(Medical) Transition in the Time of Fascism

I’ve been out as nonbinary for a few years now, after an earth-shattering realization in the early 2020s that I am, in fact, not cisgender after all. For awhile, I was content to leave it at that: I am a transgender nonbinary human, no further categorization needed. The language of queerness helped verbalize the feelings and experiences I’d had for a long time but was unable to process or even recognize (as an aside, language is such a powerful tool for both liberation and oppression). Language—and the power to self-label and self-determine—was all I needed.

But over time—as I learned more about myself and the expansive experiences of trans and gender-variant people, deconstructed my internalized transphobia, and overcame gendered anxieties I had developed from being a closeted trans person raised in evangelicalism—my feelings continued to evolve and shift. I learned about gender-affirming surgeries (which I immediately wanted) and hormone-replacement therapy, aka HRT (which I initially disregarded). I got on a long wait-list for surgery consultation (a year and a half just to meet with a surgeon, and then what felt like a yawning chasm of time after that to actually get surgery—here I am, still waiting). I added a second surgery to the first because they can be done together, then took away the original one because of financial constraints.

And gradually I came to accept that surgery—even both of the surgeries I want—would no longer be sufficient for my own feelings of gender dysphoria and my desires for who I want to be(come).

I don’t want to get too into the weeds of my own dysphoric feelings and what triggers them, but suffice it to say, it has become harder to navigate some areas of my life and to engage with some things I would otherwise enjoy due to my dysphoria. And, frankly, while surgery would help tremendously, I no longer believe it will be enough.

Plus, I’m curious to see myself change and become someone wholly new—self-made, if you will. It sounds interesting and exciting to watch the gradual, physical change of the self.

So I’m starting HRT, that thing I initially, quickly rejected because it seemed scary and intimidating (and did not align with what I wanted or was ready for at the time). In fact, starting HRT feels urgent now, and not just on a personal level. To be frank, I don’t know how long trans and gender-variant adults will have access to HRT and gender-affirming surgeries in the United States. (This next part of the paragraph is a real bummer, so buckle up.) Access to gender-affirming medical care has become severely restricted for minors, with more and more hospitals and medical organizations capitulating to the white supremacist, fascist regime that is in power (and has been building power for decades). Trans people in federal prisons are being medically experimented on through forced conversion therapy that dehumanizes them by denying them their life-saving and medically necessary hormones and surgeries. Respected experts and international bodies have announced the United States is in the early stages of a genocide against trans people—as of drafting this post, the Lemkin Institute for Genocide Prevention has released a third red flag warning about the US. Kansas very quickly and suddenly invalidated all legal documentation for people who had their gender (legally) changed, on top of a dangerous anti-trans bathroom bill. Vanderbilt University Medical Center in Nashville, Tennessee announced that they are ending gender-affirming surgeries for transgender adults, and I am very concerned that a number of hospitals—including the one I will be getting surgery through—will follow suit in the coming months. On and on.

It’s a terrifying and tumultuous time to be transitioning medically, legally, and/or socially.

And it also feels like, if I’m ever going to get on hormones, if I’m ever going to try, it needs to be now. I want to know what it’s like and to experience those changes; I’m curious about how my body will respond, and how my mind will respond, too. It’s a need in terms of my dysphoria and how that has shifted and grown over time. Plus, I’ve already had to give up one desired method of medical transition (that surgery may now be years, if not decades, away, a setback I am grappling with); I refuse to let another means of medical transition that I want slip through my fingers.

Those fateful, indicting words—“gender dysphoria”—are already in my medical and psych records (I had to get that far for the surgery). But now those things will be reinforced, written on my body, buried under my skin, coursing through my veins. It puts me at risk for violence in the future, the violence trans people have always faced from hate-mongerers and bigots and people ruled by fear and vitriol instead of curiosity, or even indifference for living and letting live. But there’s also the political violence roiling just under the surface. All those things I’ve listed, all those and more, are coming to a head.

I’m deeply afraid for the future of myself and my community. Immigrants are already being detained in horrific and inhumane compounds where sickness and disease spread rampant—did you know Anne Frank died of disease, most likely a typhus epidemic that swept through the camp she was imprisoned in? You can kill a human through more than gas chambers and firing squads; pure neglect is all that’s needed. I fear that after immigrants (regardless of legal status in the US) have been rounded up, cleared away from the public eye, and disappeared into compounds and detention centers—concentration camps—the already-stirring hatred and scapegoating of trans folks will ratchet even higher. I fear we are next; we kind of already are.

The logical thing—the safe thing—is for me to not medically transition. Stop the surgeries, stop the hormones, maybe even stop the use of they/them at work. Take the pride flag bumper sticker off my car, take the pride flag down from my work desk, take all the pride flags down and hide them away like they’re something to be ashamed of.

But everything within me screams against that. I cannot bear the thought of backtracking or hiding. While I dislike the phrasing of “being one’s authentic self,” I still long to be who I am, to have the space and freedom to explore that person and welcome them into the light of reality. I need this to happen, and I revolt against the impulse that seeks to cower and hide. I have hidden for too long, raised in a death cult that so effectively pounded me into submission that it took me two decades to uncover who I actually am and what I actually want.

My partner told me, after a long conversation about hormones and political danger, that starting HRT is an act of resistance. I resist the gendered box that I have been put into, those expectations that make me chafe. I resist yielding to fear and threats. I resist assimilation, which threatens my existence and, I think, threatens my own humanity.

I will not stop being myself, and I will not stop fighting for the other vulnerable and at-risk people: the immigrants and the disabled, the Palestinians, the man on the corner asking for loose change, the neighbor who got arrested for having a bad day. It is my love for myself and for the people around me, it is that softness, that gives me the strength and hope to continue; I move forward in compassion and love for myself and other people, consequences be damned.

I shall not yield.