Diary of a Pre-Trans Woman, Part 4: Relapse

Feb 25, 2017 — Another weekend, another breakdown.

In the previous installment, I demonstrated (using the power of math!) that hormone therapy was having a measurable positive impact on my state of mind. But it didn’t feel like that at the time. It felt like a letdown. My great hope when starting HRT was to feel a sense of calm or relief and gain some clarity about what I was doing and how I should continue. That never happened. At least, not in the first few months.

Many of the forum posts I was reading were from trans women who said they immediately felt better when they started taking estrogen. I assumed that was mostly a placebo effect, but I still hoped things would eventually just ‘feel right’ for me too. Instead, I was still depressed, and that made me doubt my decision to go on hormones even more. I guess you could say I was moody.

1/13 — Depressive episode in the morning. I cried on the train heading into work.
1/14 — Depressive thoughts — What am I even doing? I’m not going to transition, so why pretend that I might? Female things are not for me and never will be. It feels like I’m in a trap that I built for myself — life in general, not just trans stuff. I did this to myself, since college, forcing myself to be normal. Fraternity so I wouldn’t be a loner, marriage quickly to have someone who will make me more social, move out of state to force career drive (not be complacent).
1/22 — Went shopping, bought a shirt. Looking at women’s clothing just makes me depressed now. I was in a bad mood this evening, with negative thoughts. I purged clothing and removed toenail polish.
1/23 — Bad morning, couldn’t get out of bed. I had negative self-talk, cried, skipped meds. Depressive thoughts — I hate my life, screw work, quit pretending I’m a woman. I can’t say how I feel, that just makes things worse. I don’t love my wife, just going through the motions. I can’t make changes without hurting anybody, and don’t want to make changes anyway. I’ll be sad no matter what. I need pills just to feel normal, lots of them. That’s not a real life. Hormones aren’t working so I need to switch to an SSRI and give up this delusion. But then I lose my cover and will have to admit what I really want. There’s no escape. Every outcome is bad. I will suffer my whole life no matter what.

It’s a cliche in the trans community that starting estrogen is a wild emotional ride, and looking back at some of my writing, I can see where that comes from. At the time, I assumed I wasn’t having the common reaction. I didn’t cry randomly during movies. My emotions didn’t fluctuate suddenly during the day. They were still easy to suppress after years of practice. Those entries from January are actually not much different than the kind of thing I would have written a year prior, before starting therapy.

But then it got worse.

1/19 — Strange, unnerving dream last night. I was making an assisted suicide attempt at home using delivered drugs, and [wife] was supportive/helping. Waking up, I thought it was real or related to real events/plans. Only after remembering I was wearing a camisole did I know the thoughts weren’t real. This is not normal. I don’t usually dream. Memory/imagination is difficult — aphantasia?
2/18 — I just had some sort of mental breakdown. 3:30am, [son] is crying, it felt like over-stimulation, then anger. I wanted to hit things, shout, but couldn’t — trapped. I was worried/scared about hurting [son], so I left the room, then the house b/c I could still hear crying. I needed to escape. I stayed outside in the cold in just my underwear, then cried in the garage.
2/23 — [Therapist] confirmed the incident from last week was a panic attack. Depressive episodes have been fewer, which she says is definite progress. She liked the distinction I made between female and feminine. Being in-between on the gender spectrum is stress-inducing due to my binary way of thinking. Can I be comfortable anywhere?
2/25 — Another weekend, another breakdown — Went to get a haircut w/ family so [son] could get his first one too (father-son bonding experience), but they were busy and I freaked out for some reason, refusing to go in. Recurring thought: “Apparently [son] doesn’t get to have a father figure.”
3/6 — I had to fight off a panic attack at dinner. [Son] was crying. I snapped at [wife].
3/11 — Irritated and tired in afternoon. I went to see a movie in the evening. It made me cry. I got home and broke down in the garage — 20 minutes of crying and screaming! — Bad thoughts: There’s something wrong with me and I can’t figure out what it is. Nothing is working, not therapy, not hormones, not distractions. There’s nothing good to hold on to, just vague hope that never turns out. It’s not getting better. — Is an SSRI my last chance? It’s a lose/lose situation. If it doesn’t work then I have no hope, but if it does then I need drugs just to feel normal (covering up some deeper truth?) I should stop hormones, or go on low dose. I’m not going to transition. It was just a vain hope that the stories I hear about depression suddenly disappearing were true. — Mostly it’s just a general unhappiness, not really directed at anything in particular, don’t even know how to talk about it. Life sucks and it’s not getting better.
3/12 — Depressed and emotional most of the day, but better in the evening. I didn’t take hormones last night or this morning. Purged clothing — kept underwear, jeans, 1 or 2 shirts. Everything else went to Goodwill.
3/13 — Still in purge mode. I skipped E this morning.

