Yes, I have a ‘mental disorder.’ But it’s not being transgender.

July 20, 20183 Comments

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.

July 14, 2018July 14, 20184 Comments

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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Transgender people shouldn’t have to lie about their mental health. But many do.

June 23, 20185 Comments

Until this last year, accessing top surgery was a losing battle for me. But it’s not because of where I live, my health insurance, or any of the other typical barriers you might imagine when trans people are looking for care.

It’s because I’m mentally ill.

I live with obsessive-compulsive disorder (OCD) and complex trauma; I’m also transgender. And I’ve found that, at this particular intersection, accessing the health care I need has been an uphill battle.

I’ve been denied care numerous times over the years, under the premise that I was too mentally ill to undergo a major surgery — ignoring that gender dysphoria, an acutely painful experience for many trans people, was contributing to my poor mental health.

It took two years to be placed on a waitlist for surgery, when a therapist finally decided that I was “stable” enough (without any explanation of what that actually means).

And it wasn’t just surgery that was made difficult. Psychiatrists in the past have encouraged me to stop taking testosterone, convinced it was making me “worse.” While hospitalized for depression, I had nurses trying to withhold my hormones because they didn’t feel it was “necessary.”

This last January, I finally got top surgery and I now have consistent access to hormone replacement therapy. But I still live in fear that, should my mental health decline again, I won’t have access to the gender-affirming care that has vastly improved my life and wellbeing.

Frustrated by my own experiences, I started reaching out to other trans people with mental illness to see if they’d encountered similar challenges — and I was horrified by what I found.

“A lot of doctors I saw questioned my ability to handle hormones as someone with a history of depression and self-harm,” Luke, a non-binary trans man in Ontario shared with me.

Could that history really justify someone being denied hormones altogether? I was wondering that, too. So I did a little research on the literature we have. And… it’s not exactly helpful, to say the least.

The World Professional Association for Transgender Health (WPATH) created their Standards of Care. The SOC are, more or less, the most recognized clinical guidelines for treating transgender patients. They advocate for an “informed consent” model: allowing for trans people, once fully informed of the risks and benefits of treatment, to choose for themselves the right path forward.

The standards also advocate for competent treatment of co-existing mental health conditions with the use of therapy and medications, where appropriate.

But if you look closer, you’ll find that they are limited in how they discuss treatment of mentally ill trans people. “Clients should be assessed for their ability to provide educated and informed consent for medical treatments,” it reads, without actually offering adequate guidelines for what this looks like in practice.

It also states that, before surgery is considered for someone with severe psychiatric disorders and impaired reality testing (so delusions or hallucinations, really), “an effort must be made to improve these conditions with psychotropic medications and/or psychotherapy before surgery is contemplated.”

This raises a really important question: How, exactly, do we measure “improvement” in mentally ill trans people?

And if there isn’t significant enough improvement, is a trans person simply in limbo, unable to access transition-related care?

Mentally ill trans people, then, are ultimately left to the whims of whatever mental health clinician they happen to be seeing — with very little recourse if they disagree with that clinician’s assessment of their readiness for care.

The SOC directly list conditions like psychosis, bipolar disorder, dissociative identity disorder, and borderline personality disorder as mental illnesses that could impact “readiness for surgery.”

But in a document of 120 pages, the SOC actually say very little on how, exactly, to assess at what point a mentally ill trans person might be “ready” to access surgery. Until this is made clearer, transgender people are put in an impossible position of deciding whether or not it’s safe to disclose their mental health status.

Interestingly, WPATH — and the overwhelming majority of care providers who work with transgender people — agrees that gender-affirming care is medically necessary. What’s puzzling is that, in almost any other context, mental health status would not preclude someone from medically-necessary care for any other condition.

Gender-affirming care somehow seems to be an exception, reinforcing the notion that trans-related care is “optional.”

The most direct mention of denying access to surgery in the Standards of Care reads, “No surgery should be performed while a patient is actively psychotic.”

This seems to be the only statement that a trans person can point to when they encounter obstacles, but given the other mentions of “readiness” and “improvement,” there are still too many ambiguities— and too many clinicians who aren’t at all familiar with the SOC to begin with.

