Talking About Talking to Doctors

Grace is a detransitioned woman in the Midwest who you can follow on Twitter @hormonehangover. She recently spoke to the doctor that prescribed her HRT and wrote the referral letter for her top surgery. She’s exceptional for doing so- in my circle only a handful of detransitioners have gone back to inform their doctors about their detransition. We spoke about her decision to initiate the conversation and the consequences of the experience, with the hope it will help other detransitioners consider whether they’re up to have the talk.

Why did it feel important to talk to the doctor who enabled your transition?

It just felt like my duty. I know how much everything is a wild west right now with trans medicine, and I wanted her to know that there isn’t always a happy grateful trans man coming out the other side of that process. My doctor used to tell the press that no one she sees had ever regretted transition. Once we had a talk, at the very least, she would stop saying that to everyone.

Also, once she asked me to do a publicity interview to talk about how much her clinic had helped me. I did that interview really early on in my transition, and now I totally feel differently than I did then. I felt so guilty for acting as a spokesperson on her behalf. I had to set the record straight!

What was returning to that office like?

It felt like a bizarro version of my first hormone appointment. All of the cheerful affirmative gender stuff around the clinic struck me as sinister now. There was a picture of a trans child from a weird online webcomic on the wall, and all this cheerful stuff about “Be You!” And there I was, the prodigal daughter returning with bad news.

My body was hot and I felt really anxious when I went into the room. My old doctor greeted me warmly and breezily, and we went to a new — agey massage room to talk informally. For the first part of the conversation, I told her about how I had come to the decision to transition, and then why I had regretted it and detransitioned. She used a lot of language like “tell me your story, I want to honor it.”

I told her the gist of it: I started my physical transition at age 23, was very depressed, didn’t see any other way forward, got hormones, got surgery — and then I realized I was going nowhere and my fantasy of becoming a happy man was impossible. I told her that I unequivocally regretted my surgery and hormones. I told her that the surgery had brought me pain, regret, and grief. I told her I wished I had known there were other ways to deal with gender dysphoria.

“It sounds like you needed someone to offer you something besides hormones and surgery. And I’m sorry that we didn’t provide that.” A beat. “But I don’t see that as my role.”

Ooof. It’s not her role to provide something besides hormones and surgery. I would’ve lost my shit. How did you not lose your shit?

Ha. Well. It was very infuriating. Whose role is it, then? What the hell?

I was there on a mission, though, in Friendly Detransitioner Ambassador mode. So I tried to play it cool so she wouldn’t get defensive. I asked her, who is going to let people know about alternatives, if not doctors or therapists? If that’s something we need to figure out on our own, who does she think is going to be telling us about that? She didn’t really answer that.

As the conversation continued, she became closed off. Her body leaned away from me and she looked very uncomfortable. I think she wasn’t expecting me to be so angry and hurt.

I asked her if she followed WPATH Standards of Care.

“Of course.”

I brought up that in WPATH, they say you should be screened for “anxiety, depression, self-harm, a history of abuse and neglect, compulsivity, substance abuse, sexual concerns, personality disorders, eating disorders, psychotic disorders, and autistic spectrum disorders.” I mentioned that if I had been screened and treated for, for example, eating disorders, depression, and possibly compulsivity, that would have helped me a lot to lessen my gender distress.

She replied ”​the Standards of Care is a guideline that was never meant to be hard and fast.”

When I asked her if she thought there was any way to tell in advance if someone could benefit from transition, she said that there probably wasn’t, and they just had to try it and see. She said she wanted to err on the side of putting up too few “hoops” to jump through than too many. To her, if someone said they were trans, she believed them, and that was all she needed. “And you come to me and tell me you’re not trans, and I believe you now, too,” she added.

On the subject of diagnosing people with gender dysphoria/being trans, she said that she “decided early on that it [Gender Dysphoria] wasn’t a diagnosis she could make. Like I can’t determine whether someone doesn’t identify with the body that they were given.”

That stunned me. I asked her, so, who diagnosed me with gender dysphoria? She admitted that she did, in fact, write me the diagnosis. I have the paperwork.

