CN Lester
CN Lester

HEALTH

When you say you’re trans, the constant refrain is ‘Can’t you just not be?’

Trans people face stigma – whether they medically transition or not. CN Lester, who is trans, asks why a majority seem so hostile

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By CN Lester on

It’s amazing the number of people who’ll try to argue other people out of being trans, as if no one else has ever tried before. Sometimes those doing the arguing are motivated by concern, and sometimes by annoyance, confusion or outrage. Their ‘arguments’ are presented as rational undoings of our supposedly broken reasoning, as though being trans is a riddle which can be solved with the correct interpretation.

Perhaps even stranger are those people who present no arguments at all but who wonder, gently, if we’ve considered just . . . not being trans. Just, maybe, avoiding it until it goes away. It often comes down to the split between words and deeds, the question: ‘Well, why do you have to do anything about it?’ I heard that one a lot when I first informed people of my intent to medically transition. I suspect it’s the same kind of reasoning as the injunction to do as you like in private, but make sure you don’t do it in the street and frighten the horses.

Underlying all of this is the idea that being trans is something unfortunate, impossible to understand and better to ignore. Something you could probably change, if you put your mind to it, or grow out of, if you’d just see sense. That can turn so easily from ‘Why do you have to do this?’ to ‘Why are you like this in the first place?’

I don’t have a quick and easy answer as to why I’m trans, no more than as to why I’m a pianist, or how I experience the colour blue. 

The most common explanations for my transness given to me by other people?

  1. That I’m a freak of nature. 
  2. That I’m desperate for attention. 
  3. That I’m mentally ill. 
  4. That I hate nature, and want to go against it as some kind of rebellion. 
  5. That I hate women. 
  6. That I have unresolved issues with my mother. 
  7. That I’m scared to be a butch lesbian. 
  8. Because being trans is cool now. 

The resolutions to all of these ‘explanations’ are alarmingly simple, and multifunctional: stop being mad, stop being difficult, stop pretending, stop existing.

Naturally, both the resolutions and the explanations fall far short of reality. I’m both an operatic and alternative singer; when it comes to attention I’d rather have the applause of an audience than transphobic insults in the street, and it’s far easier to appear cool with the latest haircut than through coming out as trans. By virtue of being mentally ill and being in therapy for more than half my life, I’m confident that being trans is not a mental illness, and also of the fact that, if I somehow did hate women and not know it, my therapist would have told me and helped me work through it. I love my mother dearly but not in a Freudian way, and do not fear being a butch lesbian but, rather, acknowledge all the ways in which I do not fit that category. As for being a freak of nature, or desperate to deny its truth? I don’t understand how being true to my nature goes against it. I can’t begin to square that circle.

It is the question of surety that typifies this interrogative position most clearly for me. ‘Are you sure?’ is a constant refrain, the response given to my name, my passport, my pronouns, my title. It’s the final question my surgeon asked me before I went under, and the first question friends of friends offered on hearing that I was going to have surgery.

‘Are you sure?’ is the response given to my name, my passport, my pronouns, my title. It’s the final question my surgeon asked me before I went under

Being trans is not like other aspects of life, where necessary elements of doubt are considered natural. Where there would otherwise be investigation, vacillation, self-doubt and fumbling – fear necessarily bound up with desire, belief with trepidation – there can only be flat, unquestioning stasis.

To be trans, you have to be surer than you’ve ever been, because being trans is what you are when you’ve exhausted every other option. And still, other people would like there to be a chance of something different, and so they ask ‘Are you sure?’, just in case.

To be accepted for transition-related medical care in the UK you usually have to pass the Real Life Test – a revealing title. The Real Life Test means living in your ‘acquired gender’ for a period of time, sometimes up to two years, without treatment, to make sure that you’re really sure. Asking someone to go without the hormones they’re desperate for, while also navigating the world in a body more likely to be read as non-normative, might seem cruel but, presumably, that is the point. You have to run the gauntlet to prove your worth. If you don’t want it enough to expose yourself to violence, ridicule, the loss of employment, the loss of a home, then you don’t want it enough to be sure. If, after a certain period of time, you’d like to update your birth certificate, and make sure that your legal documents are in order, then you need to apply to the governmental Gender Recognition Committee, a panel of anonymous strangers, who are there to decide if you’re sure enough about who you are to be officially recognised in your own life. To them you must prove that you ‘intend to live in the acquired gender until death’ – they do not need to prove to you that they are worthy of making a judgment call about your surety. If your life has deviated in any way from the standard trans narrative you must provide explanatory evidence to back up your claim of being sure. If your claim is rejected, you cannot update your birth certificate, and cannot be fully classed as your own gender. You can try again, but each attempt will cost you.

