only recently come out.

So I’ll just be upfront and say… you all didn’t exactly make the best first impression.

And I know, I know. You might be thinking, “But that wasn’t ME! I didn’t harass you! What has this got to do with me?”

I understand why the generalization might bug you.

But when you tell someone that they have the ability to determine who is and isn’t transgender, some people will use that mentality to justify some really abhorrent behavior. Whether you’re passively advocating for that or actively doing so, the ultimate result is that people then feel emboldened to play “gender police.”

They feel emboldened to decide who is and isn’t “trans enough.” And that means people get hurt.

That’s the crux of the issue for me. Regardless of what you’re intending, people are getting hurt.

And I have yet to see folks who identify as transmedicalists acknowledge that this is happening, and that there are valid concerns here.

If you’re still with me here — and if you are, I appreciate it — I want to explain to you exactly why transmedicalism as a concept is so troubling to me, with the hopes you can better understand the pain that I’m talking about.

Not because I want to lecture you or that I think you’re incapable of googling this. It’s just that I recognize it’s possible that folks just didn’t take the time to unpack it in a way you could hear it, and instead they became reactive in a way that felt dehumanizing to you.

So let’s establish my starting place (or bias, whatever) here: It’s true that I don’t believe the presence of dysphoria is necessary to identify as transgender.

I understand that from the get-go, that can touch a few nerves. But I want to explain why I think that’s an important place to start from, regardless of how it makes either of us feel.

I stand by those points in part because I don’t think dysphoria is a helpful measure in the first place — which I’ll explain in a moment.

I don’t say this because I don’t understand the knee-jerk reaction that can happen when someone says they haven’t been dysphoric. Because yeah, dysphoria is painful. It sucks. When I got my first rejection while trying to access top surgery, I began abusing alcohol to cope — it was not a fun time for me. The pain nearly killed me.

I know it’s hard to imagine someone as trans when they don’t understand that kind of pain, especially when it’s a pain you’ve known acutely for a very long time. I’m with you there.

I’ve reacted that way before, too. I’m human. Sometimes my first reaction to something isn’t always my kindest one.

In a perfect world, we would have some reliable indicator or litmus test for helping folks to figure out if they were trans or not — some singular measurement that erases all doubt. As a fan of simplicity myself, I get the appeal.

But the reality isn’t so simple — many trans people suppress those feelings of dysphoria, or they misinterpret them and struggle to connect them to their gender.

This can make it impossible to discern — especially as an outsider — if dysphoria is present. Requiring dysphoria to identify as transgender, for that reason alone, has way too much room for error.

A personal example: I’ve actually experienced some level of dysphoria for my entire life… I just didn’t know initially what it was.

I don’t want to do a deep dive into my history here, but suffice to say, the background that I came from made it very difficult to question my own gender safely.

So I experienced dysphoria, instead, as feeling profoundly self-hating and “ugly” (I wrote about this previously in this article, if you’re wondering). 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.

It was a kind of misery I was accustomed to, to the point where I was the fish in the bowl that couldn’t really see the water. You know what I mean? But now that I’m post-op, it’s like I’ve experienced a kind of joy and ease that I didn’t know was possible.

There’s also folks for whom their feelings of dysphoria progressively appear or worsen overtime.

I think of this as a kind of “hibernation.” People suppress all kinds of emotions, and dysphoric ones aren’t some magical exception. But as they start to experiment with language, and explore their identity and expression, those feelings start to surface. As the outside world begins to reject them, that can trigger those feelings they’ve managed to push down as well.

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 as a trans person a little wonky.

That’s what brains do with any kind of trauma. And this can show up as a total break from our own sense of dysphoric feelings, or misunderstanding the source or nature of those feelings. It’s more common than you’d think.

So when a trans person says they don’t experience dysphoria? It might be their truth at that particular stage in transition. But that doesn’t mean it always will be. Those feelings could surface in the future, become better understood and recognized overtime, or progressively appear as it becomes safer to process them.

But if we accuse trans folks of being imposters from the start, we might closet them before they ever figure any of that out.

So for me? One of the big problems with transmedicalism as a concept is its potential for “friendly fire.” When you use dysphoria as this “infallible” meter stick, you actually end up excluding a lot of trans people who are traumatized or vulnerable, and arguably most in need of support, especially if they’re emerging from denial or dissociation.

Transmedicalists are more likely to harm someone who is trans than successfully cast out an “imposter.” Because in actuality, more of us are traumatized than faking it.