So that was strange. It seemed really bizarre that she would say verbatim that she couldn’t diagnose gender dysphoria but that she did it anyway. I wondered to myself: what would a lawyer think of this? I mean, I certainly misdiagnosed myself as someone who would benefit from transition. I won’t deny that. But she’s the doctor. Are patients expected to be able to diagnose themselves accurately for, say, schizophrenia or breast cancer, and receive treatment with no questions asked?

She had a couple of tips for me. One was that most people, unlike me, had seriously thought about it before coming in to get their hormones. The other one was that I had moved too fast getting surgery, much faster than most people. She also told me that she wanted me to know that my story is valid, and that this just shows how much bigger the spectrum of human gender is. These were not especially comforting or useful things for me to hear at that juncture.

So she’s telling you your story is valid but she’s also stating other people thought harder, with the implication being your failure to think hard led to this negative outcome. I see this response to detransitioner stories a lot online, but hearing it straight out of the mouth of a doctor who is beholden to an ethics board must have been surreal. How did you respond?

I didn’t know how to respond to that. It felt almost insulting to be told that post-transition. How does she know other people thought about it more? And, how does she know I didn’t think about it? I was nonbinary-idenified for like 3 years prior, and I obsessed over my body for ages. Like, if people moving too fast is a concern, why didn’t she tell me that during the process of transition, instead of writing my damn surgery letter 4 months in?

Also, I think it’s possible to think about something for a long time without being able to “think your way out,” if that makes sense. Sometimes spending a lot of time thinking about something just means you are going in circles obsessively and talking yourself into something.

It was a weird contrast to how it had been to be assessed and treated for ADHD. I had also gone to a doctor specifically because I thought I might have ADHD, just like I did with gender dysphoria, but in that case, they had a robust battery of tests that they did. When that was done, I had to wait until I had my eating disorder into remission until I got given any medication.

By contrast, my doctor asked me basically one question-

Her: Why do you want to transition?

Me: Being a woman isn’t working for me anymore.

-and then gave me an informed consent form to sign, and that was it. She diagnosed me with gender dysphoria based on my uninformed opinion. She also wrote me a letter for my double mastectomy five month in. No questions asked.

Backing up so we can get context, what was happening in your life when you pursued transition?

I had identified as nonbinary since I was 19, but had never thought of myself as a candidate for physical transition or known anyone who physically transitioned. That all changed when I dated a nonbinary person who told me they wanted top surgery, and it felt like an “aha” moment. I realized I had this idea of trans men that was this super masculine person, but this person was just like me — a kind of awkward, androgynous, sweet female person. I suddenly realized that transition was a possibility for little old me, and that was exhilarating. The idea of a mastectomy really appealed to me in particular, and of passing as a man.

When I was 22, I moved back in with my parents and started isolating myself and obsessing over trans men on the internet. I binged on trans reddits and followed tons of trans men on instagram. It was kind of like a religious epiphany crashing over me. It was like, “Wow, this is it.” I felt like I had unlocked the true secret of why I seemed to feel so miserable and uncomfortable and weird all the time.

I made the decision to transition at a time when a lot of different rough stuff was converging in my life. In no particular order: I had just gotten out of a relationship with a scary alcoholic guy. I was out of college and unemployed and had no idea what to do with my cool Gender Studies degree. Being out of the structure of school for the first time in my life was really hard for me. I had just been diagnosed with adult ADHD, and was adrift, miserably bad at structuring my time on my own. I also had been struggling with low-grade eating disorders for years and was completely checked out from my body. I had some traumatic sexual experiences that made me feel disgusted about my body.

Also, for the first time, there were these scary suicidal thoughts popping into my head. In retrospect, it would have been a great time to chill out and focus on my mental health and put off permanent surgical decisions. But alas, I am an impulsive person, and instead, I became obsessed with transition as the thing that would save me.

Trump had just been elected, which filled me with fear. I was in a hyper-liberal bubble. There was a lot of talk amongst my trans friends of him shutting down the ability of people to get healthcare. I was totally caught up in it. I thought there was going to be a big shutdown of the ability to transition, and I thought that that would mean I would succumb to despair without it. My friends and family were all supportive of me transitioning. They wanted me to be happy and they had been educated enough on trans activism to know that questioning me would be considered “very transphobic”.

So I went down to the doctor and got on hormones a bit before my 23rd birthday, in April of 2017. I was excited and terrified. The day I got T I was insanely happy. I cried with joy. It was very touching. 5 months later, I got top surgery, which was so grotesque and that it gave me major pause. That was the beginning of the end of my manic, ill-thought-out transition.