For most of my life, I’ve been a very calm, level-headed person. When I started losing control like this, it was incredibly unnerving. I was really worried these episodes meant I was having a negative reaction to estrogen and therefore I was cisgender and needed to stop taking it and switch to an anti-depressant. When I saw my doctor for our 3-month follow-up appointment, we agreed to lower the estrogen dosage but keep the testosterone blocker, and she prescribed an anti-depressant as well.


It wasn’t all chaos, though. The lowered libido was a huge relief. I was incredibly grateful to finally be able to focus on how I felt regarding my gender without the distraction of an erection. That was probably the biggest factor in being able to eventually come to terms with being transgender.

I didn’t actually write much in my journal about that aspect, as it turns out. It was definitely on my mind, but the only evidence in my writing was an uptick in the amount of personal reflection alongside the depressive episodes due to having, uh… more time on my hands.

1/2 — Talking in therapy about self-confidence. When does it switch from confidence to arrogance? I know a truth about myself (I’m skilled at some particular thing) and it’s good to have that confidence. But if I express it, people get upset and it becomes arrogance, which is bad. So how is gender identity any different? I know a truth about myself (gender), which is good, but if I express it, people get upset. Except now that’s a good thing! The world makes no sense to me.
1/15 — Not depressed today really, just research-obsessed (anxious?) — A lack of sense of self is common (even proscriptive) in autism — many masks, nothing beneath. Many people don’t have a gender identity, are neutral regarding their own gender. And yet, desire to be female is not neutral. — Detransition thoughts: I should focus less on identity and more on being. I.e. not “who am I?” but “what will make me better/happier/improve my life?” — Reading about identity as a barrier to authenticity. Labels can lead to being close-minded, heuristic. This is the opposite of the “if you have gender dysphoria, you are trans” mindset, and the corollary, “if you’re trans, you must transition to be happy.”
2/2 — Therapy notes: “I want to be female” is trying to deny or change reality (bad). “I am female but with a male body” is just trying to resolve two divergent realities (good). [Therapist] liked that I had this insight. It still feels like I want to be female, not that I am.
2/28 — Gender dissonance — I’m liking this term more and more. Terms like dysphoria and euphoria are too extreme for what I experience. Gender-related cognitive dissonance is a lot closer. I don’t want to feel this way, but I can’t stop. How to resolve this? I don’t know. It’s hard to even articulate the conflicting thoughts/feelings/desires. When I try, it usually turns into denying the feminine side of the conflict — I want to be female; no I don’t, it just seems appealing; that’s a delusion b/c it wouldn’t be that different; etc. Apparently this is normal coping for cognitive dissonance.
3/12 — Reading about Asperger’s and links to transgenderism and depression — I’m screwed. Autistic people are 10x more likely to be trans than the general population, and vice versa. Both are susceptible to depression (>50%) and suicide. Book mentioned “depressive attacks”, pent-up despair leading to sudden suicide. I’m scared of this — my depression comes in attack form, spiking and debilitating on bad days. I cannot disentangle autism, transgender, mid-life crisis, and relationship problems. [Therapist] will say they are all factors, but that isn’t helpful. I can’t address all at once.

This kind of self-reflection continued and intensified in the months that followed, until I was finally able to come to terms with how I felt. The story of how that happened will be told in the final installment.

(Continued in Part 5)

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