Tag: transgender

Dear Body: A peace treaty with my queer, trans, and recovering body.

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When we entered into this world, I can’t imagine that we feared becoming more. Back then, the moon was full and the world was fuller; the majesty of being small was only in relation to everything that was still unknown.

We had not yet been told to fear hunger. We knew hunger in the way we know our names — you always answer to it.

Body, this is my olive branch to you.

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I was 27 years old when “anorexia nervosa” appeared on my medical chart. In a quiet moment, staring at a flickering screen, I listened to my breath empty out of my body, a mix of relief and petrification.

Someone named what I could not: I was hungry.

The kind of hunger that moves in like an eclipse, enveloping your whole world in empty shadows. The kind of hunger you invite because staying small, in a cocoon or a corset of your own painful design, feels safer than stepping into the fullness of your life.

Your stubbornness and mine, colliding day after day. I ask you to die; you demand to live. I ask you to diminish yourself; you hold the line. I ask you to hide; you remain tangible. I am angry at every headache, every dizzy spell, every time I nearly fell down on the train. I am angry that you keep me tethered here.

I mistook your refusal to allow me to starve as a weakness, but I’m breathless now, looking back at all the ways you would not back down from survival. All the times you revolted, sounding every alarm, as if by sheer force of will we might find the urge again to live.

Body, I am in awe of you.

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You are daring and spectacular. You’ve shrieked in defiance of every label you couldn’t hold. You held the truth of “boy” before I could feel it for myself. You were uncompromising in the truth of what you carried, chest open on an operating table, with a river of bright red blood exposed by two perfect incisions.

The truth of the body, you whispered, runs deeper than the mind. When I woke up, shrouded in the fog of anesthesia, I felt us move closer — like two pieces of a puzzle, surrendering to each other — and I was not afraid. The shape was new and the picture was clearer.

The bottom of the glass, the bowl, the bottle was not enough to dissuade you from being. When I hid, you followed; when I silenced you, you boomed and bellowed like thunder. I am still here, you sighed. You would not disappear. You would not dim.

Body, you are a vision.

/

When I began to eat again, I could feel you coming back to life. The noise was ecstatic and overwhelming. Sometimes I raged with so much hunger, it scared me. It was the first time I knew myself as an animal first, above all else.

Somewhere along the way, I’d forgotten that you needed me, that I needed you, that we were bound to each other. You were so patient still. You promised me a home when I had nowhere else to go. You promised me a vessel for the adventure of a lifetime. You were the light that drew me back, like a moth continually pulled from the darkness again, and again, and again.

Sitting in the dark with me, you waited. A lighthouse on the cove, a flare popping open in the sky, a smoke signal spiraling — every pang of hunger, every shaky hand, every heart palpitation and terror a subtlety that said, “More than this, Sam, we need more.”

Body, your courage stuns me.

/

I realized I was truly starving when I couldn’t shake the tunnel vision. Had the walls around us been any smaller, it might have become a casket. Back then, the world was a single dimension, an endless stream of self-imposed calculations. They were abstractions I used to comfort myself, to convince myself that I’d done good.

I will be exactly enough, I told you.

For the boys who couldn’t love me, the parents who couldn’t understand me, the world that couldn’t see me. I will make myself so small and inconsequential, I’ll be as harmless as the fly that sits on the windowsill. I will be the closest thing I can to being nothing, because to be nothing means that I will never take up more space than I deserved, more love than I’d earned.

But you refused. You kept the lights on. I shattered every lantern; you reassembled the pieces.

And stubbornly, you survived, so that I might one day understand that worthiness is not awarded like a ribbon at the spelling bee.

There is space here. There is love here. And both are the gifts of being.

Body, teach me.

/

I am learning to love you back. I pause to feel the spaciousness between each breath.

“Marvel at this,” you remind me, eyes fixed on the horizon. “Let me show you.” One bite at a time, you restore me. The warmth returns to my belly. The sweetness to my laugh. The glow to my cheeks.

