Lost to Follow-Up/How Far Can You Follow Me?
[Re-reading this lately, I find there’s a lot I no longer relate to. I go through periods were I feel very distraught by my transition but more and more I’m finding ways to make peace with my past and accept how I got to where I am today. I will probably always have a lot of complicated and somewhat conflicted feelings about my transition. I was working through the ways transitioning had hurt me and my shame around transitioning when I wrote this. Many detransitioned women I know have felt extreme negativity about their past transition at some point and that affects our relationships to the medical and psychiatric professionals who helped us transition. I still thinks it’s important for those facilitating medical transition to know that detransitioned people may not be forthcoming about our experiences because our transitions are associated with trauma, self-destructiveness and shame, among other things. Since writing this post I’ve written a follow-up post that can be read here.]
I haven’t told any of the medical providers who helped me transition that I’ve since detransitioned and accepted myself as a woman. Not the therapist who diagnosed me with gender identity disorder, not the doctors or nurse practitioners who prescribed me testosterone and took my blood for testing. I haven’t contacted any of these women (all the providers I saw happened to be female) and told them what became of me.
I wouldn’t bother telling them about my detransition without telling them why I transitioned and how it was a kind of self-destructive coping mechanism. The thought of telling my old providers about how transitioning hurt me is intimidating, overwhelming. I’d be making myself very vulnerable and I don’t trust doctors to begin with, not even the nice ones. Why would it be easy to tell those who prescribed me testosterone that doing so helped me hurt myself? Why would it be easy to tell them that they were enabling my self-destruction? Their good intentions makes it even harder to tell them.
I’m thinking of one of my providers in particular. She was the one everyone wanted to see because she was so chill and respectful. I really liked seeing her, my trans and genderqueer friends liked seeing her too. We were all sad when she was transferred and started seeing younger patients exclusively because we were too old to keep her as our provider. I really enjoyed how she treated me when I went to appointments with her and she helped me take a drug that gave me problems that I’m still dealing with. It’s hard for me to wrap my head around those conflicting pieces of information. I know she was trying to help me and other suffering people. She was trying to help a group of people who face many difficulties and regularly get disrespected and treated like shit. The way she treated us with understanding and respect meant a lot to me and other trans people. It made the inconvenience of showing up and giving blood every few months for testing a lot easier to deal with.
And she hurt me, helped me hurt myself. That definitely wasn’t her intention but that’s still what happened. This contradiction is difficult to face and understand. She treated me like I wanted to be treated at the time. She was supporting me and helping me do what I was convinced was best for me and I appreciated that a lot. I appreciated all the support I got when I was transitioning. I thought taking t was what I needed to do and it seemed to be helping me. I liked how easy it was to get on testosterone and I liked how I was treated when I went to my appointments. I liked how my friends all supported me and thought it was cool that I was transitioning, that they saw it as a positive thing. I also thought of it as a positive thing.
And now when I look back I’m horrified and creeped out. There’s something disturbing about doing something you think is good for yourself but that turns out to be really self-destructive and it’s even worse when so many other people were helping you and making it easier for you to do it. It’s hard enough taking in how I managed to hurt myself when I was trying to find happiness and express my true self. How am I supposed to deal with how all these people in my life were trying to be helpful but were actually enabling? How am I supposed to make sense of that?
Part of me feels like it’s all my fault. After all, my providers were giving me hormones on my say so, doing what I wanted. But how are they also not implicated in what I did to myself? I couldn’t have changed my body without other people helping me, writing me prescriptions for testosterone and showing me how to inject it.
I feel sad, like I let myself and other people down. Like I fucked up an unspoken agreement between all parties involved. Support me and affirm my choices and I’ll do great, just you wait and see. Well, they supported me and went along with what I wanted and transitioning didn’t end up being so great for me in the end. It’s as if I wasn’t actually worthy of such treatment after all because I didn’t hold up my side of the bargain. Like I deceived people about my worthiness of good treatment. I can’t talk to my old providers while I still feel so ashamed of how I ended up. I’m ashamed that I deceived both of us, that the happy trans man they saw was an illusion and all the good work they thought they were doing was a lie. And telling them the truth about what was actually going on is terrifying. That I was dissociated, acting out my trauma, that I was trying to destroy what I was and become someone else, that I didn’t really know what was going on with me. That my situation turned out to be way more complicated than any of the people involved realized at the time.
