On gender transition

A testimonial

In January 2004, I started hormone treatment to transition from a woman to a man. I was a young adult. Getting to this point was not linear. And my journey from that point has not been straightforward either. My last medical intervention was in in 2010, when I had my final gender transition-related surgery. I continue to take cross-sex hormones which have masculinized my body to the point where I am visually indistinguishable from men in day-to-day life. Legally, socially, I am male and live my life as a man.

Psychologically, however, I have had a variety of challenges over the years. I have suffered from anxiety and clinical depression for as long as I can remember.

When I embarked on my gender transition from female to male, I was working with a therapist. Despite a deep anxiety about speaking about anything related to sex or sexuality, I informed my therapist that I was thinking of gender transition. I recall her being surprised but supportive, suggesting that I explore social transition; she even agreed to write a referral letter to a psychologist for a formal assessment.

I saw the assessing psychologist for only one 90 minute session. The natural next step was hormones and surgery. That was the only real option that was presented to me.

Armed with my assessment letter and a referral to an endocrinologist, I started hormone therapy. The long and arduous journey of medical, social and legal gender transition was underway.

My family didn’t accept my decision to transition. They told me that I was delusional. My transition, I was told, was an embarrassment that tainted the entire family.

I expected these rejections, but they hurt nonetheless. Because I had anticipated hostility I had held off telling them anything of my plans in the first place, although looking back, I wish I had been braver, for their sake and mine. For a time, I harboured hopes that they would come around, particularly as I started to gain firmer footing in my life – I found a job, started to date, developed friendships, and managed to keep the depression and anxiety at least somewhat - though not entirely - at bay.

But when my father died one year into my medical transition, what little progress I had made crashed to a halt.

Shortly after his funeral, I sank into a deep depression. Eventually I managed to move on with my life. I completed my medical transition, tried to find my footing career-wise, returned to university, and entered the mental health field, not as a patient this time, but as a practitioner.

My hope was that if I could become a mental health clinician, I could help others struggling with gender dysphoria, could maybe even help their families, though it was too late for my own. I had managed to keep the darkness at bay thanks in large part to the people who showed up in my life, who accepted me as I was, though I did not always understand why. I had successfully navigated the most difficult period in my life, I thought — perhaps that could inspire others to keep going too.

While I had made great strides after transitioning, the doubts surfaced almost as early as the decision to transition itself, though they were faint at first. I felt a general sense of cognitive dis-ease with having to change my body in order to feel at home in my own skin. At first I attributed my reservations to internalized transphobia, a deep self-loathing I harboured for my own difference. I tried to shake it off by clinging to the belief that the medical professionals knew what they were doing. But I had flashes of memories — moments where I had made choices, not based on the belief that I was a man, but rather on the belief that I was not much of a woman. I remember telling myself that being a broken man was better than being a flawed woman in our culture. I recalled an incident where I exposed my newfound transgender identity to a university professor, himself a trans man who had transitioned a generation before. He did not immediately affirm me, instead listening to my difficulties with my family and suggesting that I had much to talk about before making the decision to transition. At the time I resented his cautiousness. Ensconced in the faith that transition would cure my ills, I didn’t approach him again.

Four years after starting hormones, I had a double mastectomy. It was a practical decision. Since I had no intention of returning to living my life as a woman, I did not want to have to flatten my breasts with binders for the rest of my life; it was too painful and uncomfortable. In the nights that followed the surgery, I remember waking up from a dream in which I still had my breasts but they were black and blue with bruises. I started to wonder if I had made a terrible mistake. The few people I dared to admit these feelings to, reassured me that this was a not uncommon response and that it, too, would pass. They were right. With time, I grew to love my flat chest, though the healing was arduous and required multiple surgeries to repair the damage of a hematoma that followed the first surgery. I still bear the scars. But at least I was no longer constantly in fear of having my breasts discovered or my identity called into question.

