Can gender transition save lives?
It’s complicated.
The evidence that medical gender transition reduces suicide is flimsy at best. In fact, at least one study seems to indicate an increase in suicide in those who have medicalized. How do I square that with my own belief that transition saved my life? I think both statements can be true.
In Dec 2003, I went to see the psychologist who would diagnose me with “Gender Identity Disorder – High Intensity”. This followed three years of regular talk therapy appointments with a psychiatrist who also heavily medicated me (for anxiety and depression). My ongoing mental health struggles, including suicidal depression and an eating disorder, spanned back to my early teens.
In the short term, medical transition offered me a path forward in the world of the living; clear steps I could follow. The healthcare providers I consulted assured me I would feel better and I believed them. Finally, someone was offering me a solution to my problems, a lifeline. And because gender transition, socially, medically and legally, was such a long, drawn-out process, the end of the rainbow was just sufficiently out of reach to keep me motivated to continue. I had something to ruminate on that kept me focused away from death, which had become something of an obsession by that point.
I had tried all the traditional avenues I could think of to feel better. Doctors, therapists, social workers, books. I did not understand why I was so unhappy, and I could not understand why no one seemed able to help me. I wanted someone to rescue me from myself — yet no one seemed to have the answers I sought. The thought that this was as good as my life might ever get was terrifying. I couldn’t imagine myself living this way for much longer. I didn’t want to. I felt weak for not being able to get out of my funk. I felt like a failure for not measuring up to my parents’ and my own expectations.
What do you do when all the doors seem to shut in your face and you are left in the dark? I sent myself to a self-imposed solitary confinement. For weeks on end in my late teens and early 20s, I would literally lay in bed for most of the day, lights off, under the covers, door shut. The noises and lights of the world felt like nails on a chalkboard. The chitter-chatter of human voices in the distance pierced me like glass. I convinced myself that I was protecting others by withdrawing from social life.
Gender transition changed all of this. As I started down the gender transition path, I felt a new confidence in myself. For the first time in years, I felt hopeful about the future. I got my first serious job, had my first serious romantic relationship, stopped self-harming, and felt more able to connect with those around me. Life was looking up.
Once the novelty wore off, however, and the bi-weekly hormone injections became routine, the depression slowly started to creep back in, like a shadow spreading its pall across a dimly lit room. I cannot pinpoint the precise moment when I realized that I was again having suicidal thoughts. Likely it started in 2006, two years after my first hormone injection.
In April 2005, a close friend died by suicide, followed by my father’s death to cancer six months later and the implosion of my relationship with the remainder of my family. In the midst of this tsunami of loss, I clung to the raft of gender transition to keep me from spiralling completely out of control. Medicalizing my body was perhaps the most predictable, most controllable aspect of my life. While I felt no control over my father’s cancer, nor of life and death itself, and I did not seem to have the skills to resolve the interpersonal conflicts that plagued my family of origin, I at least could control how and when I injected myself with hormones, or which surgeries I chose to have.
These small acts gave me a sense of agency in the turbulent ocean of my life. They kept me grounded in the now, while the bones of my grief scattered across my shores. With every gender-related decision I was moulding myself into a new, more resilient person. One could say I was attempting to wash away that other version of me, that burdensome, depressed, fragile, flawed and largely useless young woman who seemed not to have gotten the memo on the rules of life and death.
That young woman’s body was a constant disappointment, from the painful monthly periods, to the acne covering her back and face, to her physical clumsiness and sensitivity to noise. Romantically, too, she had failed. Her first boyfriend had found her breasts wanting, and a greasy Texan passenger on a Greyhound bus sexually assaulted her on a cross-country road trip. Her body was offensive to lovers and abused by strangers. She struggled to connect with other women. Some even approached her with hostility — like the cleaning lady at an international airport who chased her out of the women’s washroom with a broom for apparently looking too much like a man. No one wanted her around. Not even me.
That young woman, whose mother despised her, whose father was disappointed in her when he died, whose siblings didn’t understand her, whose friends couldn’t really get close to her, that young woman had very little going for her. She belonged nowhere and with no one. I abandoned her too.
Sacrificing parts of her female body seemed like a small price to pay for the possibility of staying alive. She wanted to fit in, to love and be loved, and yes, to live. Yet who she was as she was then, seemed unlovable, by others or even herself. The depth of my self-loathing is hard to put into words.
I did what I needed to do to say alive. And for that reason, I am grateful that I transitioned. Was it the only option? I don’t know, truly. I had tried everything else. If I had it all to do over again, I don’t know that I would have done anything different — not based on the information I had at the time.
Turning point
As recent as 2017, I was still convinced that gender affirming medical care was a generally good thing. It had saved my life, so surely it could help others. Then I started listening to the stories of detransitioners. It started with Jesse Singal’s article and later I found Benjamin Boyce’s series of interviews with detransitioners. What struck me was how similar their stories were to mine. Like me, many of them had autistic traits. Like me, many struggled socially or had some kind of sexual trauma or loss.
It wasn’t just the stories I heard online that shifted my thinking. Also in my personal life, people I knew were living realities that ran counter to what was supposed to be. In 2022, a transmasculine friend slightly younger than me died by suicide after developing paranoid psychosis symptoms involving believing that he had given birth to multiple children. Another friend that transitioned around the same time as me, came out as a detransitioner and told a tale of being sexually exploited by a pedophile as a child. Another friend grew disillusioned with his trans identity and eventually chose to return to a butch lesbian identity instead.
Gender, I’d read, was supposed to be hard-wired. Kids knew who they were, the experts said. And yet, this was not my own experience, nor it seemed, the experience of those close to me who had followed a similar medicalization path to the one I had.
If this were true for me, and for at least some of my friends, then that meant we were medicalizing people, without knowing whether their gender identity would remain stable over time. We were irreversibly altering their physical bodies with no long-term studies to back up this practice. And increasingly, we were doing it to minors.
Realizing this made my pause. It was destabilizing to acknowledge that I had bought into a belief system for which there was little evidence — that someone could be ‘born in the wrong body’ or could ‘change sex’. Yet my own transition, I had to admit, had at least temporarily allowed me to reinvent myself sufficiently to find a footing in my own life, so that I could become a contributing member of society. I could not deny that it had benefited me.
As a woman, I had been a disaster – mentally ill, self-harming, suicidal, unemployed and unstable. As the male-appearing person I became, I still had some mental health struggles, but not anything close to as severe as before, and I was working, contributing to the larger community. Could I have learned to do so as a woman? Perhaps. But I didn’t. Transitioning was as close to a re-set button as I could get without killing myself.
I am not proud of transitioning, nor do I wish it on anyone else. If it can be avoided, I think it should. But in some cases, I think we must acknowledge that until the world finds a better way to nonmedically integrate gender variant people, we will always have a few who will seek to surgically and hormonally alter themselves in search of a better life. And for a few, medicalizing will help them thrive.