When someone tries to do good and ends up hurting you it makes it hard to trust them. I did trust my providers (as much as I can trust any medical professional) and they helped me destroy myself. Can they accept whatever responsibility they had in that or will they deny it? If I open myself up and tell them how the drugs they gave me affected my life in the long run will they be able to face that? Are they going to say it was all my fault and I should’ve known better? Will they actually be able to do anything that will help me now? Are they going to treat me like I’m crazy? Are they going to get defensive? What should I expect if I tell my old providers that I transitioned because I was severely harassed for being a lesbian and traumatized by my mom’s suicide?
I ask myself what reaction I’d most want if I did tell my old providers about how transitioning hurt me. I’d want them to apologize to me. I’d want them to recognize the harm they were a part of. Not take it all on themselves but accept their role in it. Just hearing something simple like “I didn’t mean to hurt you and I’m sorry I did” would be enough.
I’m not ready to have that conversation and I’m not sure when I will be, if ever. I know if my providers acknowledged my suffering and their role in creating it that would be tremendously healing but right now I’m not willing to risk it. I’m afraid of being dismissed, being called crazy. I’m afraid of opening up and talking about very painful parts of my life and them not knowing how to respond or what to do with me.
People like me are not factored into an informed consent model. Informed consent presumes I know what’s going on and what I want. I knew what I wanted but I didn’t know what all was going on with me. I was dissociated, I was blocking and repressing parts of myself and my past. And there was no way I would’ve listened to anyone if they had tried to tell me that. I don’t even know that I gave many signs that I was repressing anything, since my therapist approved me and a bunch of people told me how much happier and more together I seemed once I started t. My transition seemed like a success for years until what I buried came back up. My situation, the problems I was dealing with, turned out to be more complicated and messy than I thought. Everyone involved was acting with the best of intentions and we all didn’t know what was going on. My providers didn’t know they were giving hormones to a traumatized self-hating lesbian, I didn’t know that’s what I was.
Thinking about my medical transition is upsetting, hard to revisit. It’s hard now to go back to that time in my life when I was injecting t. It’s such a mindfuck because it was very satisfying to watch my body change then but from where I am now it looks very self-destructive. I was hurting myself. And I feel ashamed that I was hurting myself and didn’t even know that’s what I was doing. I wasn’t well when I was doing that to myself, wasn’t in a good place. I was acting out. I wasn’t fully aware of what was going on inside of me. And thinking about how people were prescribing me the chemicals I was using to hurt myself is even more bizarre and troubling. It’s disturbing to remember going in for appointments, how much I coveted my prescriptions and felt more secure after I’d refilled them. It’s distressing to remember how I used to give myself shots like it was no big deal and now I think how could I do that to myself?
Of all the forms of self-destruction I’ve engaged in, taking testosterone is the most surreal for me to think about. I hurt myself pretty bad doing too many drugs when I was younger and I used to cut and burn myself but I don’t get the feeling of distraught, horrified confusion that I get when I think back on taking t. Some of the difference is due to how no one is touting drugging yourself into oblivion and cutting yourself with razor blades as life-saving treatment the same way transition is spoken of. I knew I was a drug addict, consuming more than was good for me. I cut and burned mostly in secret because I knew other people would think I was crazy for doing that. Transitioning was out in the open and celebrated. Besides being a medical treatment, it was supposed to be a kind of radical self-creation. Watching my body change was exciting and felt powerful. The way testosterone affected my body made me so happy then but now it’s distressing to think about.
I’m not even that upset about how taking t has permanently changed my body. I think there’s a lot of confusion about that, about why detransitioned people were harmed by altering our bodies. We don’t feel one way about it. Some of us are very distressed by the permanent changes but not all of us are. Other people seem to be a lot more upset about my deep voice and facial hair than I am. I can accept how my body is now. What disturbs me looking back is how eager and happy I was to change myself so drastically, that I couldn’t accept who I was without intense modification. Medically transitioning symbolized how I felt that who and what I was wrong, not enough, and had to be totally reshaped to be made good. That I would rather become another person than be who I am, that being who I am was so unthinkable that I was split off and in denial of my actual self. That’s the real violence, that’s the mutilation, self cutting down self to make it a more acceptable shape. Thinking about what it meant to take t cuts me deep and thinking about where I had to be psychologically in order to do that is humiliating.
