Tag: bipolar

When You’re Too Mentally Ill To Transition

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Nearly seven months ago, I made the decision to start testosterone as a part of my gender transition.

I remember feeling so overjoyed that this part of my journey was beginning. The torment of being in a body that caused me so much distress, and being misgendered left and right adding salt to my wounds, made HRT not just a desire of mine but a real necessity.

If you’d asked me where I’d be by now, my self of seven months ago would talk about how high my dose would be, all the changes that would be happening, my desired date for top surgery (would it be September? December?), and how I’d be so much closer to the body I needed to have – closer than I’d ever been.

But none of that is true. In fact, I’m almost exactly where I started.

I’m still here because my testosterone dosage is only half of a typical starting dose – extraordinarily low and nearly ineffective, because there’s not a single doctor willing to increase it.

I’m still here because I was denied the recommendation needed to move forward with top surgery.

I’m transgender and I’m trying to transition. But the door keeps getting slammed in my face again, and again, and again.

There’s not a lot of conversation happening around the specific challenges that transgender people with mental illness are facing. I first wrote about this when I discussed my experiences in a psychiatric hospital, where I was almost denied my hormones altogether.

As someone with bipolar and a whole assortment of other diagnoses, I continually come up against obstacles in my transition that I would not otherwise face if I were neurotypical. 

I’ve been told before to stop taking hormones. I still remain on a dosage that barely alters my body – because there are concerns about how the hormonal changes will affect my sanity, despite having no evidence that it will and knowing we could lower the dosage if it did.

Most recently, I was told that I couldn’t move forward with top surgery because I was in a mild depressive episode, and that we would have to wait a few months to revisit the possibility of surgery. Seeing as the waiting period for surgery can be anywhere from six months to 2 years, it’s unclear to me why we couldn’t address my depression while I was on the waiting list for surgery.

Transition can already feel like it takes centuries just to get an inch closer to where we need to be.

So imagine, then, that you are a transgender person with mental illness, who not only has to deal with the typical challenges of gender transition, but you must also navigate the exhausting barriers that therapists, psychiatrists, and doctors place in front of you.

Imagine having no idea when you’ll be permitted to access the care that you desperately need – that you’ll remain imprisoned in a dysphoria-induced hell until you pull it together and become acceptably sane for your doctors.

It’s true that transgender people with mental illness have needs that are unique and important, due to the biochemical nature of both medical transition and mental illness. And it’s true that making life-altering changes during times of turmoil can sometimes do more harm than good.

But it’s also true that countless mentally ill transgender people have been denied hormones or surgery to their own detriment, causing real and even lasting damage.

It’s true that the woeful lack of research around mentally ill transgender people means that many medical professionals simply don’t know how to support this vulnerable population.

And it’s absolutely true that being unable to transition can worsen a transgender person’s mental health – and clinicians who do not take this into account, treating medical transition as optional rather than urgent and necessary, are contributing to the very mental health crisis they wish to avoid.

As I sit here with the inability to go further in my medical transition – stuck in a desperate situation that continues to eat me alive every day – it is obvious to me that mentally ill transgender people are being failed at every level.

If our only “solution” is to not transition, we need new and better solutions.

Assuming my bipolar stabilizes further, there will most likely be a time – I don’t know, hopefully this year? – when I can move forward, after more than half a year of being held back.

And while I’m hopeful that I’ll be able to resume my transition, I remain paranoid and fearful that it can be taken away from me at any time.

If this is what it looks like to be a mentally ill transgender person in the San Francisco Bay Area, I’m terrified to know what it looks like elsewhere in the country, where care is even less accessible and trans-competent clinicians are few and far between.

We deserve better than this. If a medical intervention is what a person needs to be well, why would we ever treat it like it’s optional? How are our gender transitions any different?

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5 Reminders For Anyone Who’s Depressed

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I’m a little over two weeks into a depressive episode. According to my therapist, anyway. I’ve been a human slug, inching my way around my apartment, dramatically sighing and eating microwave meals and watching the dishes stack up in the sink.

You know the deal.

This, just two months after being hospitalized (can I just catch a break?). You’d think that all the intensive therapies, support groups, medication changes, and workbooks would have prevented this. But alas, here I am – sometimes depression manages to get a foot in the door despite your best efforts.

Sometimes when I’m entering into a depressive episode, I like to write down reminders that I want to hold onto as I go through it. They can be affirmations, reality checks, or words of wisdom.

Anything, really, to keep some perspective when I’m dealing with my episode. I try to write down the words I think I’ll need to hear as I struggle – because too often, we lose sight of the important stuff.

This time, I figured, why not share my list? And even better – encourage people to write their own.

Here are five of my own reminders to get us started.

1. Sometimes what’s best for us is the thing we resist the most.

I wrote about this recently in another article – how mental illness can encourage us to do the exact opposite of what we need to be doing. For example, my depression often urges me to stay in my apartment, even though going out into the world and socializing would actually boost my mood.

When you lack energy and motivation, and you don’t find the things you used to love as pleasurable as you once did, it can be damn near impossible to find a reason to do anything but curl up in bed.

