In 2015, in my practice evaluation class, Stephen Tripodi, who had a ponytail and was always trying to quit smoking, taught us about single system design: how to study the effects of an intervention on a person or family or classroom. Dr. Tripodi taught us to operationalize love and conflict. He insisted you can measure anything if you define it properly, adjust one variable, and pay attention.
At the time my brain was racing; I was trying everything possible to help my (then foster) child: we were in play therapy, occupational therapy, and a parent-child interaction therapy trial. We were feeding him vitamins and supplements; wrapping him in expensive weighted blankets; sending him to tutoring and interventions at school with high-protein snacks and fidget toys tucked in his pockets. Because in real life you don’t isolate one variable at a time. You panic and do everything you can.
On June twentieth, I swallowed, instead of 60 mg of the SNRI that I’d been taking for a little over three years, half that—a different shade of blue. Every so often the pharmacy swaps the generic they use and the color changes. For awhile, they were a baby-duck yellow on one side, cream on the other. The last few months they’ve been a bright teal. The smallest pills—for the last week of the taper—are lime green, the color my mom and I painted my bedroom the summer I was twelve. When you shake the capsules you can hear the time release beads whispering inside, like rice.
I’m nervous about this experiment, but uneasy that I’ve been taking these meds for longer than I had intended, because I’m scared of the withdrawals; I’m scared of feeling too much. The meds helped me feel calm enough to fix my life, so I could attach to my child and start to transition and, as they say (as we say, because I’m a therapist too)—do the work. In part I’m doing this experiment because it will no longer be easy to get them—I have one full time job now, rather than three part time ones, and so my very cheap ACA policy is being replaced by a high-deductible plan through my work. It feels crass to talk about these things, but it also feels necessary—because we all have these convoluted ways we get what we need, or don’t, and how we decided what we need, or don’t; and they have to do with money and bodies so there’s shame there.
Underlying the question of whether I should take medication—which is separate, of course, from the questions of your body and whether you should take medication—is an existential question: whether feelings are a problem or feelings are a source of information. If my inner restlessness and physiological discomfort is information, I need to listen to it, to figure it out. Sometimes I hypothesize that this free floating anxiety is or was dysphoria without a name or a place to land: bad, weird feelings about my bones, my face: hearing my voice or seeing how I move my hands when I talk to someone. When we feel uncomfortable we want, sometimes, to keep moving: this is how my anxiety often felt. If that is the case, the drugs were, or could be, temporary: to take the edge off, so I could look clearly at my life, come out, begin to transition.
I have had a high level of baseline anxiety my whole life. As a kid I cycled through germ fears, religious preoccupation, paranoia that my family was going to be killed, episodes of praying without ceasing, excessive guilt, excessive worry, headaches, stomachaches, trouble sleeping. In 2016, around the time my wife and I adopted our son, my anxiety was exceptionally bad: racing thoughts, obsessive thoughts, excessive worry, compulsive rituals. I’d always prided myself on being able to push through anything for school or work, but for the first time it was affecting my ability to focus. I told my primary care doctor, a nice resident who wore narrow dresses under her white lab coats, that I wanted medication for my anxiety. She brought me a few quick surveys, one to rule out major depression, one to rule out bipolar, and one for generalized anxiety; tabulated my scores, consulted with her attending, and wrote me a prescription for a serotonin-norepinephrine reuptake inhibitor, which I began taking a few days later.
After a couple weeks of restless sleep, I started to feel, miraculously, way better: more settled, more present. I survived an internship counseling high school students, the 2016 election, the fight with my uncle in which he defended a choice he made by saying, well, all I know is your son could use a man to hang out with, in which he yelled at my wife and stormed out of my mom’s house and I cried into a paper plate of ham and mashed potatoes because it was Christmas, and my sister had just gotten a Polaroid camera so there is a picture of me, red faced and sobbing.
I survived the nightmares I had for weeks after that; I survived wishing someone had stepped in and made him stop; I survived talking about shame and setting boundaries. Setting boundaries allowed me to think clearly about my gender: always, in the back of my mind, when I saw friends, freshly on T with their new angular faces and wide shoulders and unselfconscious grins, I thought: I want that. Also: If I didn’t have a mom, I could have testosterone. Not because I was trans, mind you, I just didn’t— quite— like my body. Just a little testosterone, to take the edge off. Like drinking a cup of coffee when you have a headache, or a few sweet sips of Coke.
(The same thing that makes writing this essay hard is what makes transition hard: to speak about my body as fragile, needy, becoming. Also, too: wanting to parse: where do feelings come from, what do they mean, how can we say with any certainty: this feeling is a result of a chemical imbalance; that one is dysphoria; that one is trauma. Here is your intuition, over there is your hypervigilance.)