****

Bodily dysphoria, the sense that the felt sexed body is not right and needs alteration, is a burden that many, but not all, trans people bear. But there is another kind of dysphoria, one I have found common to every trans person I have ever met. Social dysphoria: the collision between who we are, how we should be, how we need to express ourselves and live our lives, and the gendered straitjackets others would force us into. It is the misery, the wrongness, of being forced to live a lie. The pain of being called fakes for our authenticity.

It is being turned invisible, which serves a dual role; not only is our disquieting presence removed, but the pain we experience as a result can be safely ignored.

Some critics of trans people have told us that we shouldn’t feel this pain at being denied the legitimacy of our own selves; gender is, of course, just a social construct.

I wonder if these people also tell widows not to bother grieving over their husbands, because marriage is also just another social construct. Love, justice, mercy, faith: all just social constructs. It’s a nonsensical argument that understands nothing of how we are constructed as social creatures, how we have created our interlocking but individual worlds of being human. Trying to deny us the right to exist as we know we are is to deny us the right to exist.

The results of that pressure? To stop being? Two of the biggest surveys ever carried out on trans populations can give us part of the answer. A study conducted by the National Center for Transgender Equality in the USA found that transgender and gender non-conforming people face injustice at every turn: in childhood homes, in school systems that promise to shelter and educate, in harsh and exclusionary workplaces, at the grocery store, the hotel front desk, in doctors’ offices and emergency rooms, before judges and at the hands of landlords, police officers, health care workers and other service providers.

This report is a litany of suffering. A full 41 per cent of respondents had attempted suicide, compared with 1.6 per cent of the general population. Seventy-eight per cent of gender non-conforming kids had experienced harassment at school; 15 per cent were forced to leave school to escape abuse. Nearly half of all respondents had been discriminated against in employment, which makes sense of the fact that 16 per cent of respondents worked in underground economies as a way to survive. Around one-fifth had experienced homelessness as a direct result of being trans, and the majority of those who sought shelter at a refuge were further harassed, assaulted, or simply turned away. More than half of respondents had been harassed in a public place; more than a quarter had been harassed by police. More than a quarter of respondents reported being abused in a medical setting: being mocked by staff after suicide attempts, undressed and left on public display, forced into unnecessary genital exams. Across the board, people of colour suffered more than white people; racism and transphobia is a terrifying combination.

A similar survey was produced by the European Union Agency for Fundamental Rights in 2014. With 6,569 respondents, the results are strikingly similar to the American study. All of the research that I’ve seen – all of it – shows a global epidemic of stigmatisation, discrimination, erasure and violence against trans people. 

We are not asking for pity when we describe the ways in which we are delegitimised and punished. We are asking for outrage, and respect for the fact that, despite all of this, we struggle on, and find joy as well as sadness. We are demonstrating our courage, and asking for shared strength.

Trying to ignore the fact of being trans is the most common option, and the one that nearly all trans people themselves have tried. It’s the one we’ve been raised to, after all. We can ignore from fear, from the knowledge that who we really are would hurt the ones we love, out of a desire to avoid bigotry and censure, and because we have internalised every awful aspect of transphobia our culture has to offer.

For me, it becomes an issue of personal alignment, of revealing the body already felt to be there. It doesn’t solve the problems of being trans in a transphobic world, but it can at least make our personal worlds right

When the need finally becomes too great, and we cannot ignore ourselves any longer, we can gather our courage and confide in the medical system where, too often, we are ignored all over again.

****

I took an option unavailable to the majority of trans people, and paid for my own treatment privately. Everything I had found out about the NHS gender treatment pathway told me that, in the late 2000s, I would not be offered care as an openly genderqueer person. My musical career meant that I couldn’t follow the standard pathway of hormones followed by surgery and, after having had to delay surgery for many years to care for my brother when he became ill, I didn’t know if I could wait any longer to try to fight for care I might never receive. I remembered the ways in which my ongoing mental health care had been cut off, and the pressure I had been under from doctors who did not know me to come off the antidepressants prescribed to me by my psychiatrist, because a young person on antidepressants did not fit their world view. Having experienced that kind of medical failure in one field, I wasn’t prepared to try it in another. I used my savings, made the changes I needed, and learnt what it was to feel comfortable in my own skin. That basic and extraordinary freedom – of finally feeling at peace in my own body – available only because of the luck and privilege of being middle class with money in the bank.