Our instincts, clouded by the depression, often leave us opting for behaviors that are worsening our mood.

Some days, I am simply unable to move or participate in things. And that’s totally okay! It’s most important to be compassionate with ourselves and take care of ourselves.

But I’ve found that sometimes, telling myself to ignore my depressive instincts and do some self-care – even if it sounds unappealing, exhausting, or boring – really does help me.

You get to decide, ultimately, what’s feasible for you and what’s not. But it’s good to remind yourself that depression does not always have your best interest in mind.

2. Surviving depression involves being skeptical of 95% of your thoughts.

One of the best pieces of advice I’ve ever received was something like, “Not everything you think is true.” This is especially relevant advice when dealing with depression.

Too often we forget that depression doesn’t just impact how we feel, but it affects how we think.

Things like low self-esteem, pessimism, suicidal thoughts, catastrophizing, rumination, and harsh self-criticism are just a small slice of the impact that depression has on our thinking.

Which is to say, it’s important to approach our negative thinking with a certain amount of skepticism.

Some healthy questions worth asking yourself: (1) Have I always felt this way?, (2) How do I know, logically, that this is true?, (3) What advice would I give to a friend who struggled with this?, and (4) Could depression be impacting my feelings about this?

When I’m grappling with low self-esteem, for example, and I go down the shame spiral of feeling like I’m not worth anything to anyone, I can go through these questions.

No, I haven’t always felt this way. And logically, none of my friends have told me I’m not worth anything to them – quite the opposite. If my friend were struggling with this, I would encourage them to reach out to their friends and express how they’re feeling. And yes, it’s possible that depression is impacting this because I guess it’s neither permanent nor logical.

Sometimes the questions help, but sometimes I’m too depressed to think outside of my situation. Regardless, it’s one useful tool amongst many in my toolbox that I can call on any time, and it’s helped me to push back on a lot of the negative self-talk that is so typical of depression.

3. Asking for help is sometimes the most difficult but necessary thing we can do.

My recent breakdown required that I call on my friends and ask for their help despite desperately wanting to leave everyone out of it. And while in hindsight there’s a lot I would do differently, I can’t say for certain that I would be alive today if I hadn’t reached out.

Asking for help is really hard. I will never invalidate the very real fears that come with reaching out.

We’re afraid of the possible rejection we’ll face from others. We’re afraid of being burdens on the people we love. We’re afraid that we’ll push people away. We’re afraid of being ostracized by our communities. We’re afraid of being further stigmatized.

And sometimes, we’re just ashamed to say that we’re hurting. We don’t want others to see us when we’re vulnerable. We don’t want others to see us at our lowest. I can assure you that I know how that feels.

Reaching out when you’re struggling with a mental illness is complicated, and everyone’s situation is complex and different. I can’t tell you what the right road to recovery looks like for you.

But at the end of the day, I’d like to remind you of this: Your survival is critically important, your life holds value, and you deserve compassionate care that will help you through this struggle.

Often times, sadly, that care is only within reach when we ask for it. And often times, that care is not just optional – it’s necessary if we are going to survive.

As I navigate recovery, I’m grateful every single day that there were people in my life there to help me. I would’ve died a long time ago if they hadn’t been.

I don’t know your situation, but I will say that I hope you are able to find the support that you need – even if it’s scary to ask, your life and your happiness are worth it.

4. None of this is your fault. None of it.

Damn, this one is too real.

Sometimes when I’m depressed, I get caught in this loop of self-blame that seems never-ending. If I had done this differently, if I just pushed harder, if I had better coping skills, if I went to more groups, if I did this, or that, or this, or that… apparently depression would disappear by sheer effort alone.

That’s not how it works. Depression isn’t a matter of willpower. Deep down, I think most, if not all of us understand that.

…but this is kind of incredible, right? Because part of my profession is knowing stuff about mental health, so you’d think I’d get the message by now. But depression shows up, and suddenly everything I know about mental health goes out the window and I’m punishing myself for something beyond my control.

I would never go up to someone with mental illness and say, “You need to try harder.” But apparently I’ll tell myself that twenty times a day?

(See, this is what I mean about being skeptical of your thoughts.)

So here’s the reminder for that inevitable moment that I fall back into that unending loop: It’s. Not. Your. Fault.

If it were a matter of willpower, the depression would be gone by now. If you could do something more, you would’ve already been doing it. No one chooses their depression.

But if you’re looking to make life changes to address your depression, I do have some advice. Make changes in the name of self-care – not in the name of self-blame. Because yes, you deserve a lot of care right now and no, you don’t deserve the blame.

5. It is impossible to know what the future will look like.

When I’m deep in a depressive episode, I find myself saying – with complete and total conviction – that nothing will ever get better, that my future is empty, that I will always struggle, that there’s nothing worth living for.

(Pro-tip: Words like “nothing,” “never,” “always” – or any words that exist in an “all or nothing” framework – are really big red flags. Folks dealing with depression often think in absolutes, which can feed into the hopelessness that we’re already feeling.)

As someone who both struggles with mental illness AND regularly supports people who do, I see it time and time again.