On day two of the experiment, I feel sensitive and too-soft. Leaving work at night, the dark humidity makes an ache in my chest. It makes me want to smoke. That is surprising. On day four, I forget to eat breakfast and feel like I have the flu. We run our after-church errands, going to the library and the grocery store. I eat two cheese sticks in the car, one right after the other, all my groceries sweating. They are so fucking delicious.
After a week, I text a therapist friend about going off my meds. You’re working with a doctor, right, he writes back, concerned. Oh yes. Good. I like feeling cared for by my friends. Be prepared for at least a month of debilitating anxiety spikes, he writes. I fill my son’s tiny lunchbox with cut fruits whenever I leave the house. I get a reputation at work for being ‘healthy.’ Whatever that means.
On the twelfth day, I drop my wife and son off at my mother’s house; they are driving to Long Island with her to see family and swim in the cold Sound. Some old sadness, same old fear: the restless energy of leaving my mom’s house, the evening sky darkening as I drive away. To leave the people you love somewhere feels hard and strange. (Even or especially if all you want is to be alone: the house to myself and a storm outside the window.)
Two weeks in, I help Lindsey move, carrying infinite green grocery bags of books and records up the painted wood stairs to her new apartment. Doing this stills my brain, which has been roiling like the sea. Talking casually and with little purpose as we sit among the crowd of boxes, waiting for a thunderstorm to pass so we can finish unloading the moving truck, dark and cool with the window unit. I like window units because you can really feel them, and you can hear them, the cool air blowing over you, their breathing, converting outside to inside. My voice sounds different to me, scratchy and new. Later, Lindsay drapes a weighted blanket over me, and her fat cat Ghost pets my hand with her head.
That night at work I come out to my boss Emily. Like a lot of transition related things, it feels impossible until it is happening. I make eye contact and say something like this: I wanted to tell you that I’m transgender. The way people refer to me and see me at work is not how I show up in the rest of my life. Her response was wildly appropriate; she said thank you for telling me and what pronouns do you use and how can I support you, which I don’t really know.
That’s the problem, that what makes me feel all twisted up, that I don’t quite know, and I cannot expect people to read my mind, and when I feel anxious or muddled I get to yelling at myself: well what do you expect people can’t read your mind. I catch myself holding my breath, take a deep one, and again. No brain zaps but my skin feels weirdly sensitive. We agree that I will write an email to our team, which she will forward to her supervisor, and HR. It takes me hours to write the short paragraph.
The next day, jittery, I take magnesium supplements and fish oil. Sometimes I try to be that guy, the one who takes vitamins. The magnesium powder is named CALM in all caps and tastes like crushed Tums, which I used to eat like candy at Goggi’s house when I was little—she always had a chalky bottle by her bed. Then I go to yoga at the YMCA—that guy goes to yoga, too—and get stressed out about the bathroom. I used to use the one at the end of the hall by the basketball court that nobody else uses, but now it’s summer camp and there’s a new sign that says ONLY CHILDCARE STAFF AND PARTICIPANTS BEYOND THIS POINT so no abandoned bathroom with the wobbly toilet for me. I leave early because I feel shaky and I have to pee.
On the eighteenth day, four days after I stopped swallowing even the yellow (smallest) pills, I read On Earth We’re Briefly Gorgeous with a wounded animal caught in my throat. Noises come out of me, weeping and other ones. Books don’t usually make me cry, but everything makes me cry now. I have a crush on it, this book. Not just that I have a crush on Ocean Vuong, which of course I do, but that I want to walk around in/with the book, and touch it, and feel terrified and excited and sick with longing that isn’t going anyplace, not quite. The book makes me long for something—to be a boy, to have had a boyhood. (The verb tenses get tricky.)
It feels lonely inside my body. Lindsay dug her thumbs into my knotted shoulders the other night, slick with Tiger Balm. If she had done it a few minutes longer I think I would have come undone entirely. Ocean Vuong talks about being submissive as offering yourself up. I think I want to submit like that—not to pain exactly, but a kind of contact that softens and remakes. Finding a parasympathetic state where something loosens or is undone, put together differently. To go limp.
To be in water does it; being turned over and touched in a certain way; getting a massage. Immobilization without fear is what makes the baby attach, to be held and fed. I don’t need more responsibilities but I want to hold a baby. Wear the small body, feel the oxytocin pull. This, too, is a post-medication feeling: desire, in general, more of it, even when it’s complicated. To be seen and touched, to be made new. A baby is baptized at church and I want that: to be touched with water and given a new name. It’s all I can think about for the rest of the day.
