The life-or-death stakes of transition

Hormone replacement therapy is often essential

Three years ago, Christine Daniels, a Los Angeles Times sportswriter, publicly announced that she was transitioning from male to female. When her friend and fellow sportswriter, Rick Reilly, asked her why she transitioned at age 49, she said, “Survival…. I had to do it. It was this or die.” (ESPN The Magazine, January 25, 2010). About a year after coming out, she started presenting herself as male again, returned to her old byline, then withdrew from the public eye.

Last November, she committed suicide. We can’t know exactly what was going through her head. But her minister has stated that she was very clear that, even though she was publicly male, she would always be Christine (which is why I refer to her with female pronouns). We do know that she was facing a considerable amount of pressure and stress – from a divorce, from trans people who wanted her to be an activist, and from society at large. We also know that she, like other transsexuals, faced a world that treated her as neither male nor female. These observations help explain why she returned to living as male, against her own wishes.

In a perfect society, the social pressures that she confronted would not have made her life harder to live – because they wouldn’t exist. In the real world, however, that she survived as long as she did is surprising.

Transsexuals have a much higher risk of suicide than the general population. No one who studies the issue really disputes this claim, though we have not yet developed a consensus of how much higher rates of suicides and attempted suicides are.

Suicide rates among transsexuals are so high primarily because our society has constructed obstacles to transition. Since transitioning is the most successful way of addressing the depression and body image issues that many transsexuals face, any barrier to that process allows those problems to remain. Unaddressed, these problems can lead to suicide.

Social stigma undoubtedly plays a central role in preventing transition. For example, when I was first learning about transsexuality, I learned that other people had successfully transitioned. Despite this, I decided not to talk about my feelings – and eventually started pretending that they never existed – because I was afraid that my family would ostracize me. Because they are afraid of job or housing discrimination, other trans people do not transition.

Our mental health system has created even more explicit barriers. Psychologists, psychiatrists ,and therapists often vet trans clients for how well they fit into a specific narrative of transsexuality. For example, they often look at how young a person was when they first felt trans feelings. According to the traditional narrative, transsexuals are supposed to have “cross-gender” thoughts before the age of seven – and five is even more authentic. The medical establishment is likely to refuse treatment to anyone who reports these feelings at a later age. Many mental health “experts” have thought that “real” male-to-female transsexuals are only attracted to men. If they had their way, I wouldn’t have been able to transition physically because I’m generally attracted to women. These mental health gatekeepers can and do block trans people who are depressed – and, consequently, at higher risk for suicide – from obtaining hormones when they need them. As a result, some trans people purchase hormones on the black market, endangering their health. Others simply go without hormones, which again, in severe cases, can lead to suicide.

We need to tear down these barriers. Mental health providers need to expand their sense of who is eligible for hormone replacement therapy so that anyone who needs it can get it. We need to educate everyone about trans people to remove the stigma – and, in the meantime, pass laws prohibiting discrimination against those who need to transition.

Whenever we think about trans issues, we need to remember the many transsexuals like Christine Daniels who have to choose between transition and suicide.

Quinn Albaugh writes in this space every week. Send Quinn your thoughts at