We’re deeply depressed, and then we’ve convinced ourselves we already know what the future looks like – despite the reality that none of us could possibly know.

Remember that skepticism I talked about? We’ve got to utilize it here above all else. Because our feelings about the future can drive our depression.

It’s so important to remember that you can’t know what the last page of a book says if you’re only in the middle of the book.

It makes perfect sense that, when we’re depressed, we see the future as being hopeless. But it’s impossible in any given moment to predict the outcome of our lives, no matter how despondent and awful our present moment might be.

The future is always unknowable. I’ve learned this the hard way many times, when I made rash decisions to harm myself under the assumption that nothing would get better, and later regretted it as I discovered that the future was not as predictable as I thought.

To be clear, I’m not asking any depressed person to remain hopeful about a future that they can’t see. Hope is a feeling that depression often robs us of.

But I am asking depressed folks to consider not making decisions based on a future they’ve assumed will happen, and instead, try to deal with the present, one day at a time.

It is possible that things will not get better. None of us can know for sure. But it’s also possible that they will. And I sincerely believe that every one of us deserves the opportunity to find out – and the tools to make that future as bright as possible.

On the days when I am crumbling under the weight of depression, and the future seems utterly hopeless, I try to remind myself of the many times I counted myself out, only to discover that there was something in the future that was waiting for me – something I never saw coming.

This may sound cheesy, but I had people to meet, and places to travel to, and articles to write, and communities to be a part of. I couldn’t have imagined these things in my life, but now I can’t imagine my life without it.

If there’s only one reminder that you take from this list, it’s this: There is a life for you beyond depression. 

And I’d like to believe that there’s one for every one of us.

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6 Things Mental Health Recovery Has Taught Me

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When I say that I’m in recovery, I mean it. It’s basically my part-time job.

My recent psychiatric hospitalization flipped my entire world upside-down. When I saw the aftermath of my breakdown, I knew it was time to confront my bipolar disorder and make a real commitment to my wellness.

So I went all in, taking advantage of every resource available to me (which I recognize is not the same for everyone).

Three days of the week, I am in intensive outpatient, which consists of mindfulness exercises, meetings with psychiatrists and social workers, group therapy, and skill-building.

Additional hours are spent in support groups around mental illness and sobriety, workshops on triggers and crisis management, reading every book on bipolar disorder that has ever existed, journaling to reflect on what I’ve been learning, and meeting with other folks in crisis to do some co-supporting and processing.

I couldn’t guarantee that I would never have another episode. But I could do everything in my power to make sure that I was ready for whatever this disorder threw at me.

Recovery has taught me more than I could possibly compile in a single list. But I did want to share just a handful of the things I’ve been reflecting upon lately as I start to emerge from the other side of this crisis.

Here are six things I’ve learned as I navigated my recovery:

 

1. Ignoring your illness doesn’t make it go away.

I can’t restate this enough. I spent the last two years evading the reality of my illness, which ultimately meant that I missed all the red flags as a major episode approached.

You can pretend that your mental illness doesn’t exist, and you can put it on the back burner if you’d like. But you can’t outrun it – it will always catch back up to you.

 

2. You are not helpless in the face of mental illness.

This can seem completely counter to everything our illnesses are telling us, especially if we’re feeling particularly hopeless.

But it is absolutely untrue that there’s nothing we can do to manage our illnesses. There are countless forms of therapy (both in human form and in the form of very accessible workbooks), coping strategies, self-care, and mindfulness practices that can help.

We can track our moods and sleep patterns, we can find communities of support, we can become aware of and minimize our triggers.

This is not to say that we control our illnesses. But we can certainly mitigate the kind of control that our illnesses have over us, and become aware of the warning signs that we need to prevent acute episodes as they approach.

 

3. Plant your feet firmly on the ground, in the here and now.

You can run on the hamster wheel of the past, overanalyzing what you could and should have done. You can ruminate on the future, and how seemingly impossible and overwhelming it really is.

Or, as they often tell us in recovery, you can take it one day at a time.

One of the best pieces of advice I ever got was in a support group, when I was rambling about how much remorse I felt about the way I had handled my breakdown, and everything I should have done differently.

Suddenly, someone interrupted and said to me, “Sam, is this helpful?”

I paused, taken aback. It wasn’t helpful at all.

And I highly recommend, when you find yourself ruminating on the past or panicking about the future, that you ask yourself who it serves. If it’s not helpful, opt for some good ol’ self-care instead.

 

4. Grief is an absolutely valid (and expected!) part of recovery.

I remember telling a social worker that I was worried that I was getting depressed again. I was having frequent spells of sadness and rumination, and I thought it might be an indication that things were taking a turn.

She asked if it was possible that I was experiencing grief instead, gently suggesting that instead of trying to push my sadness away, I should let it be.

“You’re used to fighting sadness,” she said to me. “With bipolar disorder, sadness always meant an impending crisis. But you seem perfectly stable to me. Maybe it’s time to get acquainted with sadness, with grief, instead of pushing it away.”

