Chapter 8: Tell your therapist what they need to hear

About gatekeeping during your medical transition.¹

You walk in, sit down, take a deep breath, and start your performance. Welcome to the casting call for your own life. Your role: “trans enough, but not too trans.” The therapist looks at you like a cautious producer. Convince me. So, you smile. You stay calm, rational, digestible. You’ve “always been like this,” since childhood. Never a doubt. You didn’t like cars and trucks, you preferred dolls. Or the reverse – whatever fits the narrative better. Just make sure it’s coherent. Credible. Ideally, a little tragic. Authenticity sells better with a pinch of suffering.

Don’t be too queer. Too nonconforming. No nonbinary pronouns, no “I’m not sure.”, no “things have shifted over time.” Grey zones are for people with safety nets. You need a straight line. Direct, but not too direct. And don’t you dare admit you ever laughed, experimented, or felt okay for a moment.

That might suggest: You’re not miserable enough. And if you’re not suffering, why would you deserve treatment?

So, you tell them what they need to hear. That you hate your body. That you can’t stand your reflection. That you’ve known exactly what you wanted for as long as you can remember. Don’t dodge questions. Stick to the script. You are the PowerPoint deck of a medically relevant identity. If you want hormones, you pass the gate. If you want surgery, you prove that you’re worthy. If you think too much, feel too much, or ask too many questions, you’re out. All of it, of course, “for your own protection.”

And finally, you get the letter. The signature. The blessing. You smile again, exhausted. You won, and somehow it still feels like losing.

Keep in mind: If you want hormones, you need to learn the script. Tears in the right moment, certainty without hesitation and not a single second thought between the lines.

Most trans people are in therapy. This is easily explained as gender-affirming care is typically provided according to the WPATH Standards of Care (see https://wpath.org/publications/soc8/), which require therapy as an entry gate. While my therapist has been wonderful throughout, I know others were less fortunate. ↩︎