The Diagnostic and Statistical Manual of Mental Disorders (DSM) recognizes both gender identity disorder and schizophrenia as mental illnesses that can and do coexist. So I was surprised to find that, when my doctor would not prescribe me hormones without a letter from my psychiatrist stating that my gender identity issues weren’t a product of my schizophrenia, the psychiatrist said he would never write such a letter.
“You can’t prove a negative,” he said. “I’m not saying you’re not transgendered, but I can never be sure that this transgendered thing is legitimate.”
So there it was. Although I could pass pretty well without the hormones, one day I would develop male-pattern baldness and other secondary sex characteristics of the wrong gender. I was doomed to become irreversibly masculine.
My parents and I were stunned. In modern times, most people wouldn’t think it was mentally healthy for a person to conceal her gender identity and live as the wrong gender for the rest of her life. How, then, could it be not only right, but necessary for someone who had already suffered a psychotic break to live that way? Even worse, my mother asked him if he understood what an emotional blow it was for me to hear that I could never have hormones for the rest of my life. Basically he shrugged and said “that’s protocol.” Before my mother could recover from her shock at his response he went on to say that because my medicine was so effective for me, he would only need to see me once every three months. I was forced to consider the possibility that he just didn’t give a damn about my happiness.
If he had read my medical records he would have known that my first psychotic break was exacerbated by my fear that I would never be recognized as a woman. In my senior year of high school I had come out to my parents and friends as trans. I began seeing a therapist and after six months I got her to sign off on my getting hormones. At the time, my therapist’s approval was all I needed, and so I initiated hormone replacement therapy. All this time I had been taking anti-psychotics for past mental health issues that included toileting in a bucket, fear of robots from the future, and running around in my underwear in the middle of winter. But I hadn’t actually been diagnosed with schizophrenia yet, so no one stood in my way of getting hormones.
That would change as my symptoms progressed. Despite loyally sticking to my medication regimen, I fell ill again. I was afraid that Israel would invade the U.S. and so I thought I had to get the president’s attention. Jill Biden taught at the school I was attending, and when I saw her secret service detail I began to scan them closely with my eyes to see if they had any devices to communicate to the president with.
“Who is she?” one of them whispered to another.
“I think she’s a student.”
I became fearful, so I left. Next week when I came back for class, a couple of secret service agents pulled me aside and interviewed me.
“Why did you run from them? Did you know they were secret service agents?” they asked.
I became fearful so I started banging my head against the wall to control my thoughts, but they then decided to take me to the hospital because I was hurting myself. “We need to take you for a psychological evaluation because we think you’re a danger to yourself.”
I turned and tried to run, so they wrestled me into handcuffs and brought me to the emergency room. At the emergency room I tried to run away and so they tied me to the bed. Blinded by rage I screamed, “You can’t stop me from killing the president!”
“How would you kill the president?” one agent asked.
“If you donate to his campaign you’re entered into a raffle. The prize is a seat at a dinner with him. I’m going to win and choke him at the dinner.”
I was committed to a psychiatric unit, and when I was discharged three weeks later the secret service pressed charges and I was arrested. They dropped the charges after I’d spent nine months in jail because they decided I was too mentally ill to understand the charge or the court proceedings. I was transferred back to the same psychiatric unit and two months later I went home.
But I was haunted by memories of my time as a female in a male jail. While in jail, I ran into several problems because I looked like a woman. I had inmates chasing me around the corridors, offering me food for sex, and one inmate even sexually assaulted me. The worst part was that they wouldn’t give me my hormones in jail. So when I got out I immediately went back to the doctor who had prescribed them to me. She wouldn’t do this without a letter from my psychiatrist because I had been diagnosed as schizophrenic.
“I know you were on hormones before, but I just need some extra assurance,” she said.
When I was actively psychotic I never mentioned my desire to transition. It’s only when I’m healthy that I pursue hormone replacement therapy and laser hair removal. When I was at my worst, I couldn’t even think about my gender identity. I was too preoccupied by my fears. I was afraid harmless things, like street signs or trees, were trying to kill me. I became concerned only for my survival. I couldn’t even think about my gender identity.
My parents have noticed the trend that I only talk about transitioning when I’m healthy, and they support me in my transition. But even with my parents on my side my psychiatrist refuses to write me the letter I need. No matter how long I’m mentally stable, no matter how long I live full time as a woman, he will never approve me for hormone replacement therapy. This is why my parents and I were so stunned at my psychiatrist refusal to even discuss the matter. It doesn’t mean I can’t transition. What it does is create an additional financial barrier. This doctor was not the first to refuse to write me a letter for hormones. Every doctor that I’ve seen within my health insurance has refused. So I have to see a private psychiatrist for several months to get his or her approval. The only way around this is to take black market hormones, which I don’t want to do.
With my parents’ encouragement, I hope to share my story to help other people in my position. No one should have to live as the wrong gender for his or her entire life because they have a mental illness.
About the author: Sam Ashkenas is a twenty-year-old former college student. She came out as trans at the age of seventeen. At the age of eighteen she was diagnosed with schizophrenia. She initiated hormone replacement therapy, but was taken off the hormones after being arrested. Now she is out of jail and working to get back on hormones.
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