I want to start by saying that I do not have any simple answers about what the best path forward is, when it comes to policy or healthcare decisions for gender dysphoric people as a whole. It’s a messy issue. No matter what, some people will get hurt. Bans create panic and disruption for individuals and families. Regulation and gatekeeping can lead to suffering for those who don’t have easy access to services. No gatekeeping puts those who are vulnerable at risk of being harmed.
My hope is that as I tell my story and explore my experiences further, some clarity might emerge that might be helpful. So far that clarity has remained elusive, at least to me.
Tell the truth.
I have always attempted to be as truthful as possible. Sometimes I have failed, either because of a lack of courage, or because I have not known how to put into words the truth I felt. Sometimes I have had difficulty interpreting my own thoughts and feelings. Yet, some might say, here I am, living a lie day by day. Presenting myself as something other than what I am. It is a burden on my conscience that I wrestle with daily.
Then again, I’m not entirely sure that what I am living is a lie. I have sought to change my legal status, my body, in order to socially belong as best I can, to exist in a way that does not further alienate people. I have made these changes gradually, with the support and encouragement of healthcare providers with whom I have tried to be as honest as possible. Yet, by making these changes, I have come to inhabit a space that is both real and not real.
Males cannot be females. Females cannot be males. I accept that. But societally we have created a space for females to be legally male even though they are not natally male, and vice versa. That ship has sailed. And that’s not on me. Other people created this space. I merely stepped into it.
I did not do this alone. An entire infrastructure was created before I ever went for my gender assessment and dysphoria diagnosis — an infrastructure that I thought was built on solid foundation. It was not. Should I have known better? Maybe I was too trusting. But the setting up of that infrastructure, that part is not my fault.
The question of fault, is one I struggle with. Not fault, exactly, but responsibility. What, as an adult, am I responsible for? And what am I not?
I am responsible for my decisions. But in all of our lives, there are times when surely we cannot be held responsible, even for that. Imagine, for example, a 75 year old woman with dementia who walks into traffic. Is she responsible for disrupting traffic and putting lives at risk? Yes, perhaps. But is she responsible for having the symptoms of dementia? Is she responsible for her caretakers’ neglectful oversight? Surely, no.
I accept that I went to a psychologist, a supposedly learned man who I thought was trained to understand the intricacies of the human mind. Someone who I thought was equipped with knowledge about how the brain worked, with knowledge that surpassed my own.
I told this psychologist a version of my life story that confirmed my belief that I was trans. The story included the truth as I saw it at the time. I had always been uncomfortable with my body. Puberty was brutal. I was attracted to both males and females. I had always been a tomboy. I had as a child been confused about my gender and my sexuality — for example, at age 12 I asked an adult how you can tell the difference between a male sheep and a female sheep. That adult told me, with a smirk, “because they are bigger”.
Well. I was a 6ft 1 teenager — taller than my father. Though I was slender, I was certainly bigger than most boys and girls in my class. Did being bigger make me a man? Or just a very tall girl?
As far as I know the assessing psychologist did not ask for the notes of my own psychiatrist that I had been seeing for 3 years. She had referred me there for an assessment because she did not feel qualified to do a diagnosis herself. At the time only a select few experts were approved to provide referrals for medical interventions.
Had he asked for collateral information, he would have learned of my struggles with sexuality, my history of depression and anxiety, especially as related to sex and my body. He would have learned about my ongoing difficult relationship with my parents and siblings, and my cultural disorientation, having grown up in two continents, not fitting easily into either. He would have heard what it was like to grow up with a disabled father who, I was told, was about to die at any moment. He would have learned that I was sexually assaulted by a stranger two years prior.
He would have learned that rather than feeling like a man, my dysphoria was more a realization that I did not feel like, act like, or fit in with other women.
But he asked none of that.
After a 90 minute appointment, he generated a brief psychosocial overview of my life. He wrote a letter stating that I was a transsexual, that I wanted to transition, and recommended that I be referred to an endocrinologist.
Three weeks after first declaring that I might be trans, after never expressing such a thought prior to this, an endocrinologist gave me a prescription for Testosterone.
What am I responsible for? What are they responsible for?
I was responsible for asking for help. I was responsible for talking to these experts about my struggles. I was responsible for not wanting my parents to be involved in my care, because I felt they judged me. Besides, I was an adult. I didn’t need them there.
I was not responsible for my diagnosis or treatment plan. That came from the experts I consulted with. I assumed it was backed by research — something I no longer believe. I was responsible for accepting their recommended treatment plan. Why should I have doubted them?
The mistake I made was to have had a preconceived idea of what was wrong with me. And they simply confirmed it, without testing it for size. I thought I was going in for a diagnosis and treatment. That’s not what I got. What I got was an assembly line: Patient says they’re trans = they are trans = they should be started on hormones = they should get on the waitlist for surgery.
