Comments on Ohio’s Gender Transition Care Rules

My name is Carey Callahan English, I am a LPCC and IMFT licensed in Ohio, and in 2012 I moved from Ohio to California to access gender affirming care. Trans healthcare in Ohio in 2012 was hard to get. I had to find a therapist who had gotten what was back then a rare certification to write a letter diagnosing me with Gender Identity Disorder. I then had to take that letter to an endocrinologist to get a prescription for testosterone and learn how to inject it. Health insurance in Ohio would not cover gender affirming surgery, so I had made a plan I would take student loan money and spend 10,000 dollars on the mastectomy and liposuction that someone with my body would need to pass as a man, even with facial hair from testosterone.

The logistics of all of this was tricky to pull off. Being a non-passing trans person is daily awkwardness- you’re always explaining preferences that feel more intimate than you want to share with people who are getting you wrong. People mean to be nice, they give you a compliment on your body or assume gendered interests from you, they’re consistently way off the mark with who they assume you to be and you have to make the choice about being misunderstood or trying to self-reveal. The awkwardness of trying to self-reveal appropriately, while figuring out the money, while trying to begin physical transition to give myself some relief- I couldn’t figure it out. My therapist with her rare certificate had never transitioned herself and had some understandably limited skills in guiding me. I thought, ok, time to leave Ohio for a place where it’s easier to be trans.

Here’s what I learned from uprooting my life to live in a place where it’s easier to be trans. When you are a marginalized “type” of a person and you enter a room how everyone responds to you will depend on the social identity they’ve chosen and how relating to you will soothe their own identity anxiety. You enter a room as a trans person and if someone has decided their social identity is oppositional dark webber, they might ask you rather quickly if you think the chemicals in Cleveland’s soil made you trans. If you enter a room as a trans person and someone has decided their social identity is deeply moral unitarian-universalist, a picture with you will end up on their instagram that night. Trans people are the focus of a lot of anxiety in our culture and people’s relationships to trans people carry an identity establishing weight. You’re not a good Democrat if you don’t have a trans friend to show off. You’re not a good Republican if your kid comes back from art school trans. Entering the room as a trans person in a culture where other people’s identities turn on their relationship to you is a wild experience. You feel invisible, you feel blocked out and unknowable because other people are so agitated by you existing near them.

Now, if I had learned this weird truth about humanity’s quirks in Ohio it would have been safer for me. Because in Ohio I had a childhood home I could always crash at. I had previous bosses who liked me and would re-hire me if I fell on rough times. I had friends who would hang out with me and joke around irrespective of pronouns.

But because it was easier to be trans in California, and specifically much easier to access hormones and surgery in California than Ohio, I learned that truth about how strange people can become when I myself was in a strange land. In a state where I didn’t have a childhood home to crash at. Where I did not have deeply caring old friends. Where I did not have old bosses who knew I show up on time and work hard. In California where it was easier to be trans I had no one who I had a deep enough relationship with that they would be invested in my wellbeing even if I couldn’t be a boon to their self interest.

So in California where it was easier to be trans I learned about maxing out my credit card on groceries while I was still 3 weeks away from getting a paycheck. I learned about not being able to support myself as a restaurant server because I was getting pudgy and un-cute and not tippable. I learned about living in a basement with spiders and bugs in a Berkeley commune and how the condition for living in that commune was that I had to be ok with commune guests pretending I wasn’t in the room because as an un-cute non-passing trans guy I was not worthy of the acknowledgement of eye contact. I learned about new flavors of street harassment which were no longer just about my body but also me being simultaneously the D word insult for lesbians and the F word insult for gay men and the T word insult for trans people. I learned about being in bad situations you just are not able to leave. I learned about getting screamed at daily at one job, getting pushed to be the mascot to make a company look trans friendly at another job, managing elderly residents begging to be allowed to quit eating so they could die at a third job. I learned about confiding about hard jobs and people trying to be helpful by giving me tips for where I could go to get paid for sex work. (No better way to really freak out a lapsed Catholic.) I learned about months of being chronically suicidal and using marijuana to try and get away from those thoughts, and on a daily basis finding myself staring at Lake Merritt weighing out the pros and cons of ending things.

When I think about that time in my life I cry every time without fail. That was a decade ago, but the reality of how alone many, many people are in this world is still painful for my body to run up against. I never have forgotten any of those lessons, and they actually aren’t the kind of lessons that are helpful to learn. I’ve never trusted people the same way. My relationship to money has totally changed, I am one of those people who will endure a lot just to have a stockpile of money. I’m flinchy generally. It’s easy to be my acquaintance and very hard to move into a social role like friendship where I give you any potential power to do me harm. My standards for other people’s ethical behavior are exacting. I generally am not a forgiver. Those years had the impact of making me a much more habitually disagreeable and scared person.

My suspicion is that if you were to run an economic analysis of the impact enforcing these administrative rules would have for Ohio we would discover these are expensive changes to affect. It will be expensive to lose the business of the companies who won’t have operations in Ohio because they aren’t willing to put their employees in a situation where they can’t get necessary healthcare. It will be expensive to lose all the college students who won’t attend Ohio universities because they can’t get necessary healthcare. The state employees whose jobs it will be to enforce these rules will need to paid expensive salaries and pensions. We are talking about both spending quite a bit of money and losing lots of future money to make Ohio a place people have to move away from to get trans healthcare.

It’s wise to consider the cost to the state government and Ohio’s citizens in adopting these rules. I am most connected, because of my life experiences, to the long term cost to the people who end up moving out of Ohio for gender affirming healthcare. I’m not the same since then and I’ve taken medications to help with the impact of those years and done trauma therapy and I’m still just different. Creating situations where people have to leave their families and their familiar places and their ex-bosses and old friends to get healthcare inevitably means people end up alone and in totally preventable anguish. Ohio is an important place for so many people’s hearts. It’s our childhoods, our families, the churches we did first communion at, the college bars we were foolish in. With these rules we’re actively creating barriers to our loved ones remaining safe and connected to us. There will be an enormous cost to those people. There was an enormous cost to me.

I don’t understand why Ohio would spend money to recreate the experience I had moving away to get gender affirming care. No one profited or was helped out or accessed a better life because I was in that situation. I’ve been public about being a detransitioned person, and I’ve done that so that detransitioned people can have community and understanding and healthcare. These proposed rules undermine all of that. These rules put other Ohioans through the same bad situation I’m not recovered from.

So just don’t. Let’s remember trans people are people we love and we don’t want the people we love to be alone and scared. If someone else detransitions, that will make 3 detransitioners total in Ohio and we can have a book club and everything will be fine. Everything will not be fine if we spend money to push our loved ones out of the state. Let’s choose to step away from the dangerous experiment of restricting healthcare so that we can hold the people we love close and keep them safe.