When I first came out, I said that I didn’t want hormones and I wasn’t sure I wanted surgery. I am definitely the kind of “transtrender” that you would’ve rallied against (and, well, you did for a while).

Looking back, I have to laugh out loud. I can’t imagine not having medically transitioned.

With proper mental health care and, yes, incredible community support, I was able to get to a place where I could identify this resistance as a fear of rejection by society and my family especially. I was in deep denial because I was afraid of what would happen if I transitioned.

I didn’t want to lose my family. So instead, I lost myself. It took a long time (and a lot of support) to really come to terms with that.

That’s the thing, though: I needed space, support, time, and compassion to be able to figure out my path.

As of 2018, I’ve been on testosterone for a few years now, which drastically improved my life and my mental health. And I’ve had top surgery, which was the single best decision I’ve ever made. I am so much healthier and happier now.

But when you use a singular measure like dysphoria to decide if someone is worthy of those things, you run the risk of doing a lot of harm to folks who aren’t “faking” anything — folks like me who needed to process things before they could make the right choice.

And there are plenty of reasons why medical transition isn’t an easy decision, too.

Some people can’t access it for financial reasons or are denied access by clinicians. Some folks have chronic illnesses that would make medical transition risky or undesirable. Some folks might consider it safer to remain closeted. Some folks are in abusive environments where they can’t even begin to contemplate something like this.

And for some folks, right here and right now? They just don’t want to or aren’t ready to.

Maybe they’re questioning, maybe they’re afraid, maybe they’re overwhelmed, or maybe they’re just fucking tired. That could change and that may not… but it’s not up to us.

It’s not our business why and it’s definitely not our place to interrogate them, especially because we run the risk of doing serious harm for folks who might be going through some shit — shit that maybe they don’t even understand yet and can’t articulate.

You just. Never. Know.

It’s kind of like that quote, about how everyone is fighting their own battle. Even if it’s a battle you can’t see — because with trans folks especially, it’s the battles we can’t see that most often define our experiences.

So listen, I’ll give you this: Some disagreement over how we define “transgender” is bound to happen. It’s not the disagreement part that I necessarily take issue with.

It’s miraculous (and incredibly rare) that anyone agrees unanimously about anything. There are some people, for example, who don’t like Nutella, and that I will literally never understand. The difference here is that when someone tells me they don’t like Nutella, no one is actually being harmed in the process.

I acknowledge that there are going to be growing pains for our community, and I think this is part of that. These aren’t the first pains, and they won’t be the last. Historically, in every community ever, there have been divisions and disputes.

What I’m questioning here isn’t the definition of transgender. It’s what actually happens in the real world when we rely on your definition specifically.

Using dysphoria or medical transition as the way to define transness results in gatekeeping — and gatekeeping doesn’t work, because it’s too easy to get it wrong. And when we get it wrong? Trans people get hurt. Period.

The people who end up hurt most often (like, overwhelmingly so) aren’t actually faking anything and just wouldn’t benefit from doing so.

I was one of those trans people when transmedicalists harassed me in 2015. I was struggling to identify and understand my own dysphoria. I was being denied access to gender-affirming care by clinicians. I was struggling with PTSD and mental illness.

It was a battle you couldn’t see, and instead of offering empathy, I was harmed by folks who should’ve stood by me.

Are there trans people who haven’t experienced dysphoria and never, ever will? There could be.

Regardless of what you think, I’m not convinced that the existence of trans folks who don’t presently experience dysphoria is justification for disbelieving people who come out of the closet.

Those folks might want to access transition-related care in the future anyway, because it could make them happier or healthier. They might uncover that they have been dysphoric as they learn more and gain more hindsight.

Which means that either way you slice it, you can’t know for sure if someone is transgender or isn’t, even by your own definition — because people change and grow all the time.

Otherwise, I apparently wasn’t transgender in 2012 but I was in 2014. I wasn’t transgender when I was too traumatized to grasp it, but I was when I was able to access and process my emotions. Which… doesn’t make any sense.

Personally? I think gender identity is a diverse and complex thing — which to me is pretty exciting — but we might never agree there, I realize.

But you don’t have to understand their experience to respect their process.

Folks need to be able to explore their gender identity without hostility, because we simply don’t know their internal reality and we never will. The paradoxical reality is that the more fiercely you try to keep “outsiders” out of the trans community, the more likely you are to hurt trans people.

It’s not effective. It’s not helpful. It serves no other purpose than to hurt people.

So if someone says they’re transgender? You should believe them (or at least leave them alone, okay?), no matter how you choose to define “transgender” at the end of the day. The risk of driving a trans person deeper into the closet is simply too great.