Nowhere in this process did any of the medical providers push back and say: you know? Maybe we should look at your motivations for wanting to do this. What is it about living as a woman that is causing you so much distress? What have you tried so far? What are you willing to try? Let’s start with exploration first (e.g. If you had to live your life as a woman, what kind of woman could you be?)
No one asked about the sexual discomfort or pain I experienced during intercourse and I certainly didn’t bring it up. I felt too much shame and embarrassment about anything related to my body. It felt less shameful to change my entire physical being, my legal status as a woman, than to admit that penetrative sex was so painful as to be impossible for me. Even as I write this sentence I feel shame burn in my cheeks.
No one seemed the least bit curious about any of this, because they inhabited a space of certainty that up to then I had craved with all my heart. They knew what was wrong with me, and hormones and surgery would fix me. I wanted to believe them. I am responsible for believing them. But I am not responsible for the lie they told me. Perhaps they did not think it was a lie.
I do not know what to do with any of this. It feels like such a tangled mess. I want to be mad at someone, point the finger somewhere. I can point the finger at the psychologist who was so incurious. I can point the finger at the psychiatrist who, after I started my medical transition, fired me as a patient stating that she had nothing more to offer me. I can point the finger at the pharmaceutical companies and medical leaders who continue to turn a blind eye to the harms they have contributed to. And I can point a finger at myself, for being so gullible, so foolish, as to think that surgery would cure my mental anguish. I can point my finger at my parents, for years of emotional neglect. There are plenty of people to blame. Including me.
But what does that change, exactly? Let’s say it is all my fault. Or the doctor’s fault. Or my mother’s fault. Or my father’s fault. Or the psychologist’s fault. Does that undo the damage? Does that fix anything? This is not something that can be fixed through blame.
I don’t want to live a life of resentment. I still have years ahead of me (I hope). I’d like to spend it creating something constructive, rather than wallowing in regret for decisions I cannot undo. I am less interested in blame and more interested in figuring out how to build a system that actually better supports people who may have struggles like mine. If we could build a better system, what would be the key components? What would it look like?
I think it would need to involve:
Time
A focus on psychological as well as physical health
Healthcare providers that look at the full human in context
Honesty, about what we know and don’t know
Honesty, about risks, common medical complications, and benefits, for those who choose to medicalize
Collecting collateral information from family/friends
Psychosocial support for clients navigating a world that is not required to accept them
Ongoing competent medical and psychological support whether that person medicalizes, doest not medicalize, or chooses to discontinue medicalization
My story is just one of many, but I no longer believe that I am an outlier or all that rare. I am coming to terms with the mistakes I made and the reasons why I made them. My story isn’t over. I’m still figuring out how to put the puzzle-pieces back together again. Some pieces are missing, and probably always will be. That’s OK. I’ll leave the blame game to someone else. Plenty of people are ready to step up to that plate.
The question I regularly come back to is a different one: What is the best use of me, now? I don’t fully know yet. I’ll continue to tell the truth. Even if it’s inconvenient, to myself and others. Even if it doesn’t fit into everyone else’s preferred narrative.
The truth as I see it is that I sought out transition because I thought it would help fix my mental struggles. It didn’t. And yet, it did help me break out of old patterns for long enough to find a strange kind of footing in this world. By the time my depression and anxiety returned, at least I was alive to access psychotherapy that actually helped.
I am making my peace with living my life as a legal man while knowing that I am a natal female. I’m not sure I believe medical transition is ever the right answer, and doubly so for children. But while it may not be the right answer, for some it becomes the default answer and it is still possible to live a meaningful and even happy life after having medicalized.
This is the inconvenient truth as I see it.
I appreciate your honesty here. This is all so difficult, and I appreciate the line about the opportunity was there and you stepped into it. I just keep thinking how this has become so widely accepted as just no big deal, with no regard for the human life that could be permanently harmed. It truly hurts my heart to think about it. Someone called it a pyramid scheme- the promise of happiness at each step until all the steps are completed and no guarantee that this was the best solution, so now you must just accept what you’ve done. I wish you peace and I’m sorry this was allowed to happen to you.
Powerful. I relate particularly ‘cause I, too was a precociously tall teenage girl! Back then (1963) my parents came at me with “We hear there’s a ‘treatment’ to make you stop growing.” That seemed totally wacky (who the heck wants to ‘stop growing’?!) Saw it as a judgement of me (‘you’re freaky’) more than anything. Well, being a tall woman has caused me difficulties conforming, clothing-wise (women’s shoes & clothes don’t fit) & getting misgendered (taken as a man) occasionally. Not a big deal since my life’s been filled with plenty of good stuff (friends, art, music, books, nature, etc). I kinda joke being taken for a man gives me a unique perspective, like a spy or a fly on the wall, observing surreptitiously. Plus, get to see over the crowd & reach high shelves! I wish you the best & hope you don’t despair. Thanks for sharing.