On the other hand, I also think bad thoughts, weird thoughts: I wish I were dead. (I do not wish I were dead!) I pile blankets on myself even though it’s ninety degrees outside. I entice the dogs to lie on my legs. Flat on the floor I try to meditate to the voice of my favorite internet meditation teacher Manoj Dias, whose name I first thought was pronounced like ‘Diaz’, but once I hear a name right it gets in my brain that way; it’s not that hard to call people what they want to be called, honestly. I lie on the yellow rug and I can hear the dogs snoring and Manoj intones in his gentle voice, let it go, let it go, let it go as he names each body part: toes, ankles, and upward. My mind races away like a pony with a cart jangling over roots and cobblestones.
When I run in my thin shoes i can feel all the rocks on the unpaved road. Thin shoes are supposed to be good for you in a way that hurts, developing all the muscles of your feet and toes. For years my mother bought me thick, white gym shoes that my backup barber calls ‘biscuits.’ I wore them with my middle school uniform– plaid culottes that looked like a pleated skirt, a blue or green or white shirt tucked in—and felt bewildered, ugly, and disjointed. (Is that a generic middle school feeling? Or is that a trans feeling, in hindsight?) (How can a person even know?)
Now I’m an adult and no longer a girl and I can choose my own clothing and shoes, choose my body, to an extent. I rest my hands in my concave chest, which is still, in places, numb from top surgery last fall, and try to breath. My new body is a miracle, it feels like; it feels like a mess.
Two weeks after I draft it, I send out the email telling my coworkers I’m trans, to please stop calling me ‘ma’am’ and to use they/them pronouns. Part of me feels silly because ‘they’ is not the hill I want to die on—keep going back to that phrase, like a parched and wounded soldier, even though I’m trying to stop using violent metaphors unless I have a good reason; I don’t want to die on any hills, truly.
Part of me feels ridiculous, about all of this. I’m often scanning the horizon for reasons to feel ridiculous about being trans in public: I’m too old, I have too many responsibilities, I work inside an institution. One of the nurses starts calling me ‘he,’ even to patients (which feels— fine?); others keep calling me ‘ma’am,’ to which I breezily say, please just call me by my name. Someone else calls me ‘boo’ and then apologizes later. Oh, no, that was nice, I tell her. A patient calls me ‘sir’ and then five minutes later, ‘miss.’ Children think (know?) I’m a boy, and people with dementia do. Otherwise, I’m still called miss, or “the [job title]” or just my name, or nothing at all.
In my panic one night—there is more panic, now, without the medication—I finally articulated what my dysphoria is like right now. Articulate is the wrong word I think because it wasn’t a language thing: it was a body getting clarity, after months of bracing. It’s like walking around and almost everyone all the time is calling me the wrong name, but I cannot correct them because I don’t know what the right name is. All the time, everyday. I just keep repeating that. All the time, everyday. (As my very smart friend says: it’s probably hard to name a person when you are also trying to figure out how to be that person.)
The last time something felt increasingly wrong and increasingly urgent I decided to transition, even if I wasn’t sure what that meant, where I would end up. I decided I wanted or needed to tell the people close to me, I don’t think I feel like a woman, actually, and I thought I could quietly change my body and that would be it, that would be enough. But as I feared, as I always fear when it comes to desire, letting myself want things makes me want more things, leads to insight about more desires, and it’s all terribly inconvenient. I am trying to say a thing plainly, but none of this is clear.
At yoga the teacher adjusts my body, pulling my wrist, elongating my arm and pulling my hip backwards, into her bracing thigh. She stays there a moment and I breathe; as I do she pulls a little more and my side melts open, hot, a little painful but something else too. It’s called a hands on assist. I want her to stay there, her hands on me, assisting me, but also I’m self-conscious. She plays Lauryn Hill and Radiohead, calls bodies ‘shapes.’ I want her to come touch me again, but she doesn’t.
Sometimes I can’t breathe into my belly, but other times I can. When I run, I can feel my shirt rubbing against my skin, and the muscles underneath. I can flex and my body feels dense, hard. If I touch a certain spot, it tracks as sensation a couple inches over. I imagine a bubble or bead, sliding around under my fingers. A can’t-quite-touch. Sometimes I can’t even get into my body, it’s all racing thoughts. But other times, I can. Without the medication, there is more panic and also more desire. It feels more urgent, the question of who I am. But urgent doesn’t have to mean anxious; sometimes it just means vital.
And here I am, crying about my name.