The Perils of Being Trans and Mental

Here’s a thing about me: My mental health is fucking shite. Depression underscores everything that goes on in my life. It got particularly bad in the last 24 hours. For certain reasons, I became consumed with regret and associated self-hatred, something I have a tendency to do. I spent much of that time crying. I wanted to do things to hurt myself, and I just about managed to avoid that. Just about.

This reminded me of my need to have some kind of serious help from people that are trained professionals in mental health. I’m woefully ill-equipped to deal with things myself. The lack of that support impacts upon me, and it leads to things spilling out over my friends. They see my tweets and facebook updates that desperately cry for attention, they get my texts and calls. One of my housemates found herself sitting with me as I cried when she should have been getting her sleep before work a couple of times recently.

Those able to handle this stuff are wonderful, and their talking to me helps things a great deal. But it can only help so much when they don’t necessarily know how best to deal with my mental health as it manifests itself at that particular time. Certainly, neither the strategy of being pragmatic and positive, nor vague attempts at comforting, make things very much better. What tends to happen is I keep moaning until I feel I’ve moaned too much and little has changed.

And I’m probably never going to access what support is available from the NHS. Why? Because the NHS are also handling my transition, which is the most important thing to me, more important than mere matters of being horribly depressed.

Are the two things mutually exclusive? The problem is that I don’t know. We that are transitioning on the NHS know well that any excuse will be used to delay or stop the transition related care we’re getting or we’re going to get. In discussions of NHS trans support, there’s always a notion that we must have mental health problems only such as we can persuade medical practitioners is directly related to dysphoria – anything else can demonstrate that we’re not capable of being certain about transitioning (for we must be certain). We hear horror stories demonstrating that issues of mental health appearing on one’s medical records can be a really bad idea.

Would that happen to me for pretty routine mental health support? The problem is that I don’t know. Like so many people transitioning on the NHS, I want to take no risks whatsoever. There are prescribed hormones taken safely under medical supervision at stake. There is a cunt at stake. Both of those things are important to me.

We suffer a complete lack of  clarity in what should and shouldn’t affect one’s ability to transition. Everything comes down to the judgment of clinical staff. That is, the gatekeepers; the same gatekeepers to whom we must appear perfectly gender-normative, question nothing, not be at all queer, just in case they decide we’re not trans enough.  I find myself not accessing mental health support I need, just in case the gatekeepers think it looks bad on my medical records. Perhaps I’m wrong and it would be just fine. The problem is that I don’t know.

These gatekeepers are in place to restrict transition to only the most worthy. Some trans people have reported doctors openly saying that it’s to be sure their budget is spent well. We must be worthy, and just about anything can render us unworthy. Fuck that. Trans people have pretty universally struggled long and hard to get to a point of accepting the need to transition; when we seek support for our transition it’s because we need to get on with it. Instead we spend years proving ourselves worthy as we jump through the hoops. Our freedom to keep living our lives during transition requires a system that seeks not to define worthiness, but to collaboratively seek the best outcome with each trans patient. No Gatekeepers, No Masters.


9 thoughts on “The Perils of Being Trans and Mental

  1. If I could, and you consented, I would give you all the hugs!

    While I am in the US, what you describe here is very similar to my experiences. I delayed treatment for depression which was a lot like you describe until I was certain nothing could interfere with my access to SRS, and the delays were while having extra delays accessing surgery, having met by more than double the RLE requirement by the time I had access to GCS.

    • Interesting to hear that even when profitable private interests are responsible for treatment it works that way.

      And this is exactly what I’m shit scared of. I am trying my best to obediently jump through the hoops and get what I need as quickly as possible. But there are so many possible pitfalls I don’t want to even think about.

      • Here, I feel it’s the last gasp of the gatekeepers. I began transition in 1994 but had a lot of delays. It’s changed a lot in the last two decades, but there are still pockets where there either aren’t more enlightened providers available or, like mine, the others aren’t common knowledge. My second surgery letter was actually written first due to the gatekeeping I experienced.

        If it means anything to you, I had GRS this past May and am now consulting for FFS and BA. I find the consultations I’m now having so much better; that I’m granted a measure of agency that I wasn’t before, and there is no requirement for therapy, etc. (which, IMHO, reveals a lot of the social biases underlying gatekeeping.)

  2. Thank you for a thoughtful and sobering article. This sentence particularly resonates:- “Trans people have pretty universally struggled long and hard to get to a point of accepting the need to transition; when we seek support for our transition it’s because we need to get on with it.”

    Personally I am very lucky in having full support from a fantastic GP for my mental health problems, whether dysphoria-related or not, but I am still worried and apprehensive about re-engaging with the system for many of the reasons you outline.

    • That sentence is a point I want to scream from the rooftops. Every trans person I spoke to, like me, spent years proving to themselves they’re sure about transitioning. It’s a punch in the face to have to spend years then proving this to the gatekeepers of transgender healthcare, as if they think we’re jumping right into this.

      I’d love it if we were able to accept how things were early on, jump right into transgender healthcare and then be supported by specialists in deciding how we wanted to move forward. But we live in a society that tells us to suppress any feelings that don’t match our assigned gender, so the years of processing things before doing it is pretty much inevitable.

  3. I’ve been right there, but transitioning to male. You have my sympathy. Being a few years through the GIC ‘system’ now, I may be able to give you some advice based on my own experiences, so feel free to email me.

    Thank you for writing so well about the horror these gatekeepers put us through.

  4. *sends hugs if wanted*

    Is non-NHS mental health support possibly an option? Some charity and community groups provide free / low cost mental health care and access to therapists *without necessarily contacting your GP*. I know money is often a problem but in my experience getting non-NHS help for being mental was cheaper than getting non-NHS help for being trans.

  5. Oh this is frightening me so much right now. I’m basically in the same place as you, except I’m being ‘treated’ by the NHS for mental health stuff already and I’m in the queue for transition. One of the many things that keeps me up at night is that line from the diagnosis criteria about not suffering from other mental health issues. I can simplify it down to a horrific vicious circle – because I’m trans I’m crazy, but because I’m crazy they might not let me transition. Oh god I can’t even think about it.

  6. Thanks for sharing your pain. I am transitioning thru the US veterans administration (hear me NSA?) but get therapy privately. A psych and a Med Doc at the VA told me to not try psyhco therapy there; that they are incompetent. If you wanted to “talk” sometime via email mine is Best, Johnnie

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