Experiences of trans and gender diverse young people

So I don’t do anything or have anything through the NHS so but when I kind of first came out as Trans I did a few sessions of therapy with a local group called [name] in [city] they did six sessions of therapy like people who were kind of questioning gender or who are transgender and kind of questioning stuff around that or want to just explore deeper with like a therapist that’s trained in those issues specifically. So I did two courses of that, 12 sessions in total which was really beneficial just for like not that being Trans is a mental health issue but there are mental health issues that can be exacerbated or kind of caused by being Trans, you know, you experience dysphoria because you are Trans and you know, it’s the way, or you can be depressed with anxiety and stuff as a result of, you know, the reactions you have from people or kind of knowing like the waiting list is so long and knowing, yeah, you know, no, it’s almost like, I remember saying to the therapist, no shit I feel depressed like I know I’ve gotta wait several years before I can even begin to change certain things about my body that I feel like need changing, you know, of course I’m depressed, of course I feel bad.

Yeah I mean currently I’m seeing a therapist privately not specifically for Trans issues but support with you know, depression kind of stuff which Trans issues do factor in somewhat especially, you know, I see in the news a lot really transphobic just hateful articles and messages coming from everywhere, you know, right wing and left wing newspapers, you know I expect it from right wing you don’t expect it from the left wing. Just seeing that shit everywhere does take the toll on you and it does make you feel low, it does make you feel just like alone and isolated so I do see a therapist and kind of talk around that stuff with them and again I’m lucky to be in a position that I can afford to go to private therapy because unfortunately the NHS doesn’t have the funding or the kind of ability to provide long term therapy for many people at all. I don’t think every trans person does need long term therapy or even any therapy at all but for me personally some of that has been beneficial to me to have a space where I can talk about how I feel and, you know, stuff that’s important to me and issues that are affecting how I’m feeling that have to do with being trans in a confidential space where I know I’m not going to be judged.

Yeah, so I started experiencing depression around the same time I started undergoing puberty, whether that is just part and parcel of hormones raging around the body or some kind of link there. I don’t really know. But I do know that my dysphoria has impacted my mental health a lot. I know that when I get misgendered and that sort of thing it tends to impact my mental health. But the kind of the buffets by it have become less impactful and now I’m in a better place.

When I was on benefits they sort of, because like I had depression they sort of, they assign you with like a mentor sort of thing that’s meant to help you sort of apply for jobs and everything and get on with stuff like that. And I had somebody else who I saw very briefly who like they were just sort of, and there was a counsellor that I saw who kept banging on about well what, what’s your sexuality then, you know and I was sort of like I didn’t come in here to talk about that. And I had like another counsellor who like sort of like before I’d come out I sort of brought up like I sort of felt more male than female and he was like oh we should talk about that and I was like nah I don’t want to and I think he was kind of annoyed that I didn’t wanna progress with it any further but I think it’s because I’d already realised at that point that my dysphoria and my depression were pretty much separate things like I’d say the dysphoria sort of aggravates the depression but, I don’t know it’s almost like you know how you have the difference between tears of joy and tears of sadness you just know the difference like I know when I’m crying because I’m depressed and I know when I’m crying because of the dysphoria and at the moment it’s sort of leaning more towards the dysphoria which I’m weirdly more happy about because it means I’m sort of coming to terms with myself.

I had to go into therapy and say like, “There are going to be times where you’re going to be tempted to be like, ‘oh tell me about transition’, and it’s not going to be transition related.” Because I think that gets forgotten a lot in mental health. There is this idea that trans people have issues with depression and anxiety, therefore all of the trans person’s depression and anxiety is to do with them being trans, and like cause and effect tend to get a little bit muddled up in that way because sure it can be to do with that, but it can also be separately, in exactly the same way that all people kind of contain myriads. So I found that once I’d done that, and actually straight up had that moment, my therapist was great.

Personally, I didn’t want to use the LGBT counselling because, in my head I was convinced that it would then become, my mental health would be centred around the fact that I was trans which is why I was being suggested LGBT counselling in the first place by this GP. I didn’t feel that my mental health was related to my gender identity. I used university counselling which then also kept returning to my gender identity and when I tried to reinstate that I did not think it was related to my mental health was related to my gender identity. It, they were trying to like again do the hot potato and move it over to maybe my religious upbringing or my conservative parents. So, there were a lot of like I feel, personally, for me shortcuts that they could make to explain why I wouldn't be in a good mental health, a mental state of mind and the transgender element was definitely like the first shortcut that it kept returning to just it didn’t really believe that it was not related to it. I am not saying that it wasn’t. I am sure a part of the frustration I had at the time was also to do with feeling like I wasn’t going anywhere and I kept having to convince people that I was who I was saying I was. But yeah, I think it’s hard in a counselling mental health issue like situation to convince people that you have other issues in your life than being trans, because it kind of overshadows a lot of other things.