Even if I give my old providers an abbreviated account of why I transitioned and detransitioned, the whole story, the whole truth will still be there welling up inside of me. I’ll know the full implications of what I’m telling them even if I don’t provide all the details, even if I give them a bare, sanitized outline of how and why. And if I do hold back, I’ll know that one of my reasons is that I feel ashamed and afraid. I don’t think it’s their business to know my entire story anyways, but if I were to tell them only that I stopped t and started living as a woman I’d be obscuring the truth. Because it’s not that simple, it’s not like my sense of self just changed one day because gender is fluid or whatever. The truth is that they were helping a traumatized troubled woman act out her self-hatred. I don’t have to tell them everything but if I’m going to tell them I feel like giving them at least a rough sketch of the painful reality.
These providers have seen hundreds, maybe thousands of people and helped them transition and most of their patients have expressed satisfaction. I think of that and compare it to what I have to say and feel crazy and fucked up. I know I’m going to stand out. But then I think there could be many others holding back for the same reason, we’re afraid of looking like the troubled anomaly sticking out among the many apparently satisfactory outcomes.
Detransitioned people have only just begun to organize into communities. Detransitioned women, as far as I know, only began to connect with each about three or four years ago and since that time more and more of us have been coming out. It’s hard to know how many of us there are and anyone who says they know the real rates of detransitioning is lying. There has never yet been adequate research done to determine our real numbers. The studies I’ve seen conducted so far would not have included me or many other detransitioned women I know. Studies that look at satisfaction rates of surgery aren’t going to include those who only took hormones and then stopped. People also conflate detransition with post-transition regret when many who detransition, including many who felt harmed by transitioning, don’t find that regret accurately expresses their feelings about transition. All the research so far hasn’t used the right criteria to get an accurate picture of how many of us there are. So we don’t know how many people end up detransitioning but I suspect it’s more than many think. An informal survey done by a member of our own community found two hundred detransitioned and desisted women in the two week period the survey was posted online.
Providers working with trans patients may be motivated to ignore or dismiss detransitioned people, not only despite but because of their good intentions. I’ve noticed that many of these people take pride in the good work they see themselves doing for a socially marginalized population. They’re invested in a certain self-image of themselves that our experiences may challenge. If my supposed satisfaction didn’t last and was motivated by a deluded understanding of myself, then couldn’t other supposedly happy patients eventually come forward with similar problems? Why are people happy with their transitions? Is it because they’re expressing who they really are or are they creating a new self to replace a previous one they’ve come to reject? If an identity is a coping mechanisms is it bound to fall apart or could it hold together for the rest of that person’s life? Could people be happy with transitioning because it allows them to escape a part of themselves they hate and reject? Am I categorically different from people who stay transitioned or is our struggle the same and the difference is that I found another way to deal with it?
Could my old providers see that I am not only a challenge to the validity of their work but that my experience also points to new possibilities? That my story offers not only an example of how transitioning can be harmful but also offers up other methods to treat dysphoria and help people find peace with themselves? Because while I have suffered, I have also come to a better place through detransitioning and accepting myself. I found what I was looking for not in the testosterone they prescribed me but in embracing what I once rejected in myself and through connecting with other women. Can they hear and appreciate how I gained more from my own efforts than from their attempts to help me? Can they hear how they may not be necessary to relieve the suffering of the group they have pledged themselves to serve?
My providers didn’t help me. Taking testosterone didn’t get to the root of my suffering, it only relieved it temporarily. I came out of my transition with many of the same problems I had before and then some. Being supported in my trans identity didn’t help me, letting go of it and accepting myself as a woman did. Changing my body didn’t help me find lasting peace. I helped myself by tracing back my trans identity and dysphoria to trauma and working through how I’d been hurt. Developing a daily meditation practice ended up improving my life in many more ways than taking t ever did and helped me become more present in my body. Reaching out to other women, specifically other lesbians and detransitioned women, helped enormously.