Grief is an expected part of recovery, especially if you’re coming off of a crisis. There’s so much to grieve – the loss of trust in yourself or your reality, a deep sense of vulnerability or even mortality, the shattering of your own security or feelings of normalcy, and any trauma that was endured.

When you’re mentally ill, you may be conditioned to fear sadness and grief – but it’s okay to sit with those feelings instead of resisting them, knowing they are simply a part of the recovery process, and that they are, in fact, transient.

 

5. Returning to your “normal life” is overrated. Build something better instead.

For the first two weeks of recovery, all I wanted was my “old life” back. I wanted to go back to work, I wanted to finish outpatient and go on my big East Coast trip, I wanted everyone to act as if it hadn’t happened.

I was reading a book on bipolar disorder – it had an entire chapter on lifestyle changes – when I realized two things.

The first was that my “normal life” would never be the same, and that it wasn’t something I could return to.

But the second more important realization was that it wasn’t something I wanted to return to.

My recovery was now an opportunity to build a life that was better than the one I had before – with more mindfulness, more resilience, better coping strategies, a real commitment to sobriety, and better boundaries.

Instead of seeing recovery as the road back to “normal life,” I saw it as a chance to create something better for myself.

I think that has been an incredibly important realization for me.

 

6. You have never been in a better position to change your life.

When did I get so disgustingly optimistic? (Y’all, they put me on some really great medications…)

I know, I know. But listen, it’s true – there has never existed another moment in your life where you’ve had the same awareness, knowledge, and lived experience that you do now.

So really, in this moment, there has never been a better time for you to make a commitment to your own wellness and recovery.

Dive in. Read everything you can get your hands on. Watch as many videos on self-care and coping strategies as you possibly can. Get yourself a good shrink if you’re able to. Give yourself 90 days of sobriety. Seek out a support group, online or offline, and pour your heart out.

Check out your local community college and see what classes they offer; get in touch with your local NAMI chapter and see what resources are available to you. Study yourself, study your illness, delve into your history with complete conviction – study like it’s the last class before graduation and you need to ace the exam.

Recovery is not about going back to the way things were. Recovery is about shaping your life to resemble the way you want things to be.

And there’s never been a better moment to do that than the one we’re in, right now.

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I Had Everything I Wanted – And I Still Wanted To Die

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I’ve spent an hour, give or take, furiously pacing the floor of my apartment. They call this “psychomotor agitation,” though I don’t know it yet.

I feel like I can’t stand to be in my skin another second, like I’m completely wired and simultaneously the most depressed I’ve ever been. They call this a “mixed episode,” though I haven’t realized that yet.

My apartment is my sanctuary. I remember when I moved into the place – the joy I felt to be downtown, to be in the heart of things. It was full of 1920s charm. It felt surreal to be in a place so nice. I put a lot of thought into how I decorated the place, down to the candles and the twinkle lights and the succulents.

It was my safe place – was, up until that moment, when suddenly the train was coming off the rails.

I abruptly stop pacing. I know what I need to do.

I grab a pad of paper and a pen, and begin to write.

I’m sorry…

/

“But nothing was actually wrong,” I say quietly. “I wouldn’t have changed anything about my life – just how I felt.”

I’m in group therapy for the second time that day. We all sit in a circle, wearing pajamas and hospital gowns.

“Bipolar disorder doesn’t give a shit about my ‘perfect’ life,” I continue. “I had everything I wanted and I still wanted to die.”

My body trembles ever so slightly.

“It can be hard to accept that these illnesses are not always within our control,” the group facilitator says. “We can feel very vulnerable when we realize this.”

Vulnerable. Vulnerable doesn’t even begin to describe the fears that have overtaken me since my breakdown.

Was it really possible that, no matter how I arranged my life – no matter what the circumstances were and how meticulously I controlled them – I could lose my mind anyway?

I could have a career that I loved, a community of friends and partners that brought me joy, and yes, the charming little apartment, but as soon as the chemicals in my brain turned on me, all of these things were irrelevant at best.

“I thought building my perfect life could keep my illness away, could keep me safe,” I tell the group. I look down at my hospital band around my wrist, a painful reminder.

I was sorely mistaken.

/

I’ve gotten too drunk. Again.

This is a new habit of mine. I’ve taken to drinking in the middle of the day, drinking alone, which everyone tells me is a bad sign.

They all tell me to sober up, and I don’t listen. I don’t listen because it’s better to be drunk than to be restless, the kind of restlessness that feels like thousands of insects crawling underneath your skin.

I glance at my phone.

“We found your note, Sam,” a message reads.

The panic begins to settle in. No one was supposed to find it until after I jumped in front of the train.

“Just tell us where you are,” another message reads. “Please.”

“Almost everyone who has jumped off the Golden Gate Bridge and survived said they regretted it immediately,” someone else says.

I already know what that regret feels like.

Seven years ago, the closest I’ve ever come to death, I felt that regret after the seizure and before I blacked out.

And in that moment, the memory of that regret scares me.

/

The answer is horrifyingly simple: Lithium.

The answer is not an apartment, or a relationship, or my job – the answer is lithium, and three days into my hospitalization, the chaos in my mind begins to subside.

