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Why Gatekeeping Trans Healthcare Fails Everyone but the System
The black market and the reality of gatekeeping gender-affirming care
The doctor — an elderly man with an air of weariness — looked over his glasses and asked, “So, you think you want to be a woman?”
“I am a woman,” I replied, “but I need help aligning my body with who I am.”
He scoffed, flipping through the papers I’d brought. “Says right here you’re a man.”
In that moment, I understood: this conversation was going to be anything but easy.
And even though I came prepared — knowing the right words to say, what to keep silent about, how much to reveal (all carefully collected from those who had survived this particular rite of passage before me) — I left with nothing but frustration and a generous stack of referrals.
Apparently, I needed to be tested for nearly every mental health condition known to modern psychiatry — just in case something else could explain why I wanted to transition.
The doctor didn’t care what I said. He wasn’t looking for understanding — he was hunting for a diagnosis that wasn’t “transgender.” Because clearly, that couldn’t be it. I mean, I was “too ugly to be a woman,” anyway. Case closed.
