Why Did I Think Transitioning Was Impossible?

When people ask me why I didn't transition earlier, one of my most common responses is that I thought transitioning was impossible. My brain, not believing that it was possible to have congruence between my gender identity and gender expression, took many of the painful memories where I knew something was seriously different and hid them from me in what I call memory vaults. Many of these events included severe trauma or incidents that pointed to that trauma. Those memory vaults don't in and of themselves tell the full story though, so let me introduce a second concept - a floating memory. My best analogy of a floating memory is from dreams. Have you ever had a dream where in the dream you are at your house? In your waking life you've never seen this house before and you've certainly never lived there. But in the dream it's your house. You have no idea how long you've lived there and you don't have any memories associated to that house unless there was context in the dream that allowed you to access another memory. That's how I'd describe my experience of having a floating memory.

As a kid, all the memories of me lying in bed at night, wishing I could be the girl that some part of me knew I was, would take the form of floating memories. I'd have these heartbroken, crying episodes in my bed at night and I was aware at the time that this was a recurring thought. But they turned into floating memories that were completely unmoored from my life's timeline. I basically retained the emotional memories but was not able to transfer that into logic so that I could recognize patterns. So I was aware of how I'm drawn to femininity, but asking a question of myself about being trans was out of reach. That memory of crying in bed that was frequently unmoored from everything explains why those memories didn't have the full weight of their meaning over time in my brain. My brain had to develop this trauma response to make it through childhood. So I thought this was the answer as to why I thought transitioning was impossible.

But was this really the full and complete answer? I logically know that I had some kind of partial awareness in the '90's of being outside of the gender binary. Heck, I wrote about signs from early in the relationship with my wife that started during that timeframe, so I had some type of awareness then, even if it was just a general awareness that I was drawn to femininity. Were memory vaults and floating memories really enough to fully explain why I didn't transition? I know that I had knowledge at some level about transitioning. I know I had impressions about how difficult it was to transition from somewhere. Did I stick my head above the water and look into if transitioning was possible in the late '90's? I can't fully answer that, but I thought an investigation into what the standard to transition in the late '90's was would answer these questions. Would it have been possible for me to transition then? I went on a quest to find the pathway to how I could have transitioned much earlier.

Much of my life was spent below the surface. Did I stick my head above the surface to see if transition was possible? (Photo by Jeremy Bishop on Unsplash)

***Note: Due to some of the language of the time that this post covers, there will be some usage of antiquated language in this article. It's important to use the language of the original text, as it is through a historical perspective and the language itself is a component of the answer to the question of why I thought it was impossible to transition. Thus, some terms in this article may be considered offensive or potentially triggering. Readers should take this under advisement when deciding if they should proceed in reading the rest of this article. There are also references to self-harm told in the first person.***

So I dug in to research what the past standards of care were. I discovered this document online: 1998 Harry Benjamin Standards of Care. This was the forerunner to WPATH, the current body that sets global standards of medical care for trans folks. The 1998 version, version 5, was the first time ANY input from trans individuals was even taken into account for trans care, and that input was not strongly weighted. Before 1998, the experience of trans people didn't factor into the medical standards that were set, which is just incomprehensible. I'm not sure exactly what I expected to find in this document. Likely I wanted documentation that I could have transitioned much earlier and my own brain and social stigma was the full explanation. But that's not what I found at all.

Under the 1998 Standards of Care, I would not have been able to medically transition.

Let me say that another way. I thought that transitioning was impossible because it was, in fact, impossible for me to transition under the standards of care in 1998. I want to walk you through some of the challenges to transition that I would have had. I'm going to highlight different areas of the standards and walk through how it would have been a road block to living authentically.

(This article is a companion to the article: “Why Are There So Many Trans Teens” Is the Wrong Question)

One - The Triadic Therapeutic Sequence - This was the belief that there were three stages that needed to be progressed through, in order, for the medical establishment to allow someone to medically transition. The sequence was cross-gender living that was referred to as the real life experience (today this would be called social transition), followed by cross-sex hormones (today called GAHT, gender affirming hormone therapy, or HRT, hormone replacement therapy), and genital and potentially other surgeries (today referred to as GCS, gender conformation surgery, or GAS, gender affirming surgery). This was the sequence that was so often looked for by professionals to treat what was then known as gender identity disorder. In 1998, for most practitioners there was only one right way to be trans and it was by following this triadic treatment sequence where the end goal was surgery. So often therapists looked for someone who wanted to have surgery before they were allowed to begin the process.

This is why today you'll so often hear people in trans circles say "there's no one right way to be trans". Expecting that each trans person has a single threaded path to follow is incredibly unhelpful. So many people approach things with different goals based on their own lived experience. Additionally, the 1998 standards are still through the lens of a gender binary, so folks that don't fit neatly into that binary, like nonbinary people, fall outside of what practitioners were looking for. Expecting uniformity in these archaic standards breaks today's understanding that the trans person should always be the one controlling the steps.

