Transition Reactions p14: You need therapy

I still haven’t quite adjusted to the realization that trans rights discourse is so primitive at this stage that some of the most blatantly fucking obvious statements perpetrated in this conversation are treated as “serious points of debate.” One of these is the appallingly clueless “You need therapy,” and it’s ableist cousin “you’re just messed in the head.” It is, in my estimate, the strongest predictor of a fruitless conversation, because anyone who thinks trans folk don’t receive therapy hasn’t bothered to check their most basic assumptions which distort their opinion.

Join me as we run through the gamut of my healthcare process to illustrate why the assumption underlying the response “you need therapy” is an observation as asinine as “you have skin.”

Step one: I need to figure out I’m trans

In order to access any kind of gender related care, I first have to know I need it. In the absence of comprehensive vocabulary, many of us gender variant folk are really confused and disgruntled, which often compels us to seek–wait for it–therapy. If we’re lucky, the therapist might lift the fog and say “you have some gender identity problems,” and either address them or refer us to someone who can, at which point our pre-existing questioning starts to gain traction.

Step two: I have to convince my general practitioner or existing therapist I’m trans

The next doctor I need to impress is the one who will give me my referral to available healthcare. That means I need the generic scripts that will cue them in that direction. Some of us will face skepticism from this stage, despite the fact that the provider in question is not typically a specialist in gender identity.

Guess what question my GP asked me.

“Have you tried therapy?”


Step three: I have to convince the gender psychiatrist I’m trans

Having gone to therapy for gender confusion and having fed a half-true script to the GP to get me a referral, I arrived in the office of the third doctor to try and tinker with my psyche. By now I’ve got better vocabulary and have done some homework on gender gatekeeping, the system I am still subject to. I get it easy. I don’t have to obfuscate too much, because in my particular case, gender confusion was a pretty constant theme throughout my life prior to the meeting, which is convenient because it’s one of those easy and safe “true transsexual” nonsense narratives they like to insist on.

Nonetheless, I bear this in the open. You know, during a therapy session.

Then the gender psychiatrist says, “gee, you’re manifesting a few problems here like depression and anxiety. I’m giving you a referral to therapy to make sure you’re not making a mistake.” Alongside that, you do something called your “Real Life Experience,” where you socially transition and have to spend at least 12 months “living as your identified gender.” During which, of course, you’re going to more therapy.

Just making sure we’re all on the same page here, this is now four doctors frowning and finger-wagging about my gender confusion and 12 months of therapy.

Step four: I have to convince another psychologist I’m trans

Okay, so I’m getting help for the various co-morbidities of discrimination, my gender psychiatrist thinks I’m totes trans, and now, in order to receive bottom surgery, I have to find another motherfucker with the right piece of paper and convince that asshole I’m trans, so that I can submit to my government two letters saying “yeah, she really definitely tran.”

Five doctors. Not counting my endocrinologist, mind you, who also tends to lean over her professional boundaries and probe into something besides my blood.


“You need therapy.” At its face a claim that looks superficially reasonable, but in reality it’s like telling a gold medal Olympian gymnast they need to do more back flips.

They haven’t bothered to look up just how many hoops you have to jump through to exercise your bodily autonomy as a trans person. But jesus fucking christ. “You need therapy.” I’m getting therapy. About five times more (six if you include the endo) than you are!

It’s just a total nonstarter. Maybe I ought to get serious in collecting some patently obvious observations to fire back. “Your heart is beating. What? I thought we were stating the obvious.” Of course I need therapy. Staring at my own body used to feel like mashing every key on a piano and now that I’ve fixed that problem I have two entire political parties dedicated to bringing the piano back and two dozen lobbyists painting my existence as a rape threat in the media. You’re acting like it’s unreasonable for me to be a little depressed! How the fuck are you supposed to respond to the knowledge that millions of people hate you on principle, not because of anything you’ve actually done, but just for existing?

The sheer arrogance. Gahhhh.