“How are you feeling?” the psychiatrist asks me.

“I’m getting better.”

“That’s good news,” he says. “What about the voices? Are you hearing any?”

“No,” I reply. “My head is a lot clearer now.”

I should be overjoyed that the tides are turning. But I am in shock – was this really all that it took? Was it really just brain chemicals?

I don’t know whether to be glad that the answer was so simple or fearful that it was beyond my control.

Or both.

/

In outpatient, I sit in a support group and listen to people talking about what led to their crisis.

“I lost my job.”
“I had a terrible accident and the recovery was difficult.”
“I lost my brother and mother within six months.”
“I was in a coma.”

It’s my turn.

“I was in denial about my mental illness.”

Denial, like when you ignore all the warning signs because you don’t believe you’re sick. Denial, like when you think that if you control every element of your life, it won’t affect you. Denial, like when you’re convinced that if you take your pills every day, you’re cured.

Or when you believe that if you have everything, you won’t break down.

But the truth is, you can have everything and still want to die.

Because mental illness doesn’t care about the life you’ve built. It’s only interested in what it can take away.

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To Anyone Who’s Ever Shamed a Teenager For Being ‘Attention Seeking’

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Content Notice: self-harm, suicide

The scars I have from cutting myself as a teenager have faded. If you looked at my body today, you would never know the hell that I put it through all those years ago.

But the wounds from people labeling me “attention-seeking” or “emo” or “dramatic” are still wide open, ten years later.

You could say that I have a bone to pick. And you would be correct.

When I was a teenager, all I understood about what I was going through was that I was depressed and detached from myself. Set adrift in my pain, I fell apart. I didn’t know why, let alone what resources were available to me or how to ask for help.

In a society which does not openly discuss mental health, it should come as no surprise that a fourteen-year-old kid didn’t know what to do when he was suicidal.

A decade later, I still don’t know what to do half the time. But I’m grateful to that teenager for doing what he needed to do to keep himself alive. I wouldn’t be here without him.

I can’t tell you the number of times that people saw me suffering – desperate, hopeless, lost – and, instead of validating my struggles, they wrote them off by saying, “He’s just looking for attention.”

I can’t tell you the number of times I hurt myself, only to hear someone say to me, “Quit being so dramatic.”

And to this day, I hear the word “emo” and a part of me cringes because I remember the way that word was used to completely invalidate my pain.

To set the record straight, if I was looking for attention, it’s because I needed it. If I was being dramatic, it’s because I couldn’t contain the depth of my own turbulent emotions. And if “emo” is just another word for mentally ill, then yes, I was certifiably insane but you were too busy laughing at my eyeliner to give a fuck.

Sure, I’m emo. I’m emotional. It’s called bipolar disorder, and maybe I would’ve gotten a diagnosis sooner if someone had paused to consider that maybe I wasn’t faking it.

Call me bitter, but I can’t help but wonder how my life would be different if someone had had the courage to intervene instead of the cowardice to mock me.

Yes, this one’s personal.

Yesterday – ten years after I heard the word “emo” for the first time, ten years after my so-called friend said I was pretending to be sad, ten years after a high school counselor told me my cuts weren’t deep enough – I needed help.

A depressive episode hit me so hard, I lost my balance and I hit rock-bottom. I wasn’t in my right mind.

But instead of asking my friends for support, I felt that gut instinct that’s been ingrained in me since I was a teenager – the one that tells me not to be a burden, not to be dramatic, not to bother anyone.

Suffice to say, I ended up drunk off my ass a block away from the train station contemplating thoughts I can’t let myself say out loud just yet.

Take it from a real-life “emo” kid: When you tell us that we’re just looking for attention, what you’re really saying is that we don’t deserve to be seen.

When you tell us that we’re faking it, what you’re really saying is that our pain doesn’t matter, that WE don’t matter.

When you tell us that we’re emo, as if it’s funny to you, what you’re really saying is that our suffering is a joke.

You tell us that we don’t need help. You tell us that we don’t deserve help.

And you create the kind of world where people who are struggling feel like they have no other option but to end their own lives.

You create the kind of world where people who have a mental illness won’t find out until ten years or more after the age of onset, if they’re ever diagnosed at all. That’s a statistical fucking reality and it’s the reality I’ve been living in for a long time.

You create the kind of world where young people learn to bottle up their emotions, to lie about their pain, and to go it alone until they wind up in hospital beds, on train tracks, on concrete, in graves.

And you know what? I’ll take an attention-seeking teenager over a dead one any day of the week.

I want teenagers to shout it from the rooftop. I want teenagers to write it all over the internet. I want teenagers to make their pain known in every damn way they can.

Because guess what? That’s how you survive.

And I don’t know about you, but I want a world in which teenagers who are struggling with their mental health can get attention if and when they need it. Because every one of us deserves to have our pain seen, validated, and affirmed. 

And if that makes me “dramatic”? So be it.

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

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If you follow me basically anywhere on social media (like this Facebook, that Facebook, my Twitter, or my recent fave, Instagram), you probably already know that my mental health has been garbage recently.

