In general, people who ask whether they should transition know the answer. I don’t know the answer, at all. I have some hunches people don’t understand what kind of specialty care problems they’re signing up for, but that’s also true if you smoke OR if you have a vaginal birth. I get that people can’t live their lives always making their long term health first priority. With some people I’ve known it’s been super clear to me that a person needs to at least get their mental health stabilized for a year or two before starting medical transition, because their mental health issues are definitely affecting their ability to think through the consequences of their actions. And geez, if there’s any endeavor you want to plan with the ability to think things through very carefully and realistically, it’s medical transition.
But beyond that I don’t know what other people should do. I only know for certain you can medically transition in America while only receiving incredibly bad advice from mental health professionals. This is partly because incredibly bad advice for this human endeavor tends to be the woke shit to say, and mental health professionals have SUCH nutty hangups about being the wokest people around.
Nowadays when people write me emails asking what they should do, I ignore the emails. It didn’t used to be this way. But I’ve drafted enough careful, deliberate replies, that took me time and energy, only to never get responses, that I’m much more selfish with my time and energy now. When you write me an email you know in your heart what you’re going to do.
But here’s one thing I’ll say about gender dysphoria- if you haven’t tracked your gender dysphoria and it’s fluctuations for at least a year, if you can’t even assign your experience a number and write the number down and look at the numbers you’ve written down for 365 days, why are you already at the point of considering HRT?
It’s silly to be considering medical treatment if you haven’t even tracked the symptom in a sustained way. And remembering the past is not the same as tracking the symptom- everyone’s narratives about their childhoods change in such a big way when they want to justify taking HRT. Writing down every anecdote you have about wanting to run around shirtless with your brothers is not at all, in any way, the same thing as tracking your current gender dysphoria.
I had a terrible summer when it comes to my gender dysphoria. It got so intense, right after the Atlantic thing, and then Blood and Visions weirdly made it a lot worse, and all the way through me graduating my dysphoria was killing me. It was SO disheartening, because I’m committed to never doing anything like HRT or cutting my body up, mostly because I’m trying to be in really good shape in my 90’s. But it’s super disheartening when you’re in an episode like that and it feels like it’ll just be your whole life, and the only option is putting up with it or wrecking your pelvic floor.
And then I stopped waitressing. I started working full time as an LPC, suddenly I was going WEEKS without anyone at my workplace making comments about my body. Indeed as an LPC it’s kind of my job, if anyone does make a comment about my body, to make a big deal about boundaries and what boundaries are appropriate in the therapy room. That is the OPPOSITE of being a waitress/a receptionist/ legal assistant/barback/ working at a union. That’s such a huge difference in my working day.
Then at the same time I finally get feedback in my life that’s proof of my own self-efficacy, in that this long terrible grad school process finally produced a degree.
My gender dysphoria has been, for the past month, on vakay. I barely have been thinking about my body, except if I’m hungry or my back hurts or I’m feeling particularly energized and good. But not those obsessive thoughts about “oh my body is shaped so funny” or “everyone’s looking at my body” or “I can’t do anything in this body” or “I’m trapped in this body.” Guys and gyns, me barely thinking about my body is UNREAL. IT’S SO GOOD. IT’S SO FUN TO NOT THINK THAT MUCH ABOUT THE SHAPE OR APPEARANCE OF MY BODY.
What’s even crazier about not thinking that much about my body is that for most of September I was having pretty good naked times, and naked times have historically been prime triggers for my gender dysphoria. (The naked times have come to an end, in the calmest and non-distressing breakup I’ve ever experienced, so even though they’re over I still consider the whole thing a win?)
So we go from a July/August crazy intense GD episode to near-extinction in September. My conclusion is I think my GD is so much about stress and self-efficacy. I get those obsessive thoughts when the world has given me lots of feedback that I’m totally powerless. If I’m getting feedback that I’m capable of having some impact in the outer world, and if I’m not only allowed but strongly encouraged to enforce boundaries, my GD seems to want to take a break.
Now, the patterns to my GD don’t mean much about your GD. I’m just saying what do you know about your GD if you haven’t tracked it? Also what would you rather not know about your GD? Are there aspects to your GD you’d really rather not acknowledge?
Because I get it, I get wanting that surgery and wanting that beard and just wanting to plow through and not wait any longer. But what you don’t want to acknowledge will end up fucking you up. You have to force yourself to be super real about your GD. If your therapist is anything like how mine were, they will not force you to be very real about your GD. If the people in the community you know are anything like the people I knew, they will tell you thinking too hard about your GD is internalized transphobia. So this is on you.
Other people have not signed any kind of agreement with a higher power to give you good advice. Other people are not particularly invested in how your life turns out. You are actually the only person responsible for the advice you listen to and the consequences you have to live out because of the advice you chose to listen to. Believe you me, when shit goes south, all those people who told you to jump in and waste no time will swear they didn’t say it like that.
Track your GD for at LEAST a year. Whatever the consequences of taking T are for you, you will live out those consequences for SO MUCH LONGER than a year. Don’t accept your own bullshit, no matter what social incentives there are for accepting your own bullshit. You will create exceptionally dumb and hard situations to have to navigate. In the end no matter how it all pans out the lesson is the same- we create what we end up experiencing. Yes, in a world that is violent and dumb and unfair and a shitpile. But in this shitpile we still make our own choices, and get a lot of data back about what our choices create. Track that data now so you can think a little clearer about what kind of data you want to get a year from now.