It’s far more important to make sure that anyone who is questioning their gender has options and support, and that those options are protected no matter what, than trying to suss out who does or doesn’t “belong.”

So the moment they say “I’m transgender,” I congratulate them and I move on. What the hell do I know? That’s between them, their support network, their therapist, and whoever else they choose to involve.

Otherwise, there’s too good a chance that a transgender person who needs support will be denied it, just because of a misguided assumption about how they’re presenting in a particular moment.

We already get that from cis people constantly. Let’s not be like them, okay?

That’s why, when I define transgender as “identifying as a gender other than the one you were assigned at birth,” I do so with very intentional openness.

I want to be inclusive of folks who are questioning, and I want to give folks permission to evolve or change their minds, because that’s the only way to ensure that trans people can make the choices that are best for them.

The reality is, very few trans people emerge from the womb with an immediate and full understanding of their identity.

But people don’t make awesome choices when they’re being shouted at or put on the defense. Or in my case, harassed. Transitioning within a community that feels like a pressure cooker, demanding a particular kind of conformity, is never going to lead to the best possible outcomes.

And honestly? Asking trans people to put the horse before the cart — to know what they need and who they are before they can entertain a label — isn’t how a lot of folks actually operate.

The label is often what connects folks to more information, support, and self-discovery. It helps them uncover what they’ve suppressed and who they might become. So being possessive over the label actually winds up failing a lot of folks in the community, because they need the language before they can find a framework to operate from.

I want to say, too, that I understand it might be hard to let go of that impulse to judge.

When we identify with our struggles, it can feel insulting when someone who hasn’t struggled in the same exact way takes on a label that has so much meaning to us — a label that you feel you’ve earned, while others seem to just be sauntering right up and grabbing it.

Even so, I think we need to all agree — at the very, very least — that this is much more complicated than simply walking up to a label and dropping it into your identity shopping cart.

We’re talking about psychology, culture, language, trauma, biology, intimacy, sexuality, even spirituality — what aspect of the human experience is gender NOT touching on? And that’s ultimately why I think reductionist definitions fail us as a community.

Gender is messy and abstract. If it weren’t, we wouldn’t be debating it literally all the damn time. The very fact that we don’t agree on this is simply proof that this is a complex thing we’re dealing with here.

And for that reason alone, I recognize that we will probably never agree 100% on what it means to be transgender. But I don’t think we have to — we just need to agree on how to treat one another.

You know, with respect.

So what do we do, then? For me, I’m just trying to do the least amount of harm. I’m asking you to consider doing the same.

There are so many different paths that people take to arrive at an understanding of themselves.

But if we close the door too swiftly on people who aren’t exactly like us, we run the risk of shutting the door on someone who needs us — someone with whom we might share a lot more in common with than we’d expect.

Personally, I don’t think people choose to be trans in a world that isn’t terribly kind towards trans people. And even if they did put on some kind of weird act, I’ve accepted that I can never know that for sure, nor can I really do anything about it.

But I can be kind and gracious with the hopes that, wherever folks end up, they find the path that’s right for them. Extending that kindness to them doesn’t harm me in any way, shape, or form.

At the end of the day, it’s more important (to me, anyway) to create a community that allows trans folks to thrive. Gatekeeping doesn’t allow for that — it makes us suspicious of each other, callous, and combative.

If we want trans people to be able to come out, we have to make our community a safe enough place for them to do so.

When I came out in 2012, I had so many incredible trans folks to look to, and I owe so much of my happiness and health to them now. If I hadn’t had their support, I would still be closeted, if I’d even be alive today.

Every person deserves the chance to question their gender and explore it freely, without pressure, harassment, or gaslighting. This isn’t just a “be nice” issue — this is about the mental health and resilience of this community.

And I so badly want to believe that the majority of transmedicalists don’t actually approve of the harassment that folks like me have experienced, and don’t want to see what happened to me happen to anyone else.

I want to believe that if they knew the full story and really thought it through, they would’ve been there for me, as a trans person who knows how hard it is to be trans.

But the only way to guarantee that we aren’t caught in the snares of gatekeeping, and harming one another, is if we end this culture of interrogation altogether.

When in doubt, we need to do the kind thing instead, and let people live. You may not understand where they are in their journey right now, but they deserve the freedom and dignity to walk that path and see where it leads them. They deserve all the time and space they need to figure it out.

They may or may not continue on that path — but it’s not for us to decide.

I’ve given you all the benefit of the doubt here, because I believe every one of us deserves it.

Will you please extend the same to other folks in this community?