You may have also figured this out when I wrote my last blog entry about my friends helping me through some pretty scary depressive episodes.

What I’m saying, y’all, is that it’s an established fact that the universe is giving me a lot of shit lately (and you know, I couldn’t resist the opportunity to plug my social media #shameless).

I’ve been running back and forth between doctors, all of whom want to know why, after about two years of relative stability on my medication regimen and a life that I am really content with, I would suddenly be rapid cycling and spiraling down so quickly.

If I haven’t been locked in my bathroom, pondering why in the hell I am still alive and how it’s possible to feel this depth of emotional pain, I’ve been hypomanic and convinced I am the singular most important being that has ever walked the earth.

If you’ve never rapid cycled before, take it from me: Neither of these states of mind are particularly fun, especially when they happen in rapid succession.

We thought it was fluctuations in my hormone levels, but after a shift in medications and a stable dose of testosterone, this is starting to seem less and less likely.

And now the doctors are wondering if testosterone is simply a trigger for my bipolar disorder, if it’s my sensitivity to hormones overall, or if it’s severe PMS that necessitates a hysterectomy.

In other words, the hormones are fucking me up.

And I want to talk about this because no one – and I mean no one – prepared me for what hormone replacement therapy can mean for a transgender person with mental illness.

Not just the mood swings that have been the equivalent of a hurricane raging through my life, but the realization that the best thing that has ever happened to me is becoming my worst nightmare.

I still don’t know how to hold space for these two coexisting realities.

Sometimes the very thing that brings you total affirmation and joy can also be the thing that drives you so close to the edge that you almost tumble right over it. Sometimes the very thing you cannot live without is also the thing that leaves you feeling like you can’t continue living.

This contradiction – that these hormones can be both life-giving and life-threatening – is impossibly hard to negotiate and is a testimony to just how complex this intersection of transness and mental illness can really be.

The emotional turmoil of knowing you cannot go back, and yet realizing that it is terrifying and even dangerous to move forward, is not an experience that I was ready for.

Somehow I thought that hormonally transitioning, even with my bipolar disorder and anxiety, could not devastate me the way that it has. I didn’t know that throwing testosterone into the mix could distort my mind so deeply.

But it did.

I didn’t realize hormones could seep into my psyche this way, rattling my brain in ways that I haven’t experienced in many years.

Some days it has felt like the universe is just punishing me for being transgender. Some days I have just blamed myself for all this, as if I had any other option than to start HRT.

This experience has been profoundly lonely, and with it, there have been a lot of emotions and contradictions that I still haven’t been able to process.

And I can’t help but wonder what happens for neurodivergent trans people who do not have competent care and are left struggling – either being given more psychiatric medications to no avail, or being advised to stop HRT altogether, neither of which are real solutions.

I wonder how many folks who occupy this intersection are rendered completely helpless, faced with impossible decisions about whether or not hormones are safe for them, whether or not it’s worth the risk, whether or not the options available to them (like hysterectomy) are even feasible.

I was supposed to increase my testosterone dosage today. I walked away from the clinic being told that it wasn’t yet safe to do so. Because it’s not – not now.

I would be lying if I said I wasn’t grieving that, even if I understand and know that this is the right thing to do.

I would be lying if I said I didn’t walk out of that clinic, turn to my partner and say, “I wish someone had told me this might have happened.”

I wish someone had said that HRT can make you lose your mind. Even if that’s not what we want to hear, sometimes it’s what we need to hear.

But I’m not saying that HRT is the wrong choice for trans folks with mental illness, or that we’re doomed.

If I had known the road would be this difficult, would I have chosen differently?

No. Absolutely not.

I’ve written extensively about all the joy that it’s brought into my life, joy I wouldn’t trade for anything.

Even on my worst days, being able to look in the mirror and see the self I was meant to be is indescribably beautiful. And I would rather endure this than never know what it was like to come home, to fill my own shoes, to be at peace with myself.

HRT was never a “choice.” It was, in many ways, inevitable. And it’s ridiculous to suggest that we should will ourselves to be content without it if it’s what we need.

But no one said testosterone would be this difficult. No one said it could set off a catastrophic episode. No one said that I should be ready for anything.

Nowhere in the literature or in the conversations did they say “psychiatric breakdown.” They said “mood swings, maybe, but it’s uncommon.”

The honest truth is that HRT can be the best decision we make for our mental health. But for a small but still important minority, it can be absolute hell before we get there.

As a part of that minority, I’m left mourning the revelatory experience I had hoped for and even, in the beginning, had. But it has been replaced with an ecstatic turmoil, conflicting emotions that seem impossible to navigate or negotiate.

I’m scrambling to find a space to just affirm that, yes, this is the best thing I’ve ever done and it’s also the hardest thing I’ve ever been through.

I’m left wondering if I’m the only person to fight with my own body like this.

I have to believe that I am not the only person whose body said, “What you need will save you and destroy you all at once.”

Here’s what I know for certain: Sometimes the most worthwhile things that we do will hurt. Sometimes they’ll hurt like hell. Sometimes they’ll sneak up on us when we are least prepared, when we aren’t ready, when we’ve just gotten comfortable.

