This Is Your Gender-Affirming Care Counterprogramming

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Content warning: This story contains a mention of a suicide attempt.


Trans people are living in the crosshairs of contradiction. On the one hand, the past decade ushered in a new era of visibility, both culturally and politically, with transgender recognition hailed as America’s next frontier of civil rights and a record number of trans and non-binary people running for office in 2022. But as trans people continued to fight for acceptance, a fierce backlash mounted. Which brings us to where we are today: In 2023 alone, hundreds of bills proposed at the state level are threatening trans people’s very right to exist, seeking to block their access to legal recognition, education, public life, and health care.

In particular, gender-affirming care has become a fraught political flash point, with at least 20 states (so far) enacting laws and policies banning this lifesaving treatment for youth. Adults aren’t safe either: GOP lawmakers in at least five states have proposed bills to abolish gender care for young adults as well as minors, while seven states bar Medicaid from covering the treatment. Earlier this year, Missouri took the extreme step of becoming the first in the nation to severely restrict gender-affirming care for people of all ages.

These dangerous bans pathologize transness as an illness or write it off as a “phase.”

Often, the narratives underpinning these dangerous bans, following an old homophobic playbook, pathologize transness as an illness or write it off as a “phase.” By this logic, curbing the human rights of trans people is actually just a heroic concern for children, or “protection” for trans folks—even from themselves.

It doesn’t help that certain corners of the media have trafficked in sensationalist narratives that overwhelmingly focus on so-called “transition regret,” the idea that a large portion of trans people will regret receiving care and eventually detransition. Actual research tells a vastly different story: Only 1% of trans people regret their gender-affirming surgery and for the small portion of people who do detransition, it’s less about not being trans anymore and more about succumbing to financial, social, or familial pressure.

In reality, gender-affirming care is necessary, evidence-based health care. It is a set of services that provides holistic support for trans people, including both medical (like hormone replacement therapy, known as HRT, and surgery) and non-medical resources (like mental health support, emotional care, and social affirmations). Widely endorsed by most major medical organizations, the lifesaving impact of this care can’t be understated. Upon receiving gender-affirming healthcare, rates of suicide and depression plummet among young people.

So Cosmopolitan decided it was time for some very necessary counterprogramming—a Pride Month palate cleanser, if you will. We spoke with five young trans people around the country about how gender-affirming care has changed their lives. The majority of those with whom we spoke initiated treatment as adults but wished they had had the option as minors. All believe trans and non-binary youth deserve access to this essential health care. Here are their stories, in their own words.

marcus

Illustration by Margie Rischiotto | Photo courtesy of Marcus Knoke

Marcus Knoke, 21

Marcus (he/they) is a non-binary FTM transsexual. Originally from the Midwest, Marcus is a rising senior studying English and women/gender studies in Massachusetts, and a general manager for a radio broadcast.

I came out at 14 to my mom, friends, teachers, and classmates. My family was immensely supportive and my medical team was a saving grace. My mom found a therapist in the area who had experience working with transgender people. We got so lucky. He took me seriously.

He walked me through a questionnaire, which I had to answer in order to start HRT. He asked me, “Would you be happier if you had been born a boy?” The question absolutely stumped me. My life could have been unrecognizable if I had been born a boy. Would I have loved books with the same ferocity? Would my father and I have argued over the same things? Would my younger sister and I have grown up together the same? I couldn’t possibly answer if I would have been happier in this strange alternate universe. It wasn’t an option. My options were to continue suffering through female puberty or to start puberty blockers and hormone replacement therapy. My therapist understood. He believed me.

We scheduled an appointment for me to start testosterone two months later. At this visit, they showed me how I would inject testosterone subcutaneously every week for the foreseeable future. I’ve done it hundreds of times in the last 6 years. My period stopped after about 3 months. Other changes came. My voice dropped; my body hair thickened; I smelled way worse. It was exhilarating. It felt like a future.

“I still struggle like every person does. Yet it feels so special to struggle in a body that is mine.”

