My Dysphoria Anxiety Still Crops Up at the Weirdest Moments

London is a lot busier in February 2021 than it was in December 2020, though officially, the whole of the UK is still in lockdown. There is a government diktat to “stay at home,” except for essential purposes. It has never helped that said government’s list of “essential purposes” just about stretches to the horizon and includes going to work if you can’t work from home. Ah, capitalism.

There’s maybe three times as many people and vehicles on the streets of the capital. It feels like a normal, quiet weekday. You don’t notice the social distancing outside. It helps that the news has been a lot more positive in recent weeks. We’re inevitably absorbing that and relaxing a bit, consciously or not, especially after months of this.

There’s a sense now—bolstered by the government’s new roadmap to loosening lockdown—that we’ve all done jolly well and deserve a break. Of course, that’s not how pandemics work, so it’s a stilted sigh of relief. 

I’m grateful that all this is coinciding with my return to the fertility clinic. Maybe this next round of treatment will work, maybe a later one will, but either way, evidence suggests that by the time I manage to conceive, life will be further along the road back to normal-ish. Maybe, by the time I’m having midwife appointments, they’ll be happening in-person again. Maybe I’ll be able to plan for a home birth. 

But I’m getting ahead of myself. 

I traveled to the clinic this week for a baseline uterine scan, to check that everything is back to (my) normal after my early miscarriage over New Year. As I entered the room, the doctor seemed relaxed and welcoming. We’d spoken before, over the phone, and I’d got good vibes. His name and accent suggested he was Greek. 

I’d recently seen a Netflix documentary about the Greek-Cypriot surgeon Dr. Kypros, one of the pioneers of fetal surgery, who is based at Kings College Hospital in Camberwell, which also happens to be where one of my siblings was born. All of this irrationally combined to make me feel a warmth towards the stranger about to probe my privates.  

What happened next was also irrational. (It was self-absorbed too, as anxiety can be.) With characteristic lack of warning, I got a sharp pang of dysphoria, as I lay on the bed next to the ultrasound machine. It happened because the thought crossed my mind that the doctor might see me as the same as his other patients, all of whom are statistically likely to be women. My dysphoric brain was actually suggesting that his relaxed demeanor was “a bad sign,” that it “gave away” something about me.

“Is this weird for him?” I silently panicked. “What if it’s not weird for him? Is that worse??”

Now, if it isn’t already painfully clear, I’m English. We don’t go around voicing anxieties or being honest with strangers. In fact, many of us aren’t honest with anyone, including ourselves. To illustrate, it’s still the cultural norm here —old or young, liberal or conservative—to cringe at the idea of therapy. And, as I was recently reminded by a British-American journalist, it’s only in the UK that we still order alcohol according to gender—men enjoying pints of beer, and women white wine or spirits—not according to what we enjoy drinking, unless one wants a comment from a stranger. Reader, as a society, we are a hot mess.

So, instead of voice my anxiety, I tried to reason with myself. When I think of a trans man having a vulva or uterus, does he become a woman in my head? Honestly, not even slightly. That just is not my instinctive reaction to that information. Likewise, what if I think of a trans woman having a penis? Still a woman. And I don’t mean intellectually, like I still “understand” or “respect” that she’s a woman. I mean, I instinctively still know she is. 

After walking myself and my dysphoria ball-and-chain through this, I was able to believe in the doctor’s friendly matter-of-factness as A Good Thing. “Dude,” I said to myself, “he’s probably just a nice person who understands that trans men often have the reproductive ability to get pregnant. A fertility doctor is probably the *most* likely to appreciate this. If he’s relaxed, you can relax. Be grateful for your strapping uterus and stop catastrophizing.”

A week later, the dysphoric paranoia returned. This time, I was struggling to get through to the clinic on the phone to pay a bill. It was urgent because I needed medication sent to me in time for the start of my next cycle and transfer attempt. 

From Monday to Wednesday, I called multiple times, only to be promised call backs that never came. Within the first day, I started to imagine the worst possible scenario: I’d recently been assigned a new patient coordinator and they were transphobic. As a trans person engaging with a healthcare provider, finding one great person to work closely with can feel like winning the lottery. Switching someone’s coordinator is probably routine for the clinic, but for a guy in my position, it triggers significant anxiety. 

While waiting for call backs, I wondered whether someone with anti-trans sentiments had “accidentally” lost my file or been deleting my call back requests. As soon as I’d thought it, I believed it (such is the ruthless efficiency of anxiety). For about 24 hours, I felt panicked and became increasingly convinced the clinic would no longer treat me. 

When I eventually got through, we realized there’d been a miscommunication at their end and more than one staff member apologized profusely for any stress caused. My theories about being thrown off their books suddenly seemed ridiculous. I resented myself for creating so much anxiety out of nothing. And yet, as a trans person living in the UK right now, I know it isn’t “nothing.”

The very next day, by way of a coincidental reminder of the stress under which trans folk currently live, the UK government amended the wording of a new law, with the sole consequence of excluding and erasing trans people. 

When talking about this kind of trauma-informed stress and anxiety, we have a tendency to minimize it in contrast to the tangible obstacles LGBTQ+ people and other marginalized groups face in accessing public services. Economic and legal barriers, as well as explicit discrimination, are largely observable, quantifiable problems. In the eyes of the majority not experiencing them subjective, in other words, they are valid.

Yet those who do experience it know that the psychological stress of being marginalized is no less real. Sometimes it has a direct cause but more often, it doesn’t. It is simply a state of mind borne of a lifetime of being (and always knowing that you are) different; it is knowing that your shame and society’s still hover just behind an invisible veil; it is knowing that the very next person you encounter might see you as less than human. The stress of simply being “other” is not just real for those navigating such systems, it stops many of us from engaging with them at all. 

Alongside the tangible stuff, we need to address the psychological impact of being marginalized. We need to stop dismissing it as a result of individual weakness or as merely a symptom of systemic inequality. In short, it isn’t something therapy can solve because it doesn’t come from inside us. We might learn to cope, but this leaves the cause unexamined and the weight on our shoulders. Neither are prejudice and shame, the main drivers of this stress, going to disappear once all tangible obstacles are reigned in by politics and the legal system. In fact, they will likely never disappear. As humans, we’re probably stuck with them. The problem isn’t that they exist, it’s who takes responsibility—who carries the invisible burden.

I am lucky to have access to friendly and somewhat-inclusive fertility treatment but this week reminded me that marginalization can take many forms and that, even when its toll we pay is purely psychological, the cost is no less real.

Follow Freddy on Instagram.