Not to mention, none of this helps trans people with more severe mental health challenges who still need to access care.

It’s worth noting, too, that disorders like borderline personality disorder — which is flagged as a potential issue in the SOC — include an “unstable sense of self” as a diagnostic criteria, as well as difficulty trusting others and recurrent suicidality.

Coincidentally, these sound an awful lot like issues any trans person could struggle with simply because they are transgender.

In other words? Any trans person could be denied care if a clinician who’s unfamiliar with this population misdiagnoses them. In fact, at the time at which I was denied surgery, I myself was misdiagnosed as borderline. When that diagnosis no longer applied, I finally found myself on the waitlist.

While some boundaries surely need to exist, the utter lack of clarity in these guidelines means that trans people with any mental health struggle are at risk.

I spoke to Traci Lowenthal, a licensed psychologist that has worked closely with the transgender community. Most of the time, she shared, “mental illness should not be a barrier to getting necessary trans health care.”

The keyword here being, of course, “should.”

When assessing the readiness of a mentally ill trans person to pursue surgery, the most important factors, she says, are safety and the ability to consent.

So long as they can provide informed consent and keep themselves safe (the example she gives is proper hygiene and medication compliance post-surgery), there should be no barrier in accessing gender-affirming care.

“If a person has delusions,” she continued, “it would be ideal if their mental health provider could help them prepare for how those delusions may impact them while they receive medical care and during recovery.”

Compare this to my two-year battle to access surgery. It wasn’t because I was delusional — I was told, in essence, that I was too depressed to undergo surgery. There was no effort made to determine if surgery might improve that depression, and if there could be ways to better prepare for surgery in that state of mind.

The end result? Transgender people are scared to be honest about their mental health. And this has serious consequences.

I spoke with Ghost (a pseudonym), a trans person in Detroit, Michigan, who experiences schizoaffective disorder, delusions, and anxiety. For them, this has meant a constant fear of interference and mistrust in clinicians. “I am absolutely terrified that my mental health status will be used against me [in transitioning],” they explained.

“I’ve already experienced ‘the look’ from a medical professional,” they went on. “The one they use when you tell them [your mental health status], and they’re suddenly very skeptical of you.”

And with disorders like schizophrenia and borderline disorder especially, all of the trans folks I spoke to said they encountered disbelief when disclosing they were transgender, simply because they had one of these illnesses.

Some trans people have resorted to hiding their mental health history, or outright lying about their mental health status to providers. Others postponed psychiatric treatment altogether to ensure they could first transition without interference, which included forgoing psychotropic medications they desperately needed.

The unfortunate reality is, clinicians can’t adequately prepare someone for the specific challenges of medical transition if they don’t know about their client’s mental health status. And of course, when trans people have greater reluctance to seek out psychiatric care during their transition, they’re unlikely to get the support they need for the best possible outcome.

The fact that trans people should have to choose between gender-affirming care OR mental health care is unjust. Access to both is critical, especially for such a vulnerable population.

Trans people face an extraordinary risk for suicide — but if they fear disclosing their mental health struggles, they are likely to suffer in silence. This puts their lives in danger.

And when a trans person with mental illness is, indeed, denied access to care, the path forward is equally unclear.

Florence Ashley, transfeminine activist and LL.M. candidate at McGill University — with a special focus on bioethics and transgender health care policy — highlights just how much of a grey area this is.

Pointing again to the WPATH Standards of Care, she notes, “The only case that WPATH describes as precluding surgery is while the patient is ‘actively psychotic.’”

The rest, she agrees, is murky at best. “As with many issues faced by trans people, the best we can do is extrapolate from sources of law that have yet to be applied to the specific issue,” Ashley said, noting that a case might be made on the grounds of medical liability and professional ethics.

However, there appears to be no legal precedent for trans people specifically to look to when making such a case.

“This really ties back to a core problem in trans law,” she continues. “At some point, policymaking bodies will have to take up responsibility and pass enforceable policies and laws on trans-specific problems in collaboration with trans communities. Otherwise, we’re always going to be left behind.”

It’s evident, then, that more research and attention is needed to properly support trans people with mental health struggles. We need clearer guidelines, direct policies, and competent clinicians who are prepared to work with trans people regardless of mental health status.

