By Alex Earhart
When scrolling through TikTok, you might think that all trans and non-binary people figure out their true identity as teenagers. As a 30-year-old non-binary trans masculine adult who started low-dose testosterone (T) therapy 2 months ago, I can assure you that that’s not the case. My journey to starting T has been decades in the making and has been nothing like I imagined.
Growing up in the 90s as an undiagnosed Autistic with ADHD, chronic health issues, and severe depression, perhaps it’s reasonable that I didn’t begin truly grappling with my gender identity until college. Looking back, it’s almost hilarious that I didn’t realize my identity sooner. After all, the absolute highlight of my high school years was playing Jojo, the male lead in “Seussical the Musical.” I was so “dedicated” that I chopped off my long hair and bound my chest for the audition. I was secretly (and confusingly) elated when an audience member thought I was a boy during a cast Q&A after one performance.
But there was more than Jojo. My heroes were Disney’s Mulan, Sailor Uranus (AKA Haruka) from Sailor Moon, Alanna from Tamora Pierce’s “Song of the Lioness” series, and so many more. I didn’t realize it then, but I identified so strongly with those characters in part due to their gender exploration and identities.
Fast forward a decade, and I am finally transitioning. I’ve come out to family, friends, and coworkers. I have legally changed my name and started using they/them pronouns exclusively. I started to phase out clothes from my wardrobe that make me uncomfortable and bought chest binders.
And eight weeks ago, I started testosterone therapy.
For a long time, I had assumed that testosterone wasn’t an option for me. I wasn’t “trans enough.” I was non-binary, not a man. I didn’t want to be completely masculine. Sure, there were some things that intrigued me about it, but just as many things that scared me.
And yet, I would watch these videos of people going on T, listen to their voices drop and watch their jawlines change and fill with stubble. And I would feel such strong jealousy and such soaring elation. Those emotions were too big to handle for a while, so I stopped watching.
About six months ago, I started to reconsider. I video-chatted with friends who have undergone hormone therapy. One amazing friend even showed me their injection process on a video chat. An incredibly kind voice teacher who works with trans folks told me about what to expect from my singing voice when on T. Slowly, I was gathering information and tossing out my assumptions about the process. The more I found out the facts, the less my brain had room to jump to conclusions.
And then there were the phone conversations at work where clients often asked me invasive and incredibly personal questions. They saw my name Alex on paper and in emails, and were sent into overdrive by the amount of cognitive dissonance hearing my unexpectedly female-presenting voice.
“I’m sorry, are you a boy or a girl?”
“Wait, so your name is Alexandria or Alexis, right? Not actually Alex.”
“Excuse me, I’m confused. You’re a female, right?”
As it happened more and more, the dysphoria grew stronger and stronger, so I brought it up in therapy and then at my next doctor’s appointment.
But I had some really big concerns to address first. As a young kid, I was put through nearly every hormonal birth control regiment to try to control large cysts that were rupturing on my ovaries and sending me to the ER after blackouts, caused by PCOS (Poly-Cystic Ovarian Syndrome). Every single medication resulted in a deeper depression, sometimes accompanied by severe suicidal ideation.
So when I brought up the idea of T with my PCP, I expected him to warn me away from adding in this big change to my already complicated body. But instead, he nodded and looked at me thoughtfully for a moment. It was a virtual appointment, and I saw him clicking through on his computer, looking over my list of diagnoses. He nodded again and looked back at me.
“You know, I think that transition would mean improvements in your health. Both physical and mental.” He looked back at the list and considered again. “The eating disorder, dysphoria, anxiety, even your chronic pain and fatigue.”
With that surprising news, I finally booked an appointment with a doctor who specializes in trans healthcare. He too nodded as I told him what my PCP had said. The real test, though, was when I said, “The thing that concerns me though, is that every time I ever went on hormonal birth control as a kid for my PCOS, it was really terrible mentally. But… I’m starting to wonder. Could that be because I was going the ‘wrong’ way, and what I need is more testosterone?”
I held my breath until this doctor nodded too. “Every single body is different, but I would expect a very different result. I agree that likely the estrogen was the exact opposite of what you needed. A lot of folks find that their mental and physical health can improve.”
When he announced that he was sending me home with a prescription for T and that a nurse would be in to show me how to do shots, I panicked. It all felt like it was going too fast; every single thing I had read online had said it was rare to get a prescription on the first visit. As the nurse laid out supplies to walk me through the process (with vials of water and no intent to actually inject), my hands were shaking so much and my mind was whirling. Did the fear that this mixture of adrenaline-filled panic and excitement mean that I wasn’t really ready for this step?
But here I am, two months later and so incredibly happy. Injections are becoming easier and easier, taking only about 5 minutes of my Fridays each week. One of my best friends video-chatted with me the first few times for moral support, and now I can do them alone.
I feel strong and energetic like I haven’t in years. My chronic pain, while still present, has lessened considerably. I have even been able to do light workouts.
Possibly because my testosterone levels were already incredibly high (thanks, PCOS?) for an assigned female at birth person, changes began almost immediately. My voice has already begun dropping, I’m gaining muscle mass, even my overall smell has changed since day one for better or for worse. The unfortunate changes like acne are still exciting in the sense that it’s a real, visible sign that the T is working.
One of the most exciting things is discovering how much I look forward to experimenting with some more “feminine” things eventually: painting my nails, having longer hair, eyeliner, etc. Beginning to present more “masculine” is opening up possibilities to explore being non-binary in ways I never thought it would. This has all actually affirmed my non-binary identity rather than challenged it.
I’ve learned a lot in the past two months, but there are a few highlights:
- You don’t know how you will feel about something until you experience it. Some aspects of hormonal transition I was sure I would hate have actually been some of my favorites and the things to cause me the most gender euphoria.
- Anxiety and even grief are not necessarily negative indications. Change is change, and it’s sometimes overwhelming or even scary. The voice coach I spoke to said how incredibly common it is for singers going on T to simultaneously be excited to expand their lower range, but also grieve the loss of their higher range. That permission to experience grief and excitement all at once has been so freeing.
- There is no such thing as not being “trans enough” for any part of transition and there is no such thing as “too late” to begin.
So, yes, the transitions we tend to see on social media often feature teens beginning the process. But please know that people like me really are out here and I’m so happy to be taking my first steps toward feeling authentically and finally me.
Alex Earhart is a non-binary Autistic blogger and artist. You can find their blog, Autistically Alex, at www.autisticallyalex.com where they write about gender identity and their Autistic experience.