When I began medical transition in October of 2023, I was not aware of having gender dysphoria about any part of my existence. I clearly had and have had persistent gender dysphoria since early childhood, but I could not yet access those memories and analyze them. What alerted me to seeing a path forward as a transgender woman was gender euphoria. There’s a reason that my second article on this Substack site was about gender euphoria. Rather than putting my experience through a pain filter of dysphoria, gender euphoria acted as my lighthouse in the fog for how I could progress safely. Starting hormones helped shift and clear my thinking so that I could access these parts of myself that I had walled off. Gender euphoria with repressed gender dysphoria would not have met the diagnostic criteria to begin the triadic sequence in 1998.

Two - "The real life experience" - This is essentially an archaic form of social transition and it was almost always done under a therapist's guidance. The point of this is that the person would begin living under their new identity as the beginning of the triadic sequence. There were exceptions that could be granted, but this was how the sequence would be followed in most instances.

There was criteria where the "quality" of a person's real life experience was reviewed. The factors:

To maintain full or part time employment

To function as a student

To function in community based volunteer activity

To undertake some combination of items 1-3

To acquire a new (legal) first or last name

To provide documentation that persons other than the therapist know that the patient functions in the new gender role

Here's additional text from the guidelines: "The real-life experience tests the person's resolve, capacity to function in the aspired to gender, and the alignment of social, economic, and psychological supports. It assists both the patient and the mental health professional in their judgments how to proceed."

Here's one more additional bit of text from these standards: "Since changing one's gender role has immediate profound personal and social consequences, the decision to do so should be preceded by an awareness of what the familial, vocational, interpersonal, educational, economic, and legal consequences are likely to be…These represent external reality issues that must be confronted for success in the new gender role. This may be quite different from the personal happiness in the new gender role that was imagined prior to the real life experience."

So now I'll look at this in a modern lens. Certainly lots of people socially transition first (and for some, that's the extent of what they wish to do). That's great when this is self-directed. But here it's a gate that must be evaluated by a medical professional before getting access to hormones. What these standards are saying is that someone needs to be "successful" living as the opposite gender in order to proceed. People could be fired for transitioning at work, and often were. People were evaluated by a medical professional on if they were able to legally change their name (without a gender marker change). Folks, this is so fucked up. Someone attempts to transition at work, gets fired, and becomes unable to get a job because discrimination against trans folks in employment was legal and condoned in 1998. Yet, because people discriminate against someone and they can't hold a job, that can be seen as a reason to not allow someone to advance in the triadic sequence to access medical interventions that would allow the trans person access to a better life. There's a disclaimer about this in the standards, stating that medical professionals were wrong to block advancement in the triadic sequence and looking at it as a test while also acknowledging that this regularly happened. People couldn't hold a job or pay their bills, so they had to stop transition and this was a telltale sign to the medical professional that they must not have been truly a transexual. This was the world in 1998, and it's why so many trans women are in sex work to this day as it's the only line of work that so many trans women could do to make a living.

Look at the language that is quoted. "This tests a person's resolve". "The immediate profound personal and social consequences." How someone sees themselves is “imagined." The standards themselves are coaching the medical professional to doubt the trans person's experiences. It’s as if the standards are saying “They must be making this shit up, amirite?” This standard is being set up to intentionally put trans people through a hellscape. A transexual's ability to get through situations of blatant bigotry were the signs of "success". These standards are so thoroughly and completely messed up and put extra artificial boundaries in place for trans folks to access transition.

In 1998, I was twenty-four years old, two years removed from college. I worked at a nationally syndicated sports-talk radio network, starting as an unpaid intern in 1994 and working my way up to be the producer of a nationally syndicated show. There is absolutely no way I would have been able to transition and keep my job there. None. I became engaged to my wife, and in 1998 she out earned me. But she was not earning enough to support both of us. I have no idea how I would have had full-time employment. Just because I can't envision it today does not mean there wasn’t a path through, but it certainly adds huge questions to the viability of transition.

One other area to mention here on "The Real Life Experience" is facial hair removal. The criteria stated that hormones won't stop or slow hair growth. When getting electrolysis treatments for facial hair, trans women cannot shave for days in advance of the treatment. This process often involves weekly treatments for two years or longer to complete. So trans women might be in a constant state of growing facial hair for years so that it can be treated and get removed.

So, before even beginning social transition, the criteria for trans women recommends not beginning "The Real Life Experience" for two years. That is absolutely bonkers. A trans woman's mental health is absolutely shit on with this huge delay to living as themselves. Not completing electrolysis first would have meant trying to keep a job as a trans woman while growing facial hair, which was untenable in some places. Yet, trans women were expected to flourish despite multi-year delays and standards of care that didn't push back on bigotry. These standards were abhorrently cruel.

It's also patently false that hormones don't impact hair growth - they absolutely do. For those transitioning and starting feminizing hormone therapy, hormones will make hair finer and slow hair growth over time. Most trans women will want electrolysis or now laser hair removal, but that's not something that needs to be done FIRST in modern times. But in 1998, without any types of protections for work, a trans woman needed to regularly have four or more days of facial hair growth so that electrolysis could be successful.