Like I know I can go in and out of stages of being like quite like severely depressed but then sort of like being kind of like alright and unfortunately it’s not really decided by me and I, I’ve learned a lot in terms of how to control my emotions and how to realise when things are getting worse or when I’m spiralling down and just try and sort of keep myself a bit more level headed but you can only really have so much control over it, it’s sort of more your brain sort of chucking a bucket of like ice water at you being like okay we’re gonna be sad now. So in the past few weeks it’s been probably the best its’s been in the last few years and that could be a combination of things, you know, I couldn’t really pin it down to anything that I’ve done. I think a lot of it has just been I’ve like a counsellor who said to me about like when the feelings come just accept the feelings are there don’t over think them, don’t over analyse and don’t dwell on them and don’t submit to them just sort of accept these feelings are coming and, you know, they’re gonna pass and that’s sort of how I think about like my mental health that, you know, I’ve been in worse places before so when it sort of comes now it almost feels a bit kind of like not as strong as it was and I think there are things that sort of can tip you over the edge.

They sort of make you realise okay like I really need to sort of like start doing things, and weirdly getting my new phone has made a massive difference because I hadn’t had a smart phone for ages and a lot of my friends use social media to sort of communicate and I wasn’t hearing back from people because people don’t really respond to a lot of texts or phone calls now because everyone hates speaking on the phone apart from me it seems. So I sort of got it into my head that a lot of people just hated me that people weren’t texting me back and it wasn’t until I got the smart phone that actually now everyone’s been in contact again but I’m sort of like oh, you know, actually I do have friends they just live miles and miles away. I think social groups are a big thing I think if you’ve got a good group of friends to help you that you can go and see, that you can talk about pretty much anything with I think that helps a hell of a lot like, so I think it’s really tricky like in terms of because a big part of depression and anxiety is just being very lonely, being kind of very lonely, very afraid, very isolated and you do sort of cut yourself off quite a lot whereas I’ve sort of found in the past few weeks that I’ve got more used to contacting people, going to see them, doing things and if someone says do you want to meet up and just saying yes and actually sometimes with friends you have to be the one to make, you know, the decision to do things, to go out and say do you want to meet up and do these things and. I think also having the motivation to do things is a massive thing, that, that’s gradually coming back, I’m still struggling to do a lot of the things that I used to do when I was younger but sort of I guess the enjoyment of it is coming back and I have no idea why, I don’t know why it’s been that way I don’t know if it’s me quitting my job that’s sort of made that because in the past month I’ve been really good but it could just be a fluke it could just be, you know, in the next month I’ll be awful, so it sort of fluctuates. But weirdly very little of it is actually caused by my dysphoria of being trans like I kind of think I’m actually learning to be quite proud and accepting of that at the moment.

I don’t think my gender had a huge amount to do with my mental health, I think for me my dysphoria was less connected to my actual mental health because I had so many other things going on with my mental health that weren’t tied to gender. Obviously it had sort of some impact in that when my dysphoria was really bad my mood would be lower, my anxiety would be higher but it wasn’t completely tied into it because I had so much other stuff going on in my life outside of my gender identity because it wasn’t like most of the issue.

As the month went on, I was getting more and more exhausted. Cos I was never an every day person, but I became one because I would wake up and wake up in tears and just terrified of what my life was going to be, cos at that point, in my mind failed every job I’d ever had, I was a trans woman, Donald Trump was running for president, and the UK was going through like a really anti-trans thing in the media. All of these different factors, and my financial instability, cos I was going through the benefits thing, and by, and Workplace capability assessments are cruel and unusual, especially with someone going through with severe anxiety related thing, which is what my deal was. All of these things sort of come, combined together.

It’s hard, like, I don’t think I’ve ever spoken to anyone who’s been able to separate their trauma like that, like ever. Like I don’t think it’s possible. Like I can’t separate any of my trauma, like, the, so like if even just from symptoms, like and not even like thinking, like my symptoms don’t manifest in a way where it’s specifically linked to each specific trauma, traumatic event, like that’s not how it works.

And so like, it was, it’s that kind of like understanding, like that even like trauma itself and like even like, or anything like mental health like, it can be intertwined in, like it’s all enmeshed together, and like for, for like cis doctors like to be like, “Oh you can separate it like this, or this, and it feels just, I don’t know, it does, it doesn’t seem right even from like just as, like if, just thinking about it doesn’t, doesn’t feel right to like separate them like that, because like who thinks in that kind of block fashion, like about themselves?

