The medical establishment doesn’t want you to talk about how transgender transitioning is connected to mental illness.

When I was trans identified I took any insinuation that my gender identity was caused by mental illness, trauma, or neurodivergence as a great personal offense. It is a pervasive narrative that trans people are merely “delusional”, that being trans is caused by some sort of personal defect, and that trans-ness or any sort of proximity to being trans is a disgusting and reprehensible sort of deviance from “normal”. I have seen these narratives pop up everywhere from Jerry Springer to so-called “gender critical” resources, and I do still find them completely unhelpful, uncompassionate, and actually, still fucking offensive. They misunderstand both the nature of mental illness and what drives (at least female people) to consider transition.

I fixated most on questioning my gender and potentially transitioning when I was near-completely socially isolated, trapped in an abusive home, unemployed with no income, and spending most of my time asleep or drugged in a dirty bed. I could barely meet my most basic needs, was emotionally terrorized and functionally in captivity, and had no ability for anything resembling self-actualization. This isn’t a coincidence, and the first thing I noticed upon talking to other women within the detransition/reconciling community is that I was very distinctly not alone in this experience, sometimes down to specific details of my experiences with abuse or mental illness. If you read between the lines in FTM (or other AFAB trans) communities you will notice the same dynamics in play, just covertly, as recognizing the reality of what happens or has happened to us jeopardizes our ability to rely on trans identification or transition as a coping mechanism.

There is an extreme investment in trans community, as well as among the healthcare providers who provide transition-related medical resources, in believing that transition is either undertaken completely of one’s free will, or if it is forced, it is a decision made solely due to an unchangeable, intrinsic part of one’s makeup (a cross-sex “soul”, or more modernly, a cross-sex brain). There are a whole host of reasons why trans people believe this, but one reason I have not seen ever explored is what function it has for the medical system to be invested in this belief. Healthcare providers are invested in believing this because it essentially absolves them of responsibility for harm to very vulnerable people and justifies their homophobic and misogynist practices in a way that totally obfuscates the fact that they are committing medical abuse. In fact, this is the fundamental point of “gatekeeping”: transition gatekeeping is a ritual that manufactures the illusion of a consenting patient and a doctor that has their best interests in mind. Trans people buy into intrinsic gender identity (a thing not affected by life experience or mental illness/neurodivergence) because they have historically been coerced into believing that this was the explanation for what was “wrong with them” and why they were suffering. Once a person recognizes this “reason” (that they have an internal gender identity or at least a cross-sex brain) then it becomes a matter of mere logic to treat the suffering using transition; the trans person will now consent to medical treatment under the belief that it is best for them, and the doctors responsible for the treatment are satisfied that they not only did something permissible but that they did the right thing.

Actually recognizing that trans identification and desire to transition can be influenced by mental health issues or disability or neurodivergence, or life circumstances, or the violence LGB people and women are subjected to under a patriarchal society, would totally blow open this set of justifications. The medical establishment does not want to hear it because it would mean they would have to admit to massive, systematic abuse, particularly of lesbians and gay men. Most trans individuals don’t want to hear it because they would have to face the reality of their situation when they are using trans identification as a coping mechanism precisely because they are in a situation where their psychological or other survival depends on avoiding their pain.

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