Manual of Mental Disorders published by the American Psychiatric Association. The therapist
used an old edition that was particularly offensive in its pathologizing of trans people, implying
that Gwen was abnormal or unhealthy. The therapist wanted to diagnose Gwen with some sort of
disease because her gender identity did not match the sex on her birth certificate. Being trans is
not a mental illness. Gender as a synonym for external anatomy is not accurate.
Gwen felt devastated at being told she was mentally ill. On top of that, Gwen’s mother
forbid her from telling anyone in their family about her experiences. Most importantly, her
grandmother and her younger sister Meghan. This left Gwen estranged from her family for many
years, but she offhandedly remarked to me that eventually she was allowed home again.
Coming out is one battle trans people face. If they want to live according to their gender
identity, there are many more battles, including documentation. A trans person will need to
change their: driver’s license, social security card, passport, bank accounts, credit cards, job-
related documents, leases, medical records, birth certificates, and academic records. Some states
still require proof of gender confirmation surgery to make these changes. Not all trans people can
afford to have surgery. Not all trans people want to have surgery. Not all trans people can afford
time off for recovery.
If one goes through the process of transitioning to make their bodies align with their
gender identity that is yet, another battle. Finding a doctor familiar with trans issues can be
difficult regardless, but it is almost impossible in rural areas. If you do find a doctor, medical
interventions like hair growth or removal treatments, hormone therapy or surgeries (like breast
removal) all mean a long process of procedure and recovery.
Gwen wanted her external and internal attributes to match her gender identity.
“Imagine for a moment what it is like when you are sitting at home, relaxing and
otherwise well, but outside there is a car with a car alarm going off. It just keeps going and
going. It’s faded into the background of your consciousness, but nevertheless it is constantly
going. This noise is just in the back of your brain constant. Then, it stops as someone finally
clicks their alarm-off button. In that moment, you feel this incredible moment of relief as this one
constant, nagging annoyance is blessedly resolved. THAT is how starting hormone replacement
therapy was for me. It was like everything clicked into place, and I could finally relax and be at