I will not pretend that I’m not afraid. There are days when I will be withholding. Being alive is a tremendous responsibility, and every so often, it scares the hell out of me.

To be a breathing, feeling, trembling animal is something none of us are prepared for. We enter this world screeching and gasping and blue, and spend a lifetime learning to breathe our way through it.

But I will not abandon you. I will come back, again and again, as many times as it takes to live.

That is what I can promise you.

I’ve teased apart the taste of honey when drinking my tea. I’ve let raspberries slowly dissolve on my tongue; I’ve savored every bite of a sponge cake flavored with cardamom and pistachio, so decadent you wouldn’t trade it for anything.

I’ve learned to cherish the warmth of someone’s chest against mine, the ephemeral magic of a song so loud it reverberates inside me, and the ripeness of a pea-pod from a stranger’s spring garden, sliced open between my teeth.

When you speak to me, the cadence has become familiar — I need, I want, I am, we are. Together, we move with clumsy but purposeful choreography.

And I know now to hold the gratitude for where you’ve carried me. I know that you are not an anchor, but rather, an altar. You house everything that is sacred in me.

Body, you are a blessing.

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This blog post was sponsored by Eating Recovery Center in honor of this year’s Eating Recovery Day on May 7th! The theme, #MyRecoveryLetter, is an open invitation to reflect gratefully on what has helped us in recovery. I invite every one of you to share your own letters to whomever or whatever has helped you in your journey!

Struggling with food? Body stuff? Or just need someone to talk to? The National Eating Disorder Association (NEDA) is a wonderful place to start. They’ve been an incredible resource for me — and I hope they’ll be for you as well!

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Hey, before you go…

This blog is not sponsored by any fancy pants investors that are trying to sell you stuff.

It’s funded by readers like you via Patreon!

Photo by Chris Jarvis on Unsplash.

Denying the existence of transgender and nonbinary people is not ‘scientific.’

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Folks often ask for shareable versions of the threads that I write on social media. In this new series, “Twitter Roundup,” I’ll be compiling threads worth saving! This thread focuses on the ways in which the social sciences are overlooked when talking about the existence of transgender and nonbinary people.

A gif that reads, “When people tell you who they are you believe them.”
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Hey, friend! Before you go…

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This blog is not sponsored by any fancy pants investors that are trying to sell you stuff.

It’s funded by readers like you via Patreon!

Every donation counts. Help keep resources like these accessible to everyone that needs them! And help buy me a cup of coffee, because I write a lot of these blogs after work, late at night, so I could definitely use the caffeine.

When they misgendered you at your memorial.

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There were drains hanging from my chest when I made the first phone call. Not even two days before, I was under the knife, having a surgeon — an artist — remake my chest. These are scars that you will never see.

“Hey,” I say softly into the phone. “I think you should come over. I’ll explain when you get here.”

When I hang up, I straighten my spine and I slap myself across the cheek. Our friends are coming over, and I remind myself that I can’t crumble, not now. I’ve never had to disclose that someone is dying, to shatter the world as they knew it with a single sentence. I guess because I was the one that was usually on the brink of death.

This was not the thunder I wanted stolen from me.

There’s a knock on my door, and the words are falling out of my mouth before I can think of how to say them. “I’m so sorry,” I whisper. “Cris isn’t going to make it.” We hold onto each other for dear life, the drains pressed between us, filling with my blood.

The color is already gone from my face; I’m waiting now to see your ghost.

/

You are difficult to contain. A neuroscientist, a poet, a drag queen, a teacher — queerness, for you, was simply your way of being in the world, the shimmer held in every cell in your body.

“They” as a pronoun was the most natural thing in the world, because I can’t imagine how “she” or “he” could hold everything that you are, that you were. They, as in, “I hold the contradictions and make them beautiful.” They, as in, “I wear my trauma as drag and spin it into gold.”