Next up was a hysterectomy. That was an easy decision to make, considering how traumatic my monthly periods had become. Also, I was terrified of getting pregnant. With my long history of mental health challenges, I did not want my offspring to have to endure the same difficulties I had experienced.

Lastly, and pragmatically, if I could have my reproductive organs removed, I would no longer need to worry about attending gynaecological visits for pap smears and pelvic exams. My anxieties were largely appeased by the sacrifice of my uterus.

As my mental health gradually improved post transition, the desire to have a family of my own snuck up on me. I had not allowed myself to imagine the possibility of being a parent before. Though I was an adult when I first decided to transition, I had been deep in the thralls of depression; I was not thinking about what I would be losing by sacrificing my reproductive capacities. I had no concept of growing old at 24. In fact, I held a superstition that I would be dead by the age of 30, either by my own hand or by some act of God.

Since completing my medical transition, my life has largely stabilized. In my 40s now, I am grateful for the people who stuck by my side throughout. I mourn the people I have lost touch with along the way. And I recognize that my perspective on transition has shifted as I have settled into a life I can bear, with a family I have built.

I no longer consider myself male, though legally that is what I am. My thoughts are: if gender is a social construct, and society sees me as a man, I cannot be a woman. Yet if sex is largely fixed and all the surgeries in the world can’t change that, then I cannot be male. I am an impossibility; I am a female man. And yet in that impossibility I have found some semblance of peace.

Medical transition is touted as a very effective treatment for gender dysphoria. Doctors routinely claim that the regret rate is much lower for this type of intervention than virtually any other medical treatment for any other condition. I wish it were that simple. Perhaps for some people it is. For me my transition has raised more questions than it has answered. I see value in acknowledging these complexities.

Medical transition has complicated my already messy relationship with my body. I like myself when I look in the mirror and see my bearded face, but I miss the thick, curly brown hair I had as a girl, that at times I wore in a pony tail and sometimes cut short. These days I wear a hat to conceal the hair loss that often accompanies testosterone treatment. I like my deep voice, but I miss my singing voice, the voice my late father loved to hear when I sang carefree in the shower as a child. I like the silhouette of my flat, masculinized chest, but I regret the scars and the loss of sensation. I like that I no longer have to worry about monthly periods or have to fear unwanted pregnancy, but I grieve for the child I’ll never bear.

I have many theories on what led me to this place in my life. Is my gender dysphoria better understood as an anxiety disorder, the fear of becoming an adult woman in a misogynistic culture? Was it social influence and an obsessive disposition? Am I autistic and mistook my social awkwardness and sensory sensitivities for gender dysphoria? Do I have some undiscovered intersex condition? Was the emotional neglect I suffered as a child sufficient to lead me to dissociate from my body? Did my misattunement with my mother drive me to over-identify with my father? Is even asking for a causal mechanism a flawed approach, implying that being trans is somehow abnormal and requires fixing? Yet, if being trans were simply a natural variant, why bother with medical interventions at all?

I am bothered by those who would deny that regret happens at all, a message I’ve seen promoted by some trans people, so-called allies, and medical professionals too. It happens. More than some of us would like to admit. I’ve spoken to enough people now to know it.

I believe medical professionals owe people honesty and I’m not sure that’s happening. To acknowledge the difficulties, the complexities, the challenges, the inherent contradictions is not hate.

Take from my story what you will: Medical transition did not cure my gender dysphoria nor my anxiety and depression. Not really. Sometimes I even think transitioning was a mistake. That said, I’m grateful I had the opportunity to make it. I needed to make it to be where I am today. And, for the most part, I love my life today.

I don’t know what the right decision is for anyone else. Maybe what feels right today won’t feel so right 5-10 years down the road. If I can offer some humble advice to others wrestling with their identity, I would say this: Some people may be cruel as you try to figure out what’s best for you. Stay curious. Stay kind. Don’t let others’ cruelty harden you.The world is a beautiful, wondrous, violent, messy place. Look for the beauty in the messiness, if you can.