For the transgender people who fear that they will not be able to access gender-affirming care, however, this offers very little comfort.

“I’m constantly worrying that someone will look more deeply into my history and see attempts, hospitalizations, a history of self-harm, and take it all away,” Tamsin, trans woman in Vancouver confessed.

While she finally has access to hormones, she fears it isn’t guaranteed. “[It will] cause me at least some anxiety for life.”

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I’m Transgender. But Trust Me, I’m Just As Surprised As You Are.

February 11, 201811 Comments

I’m glad that there are transgender people who knew who they were from the time they were very young. I’m just… not one of them.

As a kid, I honestly didn’t give much thought to gender. I did find myself confused from time to time as to why gender roles existed — in my mind, I didn’t perceive myself as being any different from my older brother, so there were moments when imposed expectations felt grating.

But gender wasn’t something I gave a lot of thought to. It didn’t feel especially present in my early life.

As someone who struggles with mental illness, my teen years were largely defined by my difficulties with complex trauma and obsessive-compulsive disorder. I didn’t have the luxury of contemplating who I really was. Gender seemed to be an avenue to desirability and outside approval. It was a role that I was cast for, rather than an identity I could consider. So I played the part, reluctantly. What else was I supposed to do?

My first conscious questioning of gender was when I was watching television as a freshman in college. I saw an androgynous person on television, and I remember thinking to myself, “That seems like it would be so much better… no expectations, just being.” It planted a seed for me. I didn’t know what “transgender” meant at that time. I just knew that I was drawn to this idea of gender ambiguity, for reasons I couldn’t quite place.

I remember going to my boyfriend at the time, telling him that I was thinking about cutting my hair off and maybe changing up the clothes I wore. This possibility excited me, but it repulsed him. “I don’t think I’d be attracted to you anymore,” he explained. “I think your femininity is what makes you attractive.” Fearful that I would be rejected by those close to me, I pushed my gender questioning to the very darkest corner of my mind.

I grew up very sheltered. My world was tiny, all things considered. And while some transgender folks know immediately and intuitively who they are, I spent many years living the life I was told I should be living. My way of coping with trauma and mental illness was to mirror the expectations people had of me, with the hopes of avoiding further harm. The more I could blend in, the more protected I felt.

In a world that deliberately pushes us into very restrictive gender roles, questioning those roles can feel deeply unsafe. A delayed timeline doesn’t make us impostors; it’s an expected consequence of living in such a cisnormative world.

It shouldn’t surprise us that so many people more readily repress their gender questioning before embracing it. For trans folks who already feel unsafe, we often can’t access the questions we need to in order to become who we’re meant to be. Many of us still lack possibility models, information, and safety, all of which can delay those important realizations that push us forward.

Repressing the desire to question or explore gender can be a very important and valid form of self-protection. That was definitely true for me.

My life ultimately changed when I met another transgender person in university. They were living the life that I had imagined when I first saw that androgynous character on television — they were completely gender-ambiguous, occupying an in-between space that I’d only pictured in my mind. I immediately felt drawn to them, and as I got to know them, I found the courage to begin exploring my own gender, too.

Family and friends that had known me for a long time were shocked. I didn’t really know what to say, other than to reply, “Hey, I’m surprised, too.”

Because in many ways, I was. With every step of my transition, I worried that I was making some kind of mistake. Shouldn’t I have realized this sooner? Could this really be a weird phase? Why now? Why this?

But with each change — clothes, pronouns, hormones, and most recently, surgery — I became a happier, more confident and self-assured person. The knots that had been in my stomach for as long as I could remember came undone; my social anxiety and agoraphobia started to melt away. I found an inner peace that I never knew was possible for myself.

I came alive. And… well, it really did surprise me.

And while I can look back at my history and see how this path makes sense (the video game characters I identified most strongly with are… pretty telling, honestly), that realization only comes in hindsight. While I never enthusiastically or even explicitly identified as a girl or woman, I didn’t exactly imagine an alternative until I was much older.

I’m not alone. In my time as a public figure in the community, I’ve found this to be a totally normal experience for many of the transgender folks that I’ve talked with.