I never understood how anyone could look at you and not see “they,” or hear the mirth in your laughter and not believe it to be sheer magic or mischief, or look at your delicate hands and assign you any essence other than “everything.”

Everything, the totality.

You were the scientist who loved astrology. You were the poet who could seamlessly reference Grey’s Anatomy without missing a beat. You toiled in a lab with mice by day and wore eight-inch heels and glitter on a stage at night.

You moved between worlds, always chasing something — the secrets you found studying zebrafish, the catharsis in lip-synching pop songs in gay bars — and I fear that neither one was enough.

You could find the wisdom in a Kelly Clarkson song and in the DNA of a jellyfish. I remember thinking, I’ll follow this queen to the ends of the earth.

If only you had let me.

/

Your memorial is organized by email. This is, I think, the first time I really understood what it meant to die as a millennial. You’re just a few months shy of your 30th birthday, but if I think about that for too long, I want to set the whole world on fire.

It was foreshadowing, I realize, when you told me how your novel was going to end, just a few weeks before you died. How the characters, realizing the world is irredeemable, decide to burn it to the ground so something new can grow in its place.

You lit the metaphorical match in your bedroom on a Sunday afternoon, and I still don’t know if it was a smoke signal or a death wish. I’m not sure if you knew, either.

My whole world burns down with it. Your remains nourish the ground underneath me. Grief is a brutal and unforgiving teacher, offering lessons I never asked for. Your tombstone is a mirror reflecting back all the ways my story could’ve ended just like yours.

Your mother makes me promise that I won’t end my life like you did.

I have to grow in your place now, become something new.

You used to tell me that no one understood trauma quite like we did, like it was a language that we spoke fluently, sometimes morbidly and always earnestly. In that way, I’ll never stop hearing your voice.

/

Your graduate advisor responds to the email about your memorial. Gently, I remind him of your pronouns.

I think back to all the conversations we had about what it was like to be a transgender scientist — struggling to be seen, carefully measuring how much of yourself you could be and how much you had to hide.

Sometimes, over coffee, you’d admit to me, “I’m so tired.” The resignation in your eyes was like the dimming of a thousand stars at once.

Your advisor snaps back so harshly that the wind is knocked out of me. “That’s the side you knew, but Cris, the young man I knew, had many sides,” your advisor lectures.

How can you call it “sides” when you never asked to be deconstructed? When it’s the world splitting you apart, never allowing you to be whole in the first place?

How could he speak of you as though everything you were in life — all the magic that moved through you — was simply too inconvenient to acknowledge? How can you take a prism and demand one color?

I’m trying to find the words to explain to him how painful misgendering is, but my rage is boiling over — not just at him, but at a world that was never good enough for you, determined to take the beauty of your queerness and grind it to dust underneath a heavy heel.

I tell the professor that he should be ashamed. He calls me a “hectoring, self-absorbed, pompous twit.”

The aftertaste of the same poison that killed you is sitting on my tongue. The taste is familiar, metallic, and cold. I remember the anguish of being invisible, how it eroded your spirit, how it clipped your wings into pieces that neither of us could stitch back together.

Without wings, there was nothing to break your fall.

/

When a transgender person commits suicide, it’s almost always murder in slow motion.

When you cut a flower at the stem, no one is surprised when it wilts. When your petals fell, I tried to hold onto them as long as I could. The world might know you now as a statistic, but I knew you as you breathed and bloomed.

The morning memorial begins with a passionate plea about pronouns from a trans femme you knew, and I’m silently grateful for her courage. But I’m left trembling when I realize that you never lived to see the day when your life didn’t require a disclaimer — instead, your death now required one, too.

The professor gives the closing remarks. He stumbles over his words.

When he misgenders you, he tries to correct himself, stuttering. The pain in the room is palpable, a living reenactment of the pain you held in your last breath.

