Nearly seven months ago, I made the decision to start testosterone as a part of my gender transition.
I remember feeling so overjoyed that this part of my journey was beginning. The torment of being in a body that caused me so much distress, and being misgendered left and right adding salt to my wounds, made HRT not just a desire of mine but a real necessity.
If you’d asked me where I’d be by now, my self of seven months ago would talk about how high my dose would be, all the changes that would be happening, my desired date for top surgery (would it be September? December), and how I’d be so much closer to the body I needed to have – closer than I’d ever been.
But none of that is true. In fact, I’m almost exactly where I started.
I’m still here because my testosterone dosage is only half of a typical starting dose – extraordinarily low and nearly ineffective, because there’s not a single doctor willing to increase it.
I’m still here because I was denied the recommendation needed to move forward with top surgery.
I’m transgender and I’m trying to transition. But the door keeps getting slammed in my face again, and again, and again.
There’s not a lot of conversation happening around the specific challenges that transgender people with mental illness are facing. I first wrote about this when I discussed my experiences in a psychiatric hospital, where I was almost denied my hormones altogether.
As someone with bipolar and a whole assortment of other diagnoses, I continually come up against obstacles in my transition that I would not otherwise face if I were neurotypical.
I’ve been told before to stop taking hormones. I still remain on a dosage that barely alters my body – because there are concerns about how the hormonal changes will affect my sanity, despite having no evidence that it will and knowing we could lower the dosage if it did.
Most recently, I was told that I couldn’t move forward with top surgery because I was in a mild depressive episode, and that we would have to wait a few months to revisit the possibility of surgery. Seeing as the waiting period for surgery can be anywhere from six months to 2 years, it’s unclear to me why we couldn’t address my depression while I was on the waiting list for surgery.
Transition can already feel like it takes centuries just to get an inch closer to where we need to be.
So imagine, then, that you are a transgender person with mental illness, who not only has to deal with the typical challenges of gender transition, but you must also navigate the exhausting barriers that therapists, psychiatrists, and doctors place in front of you.
Imagine having no idea when you’ll be permitted to access the care that you desperately need – that you’ll remain imprisoned in a dysphoria-induced hell until you pull it together and become acceptably sane for your doctors.
It’s true that transgender people with mental illness have needs that are unique and important, due to the biochemical nature of both medical transition and mental illness. And it’s true that making life-altering changes during times of turmoil can sometimes do more harm than good.
But it’s also true that countless mentally ill transgender people have been denied hormones or surgery to their own detriment, causing real and even lasting damage.
It’s true that the woeful lack of research around mentally ill transgender people means that many medical professionals simply don’t know how to support this vulnerable population.
And it’s absolutely true that being unable to transition can worsen a transgender person’s mental health – and clinicians who do not take this into account, treating medical transition as optional rather than urgent and necessary, are contributing to the very mental health crisis they wish to avoid.
As I sit here with the inability to go further in my medical transition – stuck in a desperate situation that continues to eat me alive every day – it is obvious to me that mentally ill transgender people are being failed at every level.
If our only “solution” is to not transition, we need new and better solutions.
Assuming my bipolar stabilizes further, there will most likely be a time – I don’t know, hopefully this year? – when I can move forward, after more than half a year of being held back.
And while I’m hopeful that I’ll be able to resume my transition, I remain paranoid and fearful that it can be taken away from me at any time.
If this is what it looks like to be a mentally ill transgender person in the San Francisco Bay Area, I’m terrified to know what it looks like elsewhere in the country, where care is even less accessible and trans-competent clinicians are few and far between.
We deserve better than this. If a medical intervention is what a person needs to be well, why would we ever treat it like it’s optional? How are our gender transitions any different?