Because I started at 15, I was able to console my fears and insecurities by reminding myself that I was only a few years behind most of the cis boys in my class. Remember the kid who didn’t start puberty ’til sophomore year? That’s me.

I got top surgery a few years ago. I still struggle like every person does. Yet it feels so special to struggle in a body that is mine.

Gender-affirming care starts at home. Children are far more aware than we give them credit for. They make choices intentionally and remember how adults—particularly their parents—respond to these choices. They learn what is safe and what is not. And then suddenly, it’s two decades later and that child has become an adult who still doesn’t feel like it’s safe to make the choices they want to. Medical intervention is an integral part of gender-affirming care, but it is never the beginning. Care, or lack thereof, shapes what children desire and whether they feel they are allowed to ask for it.

Everyone says this, but I would be dead without gender-affirming care. I tried to kill myself when I was 13. I would have tried again if I didn’t have the meaningful support of adults in my life. Not just in being given needles and testosterone but in being believed and affirmed and heard and recognized. Each part of my body has become mine again. I sing in the shower and have tons of sex and wear whatever the hell I want and revel in the feeling of clean sheets touching my bare skin. When other people misgender me, I laugh. It just seems so ridiculous that, accidentally or not, someone could fail to see me. I’ve never been so full of myself.

theodoor

Illustration by Margie Rischiotto | Photo courtesy of Theodoor Grimes

Theodoor Grimes, 28

Theodoor (they/he) is a Black transmasculine non-binary person. They are a New York-based artist who paints queer and trans people of color.

When I was a kid, I always knew I felt different from the other girls in my classes. I related to boyhood as much as girlhood but felt othered by both at the same time. I got my period when I was 9. I was constantly being told by adults around me, especially as a young Black person in the Bronx, not to let a guy get me pregnant. I hated the feelings my period brought me, the judgments it came with, and that my body was developing in ways that felt scary.

In middle school, I wanted to look like an emo boy. I started transitioning in this way, but nobody got it. At that point, I still didn’t have the language to describe what I was experiencing. It wasn’t until I was around 16 on Tumblr that I started learning more about trans people and learned the term “non-binary.” It felt like a bell went off in my head. But I was already experiencing horrible queerphobia from being an out bisexual at my school, as well as rampant racism from my non-Black peers, so I really didn’t want to add gender to the list of reasons to bully me.

“It felt like a bell went off in my head.”

When I was in college, I slowly became more understanding of my gender identity as I embraced femininity in a really bold and performative way. I continued my hyperfemme phase for years, and started a new relationship with another non-binary person after graduating college. My partner held my hand through difficult conversations unpacking my gender. I got top surgery in the beginning of 2021, and just a few months later, I started testosterone.

People see the changes in my body, my posture, and they think it’s purely from the hormones. But I made conscious decisions to better my relationship with my body. None of these things felt possible when I felt so dysphoric that I was starving myself, trying not to gain any muscle, and just feeling completely disassociated from my body. Top surgery and hormones were a gateway to me taking care of myself in really basic ways.

I’ve taken breaks from T a couple times and even had femme moments, but transitioning has changed my life and made me feel more at home in my body than I’ve ever felt in my life.

nic

llustration by Margie Rischiotto | Photo courtesy of Nic Anstett


Nic Anstett, 29

Nic (she/her) is a trans woman living in Maryland. She is a fiction writer and English literature professor, with a particular love for bizarre stories.

Gender-affirming care is lifesaving. It’s safe. It’s expensive. And it takes a while. One of the biggest misunderstandings regarding gender-affirming care I see right now is that it’s surgical procedures that are given out quickly and easily. That just isn’t the case for anyone at any age.

As an adult, even once I realized after years of therapy that I was trans and wanted to pursue hormone therapy, I still had to coordinate between my therapist, my primary care provider, and an endocrinologist to receive care. This prep process not only included screening to learn the effects of the medication I was receiving but also included testing my blood to make sure that the dosages provided would be safe given my body chemistry. And even then, the prescriptions I received for estrogen and a testosterone suppressant were relatively low and only increased after monitoring how my body reacted to the dosages.