When he refers to you as a son, your mother — in a moment more powerful than my words can hold — adamantly corrects him.

“My child,” she says.

Her child who, after being flown to New York for a final time, would be turned over to ash. “I blew glitter over their body just before they were cremated,” your mother tells me.

And this is how you left us, anointed by the shimmering breath of your mother.

It was one final gesture to remind you that, while the world may not have seen you, we still did.

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selfcare

If you’re suicidal, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386, or reach the Crisis Text Line by texting “START” to 741741.

Hey, friend! Before you go…

cropped-heartThis blog is not sponsored by any fancy pants investors that are trying to sell you stuff.

It’s funded by readers like you via Patreon!

Every donation counts. Help keep resources like these accessible to everyone that needs them! And help buy me a cup of coffee, because I write a lot of these blogs after work, late at night, so I could definitely use the caffeine.

Photo by h heyerlein on Unsplash.

My parents and I survived my ‘Rapid Onset Gender Dysphoria.’ This is our story.

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Yes, it’s true.

I am a survivor of Rapid Onset Gender Dysphoria, otherwise known as ROGD.

And if you’d talked to my mother back then, you would’ve gotten a very panicked account of how abrupt my coming out was.

But my story isn’t hers to tell.

(She, by the way, would totally agree with that statement. This is why she isn’t posting about me in online forums or participating in “studies.” Also: Hi Mom, love you.)

And while I wish I had the Perfect Transgender Narrative™ to convince you of my validity, I don’t. I didn’t always know I was transgender. I’m not even sure exactly when my dysphoria really started.

But if you knew my story, you might realize why that makes sense.

I was a sheltered kid growing up in suburban Michigan. And while I’d been bullied for being “weird,” and always felt like the “black sheep” wherever I went, I knew literally nothing about queer or transgender people… much less “gender dysphoria.”

There was no context to place that sense of isolation into. It never occurred to me that gender was a thing I could have feelings about, and I certainly didn’t know that I didn’t have to identify as a girl if it didn’t exactly fit.

Having an older brother that was so close to me in age, my androgyny wasn’t exactly odd, either.

I figured it was a natural product of being so close to him. We shared our toys as kids, played video games for hours, and my many interests — ranging from the stereotypically “feminine” to “masculine” — made me gender-ambivalent at best.

If you’d asked me how I felt about my body as I got older, I would’ve said I “felt ugly.” When asked to describe myself? “I’m just weird.” There was no other vocabulary available to me, because my world was incredibly, incredibly tiny.

Even if I did have some sense of dysphoria, I didn’t have the ability to place where it was coming from.

I was a kid with obsessive-compulsive disorder and ADHD. As such, I was in a constant state of anxiety and agitation growing up. When it became unmanageable, I would get really depressed.

In other words, emotional overwhelm was a constant in my life. Teasing apart where any of it came from wasn’t a simple process.

It only became more complicated as I got older. When I was a teenager, I developed an eating disorder and then found myself in an abusive relationship. The disconnect from my own body from there only became more intense. I was numb to it in so many ways.

Gender was not my concern at that time — simply surviving my mental illness and that relationship was all I could muster.

But thoughts about it started to surface, slowly but surely. When I began considering taking on a more androgynous appearance, and started questioning gender in my late teens, my abuser told me that I “wouldn’t be attractive anymore.”

My self-esteem was already so diminished. His comment made me feel so deeply ashamed for ever having considered being anything other than hyperfeminine and cisgender.

So I didn’t just tiptoe back into the closet… I leapt back in.

At first, I put any kind of gender-related thoughts on the highest shelf in a locked box. I couldn’t handle the idea of destabilizing my life in the way that transition — and by extension, ending that relationship — would’ve triggered.

There just wasn’t room for questioning my identity at that time in my life.

Between my OCD and my traumatic relationship, I was repressing the hell out of any gender-questioning thoughts. I didn’t have the emotional capacity, resources, and support to work through it.