Were you seeing a therapist before transitioning? What were they like?

I found a therapist by seeing who was covered by my insurance, and then calling her. The qualifications she gave was that she had worked with several trans men in the past, which was good enough for me. We only had a couple appointments before I started HRT. The therapist experience was pretty mediocre. She was an ultra-affirmative lady who didn’t know very much about trans people. She didn’t challenge me much, and she recommended to me that if I was questioning my gender, I should go out and buy a binder and try it out. I had been holding out on doing that, but I did it on her suggestion. That turned out to have been the worst possible advice she could have given me, because binding fucks up your body and makes it hard to breath. It also made my disconnection from my breasts worse and worse. After a few months of binding, I really wanted top surgery so I could stop binding.

It seems pretty normal for people’s dysphoria to spike when they start binding, which makes some intuitive sense. You’re avoiding a body part, of course that would increase your distress when you are forced to be aware of the body part. My therapist gave me some similar terrible advice, that I should take testosterone because if I liked taking it that would mean transition was right for me. It’s so interesting how therapists who will never partake in these body modifications have this magical thinking about how they can be used for self-discovery, while they ignore the physical risks. How could a therapist have been helpful to you rather than simply cheering on body modification?

I would have liked to have a therapist who was really informed on transgender culture, but also had critical thinking skills and was willing to help me slow down and really explore my distress. I think that’s what everyone with dysphoria deserves, but very few people get.

I honestly think it would be good for her to have suggested that I get off the internet. I was basically marinating myself in trans stuff. There was a lot of other things I should have been focusing on to make myself feel better. I think I needed to probe in and learn more about what was going on, what it meant to have gender dysphoria, and maybe break out of the mindset that transition was something I had to do.

I wish I’d had a therapist who was familiar with the possibility of detransition, so she could have seen the red flags. At the same time, the sort of attitude that I had was a “us vs them” attitude. I had learned that therapists who “gatekeep” are the enemy. I would have needed a therapist to make a connection with me and help me stop rushing. Someone who could reassure me that it was bad to make decisions in a rush.

Then it would have been good to do some sort of actual structured assessment that could distinguish between gender dysphoria and other conditions. I would have liked someone to help me stop obsessing over suicide fears and body feelings and try to expand my horizons. Like, there are so many things that I should have done before transitioning. I should have gotten a new job, applied to grad school maybe, started exercising, gotten off the internet, made some friends — any of that stuff. It’s pretty basic stuff, but it would have helped me. Of course, it wouldn’t have been easy for a therapist to get through to me. I was pretty stubborn. But I did have all these secret fears and doubts I was struggling with. I think I could have been talked down if I had better information about how shitty transition and major surgery and all that are.

It strikes me that so much of detransition is about being willing to look directly at some dark truths about the world. I think I’ve never gone back to talk to my doctor or therapist in large part because I’m scared of exactly the responses you got. Was it challenging to emotionally process how the conversation went down?

When I got out of the office, I kept repeating, oh my god, oh my god. I was just a lab rat. She never knew what she was doing at all. I felt a little vindicated on one hand — I wasn’t the only one acting irrationally. I realized my doctor had been acting very unprofessionally. I saw that in retrospect, all of my professionals had done nothing to offer me any other options. I had a strange sense of understanding for my former self. At the time, I thought gender dysphoria was only treatable by hormones and surgery. It had felt like I had no options. Absolutely all of the information available to me from professionals told me that story.

A larger sense of dread enveloped me when I thought more about it. I felt so stupid for falling for a charletan like her, but I also felt outraged. She was supposed to be a doctor. She’s the one who went to med school. She was supposed to be prescribing medicine. And she had admitted that she had no way of diagnosing gender dysphoria. It felt so wrong.

How many other people would suffer like I had? I knew she was treating minors and prescribing puberty blockers.

When I told her there would be more people like me, she had said “Of course.” Of course? Of course? Well, what’s the plan for people like me? It seemed like she took no responsibility for her part in the system.

