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In this op-ed, Sam Dylan Finch recounts his experience of being misgendered by doctors after attempting suicide, showing why it's critical that doctors do better for transgender patients.
It was seven words, haphazardly scrawled on a piece of paper, that landed me in the emergency room: “I can’t do this anymore. I’m sorry.”
Social workers, nurses, doctors would all ask me what I meant by “this,” but how does one explain the feeling you get when you look in the mirror and start searching for the zipper along your spine, fully convinced you must step outside of your body? As if I could explain how I was sure that zipper should be there each and every time someone uttered the words “she” or “woman” to describe me. As if I could capture the obsessive thoughts, the conspiracy theories that I tried to ward off by knocking on wood 30 times, hoping to quell the panic overtaking me.
The note was found by a roommate who wasn’t supposed to be home that day. This is tidily summarized in the paperwork created when I was involuntarily committed. “REASON: Suicidal ideation. Gender dysphoria."
After they found the note, I was taken by ambulance to a psych ward in a town I’d never heard of. “That’s one of the nice ones,” the ambulance worker told me. “They’ll take care of you.”
They didn’t.
The first morning in the ward, I was woken up by a nurse standing over me with a small cup of pills. She didn't tell me what they were, and I didn’t ask. Instead, I stared at the bandage wrapped around the crook of my elbow.
“Did someone draw my blood while I was asleep?” I asked.
She shrugged. “My shift just started,” she said. “I don’t know.”
The nurse shifts rotated every 12 hours or so, which means as soon as the staff learned my pronouns and managed to use them, an entirely new team would clock in, and the process would begin all over again. I told everyone who would listen that I was transgender, that my pronouns were he/him — not because I enjoy disclosing this, but because I cannot stand the thought of being misgendered in a place I can’t leave.
“It’s important for my sanity,” I told them. “Please.”
This was not an exaggeration. In a study looking at transgender people in Canada who had contemplated suicide, a gender-affirming environment — in which people abide by a transgender person's pronouns and chosen name — was shown to reduce suicidal ideation by a staggering 66%, and among those with ideation, the rate at which they attempted dropped 76%.
For trans people receiving psychiatric care, then, transphobia is literally a matter of life or death.
Still, my request for a basic dignity was met with mixed reactions: sympathetic nods, raised eyebrows, but for most, it was like the words disintegrated the moment they came out of my mouth, swatted away like fruit flies.
I was contemplating suicide, so I didn’t exactly pack a suitcase for this “vacation.” I didn’t have my chest binder, so to obscure my body, I layered on three hospital gowns — one facing the front, one facing the back, and then another, larger one draped over me. But stripped of everything that allowed me to feel safe in my body — my binder, my carefully selected “boy clothes,” and later, I discovered, my testosterone — I felt like a terrified and tender hermit crab, alone and lost without its protective shell.
The one thing that reminded me that I was still myself, still me, still safe, was hearing my chosen name and pronouns. It acted as an anchor in uncertain waters, where you are reduced to a “patient,” where a chart held in place by a clipboard seemed to whisper “We’re watching you!” A chart that, for some godforsaken reason, told them where I should be at any given moment and what I should eat for lunch, but not the words they should use to speak about me.
I get that for a cisgender person who has never wished to step out of their body and leave it like crumpled-up laundry at the foot of the bed, pronouns are simply words, no different from mixing up “pan” and “pot” while shopping at IKEA. They seem to forget that being seen — truly seen as who we are, the truth of our being — is a fundamental human need. It’s part of the connection that we crave: to be known by others, to be understood. To be cisgender is to float peacefully in the oasis of recognition, existing without disclaimers, without incessant reminders that you are not seen — and if you cannot be seen, who’s to say you can ever be loved, ever be understood, ever belong?
Despite the string of people who got it all wrong, I remember one doctor very clearly.
He was holding my chart, and I told him the line I’d rehearsed with precision: “I’m transgender, and my pronouns are he/him.”
He said that was “interesting” — but apparently not interesting enough to write down, as far as I could see.
Like many transgender people before me, my “identity” became a personality disorder. My obsessive-compulsive disorder was, instead, mislabeled “bipolar psychosis.” My dysphoria, and subsequent reluctance to leave my bed, was labeled “noncompliance.” The doctor suggested that my gender transition was dangerous for my mental health, recommending that they stop giving me testosterone and, instead, give me a high dosage of lithium.
“But that will make me more dysphoric,” I told him. “Taking away my hormones won’t help me.”
I left his office more confused than ever. Borderline? Psychotic? These labels didn’t make sense to me. And why was I being told my hormones were dangerous? As I walked away, I heard the doctor giving instructions to a nurse.
“She—”
“He!” I yelled back. My body shaking, I quietly added, “My pronouns are he and him.”
I knew that this was a battle I wouldn't win. But with a glimmer of clarity, I remembered that it would never be about just me.
“Almost half of us will attempt suicide,” I told the doctor. “I will not be your last transgender patient. Do you really want to perpetuate the trauma that landed us here in the first place?”
I should say here that by then, I knew the statistics. I am a journalist by trade, so I know the profound rates of discrimination against transgender people in health care. I know how often transgender people are forced to educate their providers — half of us report a “significant lack of knowledge” from the people who are supposed to help us — and that’s assuming we aren’t denied care altogether.
But I was still stunned when the nurse shushed me and ushered me down the hall with a waterfall of excuses — ones I’ve heard a thousand times before — pouring from her mouth. Something about “patience.” Something about “learning.” Something about “trying," which for a cis clinician seems to mean “not calling you an inconvenience to your face.”
But for me, a transgender and mentally ill patient, I was told that I was not “trying” — which meant I was not willing to relinquish my humanity for the comfort of others.
I had come to this place to heal. Instead, I felt worse. Instead of fighting for my recovery, I was fighting for my testosterone, a crucial part of my transition that kept my gender dysphoria in check.
I’d given as much patience as my body could carry — years of patience. Years of searching for a zipper that’s stuck, fixed in place at the base of my neck, entrapping me in a body that hasn’t stopped feeling alien from the moment I inhabited it.
I was no more visible in that institution of “healing” than I was anywhere else in the world.
I brought a pillow to my face and let out an agonizing, muffled, animalistic scream. It lasted no more than a few seconds before a nurse appeared at the doorway, telling me, “You need to stop that — right now.”
I looked up at her, letting the pillow fall to the ground. That day, I was too tired to protest. I decided to choose different battles, the ones that happen outside of that place.
With time, I came to understand what they were inadvertently teaching me all along: that my voice is the most fearsome weapon that I have. I muffled my scream in that moment, but I promised myself that as soon as I was out, I would never let them, or anyone else, disarm me again.
If you or someone you know is going through a crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Trans Lifeline by calling 877-565-8860.
