I’ve been meaning to get around to this post for over a month now, I just haven’t been sure how to word it. I’ve decided that I probably won’t ever be entirely sure so I’m going to wing it and see what happens.
As everyone should probably know, there is an incredibly high incidence of depression and suicide amongst trans people. I don’t know if gay and trans corresponds to an even higher risk because, well, no one has ever bothered to ask. Either way, it’s a common enough problem. Some of us have situational depression due to constantly being misgendered, others have chemical depression and would be just as depressed even with all the right parts. I don’t know what it’s like to have situational depression so this is going to focus on the chemically based type.
I was first diagnosed when I was six. You’re probably thinking that’s pretty early, but when a child that young is found trying to rig up a noose there’s not a whole lot else to try blaming it on. At that point anti-depressants were 100% not prescribed to children. They were barely prescribed to teenagers. So rather than use me as a human guinea pig my parents sought out alternative treatments. I was put in martial arts, given positive thinking techniques, and taught a variety of coping mechanisms for the more terrifying aspects of my illness.
Prior to transition I’d had several major depressive episodes per year and a suicide attempt at least every other year. It got particularly bad when I was a teenager and went down to a semi-manageable level shortly before I came out. I wasn’t functional by any means, we’re still talking about spending several months a year not being able to leave my bed, but after years of having hallucinations of corpses and having to lock myself in my closet every week in order to stop myself from trying anything I was happy to just be able to chop up salad ingredients without imagining what it’d feel like to slit my wrists.
When I came out things got even better. One of the things every friend told me was that I finally seemed happy, an emotion no one had seen me express before. That was when I started getting stupid.
See, every trans guy I knew talked about how amazing it was to come out and how it was even better when they started T. They talked about mood swings and having to get just the right dose on just the right schedule, but the overall message was that T would all but make depression disappear.
It didn’t. I want to make that very clear. T will not cure depression. It can do many things, including make dysphoria related depression more bearable, but chemically based depression does not go away simply because you have more testosterone in your system. It changed the biochemistry of my brain enough that my depression is the best it’s been my entire life, but I am still depressed. I still have days when I cannot for the life of me get the energy to move out of bed. I still have feelings of intense hopelessness that will not go away no matter how hard I try to think positively. I still get suicidal for no apparent reason. I still have hallucinations when I’m in the midst of a particularly bad episode.
Very few people outside of my therapists have managed to fully understand that. I am not depressed because I am trans. I am not trans because I am depressed. I am depressed. I am trans. The two are not related.
I hear you. Though my situation is not quite as bad, I have struggled with deep depressive episodes throughout my life. Coming out as trans made me temporarily euphoric, but a half year after starting T, I was back where I started. After 8 years of living on T, I can say that it only affects my mood in that my body just seems to like it more – its a very mild effect. When I first came out I was so nervous that my therapist wouldn’t let me start T because my moods were so labile and none of the medicines worked. Thankfully, she let me, but every therapist I’ve seen since has immediately assumed that its the hormones that make me wonky. I always have to convince them that its my brain, my other chemicals and my life history that fucked me up. When you’re trans, that’s all people see – they forget that its just one tiny facet of your existence.
I’ve been lucky to not have issues with therapists. So far. I’m looking for a new one so that may change. I had a ton of problems with people early on though. “Are you SURE you want to transition? You’re already…ill.” It was incredibly frustrating
Yes, depression does make life suck a bit (a lot) more. It does that for everyone who has it though. Being trans doesn’t make it any worse unless your depression is based entirely on being dysphoric.
One last thing: I’m glad you’re still here.
I’m pretty glad too most days. Even during my depressive episodes I’m more interested in not existing than dying. Death is messy, non-existence is simple and painless.
This theme is following me everywhere I go today. If I believed in this sort of thing, I’d think the universe was trying to tell me something, because it’s absurdly appropriate for today.
Anyway, I have some hope that T will do something positive, though I understand it won’t cure me entirely. But I was fine as a little kid, not at all depressed. It was when I hit puberty that the depressive episodes began, and ever since they’ve been almost completely dictated by my hormonal variations. The ‘usual’ mood situation follows my monthly cycle (as if I wanted to pay more attention to that). Both times I was pregnant, I had year-long major depressive episodes. And birth control produced major depression with psychotic features (delusions and hallucinations).