It wasn’t until I got out of that relationship and started therapy that I could begin to untangle everything.

As I started to better manage my OCD and heal from the relationship that had destroyed my self-esteem, those questions about gender start to find their way to the surface again. I begin to wonder.

And I started searching online.

That’s when I really began questioning if some of my earlier feelings about being out of place — especially among girls my age — meant something.

I wondered if being disconnected from my body might be connected. I wondered if being drawn to androgyny (and the little things, like enjoying playing as “boy” characters on my favorite video games) might have meaning, too.

And I’ll be honest, I didn’t know for certain if those aspects of my earlier experiences did or didn’t have a gendered significance. Very few of us do in actuality, because identity is complicated, and gender is, too.

Not to mention, my history was very complex and painful. The thing about dysphoria is that so much of it is very abstract. Feelings aren’t as crystal clear as a lot of cisgender people seem to suggest.

Dysphoria isn’t this obvious neon sign that appears from the minute you exit the womb, especially in a society that does everything it can to make transgender people totally invisible to begin with.

We often don’t know where our feelings are coming from, especially if our backgrounds include trauma.

Which is why changing circumstances externally — our clothes, our pronouns, our names — can be so important. We do it to see how our feelings change so we can better understand what caused them, and more importantly, what we can do about them.

So I came out as genderqueer when I was 19 years old. I felt uncomfortable continuing to identify as a “girl” when I was having all these questions about my identity and my body.

I cut my hair, started changing how I dressed, started binding my chest, and began to imagine what my future might look like. I wanted to see if I would be happier or more comfortable in doing so.

For my parents, though, we’d never really had a conversation about my gender. What they saw was their teenager going off to college and catching something quite an awful lot like “rapid onset gender dysphoria.”

Except instead of the internet, it was that dang liberal arts school corrupting me.

But it became obvious, with each step of my social transition, that something magical was happening — I was coming out of my shell. I was happier. I felt a little more adventurous. I felt a little more at home.

I sat with myself and I said, “Okay. There’s something here.” I knew there was because with every change I made, I felt a little lighter in a way I never had before.

I soon learned that a disconnect from your body or self, disordered eating, anxiety, and a sense of isolation can all be a part of the transgender experience we call “dysphoria.”

It seems to be something a lot of us share. And more importantly, when some people transition, those experiences improve or even go away entirely.

When I finally understood that a gender transition was making me feel better and brighter… I was thrilled. But I was also hit with waves of very acute, very new gender dysphoria.

My internal reality was solidifying, but my experiences as I moved through the world weren’t aligning at the same time. That gap became more and more stark — and much more painful.

This was the “rapid onset.”

And if you talk to transgender people, a lot of us have the same story — we know our truth, but it also magnifies our pain. There’s the new distress of realizing that no one else sees it but us. The pain of invisibility.

While you are becoming the person you are meant to be, you simultaneously become invisible to the rest of the world — even to the people you love.

That is traumatic — and it can come on gradually for some people, and quickly for others, depending on when you came to understand your identity.

I knew who I was and I wanted that to be recognized. But it wasn’t. And the more erased I felt, the more pain I experienced.

I found myself focusing more and more about the aspects of my body that kept me from feeling seen. I’d never felt comfortable in my own skin, but now I had a better understanding as to why — and I had a clearer idea of what needed to change.

That’s when I started considering hormones.

At 22 years old, I was now growing impatient and miserable. I didn’t share these things with my parents at first, though, out of a fear of being rejected. They were your typical Midwest “ranch dressing” kind of parents — they knew very little about what any of this gender stuff meant.

But I came out to them anyway.

They were, in the deepest sense of the word, confused.

But more than that, they were terrified, because they’d never once heard me talk about questioning my gender. For them, the pain I was describing was sudden and life-altering.

And, yes, “rapid.”

