Unique aspects of the pandemic have worsened gender dysphoria—the distress that many transgender people feel when their bodies don’t match their gender identities—for some folks, too. For example, many folks have had to put aspects of their medical transition on hold. Kim*, a transmasculine nonbinary individual living with chronic pain, says they “was planning on going to the doctor to start getting documentation with my back pain,” with the ultimate hope of getting a chest reduction. With the pandemic, though, they are “leery now to go see a doctor, even though I suffer with the heaviness of [my chest].” Many transgender people like Kim were looking forward to already-scheduled consultations and surgeries before the pandemic hit in the U.S. With many of those canceled—and rescheduling remaining difficult in many places—a lot of people have been forced to continue to live in bodies that don’t feel right, which can trigger or worsen existing gender dysphoria.
Additionally, other health-care services that many trans people rely on, such as hormone replacement therapy (HRT), have become harder to access during the pandemic, says certified sex therapist Rae McDaniel, MEd, LCPC—which also contributes to gender dysphoria. These access issues are due to factors such as income loss affecting one’s ability to afford medication or difficulty getting an appointment with a doctor to start or refill meds. HRT is often used to treat gender dysphoria (along with mental health counseling and other treatments) because it can help make a person's features more in-line with their gender identity. Having to wait on taking gender-affirming steps like starting (or continuing to take) hormones only prolongs that pain. However, McDaniel adds that “a lot of the clinics in bigger cities are opening up to do virtual HRT appointments and just having [patients] go to a lab and get bloodwork. There are options there.” Doctors focusing on transgender care all over the country are now working to provide virtual consults, either via video or a combination of emails and photos.
Working from home—another mainstay of pandemic life for many—can also contribute to gender dysphoria. The video calls so many of us are now on all day means that trans people are confronted with their image more often, which can be triggering. “[Video calls are] a big thing," says McDaniels. "If someone isn’t feeling awesome about how they look, that can be a really triggering thing, [making it] really difficult to focus when you’re in meetings.” This is bigger than a self-esteem issue—for some transgender folks, seeing their face on camera all day, every day can be a perpetual reminder that their physical appearance may not fully match up with their true identity. There’s also the very real possibility that one can be misgendered on a video call, further compounding the issue.
“The place that I am noticing [gender dysphoria] coming up most is around how much I have to stare at my face and upper body on virtual meetings,” Jay shares. “I have literally been in the middle of facilitating a fat justice training and getting distracted by how big my face and body look, which is just a mindf**k.” Jay turns off the video when ze can, but notes ze often winds up even more concerned about looks then. Instead, ze is opting for more phone calls.
Being misgendered—another contributor to gender dysphoria—is by no means limited to work interactions, though. Jay is often misgendered in public while wearing a mask, which can trigger zir dysphoria. “No one can see my facial hair, which is often the only thing that cues ‘gender weirdness’ to people,” ze shares. However, ze notes that isn’t the case for all trans folks. “I also know a lot of trans folks—especially trans women and trans femmes—are loving wearing masks, because they are being consistently gendered correctly,” Jay says. “It is a mixed bag for everyone.”
Ways to support your mental health and gender identity during the pandemic
However, McDaniel says that there is a silver lining in some ways to folks struggling with gender identity issues during the pandemic. “The pandemic offers a lot of opportunities… What I mean by that is that [some folks] aren’t seeing people on a regular basis in most cases, so, we have a lot more opportunity to play with gender expression than we did before,” McDaniel says. While that may not be true for everyone, it is something that a lot of us can access via experimenting with hair, clothing, and makeup. Kim has found trading bras for bralettes as well as altering their hair an affirming experience.
A lot of people are focused on being comfortable right now (just look at the popularity of matching sweatsuits), and that’s something that makes a lot of sense in a time of great discomfort. But in their practice, McDaniel has “been encouraging people to take the time to actually get dressed in the morning—and get dressed in a way that feels really affirming to you.” It can bring a type of intentional mindfulness into our day that we’re missing, and help people express their identities in a way that's freeing to them.
While social connection has been challenging in the era of social distancing, McDaniel says it’s important for folks struggling with gender dysphoria to maintain those relationships as best they can to support their mental health. “Even if we can’t see those people in-person, you can do Facetime or a phone call. Depending on your comfort level and where you live, you can do an outside, socially distant hang with masks on," they say. McDaniel also runs a free virtual group for trans folks called Practical Audacity: Transition with Ease. There, people support each other through the ups and downs of living as trans, and it’s been invaluable to many of its members during the pandemic.
Due to how they’ve been spending the pandemic, Kim has found kinship in non-binary-focused social media spaces. Kim says that “just being in a space with non-binary people talking about things you thought you only thought about,” is a great reminder that they're not alone.
As far as handling dreaded video calls, McDaniel suggests “tak[ing] breaks from being on video if you need to. Most calls—not all, but most—have the option to just have voice. You don’t have to be on video all the time.” They also offered the super simple but effective method of putting a sticky note over your own image (or changing your settings to remove the self-view). That way, you can be on video if needed but not have to see yourself.
Therapy with a gender-affirming mental-health professional is also an important way to help work through any gender dysphoria that may come up. While therapy isn't always accessible thanks to financial constraints, there are some affordable therapy services out there, particularly in the digital realm. And McDaniel wants to remind people struggling with gender dysphoria and other mental health issues to not be so hard on themselves. “A lot of people are having an uptick of things like depression, anxiety, gender dysphoria,” McDaniel says, “and I just like to point out and acknowledge that we are in the middle of an unprecedented international pandemic. None of us has a rulebook or a guidebook on how to do this…If we can acknowledge that and just bring some self-compassion to that, maybe having an uptick in some of these symptoms and distress isn’t really about us or anything that we’re doing wrong. We’re just living in a time that is genuinely difficult right now.” They also recommend engaging in grounding and mindfulness activities to deal with stress in the moment.
The pandemic has been particularly trying for many transgender and genderqueer people. In spite of the hardships, it's important to “celebrate when you can,” Kim advises. “We might just have to find moments of joy and celebration beyond our calendars.”
*Name has been changed or withheld for privacy reasons.
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