Three - Requirements of Hormone Therapy for Adults - There is both an eligibility criteria for hormone therapy and a readiness criteria.

For eligibility, you must have had a documented real life experience for a minimum of three months and/or a period of psychotherapy of at least three months.

For readiness, you must have had further consolidation of gender identity during your real life experience or therapy, and you must have made some progress in mastering other identified problems leading to improving or stable mental health which implies an absence of problems like sociopathy, substance abuse, psychosis, and suicidality as examples.

One more statement on the requirements. "Can Hormones Be Given For Those Who Do Not Initially Want Surgery or a Real Life Experience? Yes, but after diagnosis and psychotherapy with a qualified mental health professional following minimal standards listed above. These cases often are deeply controversial and require particular caution." What this is saying is that if someone wants to start hormones, but they are not planning on getting surgery or a real life experience, it would be highly unusual for someone to be allowed to begin hormone treatments and the standard is still to have the real life experience before beginning HRT

I started HRT before I socially transitioned. I thought I would be socially transitioning, but I hadn't yet decided on when as I started HRT. I also had no plans for any surgery, I just wanted to start with electrolysis. This was absolutely the right path that I needed in order to transition. When someone begins feminizing or masculinizing hormones, it's typical that the first place a change is noticed is in the trans person's mind. I noticed that I had begun processing things differently on my third day on hormones, and that change in my mental processing was incredibly helpful as I then started planning social transition.

But there's more here for me. I had a breakneck pace to transitioning. My egg cracked (I knew I was trans and the closet was no longer going to be an option for me) the weekend of August 19 and 20, 2023. It was a very scary two weeks as I didn't yet see a path forward. On September 2, I first saw a path forward and on September 6 I told a friend that I'd be out everywhere before the end of the year. I came out everywhere on November 26, 2023, only 85 days after I first saw a path forward. I'm sure there are people who came out faster, but I don't know of anyone else who came out everywhere less than 90 days after first seeing a path forward.

Two months ago I ran into someone who I was in close contact with in 2023. Right after I realized that I'd be out everywhere before the end of the year, I had spoken with this person about coming out to a group of mutuals. They advised me against doing so. We talked for another 45 minutes in this conversation. Here's what I remembered about the conversation before we met up again in late 2024. I went into the conversation planning on coming out to our mutuals and I opened our conversation. I must have asked something, and all I remembered was that it was not an overly positive response. I literally have a 45 minute memory hole about this discussion and I only remembered pieces because I ran into this person again recently and they filled my memory in. My memory gap is because I was in such a dangerous place that it’s as if my brain stopped recording memories. That’s because I could not have any potential delays to my transition. I did not consciously know that I was suicidal, but I exhibited a bunch of warning signs and it’s evident when I look back at this time just how dangerous it was for me.

Now, look at the standards again. It's not a one month delay to accessing hormones, this process is years before someone can access hormones. You would need to find a therapist who validates your identity (no easy task in the late '90's). Then you need to convince the therapist that you are trans and should go forward with the real life experience. So then, before you get access to that form of social transition you would have needed to get electrolysis, which takes up to two years AND is really expensive. Then you could start the real life experience, but you better keep a job or your transition won't be deemed "successful". This is a three year process at a minimum before you take your first dose of hormones. Obviously I'm not the same person beginning transition in 2023 as I would have been in the late '90's. With that said, in 2023, someone with no actual power over me suggesting I come out on a slower timeline was so dangerous to me that I don't have a memory of that conversation. In 2024, when my name change did not go through initially because of a judge ruling that I needed to out myself, it sent me into active ideation. Folks, in 1998, there would not have been relatively minor delays or threats of a delay, there would have been a three year delay. I think it's somewhere between unlikely and very unlikely I would not have made it through that three years.

I was so dysphoric when I first transitioned. I removed my picture from everywhere for months and was only comfortable having pictures posted again after I had some professionally taken and with a crap ton of touch ups. I couldn't look at myself on a video call. I couldn’t stand smiling even when I looked in a mirror because smiling made me so dysphoric. It took me a good four months on HRT to start seeing enough of a difference that I wasn't in a dysphoria spiral every time I looked at myself. How could I possibly have existed in that type of a spiral for three years without access to HRT?

But that's not all. The standards specifically say that in order to access hormone therapy, you must have improving or stable mental health and the standards gave not being suicidal as an example. Yet, the key for me to have improving mental health and not being suicidal was those very same hormones that would have been withheld from me for years if I tried to transition in 1998. Could you imagine if other parts of medicine worked this way, where the key to healing was withheld until someone healed themselves without it? You’ll get that pin in your broken finger once it’s done healing.

I have a level of regret of this surgery from 2022 where I still haven’t regained all mobility in the knuckle that this pin was inserted through. I have zero regrets about my transition.

I didn't just have my brain think it was impossible for me to transition in the late 1990s, it actually was impossible. Just from these three areas, it seems like I only had two options in the late 1990s. Run really far from being trans or lean into transition and don’t make it. Transitioning then was impossible. It’s a cruel conclusion.