But it wasn’t the dysphoric feelings that were necessarily new. It was the urgency to address them that was new — because I learned there was a solution, a path I could finally take.

That urgency made the dysphoria feel stronger. But in all likelihood, it may have been there in some form all along.

But either way, it hardly seemed to matter when it began. I just needed to know if testosterone could help me. And if it didn’t? I could always stop.

So I held my breath, emailed my parents, and told them what I was prepared to do. And my mother especially — while she was terrified about what would happen next — did what every parent of a trans youth should be doing: she stood by me.

Rather than looking to change who I was, or digging for evidence that I was delusional, or blaming somebody else in my life… she pumped the brakes. She moved through her fears and came out on the other side of that as my biggest supporter.

And being supportive didn’t mean that she wasn’t afraid. It didn’t mean that she didn’t have questions, doubts, or worries. It didn’t mean that she understood everything that I was talking about.

What it meant was that she had the courage to walk through those fears with me, and do everything she could to support my own happiness, even if the path was totally unknown and even scary to her.

My mom didn’t see my coming out as a fluke, nor did she see my transition as a threat. She saw it as an opportunity for her to grow.

And while she stumbled and wasn’t always graceful, she did everything she could to be there for me, no matter what.

Screen Shot 2018-09-08 at 11.46.18 AMWith my family’s support, I began my medical transition. I won’t lie — I was scared, too, at first. I wondered if I could be mistaken. I wondered if it was my OCD playing tricks on me. I worried that maybe trauma had led me astray.

But after years in therapy, and multiple gender specialists weighing in, this was the conclusion we had all reached. It was worth a try.

I’m grateful every single day that I took the chance. And I’m just as grateful that my parents were by my side, supporting me through it.

I started hormones, I got top surgery, and with each step, there was a light in my eyes that wasn’t there before. I came alive. I was happier, more confident, and the emotional overwhelm that seemed to buzz around me my whole life slowly began to fade.

As my parents saw this unfolding, even they couldn’t deny what was happening. I was finally calm. I was optimistic. And most importantly, I was ecstatic.

And one of the greatest, most unexpected gifts of my transition?

My mom (who I will freely admit, like most teenagers, was not my favorite person growing up) became one of my best friends.

Even as my mom struggled to understand me (and still does sometimes), that has never once been an obstacle in her loving and supporting me.

My parents are proud of their gay, transgender son. I know this because they don’t hesitate to remind me.

And looking at their example — two people who really couldn’t have been more unprepared for a trans kid — is what still gives me hope, even as proponents of this pseudoscience try to undermine and invalidate trans youth.

Hope even for the parents that participated in the Rapid Onset Gender Dysphoria “study,” who may someday learn that their fear is worth embracing — that it’s an opportunity to grow, to love, and to listen.

An opportunity to better know this wonderful person that they brought into the world — to see, for the very first time, what lies in their heart, and to prove to them that they’re still worthy of love exactly as they are.

My parents embraced that opportunity despite all the grief that came with it. And when I ask them why, their answer to me is always simple: “Because we love you.”

We didn’t always know that I was transgender or that I even had gender dysphoria. But when my parents look at me today — and they see a happier, healthier adult — none of that really seems to matter anymore.

I hope that one day, we’ll live in a world where parents of transgender youth, no matter how “rapid” their coming out, will get to experience that same joy, too.

That moment when they look at their kids, brighter than ever, and finally understand that the journey is absolutely worth it.

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selfcare

If you’re suicidal, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386, or reach the Crisis Text Line by texting “START” to 741741.

 

Hey, friend! Before you go…

cropped-heartThis blog is not sponsored by any fancy pants investors that are trying to sell you stuff.

It’s funded by readers like you via Patreon!

Every donation counts. Help keep resources like these accessible to everyone that needs them! And help buy me a cup of coffee, because I write a lot of these blogs after work, late at night, so I could definitely use the caffeine.

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

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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.

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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.

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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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