Estrogen is part of my morning routine.
Every morning, when I can tear myself away from doom-scrolling on Twitter, I shuffle to the bathroom, pull open the middle door in the cabinet, and take the two most important pills of the day. One is large, round, and smells a bit like cat pee — spironolactone. The other is small, oval, blue-green, and feels chalky under my tongue — estradiol.
In the 16 months since I started this daily routine, I’ve fundamentally changed. My skin is softer. My pants fit tighter thanks to extra padding around my thighs, butt, and hips. I have breasts that are getting just heavy enough to need a bra at all times. I smile wider. I laugh and cry more easily. Now and then, I can look in the mirror and catch a glimpse of myself.
But now, on the verge of losing my health insurance, I have to face how what I do informs who I am.
For most of my adult life, I was fortunate enough — and perhaps ignorant enough — to not need health insurance. Every now and then I’d catch a cold, but I didn’t get sick enough to go see a doctor. I didn’t have medications. I didn’t see a therapist. I had no idea that transitioning would be an option for me, and the prospect would have frightened me even if I did. I didn’t have accidents or broken bones. I cruised along, my good health self-evident enough that I hadn’t a single worry.
I can’t say the same now. When I started seeing a therapist for depression, the mental turbulence turned out to be a symptom rather than an isolated problem. I realized that I’d been struggling with dysphoria for most of my life, and I was stuck in an unhealthy relationship that, on the worst says, made me feel like I was dying. I would get anxiety attacks while driving on the highway alone, feeling like my body would elect to jerk the wheel and veer off the side of a gorge without my brain’s consent.
I needed help. I needed care. And as I came to accept myself as a transgender lady, I decided that I needed hormones. I started them in March of 2018, and they’ve fundamentally changed my life.
I was able to get by for a while. My ex allowed me to stay covered under their health plan for a while. After that ended, I set about finding a job with benefits. I got one, and I started looking into surgical options for my transition, only to have the carpet pulled out from under me the day after I discussed top surgery with my hospital.
After I got the news, I strolled around the neighborhood with my girlfriend and tried to come up with what I could do. I could try to find another job with benefits. I could go onto the marketplace and try to buy insurance, but where I’m going to get another $350 a month, I couldn’t say. Or I could simply pay the out-of-pocket prices — more than three times more, in some cases — until I could find some way to restore my care.
I told myself all these things, that I could plan and work and strive, but I couldn’t hold back the despair. Finally, after a lifetime, I’m finally starting to become who I always wanted to be. The loss didn’t feel like anything as bureaucratic as “losing my health insurance.” I felt like my identity was at risk, the person who I’m becoming more of each day. Yes, I worry about what might happen in an emergency, but I found myself tightening my jaw at the thought that I might lose the life-saving therapies and procedures that have brought me even this far.
This is why my doctor admonished me not to buy black market medications when I started my transition. Why financial hardship and even homelessness is a very real concern for so many trans people. Our needs are deemed illegitimate and elective. There aren’t always safe and accessible options for many of us. HRT and gender-affirming surgeries are still talked about as if they’re unnecessary and can just be deferred forever. Most every trans person who’s pursued medical interventions has stories like this, of constantly having to assume that what’s offered will be given reluctantly, or even taken away in a moment. The loss isn’t of the hormones or surgical alterations themselves. We lose ourselves, told that we simply have to cope in bodies that don’t match who we are. Imprisoned.
I don’t need to tell you that the American medical system is a noxious tar pit managed by profiteers. We all know it revolves around money, not care. But that knowledge does little to dampen the fear or ease the frustration of having to dig a little deeper, to try a little harder, to find a little more fight to simply exist in a culture that actively works to undermine and erase people like me.
I’m not the sum of my medications or therapies. But who I am, who I aught to be, is inextricably tied to those treatments. To face losing them is to face the resurgence of a dead identity I thought I had buried, to compromise, to be patient, to be pliable.
If transitioning has taught me anything, it’s how to fight for myself.