Like who thinks about their life events in a, like when it comes to, especially trauma or anything, or like a depression or anything, who thinks about their like events in like a linear fashion? You know like there’s issues of like things jumping back to each other, and like the way we think and like everything is, I know they’re taught this in school, like I know, like I’ve been there, like I, I know this is the, this is what they teach you, like they tell you that the things are a mess, and nothing’s like separate like that neurologically, and so and so like and, the way we think, we, the way we process memories and stuff, so it’s just, it baffles me that like they can say this to your face like and say like, “Oh yeah, well you need to finish your transition,” or, “You need to only talk about this specific thing,” and it’s just like, how? How can you like say that with, with confidence? Like how can you like say with, like put, your like education and like what you’ve worked towards behind you and say that with a 100% confidence, when it’s just flat out wrong?

I think there’s been a lot of like expectations in terms of how to behave, I think, ah, a really good example maybe was that I, I was on an epic quest to try and find some medication that worked and I had to go through multiple psychiatric assessments just because I think the process got a bit muddled up at some point. But I remember like I think for, the final one I did, before finally being prescribed something, was they were supposed to send me a letter, and they didn’t, but they did send notes to my GP who then got in contact with me and my GP printed off their notes for me to read. And obviously like you’re not really supposed to read their notes, you’re supposed to read like the polished letter, and so sitting down with that was quite emotional, actually. I think one of the main things that hit me really quickly actually was the use of she/her pronouns throughout like, and obviously like I know like I’m not out to any of my doctors, you know I hadn’t told the assessor, you know anything about my gender identity, but like I think just seeing it written there on, on a, in this medical context where it’s like almost feels like a really concrete representation of who you are, right, it’s about your body, or your mind and it’s about how you’re existing in the world, right. And like seeing that and it, but it like it’s not me, cos it’s, you know using the wrong pronouns and stuff, like did, like hit me quite hard.

And it’s like, you know for sure like my gender and perceived gender came into play there for sure like being south Asian, you know, person who was being perceived as a woman, came into play there, and it’s just like, and being disabled, and like chronically mentally ill, right, and it’s always this thing of like, “Yeah but like, are they really telling the truth?” Like, “Things being blown up out of proportion,” and stuff like that, and, and I think it’s just these, it’s those moments of like being dismissed, even for things that’s nothing to do with like the services you’re trying to access, you know like. Fair enough like to ask about like psychiatric history maybe want to know like you know, trigger points and stuff like that, you know but, but then put them in the notes as that, you know. Because otherwise like making, I guess like passing judgment on patients isn’t beneficial to anybody, it makes it you know I didn’t, in my process of like trying to get my chronic illness diagnosis, like the second time I went to see the doctor about it, I burst into tears because she just straight up said she wasn’t going to help me. She just straight up was like oh, “We want to optimise your mental health,” and in the context that just meant she wasn’t going to do anything at all. So, I burst into tears cos I just, I’d never felt so casually dismissed in my entire life, you know.

And… and I think it’s, it’s those moments where you just, you know after that like I didn’t, I didn’t go back to them until it started getting really bad because I was like they’re not going to help me, like what, you know. Ah. It prevents, you know it felt like there was no, there was no way I could access the services that I needed to access, you know. And I guess, yeah, there’s just been lots of little moments like that, you know with that incident in my notes I found out later was that I got a bit tearful, and it was like, you know, I was just full on sobbing like it wasn’t tearful, you know. But it’s just, I guess stuff like that where I guess your own narrative is being controlled. You know it goes back into this question of power, right, it’s being controlled by professionals, you know. And they’re reading each other’s notes, they aren’t getting to hear your own words every time, so when those notes and when those interactions are you know discriminatory, or exclusionary, or downplaying what your experiencing or just you know saying it otherwise, right, excluding certain things, or changing you know even just little ways like how something, you said something or whatever, like, yeah it, it, it makes it quite difficult I think to like trust healthcare services and you know, and I want to because like I’m a massive fan of like the NHS, right, as a concept and like as you know of course I feel very lucky to be able to have like this access, but that doesn’t mean that there aren’t issues as well, that do need to be resolved, you know.

So when I started Uni initially my mental health was quite good and I was, people didn’t know my previous name which was quite nice because at my home town everyone did. So it was a constant battle, so I didn’t really have to battle with that here and even if people misgendered me [name]’s like a gender neutral name so people will just roll with it, it’ll be fine. And then like, and then like I gradually don’t think of my gender identity as being something I’ll never have because I have it now. Like, on my passport, my name, like my hormones, I have all of that. Like I have all that I wanted, that I thought I would never have and now I have it so it’s not like a thing that gets me down. Like I do have hope about my gender.

One of the key kind of downturns that kept happening was when I would find out about the various things that were going wrong with my referral and the expectations of the waiting times and that sort of thing was particularly rough. So I experienced some quite intense, you know, like suicidal ideation and that sort of thing, specifically regarding my referrals being delayed and the prospect of getting care being even further delayed in that regard.

