just want to echo everything you’re saying here, completely agree. I keep trying to think of a way to explain it, it’s really hard to come up with the right analogies. Being trans has so much to do with identity, but before I transitioned I know I wouldn’t have ever been motivated by something as trivial as “being me”. I didn’t care who I was, and I suspect a lot of trans people don’t feel at home in themselves or care that much for who they are, esp. if they have survived into adulthood without transitioning (it indicates coping strategies are at play which may help distance from that suffering, including dissociating from issues of self identity or gender).

Everything you’re saying is right, though. The reality is that being trans isn’t a choice, it’s the way we were born, and once you realize you’re trans, it’s not like you can choose not to be trans. You can choose not to transition, but it’s like choosing not to take medication - you will suffer, people around you will suffer. It’s not a reasonable or valid choice, it’s self-harm. And it’s not safe, it ends with early death for many of us. To my mind, it’s unethical to not transition, to risk dying and to choose suffering for yourself and those around you.

But all that sounds so silly if it’s just about identity, which is why I try to emphasize the significance sex hormones play in mental health. It’s not just wanting to be a woman, it’s biology - men get depressed when you put them on estrogen (e.g. David Reimer and Alan Turing), and women get depressed when you put them on testosterone. The brain seems to respond to the sex hormones, and the way I see it is that my brain just doesn’t function correctly on testosterone. In all sorts of weird ways, here are some examples from before I started estrogen:

• drugs impacted me more extremely (caffeine felt like cocaine, cannabis caused hallucinations and dramatic psychedelic experiences, etc.) as though my brain struggled to maintain a homeostasis,
• I had regular intrusive thoughts and anxiety (like not being able to sleep because some part of my mind was obsessing about the ceiling fan dropping on my stomach),
• I had constant passive suicidal ideation and sometimes intrusive ideation that was so distressing I would have to actively struggle to stay alive and not hurt myself,
• every single night I experienced nightmares some of which were traumatizing and involved bizarre bodily experiences like sleep paralysis and sometimes I couldn’t get out of the dreams after waking up - I would move around and still be stuck in the dream,
• melatonin increased probability of paranoia and sleep paralysis demon experiences,
• in general life was unpleasant and I was known for being grumpy,
• I struggled with basic executive functioning and something like going grocery shopping once a week or having plans over the weekend required taking the next weekend or two off for recovery (and even then sometimes I didn’t recover enough)
• I could sleep 12 hours every night and I woke up most mornings not feeling fully rested

After estrogen:

• drugs impact me far less and are more like other people’s experiences
• my intrusive anxiety disappeared around 3 - 4 months on estrogen and I just don’t experience it anymore, I would say at all
• passive suicidal ideation is gone and I feel life-affirming for the first time since I was 13, and suicidal ideation only occurs when I have bad days, usually when I feel acutely worthless, guilty, and low self-esteem (like making a mistake at work, getting in an argument with my spouse, etc.), and the ideation goes away and doesn’t persist past those acute moments
• I no longer have nightmares every night, and I have normal dreams and have only had one trauma dream since starting HRT (which I think may have been caused by sleep apnea)
• I no longer experience paranoia or fear regularly before falling asleep, and I haven’t had any major parasomnias or sleep paralysis since starting HRT
• melatonin doesn’t seem to cause paranoia or sleep paralysis anymore, but I also haven’t experimented enough - so take that with a grain of salt
• watching estrogen wane and testosterone come back I watched my anhedonia come back, life is literally just more alive and pleasant on estrogen and more flat and unpleasant on testosterone - I no longer engage in as many “craving” behaviors, I don’t depend on eating lots of tasty food to make life worth living, I no longer chase video games or TV just to feel a modicum of happiness
• my motivation and energy is greater and I get so much more done on estrogen, I can have a week where I have to go out of my house for appointments every day of the week and I don’t need weeks of recovery later - I actually enjoy having weekend plans now and opt to have social plans for the first time in my life
• I sleep 8 - 10 hours and feel rested more than I did before with 12 hours

Like, I don’t know about you, but it’s like a completely different life on estrogen - I see estrogen as medically necessary now, even if I don’t think of myself as a woman or you put all the social aspects of transition aside, there is some very real medical reasons for me to block testosterone and replace it with estrogen. With this perspective, transition just doesn’t feel like a choice, any more than taking insulin feels like a choice for a diabetic.

I know it’s not like this for every trans person, there is so much diversity - some trans women don’t do well on estrogen at all. But the clinical lens is often based on generalizations, and I tend to assume people are more likely to be average than exceptional, and that for anyone with gender dysphoria to consider at least trying HRT to see if it has similar benefits as it does for many of us.

I know plenty of trans women who report no mental changes, and I have read reports of trans women who have worse dysphoria on estrogen. We’re not a monolith. It’s just worth sharing my experiences and the reports of so many others who are like me in case others are like us too. In my case I feel like transition was life-saving, I just want others who don’t know yet to be able to be happy and healthy too.

Not sure how to condense all this into a believable and easy to communicate blurb, though 😅

Maybe: “born an X and want to be a Y? transition, it might save your life!” I dunno, just sounds exaggerated (esp. trying to look at it from my pre-transition perspective).