Fear and (self) loathing

Reflections on medical transition 20 years on.

Photo by Joel Filipe on Unsplash

While legally, socially, I am treated as a man, I accept that I am not a man biologically. 

When I expressed that I might be trans, an entire ecosystem emerged around me to complement the social messaging I received that medical transition was the way to go: healthcare providers who told me medical transition was the best treatment for gender dysphoria. I believed them when they said it would prevent suicide and make me feel more at ease in my skin. For a while I even believed that it worked. But then the suicidal thoughts came back and I struggled socially in ways different than before, and hard to articulate.

Medical transition was a choice I made based on the information I had available to me at the time, because I could not see a path forward for myself as a woman. No one seemed able to help me with that. And I did try — many, many years of therapy, as well as a cocktail of psychiatric medications. It didn’t work for me.

Telling someone to love themselves isn’t enough. How is the question. While I searched for ways to accept myself as female, no one had the answer for how to do so. Transition was a desperate act, but it was in a backwards way an attempt at self-love. It was me acknowledging that I was struggling. It was me reaching out for help and opening myself up to the views of others. Unfortunately the ‘help’ I was given was a lie. But I could not have known that at the time.

The lie only holds together if everyone buys into the belief that people can literally change sex. And not everyone does believe that, because quite simply it isn’t true. Nor should people have to buy into it. People should be allowed to believe in facts. The fact is humans are mammals, and like every other mammal in the world we come in two flavours. Sure, some people have extra spices added in (e.g. extra chromosomes, or anatomical differences), but essentially as a species we are divided into those who are designed to develop large gametes and those who are designed to develop small ones.

For me medical transition was a necessary step along my life path — I accept that. I wish it hadn’t been that way but it was. I regret parts of it now because of the steep cost to my body, my health, and my relationships. If I could have my life over again, I would not choose to transition. I wish I could have seen a way forward as a gender nonconforming woman. I simply couldn’t — I don’t know why. It was a failure of imagination that no one seemed to be able to guide me through.

I can’t have my life over again. And I see no point in punishing myself for what I did not know back then. And every decision comes with benefits as well as costs. The benefits are that I met my wife and we have built a happy life together over the past decade. That alone has made my strange life trajectory worth it. That I do not regret at all.

Until medical professionals stop abdicating their responsibility and start telling the truth (people don’t change sex, they just medicalize their bodies), stop lying to people about what medical transition can offer (there is no evidence it improves mental health), including openly discussing the many common harmful side effects, people will continue to embrace medical transition.

The technology exists. I doubt it’s going away any time soon. We need to figure out how to welcome everyone into the fold. But that does not mean we need to deny reality.

The reality is that I am a medically masculinized female who is legally recognized as a man. That does not make me a man. And it makes me different than most women.

What does healthy gender nonconformity look like? What can we do to create space for that?

That is a societal question that we will need to address.