Why do you think that was?

…It’s so hard to put into words. A little bit, you know, it sucks [Laughs]. It’s… particularly difficult I think just because if you’re already in a place where you’re struggling with your body and your health and your mental health and if your mental health is tied as mine sometimes is to your dysphoria, not having the opportunity of treatment or having the opportunity of treatment being so severely delayed makes it seem like there’s no possible way out or if there is a way out that it’s years away. It just makes things even harder to deal with than they are already.

I personally believe that not being able to access hormones through [Private provider] would have, well I know, it would have absolutely crushed me. And with the fact that I do have some mental health problems and I've struggled with them, I believe that I would, you know, I was born into a hole of depression for one, thinking that I've got another two years of this, this hell. I'd have to put sort of my life, my sort of my public eye life on hold. I'd have to wait until I've had the physical transition that I want and need to be out as a guy. You have to put that all on hold. All the things I enjoy, I'd have to just stop it and then go and you know, and wait, you know, put my personal life on hold just for this. I'd be very upset. I know that I'd start feeling anxious a bit, especially if I was passed my 18th birthday. I'm an adult and yet I still don't look like an adult male cause I’ve haven’t had interventions. There's only so much you can do to pass before you have testosterone. I know I'd start struggling with anxiety again. Because the problem with, you know, you look, you're actually 18 but you look like you're 14 sort of thing.

It does bring issues and it does bring anxiety with it. And so I believe I'd be feeling anxious. I generally believe that if they'd said, oh, but it's a two years wait and there was no other option, I believe that I would be feeling suicidal as a thing and I know a lot of people express these feelings as well as me and it's the sort of thing if you are being forced to sit and wait and wait and wait for this. It's, you know, you just don't wanna do it any more. When it's already been what I've been experiencing dysphoria for six maybe seven years I've got the dysphoria, I've been feeling discomfort in my body since I was four. And it's the sort of thing, you know, once you've been experiencing that for so long, another two years of your adult life, it just crushes you and you don't wanna do it anymore. So I genuinely believe it would be giving me suicidal feelings. I would be turning to any other option I could possibly find sort of self-medicating or whatever. You know, finding friends who are on testosterone and paying them to get extra doses so I could take some, sort of thing. Because I'd be so desperate to just get on with it. It's the sort of thing. I've been patient for two years and I've been feeling this for a long time. I've been trying my best to wait and understand and it's just gone too far to the point where look, I'm done now. I need to get some treatment, which is why I ended up going privately, because I can't wait for another two years. I couldn't wait another two years and then have them do long assessments and all of that. You know, I just can't wait that long.

So back when you were 13, you get this diagnosis of gender dysphoria what happened next?

Well I was in a pretty bad place so when I was sort of told about this that the doctors think like hey this might be your problem that yeah this might be what’s up with you I remember very specifically thinking to myself well look where am I right now continuing like I am, I’m probably going to end up dead within the next few months certainly within the next year I was in such a bad state. So the thought process was hey go for it I guess try, you know if you’re gonna end up dead anyway then why not, I guess. It, it was very much a kind of yeah screw it YOLO kind of attitude, you know, not in the same like reckless happy go lucky way but in, in much of a way of hey I have nothing to lose really at the time, yeah.

Been in hospital a few times. But obviously I know if sometimes if you want say hormone treatment and you're in and out of hospital with self-harm, suicide attempts, it can slow it down, because they have to make sure that you're in the right mind state. But then, when I went to [GIC] they said, well, sometimes if we prolong it, it's just gonna wind you up more and you are gonna do it more, because you're getting upset and distressed.

Well, when they said like that if we delay it might, it will just, it might just make things worse. I was quite relieved, cause I thought, they were gonna turn around and go, well you've been in hospital several times in the past year, so we're not gonna do anything for another eight months. I would have gone mental. I'd've actually gone mental. But the fact that they said that was like reassuring the fact that they understood that that was happening, because they were taking so long.

Well, I had considered whether or not I was trans in the past and that the reason I kind of mentally pushed it away was because I thought that I would make my life harder. I thought it would be too harmful for my parents. The way that I stopped myself from feeling too guilty about being trans and what that would do to my parents was because I knew that if I didn’t come out as trans like I didn’t really want to be alive. At that point, I didn’t really want to continue being alive as a woman. I think a lot of people have that breaking point, but don’t really talk about it, you know. It’s not really an easy thing to just bring up like when did you first find out that you were trans? When I decided that I either wanted to die or be trans. That’s not what people want to hear mostly when they ask. But that’s I think the reality for quite a lot of people it’s a last resort, it’s not something that you just wake up one day and you are like, that would be fun.