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People-pleasers can be drawn to toxic relationships. It’s important to know why.

I’ve learned in life that when you observe a pattern about yourself, it might be worth examining (okay, this is an understatement — I can pretty much guarantee you that you’ll come out wiser).

One of my big “aha” moments this year was around a relationship pattern that I hadn’t noticed before. I realized that I’m a people-pleaser.

Being liked by others, especially in my personal life, came at the expense of voicing my true feelings and needs. It was more important to be liked than it was to have relationships that felt honest and nourishing.

And it’s a lonely place to be — it can feel like no one knows your true feelings or self, and that you are secondary in relationships that should feel equal. Unsurprisingly, this can lead to a hell of a lot of resentment.

And thus… a pattern emerged.

My favorite kind of person to love was someone I had to chase — the kind of emotional inaccessibility that, in my mind, was a love I had to “work for.”

I didn’t like love if it felt easy. I didn’t like love if it was readily given to me. The love and affection that I valued the most came from people who were withholding, because my self-worth was defined by “earning” love, rather than feeling inherently worthy of it from the start.

Is this sounding familiar?

The flipside of this, of course, is that I was quick to avoid people who immediately cared for me, and who offered their love freely and readily. I was more likely to run from someone genuinely caring than I was from someone who treated me poorly.

I avoided the people who gave me the kind of love I wanted, because it scared me, and I was sure that I would disappoint them with time. I thought they must be mistaken — I hadn’t yet done anything “worthwhile,” and so I was reluctant to believe them when they told me that they cared. It didn’t feel deserved.

So instead, I threw myself at the people who were inconsistent or withdrawn, because I found their distance to be safer, more believable, and in some ways, more fulfilling. Each time they finally reciprocated, it felt like a special kind of reward, reserved especially for me.

But that pursuit of approval meant a lot of the relationships I invested in were also toxic by my own design.

I was more concerned with approval than honesty. I was quick to “mirror” — saying what I believed I “should” say, deferring to someone else’s opinion even if I didn’t share it, and avoided being disliked at all costs, even if the end result was being disingenuous.

I would rearrange myself for a person if it meant these distant, withholding people might love me back. I’ve done this all of my life — and at times, it’s made me pretty miserable.

I became someone I disliked a lot of the time, but for a while, it was easy to overlook this as long as I had some special person’s approval or praise. My opinion of myself didn’t matter as much as the opinions of other people — and the more emotionally unavailable and authoritative I perceived them as being, the more their opinions seemed to matter.

For years, I didn’t even consciously realize that I was doing this.

The unnerving thing is that people-pleasers, because they so often defer and try to appease, can often attract very controlling people.

This actually makes sense if you think about it.

Someone who always wants to “win” will obviously enjoy (and even exploit) the company of someone who always lets them.

People-pleasers are more than eager to offer someone whatever it is they want — praise, attention, investment — to feel valued, while controlling folks thrive from the safety they feel from being able to offer or revoke their affection at any time.

That, in turn, creates a power dynamic. The people-pleaser is trying endlessly to earn “love” to sustain the feeling of worthiness, while the controlling person decides whether or not to offer that to them in return.

They can withdraw their approval at any time. This means they can choose when to be pursued to regain a sense of control, simply by giving or withholding love. This can be used in manipulative ways.

And often times, neither party involved actually realizes what’s happening. They’re both just pursuing what makes them feel safe. The people-pleaser is pursuing approval, and the controller is seeking, well, control.

As it turns out, this is a documented phenomenon — psychologist Shirley Vandersteen actually writes about the pleaser/controller relationship archetype at length. If you’re a people-pleaser like me, it might sound more than a little familiar.

Reading this, I was pretty convinced that Vandersteen must’ve met all of the ex-boyfriends I’ve had since age fifteen. Yikes.

The thing that’s important to remember, as Vandersteen explains, is that both people-pleasing and controlling can come from family of origin trauma.

I would take that a step further, too. I know many queer and trans people who were so fearful of rejection, they took up people-pleasing as a survival strategy, simply to cope with that fear. This is especially true of queer femmes, who are already conditioned to appease and offer emotional labor in this unreciprocal way.

If you internalized any kind of homophobic or transphobic self-concept, you might’ve found yourself overcompensating in other ways. If the world wasn’t going to accept your identity, you might’ve strived to be acceptable or even perfect in any other capacity that you could be. This offers an illusion of self-protection (the logic here being something like, “if I’m ‘good enough,’ maybe they’ll still accept me”).