I know plenty of trans people who are similarly surprised to be transgender. And why shouldn’t we be? Society tells us in a thousand different ways that trans people are rare oddities, terrible mistakes, or worse, simply don’t exist at all.

When I got surgery a couple weeks ago, I remember being wheeled into the operating room and thinking, “Am I seriously doing this?” I knew that this was what I needed, and yet I was still floored that this was something I had to endure. Yet when I woke up, the relief I felt was immediate and palpable. My first thought was, “Why didn’t I do this ten years ago?”

Being a particularly effeminate trans man, I think my process took much longer because society is so limited still in its understanding of gender. It took a lot to reconcile the fact that I could be especially feminine but still need transition and move through the world being perceived as a man.

Being seen as a feminine woman made me profoundly uncomfortable, and yet somehow, being seen as a queer, feminine man feels authentic and empowering. This is something I’ve simply learned about myself with time, kind of in the same way I’ve learned anything else about who I am. Trying new things, seeing what feels right, and going with my gut.

One thing I continually hear from loved ones of trans people is some iteration of, “I had no idea. Why didn’t I see it?” What these folks fail to realize is that, chances are, their transgender loved one didn’t necessarily see it right away, either.

Some of us take years, even decades to arrive at a safe place to explore our gender. I try to imagine telling teenage Sam that he was, in fact, a boy — and that he’d eventually transition medically to live his most authentic life — and it’s laughable to me. It would’ve been as foreign to me then as it was to most of my loved ones when I came out.

“Trans… gender?” I likely would’ve asked. “What the heck do you mean?”

I do wonder what my process would’ve looked like in a society that is more encouraging of questioning and exploring gender. I like to think that the realization would’ve happened for me much sooner, though I can’t know for sure.

For now, though, I find some comfort in creating space for trans people to be surprised. We absolutely deserve the space to be shocked, particularly in a society that often interrogates trans people’s identities before accepting them. Of course we’re surprised. When cis is presented as the only option, it can be shocking to realize we could be anything else.

Our genders are valid, even if our process has shocked us, confused us, or evaded us.

I’m transgender, and most days, it still surprises me. But being surprised doesn’t change who I am. In fact, it’s one of the best surprises my life has given me.

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In 2018, let’s stop pretending cis women are the only ones having periods. Seriously.

December 30, 2017December 30, 20179 Comments

Recently on Twitter I saw, yet again, claims being made that trans people who menstruate will eventually no longer have a menstrual cycle because of testosterone… and therefore, trans inclusivity when we’re talking about periods is a moot point.

Holy cisnormativity, batman.

This irks me. Because not only have I been on testosterone for two freakin’ years and am still #blessed with a monthly, but it’s also a wildly incorrect assumption that every trans person with a uterus is going to end up on testosterone in the first place.

There are transgender people who menstruate. Let me say it again to make sure we’re all on the same page here: THERE ARE TRANS PEOPLE WHO HAVE PERIODS.

And whether they identify as non-binary, as trans men, or anything else in the gender universe, one thing is clear to me: We need gender inclusivity when we’re talking about menstruation.

For me, that week or so of bleeding is when my gender dysphoria is at its peak. It is a continual reminder of body parts that are alien to me. It’s a reminder of all the barriers in front of me as I try to medically transition. I panic about being outed as trans whenever I get supplies at the drugstore. And not only that, but I am forced to directly interact with a part of my body that horrifies me — multiple times throughout the day.

Don’t get me wrong, periods suck for everyone. But when you’re transgender, it can be a particularly miserable experience.

So when the world is trying to tell you that this difficult thing you go through every month isn’t actually happening, it’s infuriating. It’s worse, too, when every product is stereotypically marketed to women, a continual reminder that you apparently don’t exist.

Spaces for cis women to commiserate about menstruation are valuable spaces that I have no interest in interfering with. But just the same, we could be doing so much better to make sure that trans folks aren’t erased in the process — and that there are products, spaces, and conversations that trans folks can have access to as well.

Where to begin? It starts with busting the myths.

