“I Was Not Given Options Other Than Transition:” Another Open Letter to Therapists from a Detransitioning Woman

This post is from Cari, who is 22. She began transitioning at 15 and began medically transitioning with testosterone at 17. She eventually had a mastectomy before deciding to begin detransitioning earlier this year. You can read more about her experience on her blog  guideonragingstars.tumblr.com as well as here. Thank you so much for your contribution!


When I try to think about the care I wish I had when I was transitioning, a few different things come to mind, but the single biggest one is the fact that I was simply not given options other than transition.

When it comes to picking apart the reasons for my dysphoria itself, it’s easy to point to something in hindsight, but the truth is I was a stubborn child and am now a stubborn adult, and it’s possible I wouldn’t have been receptive to treatment for these issues anyway, once I had set my mind on transition.

However, why did I think that transition was the solution in the first place? Largely, because I bought into the idea that it is the only cure for dysphoria. This idea seems to be ubiquitous in trans spaces. It’s meant to illustrate why transition care should be prioritized and covered by insurance, but it also has the effect of invalidating any kind of alternative treatments. Suicide is considered a direct outcome of dysphoria by many, as simply what happens when the proper treatment (transition) isn’t given, the same kind of causal relationship as death by diabetic coma might be for untreated hypoglycemia. The application of this idea to a diagnosis that has no objective test, that has many differential diagnoses that can be difficult to pinpoint or treat, that is infrequently questioned or scrutinized in any meaningful way by gender therapists, is very dangerous.

Very soon after coming out as trans, the “reality” that I would have to transition in order to be happy hit me, and I became deeply depressed. Transition became a huge focus of my life, because I believed it needed to be, that I needed to devote my energy to it in order to alleviate my dysphoria, in order to live my life, really. I’ve seen a lot of therapists, including three who specialized in gender therapy. Yet it wasn’t until I began reading the writings of detransitioned women that I had any clue there were other viable ways of dealing with dysphoria.

Another really important thing to me is the need for trauma-informed care. Therapists need to be looking at the histories of people who are seeking transition, to be working through their trauma with them in more ways than just talking about it briefly. When I was in therapy and soon to start hormones, I told my therapist about my trauma history, which seemed to do little more to affect my treatment than having a session or two devoted to talking about it, and then pressing forward with the idea of transition. The idea that trauma could have caused body image issues, dissociation, reality distortions, not wanting to be a woman because of the “target” status it conferred, was never brought up. Nor was there much of an attempt at treating my mental health symptoms other than through transition. This needs to be part of the conversation—even if there are so-called “true transsexuals” whose issues are caused by some kind of neurological difference, (controversial, completely unproven, and supported by highly flawed studies) there are also plenty of people who can recognize their dysphoria as being based in trauma or mental illness, at least once they know where to look.

The third thing I can identify as a cause is the lack of representation of adult women who were gender nonconforming or butch, and the narrowing of “acceptable” gender expression as girls grow up. It’s one thing to be a tomboy, but tomboys are expected to “grow up” (become feminine) eventually. For me, this realization came around the same time as puberty started to make itself known, and the associations I began to make between my female body and the constriction of gender roles I felt was powerful. It does no good to ask a child “could you be happy living as a butch woman?” if she has no idea what that could possibly mean for her as an adult. One of the ways you’re supposed to be able to tell if someone is “really trans” is for them to think about how they can see themselves living in 10, 20, 30 years—as a man, or as a woman? This is a flawed diagnostic for many reasons—how many people, trans or not, can picture their future in a positive light while dealing with depression or trauma? But when there are no models for the type of woman you want to grow up to be, it becomes even more skewed.

10 thoughts on ““I Was Not Given Options Other Than Transition:” Another Open Letter to Therapists from a Detransitioning Woman

  1. Thank you so much for posting this. I think it was very brave. I’m not trans, but I did experience (thankfully brief) dysphoria in my early twenties for many of the reasons you named, following severe traumas.

    I’m extremely grateful transitioning wasn’t an option back then! Nor would it have been remotely accepted in my little corner of the world. Though I wanted to at the time, and probably would have persevered in it if encouraged, the desire didn’t last long for me. It seemed really scary, too. I’m glad to report that it naturally disappeared through the healing process (though this last isn’t yet complete). Looking back over my journey, I can see that what I really needed was simply a truthful recognition by others of my history, as well as accurate representations of womanhood as it really is, rather than what the patriarchy says it should be. If I’d had adult women whom I could relate to, I never would’ve gone through such a phase to begin with. Finding and holding those up to girls experiencing dysphoria is the first step to healing it.

    Liked by 1 person

  2. This is really brave to write. Dysphoria is so complicated, and I think people rush into transitioning sometimes rather than deciding what is best for them and their circumstance. Glad you’ve found a way to be most comfortable for yourself and I hope you continue to find peace with your gender identity, however you choose to express it 🙂

    Liked by 1 person

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