I find I don’t have much to say to my old providers in terms of how they could change their practice to better suit the needs of dysphoric women like myself. I don’t want to help them reform their work, I want to cut them out of picture as much as possible. I want dysphoric women to be able to recognize the true nature of their suffering without having to muck through transitioning and then back out again. I want to change how dysphoria is discussed and raise awareness of how it can be rooted in psychological and social factors, how there are other ways to treat it aside from changing your body. I want to create a strong community of dysphoric and detransitioned women that provides support and healing to its members. Some therapists may learn from us but it is important to remain autonomous. While some detransitioned people have found help from therapists and some are working to become therapists, there are many who have not found therapy helpful and are generally distrustful of therapists and mainstream psychiatry. As someone who is unwilling to see mental health professionals due to bad past experiences, it is important to me to create resources for those who choose to avoid therapists or find therapy doesn’t meet all of their needs. This among many reasons is why peer support and creating a community is crucial. Many of us have found ways to manage and relieve our dysphoria on our own and with the help of other dysphoric women. As our community grows and develops, our collective well of knowledge and experience will increase and our methods for treating dysphoria will evolve.
Considering my own efforts and those of other detransitioned women eases my sense of shame and relieves the despair that wells up when I think back on my self-destructive actions. While I may have forgotten who I was and tried to destroy myself, I also brought myself back to awareness and worked hard to heal. Memories of the past may disturb me but they are figments in my mind and the feelings that accompany them pass on. I experience the pain of the past to release it. I am no longer the one I remember, I have grown much since then. The present I live in is full of creation and making connections with other women healing and learning to embrace who they are.
Where my providers failed, I have succeeded. I am no longer disconnected from my body, I am more present in her and in my life overall. I’m not longer obsessed and agonizing about how to express what I used to think of as my genderqueerness, a constellation of feelings of being different genders that shifted back and forth. I used to let those feelings define me because I believed they made up who I was and I changed my body and my lifestyle in order to gratify them. Ultimately, I detached from them, began to see them as responses to the world I was living in, not as an indicator of my true self, and watched them fade out as I diminished their significance to me. They were parts of me and not even a central component but a temporary fixation. My providers gave me hormones that fed the power of these feelings and changed my concrete reality in their image. My providers helped me strengthen my illusions but I torn them down largely on my own. I was helped along in my process by another detransitioned woman, who was also working out what she had lived through. Together we took each other beyond what our doctors had imagined for us. I found the healing transformation I was looking for not in taking testosterone but in connecting to all of myself. My companion through this was no medical professional but another woman moving through her own grief and reconciliation.
Maybe someday I’ll track my old providers down, some of them at least, and tell them what became of me. Detransitioning has meant pushing through a lot of fear already. The thought of telling my family terrified me, seemed a near impossible task but I did it and it turned out well. I came out the other end stronger. It would probably be good for me to tell my old providers even if they end up reacting poorly. It would probably be good for them to know what kind of complicated tricky business they’re engaged in by helping people change their bodies. I can’t be the only one they’ve seen who was acting out trauma, nor the only self-rejecting lesbian. I know a lot of people want to pretend like we’re exceptional rare creatures, practically mythical, but I don’t buy it. I know I’m far from the only woman who stopped transitioning and hasn’t informed the providers who gave her hormones or preformed surgery. Most of us come out of this experience not exactly trusting doctors. Some of us want to move on as best we can and pretend this never happened.
When I think of the core message I want to impart to my old providers, I come up with this:
“You thought you were doing good but you were giving me tools to hurt myself. I thought I needed to come to you to get what I needed to be happy but I was wrong. We both had no idea what we were doing, what was really going on. Your good will didn’t end my suffering, it increased it. You supported the splits in myself. Your kindness led to more scars, not less. I know you want to do good, so show me what your compassion looks like when someone comes back to tell you that your efforts almost ruined them. I can forgive you if you can face what you’ve done to me as I’ve had to face what I’ve done to myself. I’ll feel more at peace if I can see doubts rise across your face, if you have the strength to consider that I may not be an isolated case. Listen, you did not help me except to move me further away from myself. You did not help me, I helped myself come back from the damage we both took part in. I found what I needed on my own, found the strength to put my knowledge into practice with the help of other women. I don’t need your acceptance or your chemical offerings, I don’t need to come back to you anymore. This is the last you’ll hear from me. I never needed your help and now I’m working hard to let other women know they don’t need your help either.”