A Gender Transition Story: How My Views on Medicalization Have Changed Over Time

Stefan

Photo by USGS on Unsplash

While gender nonconformity has existed for thousands of years in virtually every culture throughout human history, engaging in medical interventions to ‘treat’ it is a relatively new phenomenon. The first gender-related surgeries that we know of occurred in the early 20th century. Almost 100 years later, much has changed in the cultural landscape as far as our understanding of gender goes. 

In January 2004, I started hormone treatment to transition from a woman to a man. I was a young adult in my mid-20s, living in a large Canadian city, when I embarked on a medical path. My last surgical intervention was in 2010. Over the years, taking testosterone has masculinized my body to the point where I’m visually indistinguishable from men in day-to-day life. Legally, and socially, I’m treated as a man. 

My physical transition was relatively straightforward, though I experienced surgical complications along the way. Psychologically and socially, however, I have had a variety of challenges. When I initially embarked on my gender transition from female to male, I was working with a psychiatrist. I had suffered from anxiety and clinical depression for as long as I could remember, and success in therapy remained elusive. I remember the first time I raised the issue of gender transition. Despite a deep anxiety about speaking about anything related to sex or sexuality, I told her that I was thinking maybe I was a man. I recall her being supportive, suggesting that I explore social transition; she even agreed to write a referral letter to a psychologist who specialized in gender dysphoria for a formal assessment.

I saw the assessing psychologist for a single 90 minute session. The natural next step was hormones and surgery. That was the only treatment option that was presented to me. Armed with my assessment letter and a referral to an endocrinologist, I pursued hormone therapy. The long and arduous journey of medical, social and legal gender transition was underway.

In the early days of my transition, I experienced what some call gender euphoria. Taking my first hormone shot felt very empowering. I felt like I was taking control of my own identity, my own destiny. Initially, my depression lifted, my anxiety subsided. A clear path lay ahead of me: updating legal documents, informing loved ones, and looking into surgical options. It gave me a sense of purpose and direction. I built my life around moving forward with my gender transition, which included finding employment that would provide me with health benefits for when I would be recovering from surgeries. 

While my life seemed to be going well from how things looked on the outside, not everything was coming together as I’d hoped. Doubts surfaced almost as early as the decision to transition itself, though they were faint at first. I felt a general sense of cognitive dissonance with having to change my body to feel at home in my skin. That dissonance became louder with time. At first, I attributed my reservations to internalized transphobia, the deep self-loathing a trans person harbors toward their difference. I tried to shake it off by clinging to the belief that everyone saw me as male and therefore it must be true. I also told myself that the medical professionals knew what they were doing, that they had my best interests in mind, and that I’d done enough research to suggest these feelings were part of the process of adjusting to who I was really meant to be.

But I had flashes of memories I couldn’t deny — 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 recalled moments where I had felt uncomfortable because I didn’t like the look of my breasts, or was grossed out by my period, or didn’t feel like I had much in common with the women around me. I remembered an incident where I exposed my newly articulated transgender identity to a trusted professor. He didn’t immediately affirm me. Instead, upon learning about my history of gender nonconformity, he suggested that I had much to talk about with a therapist before making the decision to transition. At the time I resented how cautious he came off. Ensconced in the faith that transition would cure my ills, I didn’t approach him again.

After my transition, and as I matured, the desire to have children snuck up on me. Prior to that, I had not allowed myself to imagine the possibility of being a parent. Up to then, I had little concept of growing old, let alone growing old as a man. For much of my teen years and early twenties, I had held a belief that I would be dead by the age of thirty, either by my own hand or by some act outside of my control. As thirty came and went, however, and I continued to live, my views changed — and with it my perspective on my transition.

I no longer consider myself male, though legally that is what I am. When I first transitioned, I thought that gender transition was a cure for my depression and anxiety. Some might say that this was a foolish assumption on my part, and that I am solely responsible for holding it. But this belief didn’t come out of nowhere. This is what I was told. What responsibility do the medical providers and psychological assessors have, considering that they had a duty of care and I believed what they were telling me? 

Medical transition is held up 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 people receive for other conditions. While I wish that were true, I remain skeptical. No one who helped me along my medical transition ever followed up with me to find out how I was adjusting. Just because people don’t necessarily detransition doesn’t mean they don’t grieve or regret. And what of the rising voices of detransitioners? Do their voices not also matter? Perhaps for some people transition is the right choice and it really is that simple. But for me, my transition has raised more questions than it has answered. I see value in acknowledging these complexities.

As for my gender dysphoria, I still experience it. Only now it’s in reverse. Medical transition has complicated my already messy relationship with my body. I mostly like myself when I look in the mirror and see my bearded face, but I also miss the thick, curly brown hair I had as a girl, that at times I wore in a ponytail and sometimes cut short. These days I wear a hat to conceal the hair loss that often accompanies testosterone treatment. I don’t mind 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 teen. I have grown to like the silhouette of my flat, masculinized chest, but I regret the scars and grieve the loss of sensation that followed the loss of a nipple during surgery. I like that I no longer must worry about monthly periods or have to fear unwanted pregnancy, but I experience deep sadness for the child I’ll never bear.

Was my medical transition worth it? I’m not so sure.

Over the years I have had many theories on what led me to transition. Is my gender dysphoria better understood as an anxiety disorder, the fear of becoming an adult woman in a culture hostile to gender nonconformity? Was it social influence and an obsessive disposition that led me down this path? Am I autistic and mistook my sensory sensitivities and communication difficulties for gender dysphoria? Did my misattunement with my mother drive me to over-identify with my father? I’ll likely never know.

Regardless, I am bothered by those who would deny that regret — or more accurately, profound grief —happens when we medicalize gender nonconformity, as if it is no big deal. Or, if they do acknowledge that regret happens, they often frame it as irrelevant, or a rare event —  a message I’ve seen promoted by irresponsible healthcare professionals, so-called allies, and even in some LGBT circles. I am especially angry at the medical organizations, including WPATH, who continue to deny the iatrogenic harms of unfettered gender affirming care practices, while they barely acknowledge the significant psychological and medical needs of detransitioners. I believe medical professionals owe people honesty and that’s not happening.

It is not hateful to acknowledge the difficulties, the complexities, the challenges, and the inherent contradictions.

Stefan is a trans man who lives in Canada. He is seeking to build support services for detransitioners and those who feel they were harmed by gender-related medicine. You can find him online at gendercrossroads.org or subscribe to his Substack at gendercrossroads.substack.com

Add your voice to the dialogue. Send your submissions to lgbtcouragecoalition@gmail.com