On the Intersection of Transness, Substance Use, and a Broken Healthcare System

Woman smelling pink flowers on a sunny day.

A common experience among transfeminine people I know — myself included — is attempting to rise above the self-destruction that defined so many of our pasts in order to heal. Yet with the whirlpool of capitalism, medical trauma, and mental illness relentlessly pulling us below the surface, far too many of us are struggling to breathe — no matter how much we believe in ourselves, and no matter how much society demands perfection from us.

My transition has been an uphill battle. I am one of the unfortunate women to not respond well to HRT (hormone replacement therapy) and because of that, I suffered with a severe hormone deficiency for years, seriously impacting my physical and mental health. While I was able to get life-saving gender-affirming surgery during that time, it came with additional complications. Since then, my cocktail of symptoms has steadily progressed, and what’s worse — I’ve struggled to secure access to medical professionals who are proficient in transcare. I write this today without any answers despite invasive tests, hours upon hours of personal research, and multiple doctors and surgeons saying, “I can’t help you”.

Medical transition is already heavily stigmatized. Some of the first things I heard after I came out were “what if you’d regret it?” and “what if it goes wrong?”. I don’t regret my medical transition in the slightest (and studies frequently show that fewer than 1% of trans people do, but to say that I haven’t broken down crying over it at times would be a lie. Something being medically wrong with me is one thing — but not knowing what it is, or why it’s happening, or how it’s happening — is another altogether. And because adequate transcare is something so many of us are still fighting for, I don’t expect to have access to help any time soon. A 2011 study showed that 50% of trans people have been the ones to educate their own doctors on transcare — something I’m all too familiar with, even now.

Over the years, this wore me down physically, along with whatever was left of my mental wellbeing.

If there’s one thing that I’ve learned about trauma, mental health, and healing over the years, it’s that recovery isn’t linear.

You’re going to have bad days, weeks, and even years, and you’re going to get better, and worse, and back again. Addiction and the self-destruction that often comes with it — something that to me is deeply rooted in trauma — has been the same.

I broke, and for a while I relapsed daily. It took a toll on me: physically, mentally, and spiritually, but it was a much-needed escape from the painful reality that I had to face as a newly-disabled trans woman. The loss of family and friends, the harassment, and now the medical trauma had compounded over the years until I just couldn’t take it anymore. A 2014 study of the prevalence of substance use among trans women concluded that 70% of participants used drugs — with both the number of drug users and the riskiness of drugs used increasing significantly among those who were struggling with mental illness.

The next months were a rollercoaster of unhealthy coping mechanisms and recovery attempts, and in the end I knew that I needed to try — at least one last time — to get help. My family doctor, after admitting that he felt powerless in the situation, somehow managed to get me a referral to a psychiatrist who was said to be an expert in the field.

I’d have to write a novel just to scratch the surface on the horrific experiences I’ve had with the psychiatric industrial complex and the so-called mental health professionals charged with my care. This time was no different. Despite sharing every intimate detail of my mental health struggles and practically begging for other options, I was misdiagnosed, rushed out the door, and prescribed an anti-depressant that had a reputation for driving people to suicide due to its frequent shortages and intense, well-documented, withdrawal effects. I did not fill the prescription or book a follow-up.

A month has passed since that appointment. I’ve stopped relapsing and have been self-medicating regularly with marijuana. While it certainly hasn’t been without side effects, I still feel human on it unlike on anti-depressants. A recent study demonstrated that almost 65% of anti-depressant users experience emotional numbing — something that I have not experienced while self-medicating. Marijuana helps manage my symptoms and provides me with an escape when society (and capitalism) feels suffocating.

When life becomes completely unbearable, psychedelics bring me relief and give me the push I need to keep surviving, reminding me again of the beauty in human existence. Studies frequently show that this is a common experience, with benefits often lasting for months after treatment.

I am grateful beyond words to these substances for bringing me happiness when it feels otherwise impossible to find, but tragically this treatment ultimately feels unsustainable without the decriminalization of psychedelics.

I’ve taken my transcare into my own hands, for better or for worse, and continue to put my energy into things that are healing: art, hobbies, organizing, and most importantly, my wonderful chosen family.

While after years of hard work I generally have a healthy (albeit complex) relationship with substance use, many of my less privileged transfeminine siblings do not. Many of us still don’t have access to adequate transcare — or any healthcare, period — due to discrimination, fear, and prior trauma, especially at the intersections of our other marginalizations such as race, disability, and weight.

How can we, as transfeminine people, live up to the ridiculously high expectations that society holds us to when so many of us are just barely struggling to survive?

How do we deal with the ridicule, shame, and violence we face when we aren’t perfect (and sober) if we’re too busy fighting for our basic needs to focus our energy on healing? Self-medicating is providing me with relief for now, but what if that isn’t an option for others? What happens when we’re out of options to try on our own?

We need, at the bare minimum, access to competent transcare providers as well as trauma-informed, trans-centered mental-health and substance abuse treatment programs. A 2010 study (one of many like it) shows that by increasing access to life-saving transcare in addition to reducing minority stress, trans women can have a mental health quality of life similar to that of the general female population.

We aren’t killing ourselves because we hate being trans. We’re killing ourselves because society makes us hate ourselves and our transness. We’re killing ourselves because the system makes it near-impossible to break through the surface and find the love for ourselves that we desperately need to heal.