Caroline O'Donoghue: Let's talk about hormones

Hormonal therapy is normal in our society - so why can some access it easier than others?

'Trans people need us to see them clearly.'

When I was 16, following complaints of severe menstrual cramps and acne, my mother took me to our family GP who prescribed me the contraceptive pill. It’s a pretty common practice for teenage girls who are being punished too harshly by their periods, and many girls in my class at school were prescribed the same thing.

I’m sure there were politicians, journalists, religious figures, and random people phoning into Joe Duffy who might have objected to a 16-year-old girl going on the pill, even in 2006. They might have had sympathy, in a distant sort of way, for my pain, for the depression that followed it, for the fact tough years were being made tougher by the fact that I was missing school or skipping social events because of my unruly body. 

They would have said that how I looked or how I felt was not of very great importance when you considered the social ramifications for giving a teenage girl a free pass to have as much sex as she wanted.

I’ve been thinking about this — my being on hormonal therapy at such a young age — for a few days now. I’ve been thinking, also, about the older women I know who were given hormonal replacement therapy following menopause. 

On August 9, I read a piece around the Government’s plan to outlaw conversion therapy. The Bill describes conversion therapy as “any practice or treatment by any person that seeks to change, suppress and/or eliminate a person’s sexual orientation, gender identity and/or gender expression”. 

The piece was written by three people who work in Irish healthcare, and their worry is that by including gender identity and expression in the conversion therapy bill it would prevent therapists from querying the mental states of their patients experiencing gender dysphoria. 

“If therapists are fearful of accusations of ‘conversion therapy,’” the article concludes. “(...) there will be no chance for gender-questioning clients of this age to explore or be challenged.” Since the article has come out, there has been vocal opposition from trans people.

In the abstract, I understand what these therapists are trying to say. It seems to come from the ‘but what if I say the wrong thing’ school of fear. Which, in today’s news climate, I understand. But the argument has many gaping holes in it.

I don’t know if therapy is supposed to challenge you in the way the article is suggesting. If I said to my therapist “I think I might be gay” and they responded with “sure, lookit, we all think Cate Blanchett is lovely, you’re only a bit curious”, or even “perhaps this Cate Blanchett thing has more to do with your mother than you being gay?”, I don’t think I’d come away feeling as though I had good therapy. I’d want my therapist to ask me to describe how I felt. I would want them to ask me questions, so I could access deeper regions of how I felt but hadn’t realised yet.

One of the main points of the article was that not everyone experiencing gender dysphoria is necessarily transgender. And perhaps that’s true. I’m not a therapist, so I don’t know. But the article didn’t seem to have much interest in the differences between experiencing dysphoria and being transgender. 

You need to have a therapist confirm you are indeed transgender to access hormonal treatment, and if your therapist believes that being transgender is a condition to be avoided at all costs, they’re unlikely to prescribe it to you.

There’s no reference to the freedom and joy trans people experience when they get the right access to the right healthcare in the piece.

Again, I think of myself at 16, in physical and emotional pain over how my body looked and felt. What if my family GP had the solution on his prescription pad, but was so uncomfortable at the implicit freedom of that prescription that he refused to give it to me? What if he just hectored me instead? “How bad is it, really? 1-10? Are you sure it’s not just wind?” 

This is not to compare the experience of adolescent girls and trans youngsters; nor is it to compare menopausal women seeking HRT and trans people. This is just to say hormonal therapy is normal and exists.

The most common route to medical transition among young people is the following: puberty blockers, which are a hormonal therapy that do what they say on the tin. They stave off the signs of puberty while you, the young trans person, figure out who you are. If you stop taking them, puberty kicks in again.

After a few years of this, you are prescribed a low dose of either testosterone or estrogen, depending on your gender identity. That dosage is increased over time. After years of hormonal therapy you may decide to have surgery to help affirm your gender, in which case you need to be an adult, and in most cases, you need to have a lot of money.

I think a lot of people are scared of young people being trans. I think they are scared of trans people in general. I think we have built a world unsafe for trans people and that, rather than fix that world, they would rather just close their eyes and wish for trans people to vanish. 

In the same way we once wished for gay people to vanish by creating laws that punished and silenced them; in the same way we wished for single mothers to vanish by incarcerating them.

Eventually, we learned making provisions for people — say, by giving teenagers the pill, or by providing STD screenings and proper healthcare for queer people — was more effective than closing our eyes.

Trans people need us to see them clearly.

Let’s not pretend to be blind again.