No, testosterone doesn’t always stop someone’s period. No, not every trans person who has a menstrual cycle will opt for medical interventions that stop it. No, menstrual products are not “feminine hygiene” products. And for the love of all that is good, periods are not just a “woman’s issue” (and not all women have periods, either!).

Which means that when we’re talking about issues that affect people who menstruate, we need to be thoughtful about how we talk about it. People of any gender can have a period, because periods have to do with anatomy, not gender.

Is your mind blown yet? (Hopefully not, actually, it’d be cool if this were common knowledge by now.)

Beyond how we talk about it, we need to design products that are more inclusive. And it’s happening, slowly but surely!

One thing that has given me a lot of hope recently are the new products I’m seeing that actually are gender-inclusive. My favorite example of this, which yes, is totally worth the plug, is the Keela Cup.

It’s brilliant because it’s created with disabled folks in mind, and it’s founded by a disabled person who keeps the marketing gender neutral — a gal after my own heart, really. It’s a menstrual cup that has a pull string (why didn’t someone think of this sooner?!), so it’s more user-friendly for marginalized folks for whom traditional products just aren’t cutting it.

Its potential to decrease gender dysphoria because of the ease with which it could be used makes it personally appealing to me. But beyond that, smarts products like these matter for disabled folks, trans folks, and survivors of sexual violence — or really, anyone who struggles with their period and the demands it places on us.

For anyone who struggles to interact with their bodies during their period, especially in ways they might not be physically able to or find it triggering to do so, having products like these out in the world is seriously important.

The fact that it’s only now coming into existence means we have a long, long way to go.

If we keep pretending that menstruation is just a nondisabled cis woman’s experience, we’re going to keep getting commercials with ladies in long skirts twirling around like periods are one big funfest, and products that, frankly, suck for everyone and especially for marginalized people.

Trans people can have periods. And everyone, regardless of gender or ability, deserves access to conversations, products, and spaces that make that experience as painless as possible.

So in 2018? Let’s make a resolution to be more inclusive when we talk about periods, demand better for the folks who are often neglected in these conversations, and yes, applaud and back the folks who are working hard to create better products that serve us.

Because seriously, it’s about damn time.

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A note about the Kickstarter mentioned in this post: I wasn’t paid in any way to plug it; I just believe in boosting the signal on stuff that I think has immense value for the communities I write for! If you want to support Keela Cup, there’s no pressure to do so, but I hope you’ll check it out regardless. And as always, if there’s a project I should know about, feel free to tweet me!

I Thought I Was Ugly. I Didn’t Realize It Was Gender Dysphoria.

September 2, 2017September 15, 201715 Comments

For a long time, I couldn’t place why — I just felt ugly.

And not just in the insecure way, but in the something-is-so-wrong-but-I-can’t-place-what way.

No matter what I did, or how often my friends reassured me, nothing seemed to change the fact that something didn’t feel right when I looked in the mirror. And no one seemed to see it but me.

As someone assumed to be a girl, I figured that hating how I looked was a rite of passage. I could never articulate what I didn’t like, though. It wasn’t my nose, or my lips, or my teeth.

When people asked, I helplessly explained, “I don’t know, I’m just ugly.”

When I look at old pictures of myself, though, I start to understand. For one, it doesn’t even look like me.

It wasn’t that I was ugly, so much as I didn’t look like myself. But not even knowing what “transgender” meant, I didn’t have a point of reference to understand my feelings at the time.

It wasn’t that I was ugly by some objective measure, or even that someone had told me I was and the comment stayed with me. It was that I was dysphoric — the body I was in didn’t feel like mine, and I could only react to it with discomfort and, at times, disgust.

There’s this narrative around transness, that we all knew immediately that we were meant to transition, meant to live in a different body, that the gender we were assigned is not the gender we actually are. For many of us, however, that’s simply not our story.

For me, none of that occurred to me consciously for a long time. I just knew that I didn’t like how I looked — that I was deeply uncomfortable with myself — and at times I felt that very strongly. It took much longer to understand why.

Transitioning happened for me a little haphazardly, and maybe a little organically, too. I was drawn to short hair, and after cutting it, I felt euphoric in a way I couldn’t deny. I loved androgyny as a style, and after experimenting a little, started to find new ways to express myself. I followed my intuition, not entirely sure where it would lead me, trying not to overthink what it said about me or my gender.