I still believe that it is worth it just the same.

I also believe that there are trans people who struggle with their mental health and are afraid to get help. Afraid that it will simply “prove” that transitioning was a mistake, or lend legitimacy to the idea that trans people should be denied care, especially those of us with preexisting disorders.

I worry about those folks. I was almost one of them this week.

I’m recognizing that we need to create a larger conversation about the complexity of being a trans person with mental illness, especially when it comes to both accessing care (an astonishing number of us lie to our providers so that we won’t be denied hormones or surgery) and as we go through our transitions (during which there are countless triggers, biochemically and emotionally and socially).

Can we just pause for one fucking second and acknowledge that transition is HARD?

Like, y’all, can we take a minute and admit that transition, whether it’s medical or just social, is not always beautiful or magical?

Or that sometimes it is everything at once – sometimes it is both beautiful and awful, affirming and destroying, everything we needed and yet not at all what we hoped for?

Sometimes it’s just a mess of contradictions and that’s okay, too.

And that’s true for those of us with mental health struggles (which, hell, sometimes feels like it’s most of us, right?) but also true of those without.

Transition. Is. Hard.

So I’m writing this now to just hold some space for those of us who are so there, who are so done, so exhausted, so depleted.

Those of us who look in the mirror and say, “I’m happy with what I see but I’m not happy with how I feel.” Those of us who are fighting within themselves to know what the “right thing” to do is. Those of us who feel like there’s no easy choice.

I’m here for those of us who are tripping over obstacles we didn’t know would be there.

I’m pushing back against the reductive narrative that tells us that hormones solve everything, as if it is quick and easy and simple – the be-all and end-all – because while it may be true for some, it is far too simplistic to make room for everyone’s experiences.

And yes, at this messy intersection of queerness and mental illness, I’m here to say that sometimes shit is complicated.

I’m also here to say that we’re gonna get through it.

You and I? We’re in this together.

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To The Friends That Knew I Couldn’t Do This ‘Mental Illness Thing’ Alone

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When I hear your footsteps approaching me in the dark, what you don’t know is that I’m quietly muttering under my breath, “Please, please don’t be angry.”

I hide the bite marks on my hand. I keep my face hidden under the hood of my coat. I try to will myself into disappearance.

I fucked everything up.

I’m bracing myself for impact.

I didn’t want to hurt anyone.

You don’t remind me what I should or shouldn’t have done. You don’t remark on the inconvenience of it all. You don’t tell me, through clenched teeth, that I should know better by now.

You both sit down next to me – someone asks me if I’m okay, someone else puts an arm around me. And while I don’t move or respond to that touch, it takes everything in me not to.

In that moment, I am afraid for you to know how much I need you.

/

When I was young, I tried to do it all by myself. I didn’t know who to talk to – so I talked to no one.

For the first two years, I sobbed into my pillow so no one could hear me at night. I left cuts and bruises where no one would see them. I ran off into cold, Michigan winters and laid in the snow until I couldn’t feel my body.

No one looked for me then.

There came a day when the weeping stopped. When it took so much energy to scream that I ceased making noise altogether.

I hid in my closet and pondered how many minutes I could cut off my own breathing without dying.

No one asked about me then.

I thought that I was protecting people. I thought that if they knew about the darkness, the darkness would trap them, too. I thought that I would rather endure the pain alone than inflict it on someone else.

I thought I was being benevolent.

I didn’t yet call it “dying.”

/

The first time I ever loved someone, ever trusted someone with the darkness, it swallowed him whole.

I still remember late at night, curled in a blanket on his couch, when suddenly shadows were falling out of the ceiling and crawling across the room.

In my paranoia, I was convinced that the shadows had come for me.

I was screaming, and seizing, and I couldn’t form words – and the next thing I know, my head is hitting the fireplace, someone is holding me down against my will, and I hear him yelling the numbers, “911.”

Those numbers will always be burned into my mind, a looming threat, a weapon to be wielded.

Six months later, dialed in, the phone waving in front of my face as I stutter, as I weep, standing in a cookie-cutter Midwestern suburb, begging, “Please, please don’t be angry.”

He says, “You shouldn’t have run away.”

I say, “I didn’t know what I was doing.”

He says, “If you don’t come with me, they’re going to take you away.”

In my desperation, I lunge at him, grabbing the phone and breaking it on the ground.

And I run.

Because all I knew to do back then was run.

/

You tell me that we’re going back to your apartment. I keep my eyes closed for the entire drive because if we’re going to the hospital, I don’t want to know until we’re there.

It wouldn’t be the first time that I woke up in a hospital parking lot.

The first time was after a film – a film which spoke candidly about suicide, which I later realized must have set me off – when I have a panic attack so bad that I think I am dying.

In the chaos of his screaming and mine, I start hitting my head on the car window.

I black out.

I wake up to someone shaking my shoulder. I try to make sense of where I am when I see the words “EMERGENCY ROOM” in bright lights. I start to scream again. He tells me he had no choice.

I don’t know what is happening, but I know that I’m not safe here.

