The trans/mental healthcare Catch-22 #topsurgery

Tomorrow, I make the now weekly pilgrimage to the hospital, where I (should) now, having met ALL criteria, be given a top surgery date (realistically, within the next three months). The most common question: how are you feeling about all of this? 

Excited! is the expected answer. And yes, there’s a measure of that. This is outweighed significantly by emotional relief and exhaustion, after FINALLY getting within reach of this medically-necessary intervention. An intervention, the more I’ve sat with it, I realise I have not wanted just since coming out as trans in 2015, not just since coming out as genderqueer in 2011, but since I developed breasts (will write another post about this new clarity and the reasons for only acknowledging this now). 

The third feeling, which is the most enveloping, is worry. Honestly, as a person with Bipolar II, my moods have been completely unbalanced since December, with deep, but not severe, depression followed by the recent three weeks of hypomania caused by many internal and external factors, but mostly by increasing my anti-depressant to alleviate depression, which I now realise I’m having adverse effects to as it’s the patented med, where I was previously taking a generic (the JOYS of sensitivity to chemicals in EVERYTHING my body ingests).

I am worried about my mental health, which is, of course, worrying in itself, as the whole “mentally-ill tranny* unfit for trans healthcare**” narrative. This worry is justified, as it affects many, many levels…

  1. This worry is debilitating as a trans person as it manifests in a variety of ways because of general mental health stigma in our society, and the magnified stigma as a trans person who happens to have mental illness.Admitting mental illness struggles as a trans person is something that rarely happens. In general, the trans population will not seek physical or mental healthcare because our transness will, in all likelihood, from lived experience, be used as a contributing cause to our physical/mental illness, and the prescription will be “Panado/Prozac and stop being trans”.We might know the holistic fact that mental illness struggles are triggered not by our transness, but by others’ transphobia.
    Admitting mental health illness or current struggles with a lifelong illness to ourselves is VERY difficult, because we internalise that irrational, critical voice that says we are wrong, freakish, unnatural and ill. (One of the reasons trans people can be transphobic).
    This voice, this transphobia, rears its head even among the most functional trans people who do not have mental health issues, and causes problems where there really shouldn’t be any… but, it’s POWERFUL af…

    Admitting mental health issues to others while trans is even more difficult, because the last thing you want when you’re hearing that voice in your head, is to hear it in the voice of your friends, family, colleagues and social media circles.

  2. Writing/Speaking publicly about mental health issues while trans is thus a HUGE leap of faith, which many of the trans activist and educator friends with a public platform I have spoken to struggle with. We are opening ourselves up to the you are sick narrative. We are inviting critique, and posting a big red button marked “here you go, Trolls!” on the world-wide web. This is… scary doesn’t cover it. Because the admission to self, support systems and the public happens almost simultaneously, or in close proximity. But we, and certainly I, speak out about it because it’s something that is SO, SO fucking destructive to all individuals, cis, trans, you name it – this internalising of a non-sensical, irrational, yet POWERFULLY PERSUASIVE narrative that prevents you from seeking the help you will not survive without.
  3. Admitting mental health struggles makes me worry about jeopardising medically-necessary trans healthcare, in this case, top surgery. Because this narrative means that one can be ill enough to warrant trans healthcare intervention, or too ill to warrant it.And yes, even holistically, there is a point when mental healthcare takes priority over trans healthcare. But this is not that point.

The pending surgery will, at this point, do more to alleviate than exacerbate mental healthcare needs. This I am sure of. I am in constant contact with a trans healthcare therapist and my Instagram trans siblings who are currently pre- and post-surgery, speaking to them daily about what to expect physically, emotionally and spiritually. I could not possibly be more mentally prepared. The key now is ensuring my emotional and spiritual preparedness.

Being in a position in a country (but not unique to this country) where healthcare is not, in general, seen holistically and is not always in the best interests of the patient is EXHAUSTING to say the least. Trying to balance my mental healthcare while trying to anticipate, influence and mitigate for the im/balance of trans healthcare is the Catch-22.

The plan:

I need to work with my own mental healthcare through selfcare, medication and the one professional (my therapist) who can balance my needs holistically, and get to a place (with a pending deadline) where I have the energy to meet the non-holistic criteria of the trans healthcare side… without exhausting myself to the point where I, in conjunction with my meds and therapist, can’t balance my mental health. 

So I need to be creatively open with my need for help with the surgeons tomorrow and limit it to the need for trans healthcare; and then work with my therapist, meds and selfcare for holistic balance by the time the surgery day arrives; all while keeping this internalised you’re sick voice at bay.

But I know I will, because I know the limitations and benefits of each aspect of this balancing act and have thankfully reached the point (again) where I acknowledge the realities, can tell the you’re sick voice to quiten down and take a damn seat, and can work within a non-ideal framework. (Last week I was all for doing it by myself like some hero and then my body was like, hell no superman, here’s a dose of reality in the form of flu. Thank you, body!)

Part of this holistic approach is to limit social media interaction and rest, so will update with news ASASA (as soon as spoons allow).

As always, thank you SO MUCH for your continued support and love, which is SUCH an important aspect of holistic healthcare, in a non-holistic system. You mean more than you will ever understand. Even those who never comment, never speak to me, you, just you reading this: thank you!


* Tranny: a slur when used by cisgender people, and generally considered a slur even when used by trans people (though some reclaim it as a power word, just as “queer” has been reclaimed by and “bitch” has been reclaimed by some feminists, and the “n” word by people of colour). I use the word here for effect as the misunderstanding of transgender people and transgender health the word symbolises is also evident in the transgender healthcare system.

** Trans healthcare = gender-affirming healthcare, including therapy, psychiatry, hormones and surgery, etc.

And then my Instagram brother goes ahead and makes a video about some of the same themes, but just SO much more powerfully. Damn you, Cody! (But love you more).

For more info on surgery at Helen Joseph:


2 thoughts on “The trans/mental healthcare Catch-22 #topsurgery

  1. You do have one large advantage – clarity of mind. I’m sure it doesn’t feel like it, some of the time, but you do. So it means that even when the black dark has swooped in, under the chaos there is a steadiness you know is there, and it acts as an anchor.
    I do sympathise about the health system, sometimes it seems as if doctors have a chart in their minds, and if you don’t fit their patterns, then “they can’t help you until you do”.
    And meds – Pete changed to a generic for his migraines, and developed a strange side effect, and so had to go back to the original. Apparently the makeup of the pill or tablet also affects the actual chemical, by changing the delivery to your system. I did have it explained by a pharmacist, but while I understood the general theory, the details were a bit academic.
    It would be very unusual, I feel, to be undertaking any change as major as this, no matter how good, without a certain amount of trepidation.

    Liked by 1 person

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