The problem is, if this mentality goes unchecked, you’re likely to chase after a kind of love that just isn’t healthy or sustainable because it’s all you really know to do. You’ll be reenacting that trauma indefinitely until you learn to interrupt it.

At least, I was. The only kind of love I knew how to pursue or accept was one in which love and investment was currency — a kind of currency I had to work for, a reward for proper or desirable behavior. But this meant that I was rarely honest about my feelings, my needs, or my desires.

People-pleasers wind up giving up their autonomy in the process, too.

The pursuit of being “good enough” means that the other person holds all the cards — making your self-worth, security, and support entirely reliant on how that person feels on any given day. It’s not reciprocal. And more than likely, it doesn’t feel so great, either.

Worse yet, it opens us up for a type of abuse that is very difficult to step away from. The second a carrot of affection is dangled in front of us, the approval can be alluring enough to get us back on the hamster wheel again, and again, and again, without recognizing the true toll that it takes.

Even if that means getting hurt or never receiving the kind of love we actually want in our lives, the chase sustains the illusion that we might someday have it if we just try hard enough. It’s a comforting thought, but this is rarely (if ever) the case, because the people we’re chasing after are often the least likely to give us the love we’re actually looking for.

Here’s my advice: If any of this rings true for you, it’s time to get honest about it.

At the beginning of this year, working with a trauma-informed therapist (who is just fabulous) meant that I took a long, hard look at the ways in which I approached love and intimacy. And if you couldn’t tell from what I’ve written here… I uncovered some shit. Some really alarming, scary shit.

There’s no magical step-by-step guide that will help every individual person with these tendencies (everyone’s journey is unique — especially when it comes to trauma).

But I can share from personal experience what’s helped me. I’ll even condense it into nice bullet points, just to get you started:

  • Seek out trauma-informed care. I’m a broken record here on this blog, but therapy can be, well, therapeutic. I’ve actually found online therapy to be incredible in this regard. I am less concerned about my therapist on the other end because of the distance between us — so I’m actually more honest. I wrote about my experiences with online therapy here, if you’re interested.
  • Read up about complex trauma, especially related to families of origin. Pete Walker has written at length on this subject. His book, Complex PTSD: From Surviving To Thriving is an incredible resource, and I consider it to be one of the most important books ever written on this subject. If you’re not sure if you are “traumatized enough,” I wrote about that in this advice column. Self-knowledge really is power.
  • Approach your relationships mindfully. Sometimes we become so concerned about how others feel, we lose all awareness around how a particular relationship makes us feel. If you suspect that you struggle with people-pleasing, pay particular attention to how you feel after your interactions with the people you’re close to. Spoiler alert: You shouldn’t feel worse.
  • Look for the signs. Red flags can include feeling like a relationship is one-sided, feeling powerless, or even controlled. You might feel lonely, as if you can never say “no” or voice how you truly feel. You may notice that you’re rarely the person making decisions, that you’re a doormat, or that you cave more easily than others. You might even feel resentful, as though you aren’t getting what you want but it’s too frightening to ask. Guilt and self-blame can be really common, too, because we often attribute a relationship’s failures to our own shortcomings.
  • Take it a day at a time. Practice saying “no.” Practice vocalizing what you want or need. Validate that it’s okay to say things like, “I disagree,” “I wish I could help, but I can’t,” and “this isn’t working for me.” Take note of those moments when you say something for someone else’s benefit or happiness rather than how you truly feel. And above all else, be compassionate with yourself.
  • Stop avoiding the people who are generous with their love — even when it’s scary and even if you feel you don’t deserve it. For me personally, the biggest change I had to make was investing more in the relationships with people who didn’t hesitate to offer love and encouragement to me. I stopped avoiding their texts. I took them up on their invitations. I kept reaching out, even when it scared me. My life continues to get better and better, simply by inviting these folks into my life.
  • Take accountability. Realize that your relationships can only grow if you choose to be authentic. Recognize the ways in which you might reinforce unhealthy dynamics when you aren’t honest about your feelings. Exempting abuse, we can rob a relationship of its full potential if we aren’t being accountable for how we show up.

People-pleasing is often a survival strategy, and an understandable one at that. Thankfully, it’s one we can learn to push back on.

I genuinely believe that just recognizing these patterns in our lives can help us break out of them. And while it can be a painful process, I can honestly say it’s one of the best things I’ve ever done for myself.

Each and every one of us deserves healthy, affirming, and reciprocal love. And if you haven’t heard this recently, I’d like to remind you that you’re already worthy, exactly as you are. Don’t let anyone — past or present — convince you otherwise.

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