Antidepressants and other psychoactive medications do nothing whatsoever for me other than make me nauseous, foggy-brained, and highly suggestible. Therapy is counterproductive, especially when combined with medications because of the aforementioned suggestibility; if I spend enough time with a therapist (especially in an inpatient setting) I’ll end up manifesting whatever condition they specialize in. It takes me a long time to get myself sorted out after an encounter with a mental health professional. That’s one of the many reasons I put off transition for almost a decade.
So…I’m not pinning my hopes entirely on T, but I do sincerely hope that it at least reduces the hormonal variation so I can get a better handle on what my ‘real’ baseline mood is. Maybe then I can actually attend to that. And maybe the change in brain chemistry will affect how meds affect me. Even on my worse days, I’d usually like to know who I really am and how I really feel before I make a permanent commitment to…not existing. Although there have been some close calls there.
I’ve seen online where other people (not necessarily trans) report relief of hormonal depression symptoms once they have their ovaries removed (usually done as part of a radical hysterectomy).
I have hormonal and situational depression, and I am weighing my options (surgery = yuck) because I am getting mood swings as my injected T levels decay towards the end of my cycle and estrogen production kicks in, like that rusty old wall A/C unit. I had suicidal ideation on Lithium during Estrogen mood swings, if that gives you any context. Just switched to a more expensive (lol) anti-depressant so we’ll see. Oh, and I get migraines when the Estrogen kicks in as well.
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I’m an outsider so forgive me for chiming in.. but this is a valuable good blog. thanks.
Do most therapists get that you can be trans and depressed? Would they be less likely to help you out with physical transition if they know you are depressed? Will a regular ol’ therapist be able to help you with transition, or should you see someone who specializes in trans issues? I need help with my depression, but I also want to physically transition. Do you have any advice?
Also, I really appreciate your blog. It has made me feel more confident as an effeminate trans guy (albeit straight).
Every therapist I’ve been to has understood the difference between being trans and being depressed, but I don’t know how much of that has to do with my only ever attending therapy in liberal areas. I also have never seen a trans specialist. Actually, I’ve avoided it because most of my problems have absolutely nothing to do with transition and I didn’t want that to colour their perceptions.
Really, the best advice I can give is to try out several therapists if you have to. The first one isn’t always the one who’s best equipped to help, a large part has to do with dynamics. I’ve been through six trial runs just in my current city because I’m having trouble finding one who works well with my particular set of issues and personality.
I have a huge problem getting people to separate the two. Especially my parents. They don’t even want to try finding an endocrinologist to talk to about the vague possibility of me perhaps being able to start T at some point in the future (I have to word it like that or they ignore me and think I’m being over-eager) because “well, you’ve got these depression and anxiety issues. hormones are very powerful things, we don’t want to throw something like that into your system until we get your mental health under control”
Nevermind the fact that they’re totally happy allowing me to be on depo-provera, which I’ve been on for about seven months, not for birth control since I’m never in situations where I’d need that, but because PMS for me equals horrible pain/acne/moodiness all of which the depo-provera greatly decreases. Obviously it’s not hormone injections they have a problem with. It’s that they don’t mind artifical progesterone injections, but have a huge issue with artificial testosterone injections.
Of course, these are the parents who said that how can I think about doing a different puberty if I havent gotten used to the first? (hmmm… I wonder why I never got used to female puberty even after 5+ years or so…)
Plus, I’ve told my therapist that I’ve been comfortable with the knowledge I’m trans for 2+ years and I’ve been living as male full time in all areas of my life for over a year, so the therapy is for anxiety and depression (both the chemical kind not situational) and not at all for trans stuff. She keeps trying to talk about that and gets confused whenever my answers are calm and confident.
It’s a hard lesson in every persons life that your parents don’t necessarily know what they’re talking about. Part of being an adult is learning to trust your own judgment and take control of your own decisions. Sometimes painfully so.