It’s tiresome that so much discussion around detransition is all about “how easy/difficult it is to access trans healthcare”, and “whether or not therapy should be required first”. I wish the conversation would evolve beyond this. Don’t know if it ever will.
People seem quick to assume that the only perspective a detransitioner could offer is, “It was too easy and I shouldn’t have been allowed to do it,” when in reality, we’re equal participants in this realm of healthcare, and might have more nuanced criticisms and contributions were people to seriously engage with us. Surely we can be more than a pawn in someone’s Twitter argument.
Looking at my story, for instance, some might assume that it was “too easy” for me to transition. Some would argue that it should Never Be That Easy, others would argue that I’m straight up lying because it’s not that easy in their city/state/country (ha ha, as if modern trans healthcare has established itself to the point of having consistent standards).
I disagree that it was “too easy”, and also assert that no amount of bureaucratic hurdles or ~therapy~ would have stopped me from doing what I did. My criticisms of my healthcare have nothing to do about how “easy” or “hard” it was, and everything to do with the lack of engagement, information, or support I received over the years from the healthcare providers who were purportedly there to help me, especially the radio silence in between the “milestone” events along my transition. My criticisms also extend beyond my care and into the larger world I live in.
Some things were quick and easy to access, others were difficult; my problem is that no matter how I accessed it, it was of poor quality and had no fallback for when things didn’t go according to plan. During my entire transition, I mostly felt… very alone and on my own. Same goes double for when I detransitioned.
I don’t want people to put up more bullshit barriers for others in response to what I’ve been through; I want people to make healthcare and the world better as a whole.
Focusing on Gatekeeping is seeing the trees for the forest.
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When I was 19 and I started testosterone, I got my first dose at the Mazzoni Center after two visits. Technically 3 appointments, with two of them occurring on the same day. I was living out of town at the time, so they kindly offered to schedule the last two appointments on the same day to save me a third train ride into the city.
If I recall correctly, the first day was intake, a general visit with the primary care doctor, talking with the doc about HRT, getting bloodwork done. The second visit was something like a 1-hour session with their intake therapist. And then after that, the “third” visit (right after walking out of the therapist’s office) was signing informed consent forms and having the nurse do my first shot and teach me how to administer it myself.
I was uninsured at the time; they had some programs to make HRT cheaper for uninsured youth under 25, and the rest, I paid with my money from work-study.
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A few years later, after dropping out of college and joining the workforce, I got a job at a place that had insurance that claimed to cover trans health. I decided to spend a year saving up what I could for my top surgery and hysterectomy, and get them both done at once while I knew I still had insurance at all.
When the time came to seek letters – plural, because 2 are required for a hysto – I wrote to Mazzoni and asked what to do. They immediately sent me a letter, from a therapist I’ve never met in my life. One down!
They referred me to a local therapist for the second letter. He was a fellow trans guy, and he told me that he hated having to be a Gatekeeper. So his policy was to do 3 sessions as a bare minimum to claim that he had a therapeutic relationship with the patient, and he would then “fill in the blanks” in a template letter (which is what most therapists do for these letters, don’t kid yourself!).
I was 23 years old, had been on T for several years already, was living full time as male, and had legally changed my name and sex markers. He saw no reason to dig into what I was doing and why; it was clear I had already made up my mind about what I needed. So we just sat and shot the shit about whatever was on my mind. Told him about other stuff I was dealing with in life (surprise, there’s more to my life than my transition). On the third day, he printed my prefab letter, and off I went.
I had saved up as much money as I could, but even with insurance, it wasn’t enough. The insurance actually covered… very little, overall. Go figure. And I didn’t have a wealthy family to rely on, or an attractive face to garner sympathy with a GoFundMe. I paid for what I could at the time, and the remaining thousands of dollars – close to $10k! – I put on a 0% intro APR credit card. Made what payments I could during the interest-free year, and then rolled it into a personal loan with the best rate I could find. I’m still paying it off, 5 years later, long after I’ve detransitioned and regretted having had surgery at all. Sigh.
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A few years later, when I started seriously considering that I might be autistic, I came to this conclusion on my own, with no input or influence from the healthcare providers/clinic I’d been seeing all these years. I independently sought out a doctor who specializes in diagnosing autism in adults, to find out whether my suspicions were correct (and they were).
While I don’t expect just any doctor to be able to diagnose this, or even recognize it (honestly, it’s more likely for your average doc to be offensive about it)… I still wonder why I was on my own this whole time. Why there were no documents or resources or anything presented to me early on, to even encourage me to consider the possibility. There are a large number of autistic people who end up transitioning, but somehow it never occurred to me that I could be one of them, or that some of my struggles could have less to do with Gender and more to do with my being autistic, or being a closeted lesbian, or being a survivor of extreme abuse & trauma, or my socioeconomic status, or…
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What especially frustrates me is that, upon reading experiences like mine, people insist that I simply Needed More Therapy, as if I’ve never been to a therapist in my life or something. I’ve talked to therapists pre-, mid-, and post-transition. I’ve had my fill, thank you. In fact, I’m pretty firmly anti-therapy at this point.
I’m frustrated that what few standards of care there are,
are shoddy and mostly there for appearances, and trans healthcare organizations are so busy fighting increases in stigma and red tape that they apparently don’t have
the bandwidth to make the practice better in any other ways.
Like with my referral letters, that technically follow the WPATH standards of care, just enough that people can’t be sued, while also not actually doing anything to better my health or self-awareness. It’s just performative. It’s red tape for the sake of red tape. Adding more legislative red tape isn’t going to make people care about my well-being, it’s just going to give them one more performative barrier to juggle instead of working to make my healthcare better.
I don’t have any answers for anyone. All I know is where I’ve been.
In some ways, I don’t even know how to criticize things beyond screaming, “Why was I so alone this whole time? Why was I spinning my wheels for years? Why do I have to keep spinning them even now? Why do I still not have a doctor that can answer my questions or help me build a plan for my long-term health after these experiences? How did it get to this point?”
But it’s like screaming into an empty hallway. Nobody’s home, and nobody wants to hear it.