I run out of the car and towards the street. He catches me, grabbing me by the shirt, telling me that I either go willingly or the police will find me.

911.

I tell him he doesn’t love me. I tell him he wants to ruin my life. I tell him that he’s not helping. I tell him that no one will believe him. His grip loosens on my shirt, his eyes softening.

He begins to cry.

I see my opportunity.

I don’t console him – I break free from his grasp, running into a lane of oncoming traffic, the sound of car horns and screeching tires piercing my eardrums.

/

We don’t go to the hospital.

Like you promised, we are back at the apartment.

When I step out of the car, I am stunned that no one has grabbed me or is forcing me in. No one is fighting me.

And I’m not running.

I was not tricked into an emergency room. I was not carried away in handcuffs. I was not screaming and neither were you.

No one is angry.

I am still hiding inside a jacket that is two sizes too big (maybe more). Someone asks me if I have everything I need to stay the night. And someone else puts an arm around me again, and an unexpected emotion overtakes me.

It’s hard enough to understand that I am allowed to walk up to that house on my own. It’s even harder to understand that someone is now holding me.

Why isn’t anyone angry? Why isn’t anyone yelling?

I want to cry but I’m afraid of being vulnerable. I’m afraid, still, that you’d know that I failed to take care of my shit, that I couldn’t do this by myself.

So I sit as still as possible and I desperately hope that my stillness doesn’t make it seem like I don’t want to be touched.

I do want to be touched.

I won’t tell you that.

I don’t remember what we talked about but I remember the calmness in everyone’s voices. I remember waiting for a lecture that I never received. I remember conversations about pop culture and I would expect nothing less from you both.

I remember laughing and how good it felt to laugh.

I remember being told, gently, that we would go to the crisis center the next day – I would be picked up in the morning, and my friends would be there, and my partner would be there, and I wouldn’t be alone.

There was no trickery.

And I remember being surprised that no one was trying to trick me.

/

Three years ago, my therapist asks me why my eyes well up so often but I never cry.

“I can’t cry,” I tell her.

“Why not?”

“It’s just not something that I do.”

She pauses, waiting for me to say more. In these pauses, I always tell myself that she’s doing it because she knows I’ll fill the empty space, and that I should stop obliging her.

Even when I tell myself not to, the silence between us is compelling.

I always oblige.

“I’m afraid that if I start crying, I’ll lose control.”

“Would that be so bad?”

I remember this conversation when you are both looking for food for me to eat in the kitchen.

I know that if I start crying, I won’t stop. I know that if I don’t stop, I’ll start screaming.

And I know that if I scream, you will know a part of me that only two people in this world have ever known – the part of me that is profoundly broken, the part of me that breaks hearts – and you will never see me the same way again.

One day, I will let my guard down and you will know what it’s like to hear something so painful come out of me that your heart collapses like a trapdoor.

But I am not ready to break your hearts.

Yet.

/

You let me sleep in your bed that night. You replace your ex’s water cup with mine, which strikes me in that moment as really meaningful. We watch television and I laugh at your running commentary, which is so perfect and makes me smile, even when I don’t want to.

Sometimes you touch my arm and I don’t have the words to tell you what it means to me when you do.

Just then, I am reminded of all the nights I spent alone as a teenager.

When I was too afraid to call anyone, when I was too afraid to tell the truth, when I was too afraid to break hearts.

I am reminded of how close I came to dying because I was never brave enough to say, “I need help.”

Tonight, I will not die. I will sleep next to you. I will wake up occasionally, look over at you, and feel relieved that you’re still there.

I will remember all the nights that I rejected the people I cared about, thinking I was some sort of protector, some sort of martyr. Thinking that these walls I built were so tremendous, that I had done the world a favor.

When I hear you breathing next to me in the middle of the night, I will wonder why I ever thought I was so noble for going it alone.

I wasn’t noble.

I was just scared.

/

“What happens if I’m hospitalized?”

“It will be okay.”

“And what about my parents?”

“They will be okay.”

Quietly:

“And me?”

“You will be okay.”

/

When I leave your house in the morning, you say – in your very particular way of saying things – that today is going to be an adventure.

I stop in my tracks, looking back at you.

“An adventure?” I repeat back.

When you tell me that everything will be okay, I believe you. I’m learning to believe in you.

Everything you said yesterday was true, too – when you promised that no one was plotting against me; when you promised I could take a nap and not wake up somewhere else; when you promised that if I told you where I was, we would make things right.

I don’t know what you mean by an adventure, but I believe you when you say it.

/

The psychologist at the crisis center has assessed my responses.

“Rapid cycling,” he says, “Brought on by the hormone fluctuations when you ran out of testosterone. It set off your bipolar disorder.”

I breathe a sigh of relief.

“You mention here,” he says, looking at the dozens of papers that I filled out, “That you were experiencing some bouts of suicidality.”

“Yes,” I say quietly.

“What kept you from acting on your impulses?”

I think about it for a moment.

“My friends.”

He pauses, in the way I guess all therapists do, in the way that makes me feel like I need to fill in the spaces.

But this time, I don’t fill the space.

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