“I would really like to write you this letter, but I don’t feel comfortable supporting your transition right now.”
In 2009, I was a junior in high school, just starting to make decisions about college and my future. Barbra Siperstein had just been elected as the first openly trans member of the Democratic National Convention. For many, the year marked the start of modern trans history, and the start of public discussion surrounding trans health care.
“I recognize your gender identity, and trust me, I understand, but I just can’t bring it in me to write a letter I don’t believe in.”
I had come out as trans the year prior, but like many trans people, I had known my identity since I was a young child. I remember watching the older girls in elementary school in the ‘90s. The style back then for the girls in my Brooklyn school was Soffe shorts, and big baggy t-shirts. In my young mind, it looked like they were wearing their oversized neon shirts— emblazoned with puffy paint pictures—as dresses. I wanted to be like the other girls.
My grandmother was babysitting me when she found me in the backyard, running around in the biggest t-shirt I could find over my pink briefs. When she asked my 8-year-old self what I was doing, I explained what I thought was the height of fashion, and she looked at me with kind eyes and said, “It really does look like they aren’t wearing pants, doesn’t it? Let’s go inside and get you some shorts.” My grandmother is long passed, but I think, in her own way, she was the first person who knew, even if neither of us had the words at the time.
She would sit with me in the backyard while I made dandelion crowns for myself–a skill taught to me by my various girl friends at summer camp. I didn’t get along much with the boys my age. I couldn’t relate to their crassness, and the fact that I didn’t fit the mold of boyishness awarded me no brownie points. So I kept my girl friends close, and the boys around me at arms length.
“If I write this letter, I’m supporting something that goes against my principles. You’re so young.”
“I’m sorry,” my therapist explained.
My heart was broken. To start transition in 2009, you needed a letter from an established therapist to begin HRT—Hormone Replacement Therapy. My therapist was a kind woman, who was brought to tears many times in our sessions. I would share the torment of school, and my hopes for the future. We sat in the back room of her house, which she shared with her wife and where she held her practice. They traveled to Massachusetts for the honor of that title. I felt safe with the older lesbian as I unloaded my identity on her for months.
To an extent, my parents supported me. They always tried their best to understand and provide opportunities to grow and succeed. But to be myself, I needed to learn how to advocate for my needs very quickly. Unfortunately, that meant battling with a medical system that viewed gender dysphoria with disdain in lieu of the warm embrace necessary to combat it.
Trans people thrive in environments where they are loved and supported. I watch the young trans people now with a tinge of jealousy for the world they inhabit. Some claim that dysphoria is a prerequisite for being trans, but most understand the truth. Gender Euphoria—the feeling of undiluted joy that comes from seeing yourself in the way you were meant to be—is what really defines being trans. It’s a concept that exists only in a world where trans people can be surrounded by people who understand; who can fight off the panic and fear that comes with dysphoria with the most powerful agent of change: Love.
I never did get my letter, and by the time I started HRT, it was through backdoor channels. I had moved into my very queer, artsy dorm, Demerest Hall, at Rutgers University. A new friend used their credit card to help me order estrogen and spironolactone, a testosterone inhibitor, online from an overseas pharmacy. I remember crying as I opened the package and held the little circular pill dispenser in my hand.
In retrospect, I should have been more fearful. I had no idea where my medication was really coming from, and I wasn’t undergoing the requisite blood work to monitor my progress. I was self-medicating because it was the only option I had at the time.
My parents were furious. “How could you be doing something so stupid?” They immediately set out to research options for me. When I went for my appointment at the Mazzoni Center in Philadelphia, an LGBTQIA+ clinic, it was 2010. It was one of the only clinics in the country that was using a new, revolutionary model for a treatment called “informed consent”, which is now the standard instead of the exception. They explain the risks and benefits of HRT, take your bloodwork, and start you on your path. It was absolutely life-changing. I walked many friends into the same clinic behind me to start their path.
The only thing that would have made the experience better: if I had been given the opportunity to delay puberty and obviate my dysphoria. Many people don’t understand that if puberty is allowed to progress, the results can be irreversible. At the point of puberty, the harm of testosterone is nearly complete. Because of that, I’ve had to endure seven surgeries over the course of the past two years just to reverse the results of a puberty that should have never began.
In 2021, those life-saving options are a possibility for thousands of trans youth, and Arkansas bill HR1570 (now Act 626) removes them from the realm of possibility. The act prohibits health professionals from providing or referring trans youth for health care. It interdicts any state funds for gender-affirming health care for those under 18, and sanctions insurance companies to deny gender-affirming care for trans people of any age.
By the time trans youth turn 18, the cost of denying health care is grave. I am living proof. Suicide risk skyrockets and trans people are forced to endure painful surgeries that could have been easily avoided. The proponents of the act believe that reality causes less damage to trans youth than health care that benefits them, a ludicrous and unthinkable notion to the trans community. For context, in a 2015 survey of nearly 28,000 people by the U.S.-based National Center for Transgender Equality, 8 percent of respondents reported detransitioning. 62 percent of those people said they only detransitioned temporarily, and they reported parental pressure as the reason. Merely 0.4 percent of respondents reported realizing transitioning wasn’t right for them.
At press time, the American Civil Liberties Union is currently suing to block Act 626. The lawsuit was filed on behalf of the families of four transgender youths living in Arkansas, plus two medical doctors and their patients.
Barbra Siperstein died in 2019, in New Brunswick, NJ, where I began my medical transition. She attended the same school. I wonder if she went through the same thoughts I did as she walked the historic grounds. I wonder if she knew, and was only held back by the fear of the world she lived in at the time. A world in which there was nothing but closed doors and judgment. That’s not the world every trans person experiences anymore, but we have to fight to sustain a better world for all of us.