This choice – pay for it yourself or go without – is common to the majority of trans people who seek medical care. Globally, society has been slow to acknowledge the validity and necessity of these treatments. A few insurance plans will cover some transition-related care, and a few large corporations – hardly an option for the majority of trans people. Few nations, internationally speaking, fund hormonal, surgical and ancillary treatments for trans people. In countries like Britain, where a basic level of care is provided, the waiting lists can seem endless, and whether a trans person is allowed access to care is often at the mercy of individual doctors. We swap war stories via email lists, conferences and community meetings: GPs who withhold all care out of prejudice and spite, specialists who ask perverse questions, guidelines that place arbitrary and insulting demands on potential patients, waiting lists that last for years and drive many to desperation. Only a person who has never experienced the savage pain of bodily dysphoria, who refuses to listen to those who do, could think this an acceptable situation.

Placed in this impossible position, many people self- medicate: I know that I would. My personal experience with trans communities in the UK, Europe, North America and Australasia suggests that self-medication is extremely common, particularly now that hormones can be ordered online. Research projects into the health and wellbeing of trans people in India, Colombia and the Philippines have found that self-medication is the norm and, deprived of affordable surgical options, trans women will resort to self-surgery and peer-administered silicon injections. While dangerous, this is nothing new; sexologists in the early twentieth century found that European trans people were carrying out their own improvised genital surgeries, and injecting paraffin into their breasts to make them larger. Desperate people will do what they need to do. It’s better than suicide – and that is something that happens too.

Physical intervention – whether surgical, hormonal, life- style based or a combination of the three – should never be treated as a necessary component of being trans, nor should we adopt a one-size-fits-all policy. It was necessary for me, but in a way that did not follow the ‘standard’ route; every trans person will have their own, unique needs. For me, it becomes an issue of personal alignment, of revealing the body already felt to be there. It doesn’t solve the problems of being trans in a transphobic world, but it can at least make our personal worlds right.

****

There is always the question of regret. I have chosen to answer this question last, because I am so tired of it coming front and centre whenever medical transition is discussed.

Yes, there are cases of regret. There are people who detransition. These cases are few and far between – the percentages are very small – but that doesn’t mean they should be dismissed. With apologies to my friends who have detransitioned or retransitioned if I get this wrong, this is what I’ve learnt.

Some people who are counted under cases of ‘regret’ do not regret their treatment at all, but simply needed to pursue some further treatment to complete their transition. This is often the case for people who do not fit comfortably within the gender binary, as the treatment pathways available rarely offer support and options for people who may desire a mix of sexed traits. Other trans people who have expressed regret in the medical and community literature feel regret not over transitioning, but regret in their choice of surgeon and the results of their surgery. Some surgeons are excellent, but I know of several who have treated their trans patients badly, both in terms of results and in follow-up care. It doesn’t surprise me that a trans person who cannot have a fistula repaired, for example, would regret choosing the surgeon who refuses to fix the results of their work. Some trans people who currently express regret will later go on to try transitioning again; it is a well-known occurrence for a trans person to need to try several times before they have the wherewithal to carry through their transition. It’s not often easy. Family, friends and broader communities can exert a tremendous amount of pressure on a newly out trans person; ‘regret’ can often prove an initial withdrawal in the face of overwhelming disapproval.

And, finally, I do know a very small number of people who have detransitioned because they no longer feel like they are trans. One person explained it to me like this: sometimes life only presents you with short-term choices, and you have to take the choice that will get you through. You have to survive to have the benefit of hindsight. Transitioning got them through to a better place and, in that place, they could see that transition wasn’t their final destination after all.

I don’t believe that there should be any shame attached to taking a choice that was right at the moment of choosing, and then living to decide that, actually, another choice would be better. I think we should all be more open to the courage it takes to make both of those decWhy isions.

Life is about risk. Every choice we make has the capacity to make our lives better or worse, to hurt or help us and the ones we love, to come to be something we regret or celebrate. We give our informed consent. I don’t see why we should expect anything else, as trans people hoping for the basic right to breathe freely in our own bodies.

Trans Like Me by CN Lester is published by Virago.

@cnlester

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