And then I noticed something: The further I moved away from the gendered expectations that came with being perceived as a woman, the happier I felt.

Ugliness is such a profound, raw, and vulnerable emotional experience for some trans people. For me, it was the driving force in my transition.

“Ugly” was the only word I had to describe my dysphoria, which meant it flew under the radar for a long time.

It didn’t raise any alarms for the people around me. It just confirmed the sexist notion that women are supposed to be insecure, and therefore my discontent was an acceptable, albeit sad experience that came with the territory of my assigned gender.

But something intuitively pushed me forward. Part of that was finally meeting other transgender and non-binary people, who gave me the language I didn’t have, and filled in the gaps of knowledge I desperately needed.

I became acquainted with the feeling of gender euphoria — the sense of affirmation and even joy that comes with being “seen” as the gender you truly identify with. For me, I had waves of euphoria as I started hearing my new name, my new pronouns, and my new reflection staring back at me, being shaped before my eyes by testosterone.

Dysphoria is a complicated experience, and I think it’s very misunderstood, even by some folks in the trans community.

It’s not like I looked down at my body and saw a vision laid before me, immediately understanding that I wasn’t a girl. It was, more often than that, the sense of lingering discomfort, confusion, and profound emotional rejection that unsettled me, often on a deeply unconscious level.

Dysphoria, for me, has always been the battle between my conscious desire to take the easiest and safest route in life — one that cis people repeatedly told me would be living as a cis woman — and my unconscious and, at times, desperate need to transform my body so that I could live authentically and comfortably.

At first, it was easy to reject my dysphoria as feeling “ugly” and nothing more, because it felt safer to consider myself a cisgender person who felt ugly, rather than stepping into my life as a transgender person, considering the many risks and struggles that came with it.

Dysphoria never provided me an answer or a clear path forward, as it sometimes does for other trans people. For me, it created a problem, and it was one that I didn’t initially know how to solve.

But as it turns out, transition was the right thing for me, even if it took years to understand that.

The profound anxiety that I had when I looked at myself has been replaced with a kind of joy — a joy I’d never had before transition, in which I can see myself and not only do I look good, but it looks right.

My friend Jes Baker, a fat activist and incredible blogger/human, said to me before that a lot of our unhappiness with our bodies happens when we look at the mirror expecting to see someone else (paraphrasing, but you get the idea).

In some cases, coming to terms with our bodies as they are can be our greatest act of self-love. There’s abundant messaging in this world that tells us to reject our bodies, and unlearning that shit takes time. But for others, change is how we make peace with our reflection.

I think it all begins with the question, “Who am I expecting to see looking back at me?”

Every day, I think the person I was waiting for is finally coming back to me. And I can’t even begin to describe how beautiful that feels.

"IMG_0866.JPG" by Aimee Ardell is licensed under CC BY 2.0.

5 Totally Normal Questions Transgender People May Be Afraid to Ask, Answered

August 13, 201715 Comments

One of my favorite concepts that I’ve encountered as an activist is the idea of “holding space.”

To break it down further, “holding space” is about making room for certain experiences, feelings, or perspectives to be acknowledged and affirmed that may otherwise be pushed aside or invalidated.

Holding space can be powerful. I’m a big believer in giving people the space to open up – and in doing so, building greater understandings of where someone is coming from. A little affirmation can go a long way in making someone feel whole.

And one thing that I’ve noticed as a transgender person is that people hold very little space for us.

Society at large has a very particular idea of what the trans experience is – and it doesn’t give us room to have honest, real conversations about what we’re going through, especially when it contradicts this narrative.

This leads us to struggling internally with some big questions that we’re afraid to ask – because in asking them, we’re fearful that it undermines our identity or will lead others to question our authenticity.

So today, I want to hold a lot of space for the complicated feelings that sometimes arise when we’re coming to accept ourselves as transgender.

Because what we’re told is that we’re born with a crystal-clear understanding of our gender, embark on binary medical transition, and achieve ultimate happiness and certainty. Right? But what I know from experience is that, for many of us, it’s much more complex than that.