If you’re thinking of doing this, I would say: be prepared for it to be an emotional experience. Our doctors need to know, but they might not be ready to hear it. I went back to the woman who had enabled me to hurt myself massively and opened up to her in the hopes that she would learn from me. I hoped she might have some advice for me, somewhere for me to turn. But all she did was say I was “valid.” Thanks a lot! It’s rough to open up to someone and be met with milquetoast platitudes.

Have you considered legal action against your doctor?

I thought about suing my doctor after the conversation. It was so clear to me that she was not following WPATH or indeed any sort of rigorous medical standards.

Pros of pursuing legal action:

To push back against the current way things are done. Doctors might be more careful in handing out hormones if they knew that there was a potential for patients to hold them accountable if things go wrong. The current situation is that if you detransition, doctors have almost no resources available to help them deal with the treatments that they prescribed you. I’d like to see some more accountability come back into the scene. I think there’s a huge wave of detransitioners coming, and I know that it’s terrible to go through.

I worry a lot about the kids who are getting surgery and hormones before they can even understand what they are signing up for. Thinking of a 14 or 15 year old going through that is mind-boggling. I know a lot of detransitioners who are suffering but don’t have the desire to sue. I think as long as we are silent and don’t make too much trouble, providers will try to ignore us as an inconvenient side effect of something good they are doing. And that’s not fair to us!

Cons of pursuing legal action:

It would be harrowing, and ugly, and drawn-out. A lot of what has helped me deal with detransition trauma is honestly distracting myself from my wounds and trying new things. If I was engaged in a court battle, I would have to face that all the time. I would be open to scrutiny and cross-examination by lawyers, and I would have to hold my head up through that. This would be months, and probably years, of staring my trauma in the face and opening myself up to scrutiny. After having this confrontation with my doctor, I think the mental health effects would be intense. I think doctors usually have good lawyers, so I’d need to have access to a really good lawyer as well. It would be really expensive, and a lot of detransitioners seem, anecdotally, to be pretty broke. I am not rich. I’m also trying to move on and rebuild my life.

Moving on and rebuilding a life is a huge project. What does detransition self-care look like for you?

For my detransition, I went through a couple of phases. When I first realized I regretted my top surgery, I went off hormones and started hysterically crying every single night. I felt completely mutilated and disgusting. The scars on my chest would ooze and bleed, and I felt like a walking corpse. I viscerally missed my old body. It was like missing someone who died, or being homesick as a scared little kid. I was sure my life was ruined. I wanted to give up.

This lasted for a few months. I’d like to give a big shoutout to my boyfriend for listening to me blubber about the same variation of “oh my fucking god this feels so wrong how can I live with this” every night for that period of time.

Then I decided to knit a giant blanket and wait until I finished it to see if I felt better. I basically felt terrible for that entire time, but every time I felt like I needed to give up, I told myself I would feel better when the blanket was done. That project took me 6 months to finish knitting, and when it was done, I did feel a little better. Not great, but out of the worst part of my depression.

I don’t feel at all healed from my surgery and hormones, but I feel more at peace than I used to. If I focus on the horror of what I did to myself, it makes me want to scream! So a big coping mechanism for me has been distracting myself with crafting and video games and exercising. I paired that with EMDR therapy, with a new therapist, so I could do all my scream-crying with a soothing professional and give my friends a break.

I try to be very patient with myself and give myself time. I read something that said it’s normal to take at least two years to start feeling better after a big upheaval in your life. I still feel a lot of regret and sadness and physical pain every day, but I know I can survive now.

What do you hope to see the detransitioner movement create? Are there priorities you feel it’s especially important for us to focus on?

We need to get organized and get some tangible resources for each other. I mean, don’t get me wrong, it’s good getting the word out on twitter and such. I really want there to be a nonprofit organization for detransitioners by detransitioners.

I’d love to have an official online presence for a detrans org in addition to the huge, wonderful web of twitter and tumblr accounts that are cropping up right now. For those of us who have been through some HRT or surgeries, I think we need to get insurance to cover reconstruction and electrolysis and HRT for people who lost the ability to make hormones. I’d like there to be more awareness of other treatments for dysphoria, so that dysphoric people can possibly avoid the pain and expense of useless surgeries and hormones. Maybe we could also find good lawyers and therapists to help point people towards. There’s so much to do, it’s so overwhelming! But it’s such a crucial point right now, we could make a big difference.

Written by

LMFT/LPC, detransitioner, advocate for taking it easy

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