HRT is scientifically and medically proven to be safe and effective. In fact, with the exception of some surgeries—which themselves are shown to have an incredibly high success and satisfaction rate—all gender-affirming medical treatment is already safe and legal for use by cis people. There is nothing experimental about this care.

Gender-affirming care has undeniably changed my life for the better. Now, I look in the mirror and see a woman looking back at me. When I look at photos of myself living out those last delusional days of my manhood in my early 20s, I see a completely different person. Not only do I look different, but I carry myself differently. I actually take care of my skin and hair now. I dress in ways that I enjoy and feel confident in. I actually smile. I have now been living openly as a woman and receiving gender-affirming treatment for close to four years and I’ve never felt better about who I am.

charlie

llustration by Margie Rischiotto | Photo courtesy of Charlie Adonis Rosario


Charlie Adonis Rosario, 25

Charlie (he/they) is a Puerto Rican transmasculine person. He is a musician and artist living in Florida.

Trans/non-binary children need to flourish into confident adults. With the global suicide rate for trans adults being so high, it often feels like a coin flip’s chance for survival. Imagine these chances being slimmed by lacking affirming care. Imagine people wanting and celebrating this.

At around age 4, I noticed my interests and clothing preferences were different. My abuela always laughs through the story of me hiding dolls in the depths of her closet. I cried when I grew out of my “boy shirt,” and I detested dresses. I knew who I was, but everything around me taught me that was shameful, so I suppressed my true self. Self-resentment grew because of this. It pains me to know many are feeling this right now. The more we share our stories, the more we let others know they’re not alone.

“The more we share our stories, the more we let others know they’re not alone.”

I began socially transitioning soon after I moved away from Puerto Rico at 17. It wasn’t until I discovered other trans people living happy, affirming lives that I saw the possibility for myself.

I began my medical transition at age 23. I was fortunate to undergo top surgery shortly after. When I was prescribed testosterone by a trans doctor, I felt the heavy weight of dysphoria dissipate. I felt seen and welcomed. I finally felt like I could live life to its full potential, a new beginning. This care needs to be given without hurdles or judgment. It saved my life.

kb

llustration by Margie Rischiotto | Photo courtesy of KB Brookins

KB Brookins, 27

KB (they/them) is a Black, queer, and trans writer, cultural worker, and artist from Texas. Their first book, Freedom House, is out this summer.

Gender-affirming care is both love and grief, right? I had to grieve the loss that came with transness because of the conditions that we exist in. I had to just accept the fact that some people who were previously in my life are just never gonna get it. And I knew as soon as I took those steps toward gender-affirming care, their understanding was going to be at its limit. So I first had to grieve the fact that I was losing some people that I loved and that I wanted to love me back, but they just didn’t have the tools to do so.

Gender-affirming care transformed my relationship to love. When I was able to access gender-affirming care, I was much more open to receiving love because that love doesn’t come with the condition that I have to fit into some kind of box.

I remember when I first met my partner, who’s now my fiancé, I was very unable to connect on a physical level. Now that I have this care, I’m just walking shirtless around all the time. I am now just so much more open to hugging people and experiencing physical intimacy with any relationship in my life. It deepens the love that I can create and share with people.

I don’t take physical intimacy for granted. It’s really important in the relationships that I have with people, to be able to hug them when they’re going through something. To be able to say hi, just shake somebody’s hand and look them in the face without being slumped over or feeling withholding. You can’t feel physically available to people when your body is not physically available to you. With gender-affirming care, love became so much more possible. It’s not that I didn’t love the skin I was in before, but it felt like mine now. I was able to receive love better and give love better.

These interviews have been edited for length and clarity.

Headshot of Sara Youngblood Gregory

Sara Youngblood Gregory

Writer

Sara Youngblood Gregory is a lesbian journalist and writer. She is the author of THE POLYAMORY WORKBOOK and former staff writer for POPSUGAR. She covers sex, queerness, disability, culture, and wellness. Her work has been featured in Vice, Teen Vogue, HuffPost, Bustle, DAME, Cosmo, Jezebel, and many others. 

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