Like a lot of people across the country and around the world, Hannah, a trans woman, is self-isolating at home because of the COVID-19 global pandemic. Unable to afford to stay in New York City, Hannah, whose name has been changed to protect her identity, relocated to her home state, in a conservative part of the Midwest with few resources for trans people, including knowledgeable medical care. “I am dealing with being a post-op trans woman in the middle of America,” Hannah said.
Living in quasi-quarantine without employment in a conservtive state has exacerbated Hannah’s fears related to her gender transition. She is finding it difficult to be isolated right now, and is struggling to deal with the uncertainty of her future, and a pandemic’s impact on the infrastructures that she has relied upon to live more comfortably with gender dysphoria.
While transgender people have had more visibility in popular culture over the last decade, it’s mostly focused on external transformations, and cultural controversies, while often neglecting the realities of trans life, including the invisible struggle people often have with gender dysphoria.
This medical condition, which not all transgender people experience, refers to a misalignment between an individual’s gender identity and their sex assigned at birth. Treatment for gender dysphoria is generally known as gender transition, a process unique to every individual, but tends to include medically altering one’s physical sex characteristics in order to bring them into alignment with their inner understanding of their gender and sex. Gender dysphoria can be incredibly mentally painful, whether you’ve transitioned or not.
For Hannah, treatment of her gender dysphoria requires medical intervention. Because she can’t work in quarantine, Hannah said, she can’t afford the hormones she had been taking prior to the pandemic, nor is she able to save money for the other procedures she needs. Away from her physician in New York, she isn’t receiving any post-operative care at all.
“I worry about how I will get my hormone levels checked, or the meds I need,” Hannah said. She’s concerned that the care she once received may never be accessible to her again, due to finances and other unforeseen consequences of this crisis.
“The COVID-19 pandemic has deeply impacted folks seeking gender-affirming care, from what is considered 'routine' care—like electrolysis, for instance—to life-saving surgeries that some people have waited years to be able to either afford or access,” said Zil Goldstein, the associate director of transgender medicine of Callen-Lorde, a community health center in New York. “While all of us understand the need to stay out of the hospital at this time, increased anxiety and depression as a result of gender dysphoria is very real.”
Obtaining medical and surgical care can be an incredible challenge for trans Americans due to the country’s fraught medical care system, and a powerful political agenda to prevent such care from becoming more attainable. As COVID-19 has disrupted the flow of daily life, Hannah is dealing with her gender dysphoria alone at home, concerned about the future of life in the U.S., and our medical system. “What if I’ll never be able to fulfill what I need in my life?” Hannah speculated. “I know what I need, just not how to get it,” she said, adding that isolation has resulted in greater awareness of her body in a challenging way: “I look at my body now more than ever.”
“My body reminds me of my past,” said Cynthia, a trans woman in Los Angeles whose name has been changed to protect her privacy. Like Hannah, Cynthia expressed anxiety about losing medical care to treat gender dysphoria. She has a scheduled surgery approaching, which she said she’s worried will be canceled. Cynthia is Black and HIV positive, and understands too well how these different aspects of her life place her at risk of being discriminated against in the United States due in part to racism, stigma against HIV, and transphobia. “The odds are against me; I focus on what I can control,” she said, explaining one reason why being able to receive treatment for her gender dysphoria is so important to her mental wellbeing.
Goldstein urged transgender and nonbinary people to "reach out to personal support systems if they have them, or talk to other TGNB folks online. This is something affecting so many people, and as isolating as this is, you are not alone.
If you are feeling suicidal or are struggling with mental health and need to talk to someone, call the Trans Lifeline, a peer hotline staffed 24/7 at 877-565-8860.
But not all trans people are the same, and neither are their experiences with gender dysphoria. As much of the country heads indoors indefinitely, some trans people say they are adapting to living separated from the society that contributes to the worsening of their mental health. For Myla Cashaw, a trans woman from Texas, the isolation has been helpful to her dysphoria in certain ways. “I’d be lying if I said my anxiety hasn’t gone down,” she said, pointing toward the sad reality that a public life can be challenging in its own way. “A lot of my dysphoria is triggered by social interactions and navigating public spaces that may not be the most safe for me,” Cashaw said.
Trans women, particularly trans women of color like Cashaw, are subject to disproportionate levels of social abuse and violence. The fact that Cashaw doesn’t have to engage with that world as much right now has removed a terrifying threat that typically interferes with her life on a daily basis, exacerbating her gender dysphoria unnecessarily.
For Billie Lee, a trans woman in Los Angeles, this moment in our world’s history has motivated her toward introspection and personal growth. “I’m using this time to look within,” she said. “This time can be very healing for many of us. I feel less pressure from the outside to look or act a certain way.”
“Quarantine has not been easy but I have been patient with myself,” she said. So much of our lives are experienced in conjunction with other people’s expectations of who we are and how we should be. Gender dysphoria exists independently of that, but, like all people, trans people’s wellbeing can be worsened by the judgements of others.
Lee said she is trying to find the good, to let go of what hurts, “while embracing my trans experience with love and compassion”—something the rest of the world might consider.