What Being Institutionalized As A Trans Person Made Me Realize

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

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

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

“That’s not an option.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Transgender people with mental illness need and deserve better.

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A note on labels: Like many people with mental health struggles, I’ve experienced my fair share of misdiagnoses. Since writing this piece, I’ve finally been correctly diagnosed with obsessive-compulsive disorder and complex PTSD, which have been life-changing realizations for me. That said, I hope that the resources I created in the past can still be helpful. (Jan 2019)

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

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

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

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

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

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

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

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

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

In other words, the hormones are fucking me up.

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

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

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

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

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

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

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

But it did.

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

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

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

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

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

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

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

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

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

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

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

No. Absolutely not.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Transition. Is. Hard.

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

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

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

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

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

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

You and I? We’re in this together.

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A note on labels: Like many people with mental health struggles, I’ve experienced my fair share of misdiagnoses. Since writing this piece, I’ve finally been correctly diagnosed with obsessive-compulsive disorder and complex PTSD, which have been life-changing realizations for me. That said, I hope that the resources I created in the past can still be helpful. (Jan 2019)


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If I’m a Stranger Now, I Will Be a Stranger Forever (Reflections on Testosterone)

A cursive lettered tattoo that reads,

My favorite tattoo and my simplest one, too. A reminder.

I was at a poetry reading when an older butch woman sat down next to me and started to talk to me about her experiences in the lesbian communities of San Francisco.

Typical Bay Area. Queers chatting up queers. And for a little while, it was just an ordinary conversation for two gays in the Bay.

But then I looked at her. I mean, really looked at her. I saw the creases in the corners of her eyes, the years settling into her smile, her pixie cut graying.

“I wonder who I’ll be when I’m her age,” I innocently thought to myself. “I wonder how I’ll look…”

That’s when I panicked. I faked an important text message, pretending that some urgent situation had suddenly arisen. I picked up my things, said a hurried goodbye, and took a long, solitary walk on a hiking trail nearby.

It wasn’t getting older that scared me, per se, but the thought that I might spend the rest of my life being seen as a woman, as something I was not. It was the idea that I would be trapped in a body that felt alien to me well into old age, and with it, bearing a lifetime of misgendering, dysphoria, and invisibility.

I had a tendency to only think of my life in terms of the here and now – something of a survival skill I’d perfected after years of living with bipolar disorder.

But the thought that I would endure this kind of pain for life, the pain of being alien to oneself and misgendered by everyone else, made me realize that my transition wasn’t just about the here and now.

I could survive in this body today, but what about five years from now? Ten years from now? Twenty?

Could I really do that? When I reach the end of the line, counting down the days in my old age, when I look in the mirror, who do I want to see staring back at me?

And while I could nurse my wounds each time I heard “she,” and I could pick myself up when my dysphoria knocked me down, and I could swallow my pain and shelve it for a more convenient time, it finally occurred to me that it was not something I could keep doing for the rest of my life.

Today, maybe. Tomorrow, maybe. But all the tomorrows to come, all of the days I have left?

As adamant as I was about staying put, fear shackling me in place, I’d forgotten how the world still moves forward, with or without me.

And it was there in the woods, the smell of eucalyptus hanging in the air around me and my heart pounding through my bound chest, that I promised myself that I would put the gears into motion.

I promised myself I would get on testosterone.

/

Transition is not always simple, and not always certain.

Sometimes transition is guesswork – discarding what you are not to get closer and closer to what you are. Sometimes transition is not precise, just in the way that the beautiful pictures in our minds are never quite as beautiful when we manifest them on the page.

Being non-binary, neither a man nor a woman, is something like that. It’s knowing what I am not, and creating new spaces, new expressions, new ways of being to get closer to what I am.

I avoided testosterone for a long time. I thought, “Why should I have to choose? Can’t I just be?” It took years before I understood that not taking testosterone was just as much a choice.

There is risk in not acting. There is risk in staying the same.

Just because it isn’t precise, that doesn’t make the endeavor less worthwhile.

So I take another step. I throw another dart with the hopes it’ll strike near the target. I pick up the brush and let it kiss the canvas.

Gender has always been intangible. And when dealing with the intangible, we use what tools we have to articulate our truth – the closest approximation.

/

This September, I am starting testosterone.

I know, I know. I’m genderqueer. “If you’re not a man and you’re not a woman, what’s the difference?” they might ask. “Why do this?”

Because standing still and wishing away the pain will not douse the fire.

Because if I’m a stranger now, I will be a stranger forever.

Because all I can do is stumble my way through and hope that, on the other side of this, there is a reflection staring back that no longer scares me.

Because they will not bury me with breasts. Because they will not bury me under a false name like they did to Leelah. Because they will not mistake me for a woman at my funeral. Because they will not bury me in someone else’s body when I die.

Because of all the tomorrows that are coming.

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