So let’s talk – and I mean really talk – about some of the questions many transgender people are thinking about, but might be afraid to ask. And together, let’s hold space for all of the complicated feelings that arise as we explore them.

1. Am I Really Trans? What If I’m Making This Up?

Confession: I ask myself this a lot.

“Wait, Sam,” you might be saying. “You write publicly about your identity! You’re active in the community! You’re even taking hormones! And you mean to tell me that you’re unsure if you’re trans?”

Yes, that’s precisely what I’m saying.

In fact, I can assure you from firsthand experience that many, many transgender people grapple with this question – even years into their transition.

And I have some theories as to why, too – if it helps.

If someone told you your whole life that you were a terrible dancer and suddenly you received a first prize trophy for a dance competition, you’d probably feel like an imposter, right? Similarly, when society tells us we’re cisgender (and that being cis is the only option), it can take years and years before we feel secure in ourselves as trans.

Not only that, but trans people are often called into question for not being “trans enough,” are accused of “faking it” for dubious reasons, and are met with disbelief when we first come out.

There’s this culture of interrogation around transness – namely, that trans people have to prove that they’re trans (to get respect, to get healthcare, to find support).

We constantly have our validity called into question by cis and trans people alike. It leads us to internalize this voice of doubt and to intensely question ourselves as society at large does to us.

Feeling invalid or like an imposter is actually a totally normal thing to feel as transgender. It can be difficult to believe in ourselves when people seldom believe in us.

Getting past that hurdle can take time (look at me, I’m still trying), but it’s good to keep this in perspective and remember that feeling this way does not undermine who you are or make you any less “trans” than someone else.

2. Is It Okay If I Wasn’t Always Like This?

The short answer: YES! That’s absolutely okay!

Unless you screamed, “I’m queer and I’m here!” as you exited the womb, it seems like society is dissatisfied with trans people when they come into consciousness at a later age (it’s actually a double-edged sword: We’re too young to actually know, or we’re too old and we’re supposed to know sooner – we can’t win!).

The dominant narrative says that transgender people are expected to have always known – on some deep, intrinsic level – that we were destined to identify with a gender other than what we were assigned at birth.

But we all have reasons for when we came to terms with being transgender.

For me, it was trauma that delayed my realizations around my gender. For others, they didn’t know “transgender” was even a thing and never thought to question their assigned gender. And for some, their safety was at stake if they tried to explore their gender.

Whatever the reason, people come to terms with being trans at different places in their lives.

And there’s no “right time” or “correct way” to arrive at that conclusion – whenever you discovered your gender identity, you are completely valid, and it doesn’t mean you are more or less trans.

Identity in general is very complex – and everyone, trans or otherwise, will grow and learn about themselves at their own pace. Figuring out who we are doesn’t happen in a day. It’s okay to take your time.

Instead of viewing it as a race in which other trans people are your competitors, try viewing it as a journey that is for you and you alone. It’s my hope that the trans community will be beside you, cheering you on.

3. What If I Regret My Medical Transition?

So it’s important to first say that not all transgender people will medically transition. That’s a completely valid choice; medical interventions do not make someone more or less trans.

But for those of us who do pursue some form of medical transition, it’s unbelievably common to worry about regret.

Because our validity as trans people is always coming under fire, it doesn’t surprise me that we question our choices – especially when these choices involve some form of permanent or semi-permanent change.

Lots of transgender people worry about transition regret for different reasons.

For some, they may not feel ready to make such a big change because of other issues they’re grappling with. They may not feel prepared to come out to family, which medical transition can require (showing up to a family reunion with a deeper voice and beard without forewarning is apparently frowned upon).

Fears around transition regret can also come from a lack of knowledge – whether it’s myths about surgical regret (often pushed by anti-trans activists) or an “all or nothing” understanding of hormones (for example, the misconception that non-binary people cannot hormonally transition).

For me, I resisted medical transition because I was actually deeply ashamed of being trans (which I’ll talk more about later in the article).

I think if you’re having questions about medical transition, it’s a great idea to seek out a support group, community center, or gender therapist to help you figure out why you have these hesitations.

Fear is a normal part of transition – but confronting those fears can be a major part of healing.

