Being trans is a war: Fighting for the right to basic healthcare, HRT

Starting HRT is a tremendous part of any transgender, nonbinary or genderfluid persons life we nearly all mark it on our calendar the day we get to start. It is so important to us we celebrate our anniversary of when we get our first dose. For many it’s aspirational, our end goal we all seek. For others it is a detriment, a source of anxiety and despair for want but lack of access.

Hormone replacement therapy is one of the absolutely most basic forms of healthcare for trans individuals. Even though it is something nearly all of us crave, it’s not very well understood. For starters there are tons of gate keepers trying to prevent us from gaining access to the healthcare we seek.

Then there is the matter of science. Because HRT is so difficult to obtain it means there is a small sample group for scientists to study. This means we don’t have good science regarding the effects of HRT.

We all hear results are not typical. Every trans person knows going in that there are unknown variables. We hope it will feminize us if we are MfT or masc us up if we are FtM. The whole unknown is one of the reasons gate keepers use for withholding care. The argument goes it’s a risky transformation that a lot of medical professionals, for one reason or another, do not feel qualified to prescribe due to lack of knowledge. Of course this is a problem. How can we study the effects if we keep access away from people who need it. This is especially true for children and teenagers.

I am not going to make a plea to the powers that be in the political spectrum as to why we need easier access. I suspect my audience is largely, if not exclusively, LGBT readers. Thus I am preaching to the choir and therefore not likely to enact change. Sure by me writing about it the search engines will have one more blog that is Trans-positive to reference but again my readership is so small I’ll hardly make an impact on said algorithms.

This brings me back to the same issue. We all get our information from one another. We have to seek out other trans people who are similar to us enough we can hope their experience should align somewhat with ours. Unfortunately this is bad science. It’s more or less trial and error. Which means we are all ourselves guinea pig who are experimenting upon ourselves. The issue here is again there are no scientific studies follow or tracking our progress. Our testimonials are anecdotal and unreliable at best. This puts us at further risk because we are essentially putting ourselves at risk despite the warnings because we desire HRT so much. The pull, the call to change our genders to match our internal feelings is so strong being unable to receive this care causes us intense mental health issues.

You can tell cis people all day long how difficult it is to not get access to HRT. Often times we do this expecting that if we point out how deadly it is to withhold care they will have sympathy and be more supportive to allow us to get access to this care. However when you have those who don’t care about our health and safety it doesn’t matter if withholding healthcare leads to our suicides because they see that in and of itself a victory, one less tranny in the world for them to worry about I guess.

This doesn’t mean everyone is so callous. I know there are some who have religious hang ups who don’t understand the mental anguish our gender dysphoria can cause us. Some of these people do care about us but they don’t understand why lack of care leads to our suicides. They think it’s selfish or over dramatic to take your life because you can’t transition. One thing we need to do better, all trans people and trans allies, is sharing our personal stories. Our struggles absolutely can impact other peoples lives. We can’t change their minds if we don’t take the time to share with them why it’s so important to us.

As much as we don’t want to see gender dysphoria as a mental health disease, there are times where it is beneficial for us to cling to the fact it is regarded as a mental health condition that can be diagnosed.

This is where one aspect of the gate keeping could actually benefit us in the long term. By diagnosing us as having a mental health condition, I use condition rather than disorder intentionally, this puts in on the level of anxiety, depression and PTSD, topics people are increasingly aware of and familiar with. If you remind your uneducated friends that your gender dysphoria diagnosis is no different in terms of medical treatment as depression they might be more open minded to allowing trans people access to HRT.

Our long term goal is to get to the point where those who want HRT can just get it no questions asked.

We shouldn’t need a diagnosis and we shouldn’t have to jump through hoops. As it stands we are living in a system that has no room for us. The system is not designed to allow for individuals that don’t fit the stereotypes. The social norms we as trans people push back against because conformity causes us intense mental anguish. This is why we try so hard to enact change that will make gaining access easier.

I have found that telling people a licensed phycologist diagnosed me with gender dysphoria has helped some soften their anti-trans stance. It has been a somewhat effective method for opening a dialogue with those who otherwise would have been closed off entirely. This is a double-edged sword. Gate keeping in this manner prevents us from doing proper scientific studies that will demonstrate the effects and risks more accurately. On the other hand requiring us to get a diagnosis from a trusted mental health profession does at the very least put some weight behind the need for us to obtain the care we deserve. This is why having said letter is enough to help courts decide to offer us our name and gender changes when we apply.

We want to get to a place where self-reporting is sufficient. Until then I believe we need to work within the limits of the system, as much as we can, to further our cause. Eventually if we tell enough people our stories the word will get out, attitudes will change, and we’ll become normalized. Yes, this takes time and many of us are going to struggle and die as a result. I cry every night for the trans lives lost to this broken system. If you aren’t crying over that yourself I question your empathy. None of this is to say we can use other more assertive means to enact change then by all means we are fighting a war and we’re all soldiers whether we like it or not.

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Stephanie Bri

A transgender writer who also does podcasts and videos.