4. What If I Don’t Know Exactly What My Gender Is?

Hey, welcome to the club! Here’s your official badge. Let me teach you the secret handshake and anthem.

Seriously though, I think the world would be a much better place if we stopped putting pressure on people to know their gender identity and, instead, encouraged people to explore their gender identity and expression.

Because while it may seem that most people are incredibly sure of themselves, I’m betting there is a huge number of people who are actually really unsure. And I’m baffled as to why this has to be a problem.

Uncertainty can be unsettling, but it’s also an opportunity to explore who you are and give yourself permission to step out of your comfort zone.

Uncertainty is not, however, proof that you are not transgender or an indication that you are “less than” other trans people.

I feel like my understanding of my gender changes by the day, sometimes even by the hour.

Uncertainty can often mean that you’re on the right track – that you’re moving away from what felt safe to open yourself up to the possibility of something more honest and fulfilling.

So I say embrace the uncertainty! It’s not at all a bad thing – and I, as well as many other trans people, know it well.

5. If This Is My Truth, Why Do I Feel So Ashamed?

The hardest thing about being trans, for me, has been coming face-to-face with the fact that I deal with shame and guilt around being transgender.

When you grow up with the idea that there’s a “right” and “wrong” way to do gender, it’s a perfectly reasonable response to suppress or resist who we are or who we want to be in favor of what feels safer or more socially acceptable.

We’re taught, in subtle and overt ways, that straying outside of “gender norms” is wrong, disgusting, embarrassing, or even immoral. It’s normal and even expected to feel ashamed in a society that teaches us to be ashamed if we are not perfectly cisnormative.

In this way, being proud of being transgender and being ashamed are not even mutually exclusive – you can be proud of your identity but also grapple with the shame that comes with claiming it, and they’re both valid emotions and experiences.

My shame around being trans led me to grapple with every question on this list.

Shame convinced me that I was “making up” being trans because I couldn’t deal with the truth. Shame made me question if my journey was valid because it felt like I was doing it “wrong.” Shame made me fearful of medically transitioning because I feared my own happiness. Shame left me suppressing my identity and making it difficult to ever feel secure in myself.

I’ve written before that I didn’t even want to be transgender and compared being trans to the stages of grief (if you’re dealing with shame, I encourage you to read them or bookmark for later). The responses that I got to these articles pointed overwhelmingly to the fact that shame is a common part of the trans experience.

I talk about shame not because I want to discourage people from being trans – it’s because I want us to be honest and to validate the very difficult emotions that come with being trans in a transphobic society.

If you feel ashamed, you aren’t alone.

To deal with my own shame, I’ve found it helpful to talk about what I’m going through with other trans people, to seek out support groups (online or offline), to find a trans-competent therapist, and to journal about my transition so I can be aware of these feelings as they come up.

The important thing to remember is that shame does not have to make your decisions for you. It doesn’t have to hold you back. And feeling shame does not make your truth any less real or your identity any less valid.

***

There’s one last feeling I want to hold space for. If you read this article and found yourself saying, “Wow, this is me,” I want you to take a moment to sit with that feeling.

The feeling of being validated, seen, recognized.

I want you to remember this moment the next time you’re struggling with these questions, and to know, always, that you are not the first person to ask these questions and that you aren’t alone in what you’re feeling.

Too often, we’re afraid to be honest about our experiences because we fear that being this vulnerable opens us up to be ridiculed, interrogated, and questioned. As trans people, we already face this kind of interrogation in our daily lives – so it makes sense that we hold back on what we’re struggling with.

But I want to encourage you to open up.

At the very least, I want you to acknowledge the weight that you’ve been carrying around in trying to shoulder this alone. I know that weight well. That weight has kept me down for a long, long time.

It’s time to chip away at that heaviness. Let’s start here: I want you to know that your fears, questions, and doubts do not undermine your truth or your identity.

You are enough. And what you’re going through and the feelings that come with it deserve validation and respect.

You, my friend, deserve validation and respect. And I hope that this article is just the beginning of all the space you’ll hold not only for your own struggles, but for the struggles of others in our community as well.

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This piece that I wrote originally appeared at Everyday Feminism.