What’s the damage? Trans resilience through the lens of class struggle

Coming out as queer as a young adult was my first step into the world of financial insecurity. Thanks to my white middle class upbringing, I knew little about systemic injustice and the evils of capitalism. I couldn’t have guessed that trans people are twice as likely to be unemployed, and four times as likely to live in poverty, as the general population, or that 79% of trans people in the southeast are food insecure. (1) I barely knew what “transgender” meant. I knew I wasn’t straight, and that coming out would have implications for my relationships and finances. But I didn’t foresee how a lack of robust support systems would increase my risk of domestic violence, substance abuse, and job and housing precarity. I knew nothing of the long road ahead.

I. The Beginning

The first nine years of my life were spent a mile outside of Horace, North Dakota, a tiny town of a few hundred people. In ’96 my family moved to Casselton, a slightly larger North Dakota town that had a highschool and a population of 2,000. My two brothers and I had everything we needed: food, clothes, a warm home, a safe neighborhood, good education and healthcare. My parents worked hard to provide a good life for us, one that was grounded in faith, Christian morals, and traditional family values. They did this by embedding us deeply in the church, keeping close tabs on us, and restricting our exposure to secular culture. We had plenty of school and church activities to keep us busy, and plenty of Christian media to consume. I had various part-time jobs through junior high and high school.

My parents were also generous with their time, and money. They helped my brothers and I with our homework, and came to our ball games and school concerts. They paid for treatment when I developed an eating disorder, which I’m sure made them hit their insurance deductible several times over. They encouraged me to go to college after high school, and paid my undergrad tuition. Their dedication to my happiness and success is a huge part of why I am where I am today. It is also the source of a lot of guilt: for growing up to embody the antithesis of their beliefs and values as a (highly visible) queer and transgender man, and for being unwilling to compromise my mental health and happiness for the sake of our relationship.

Forget queer role models, I barely knew what it meant to be gay until 8th grade confirmation, one component of which was a course on Christian Sex Ed. When my parents came to learn that our pastor, who taught the class, took a neutral-to-accepting stance on homosexuality, they left the church. Despite what they said about “all sins being equal,” I knew that homosexuality was special. It was more than sinful; it was taboo, foul even. I knew this because, like sexuality in general, we never talked about it–not that it would have been much of a conversation. When it came to right and wrong, there could be no civil dialogue. Right was right and wrong was wrong, end of discussion. I grew to question, and then resent this dogmatic authoritarianism. I developed an eating disorder, which became the obsession that would dominate my teenage years. Anorexia is a private hell, defined extreme interiority and delusions of control. Wholly absorbed in its elaborate rules, I had no room to think about religion or politics, much less my own deviant desires.

I left home at eighteen and experienced my first taste of freedom. I got a job where I was surrounded by artists, anarchists, and all variety of free thinkers. At work and in school, I discovered whole belief systems and worldviews I didn’t know existed. I drank my first beer with my coworker, smoked my first joint with my roommate. I had my first kiss, and then my first kiss with a girl. I started inhabiting my mind, and then my body. As I did this, anorexia loosened its grip on me.

This should have been something to celebrate, but instead I was wracked with guilt and anxiety. I knew that my parents wouldn’t approve of the person I was becoming. For a while I lived a double life, putting on a mask when I was with my family. But by my second gay relationship, the cognitive dissonance started to wear on me. If I loved my partner, why was I hiding her? I started to think more seriously about coming out, and preparing myself for the potential consequences of doing so. I got a full time job with good pay and benefits, working third shift at a group home for disabled adults. I applied to grad schools, crossing my fingers for a full ride somewhere out of state. One cold winter day, I finally made the dreaded trip back to my childhood house. The conversation went about as well (or as terribly) as I expected it to. I knew, as I drove away, that I would never again reach out to my parents for advice or guidance, financial or emotional support. That is where this story starts.

II. The Scarcity Principle

A recent study on family bonds between queer adult children and non-affirming parents found that many queer adults maintain relationships with their biological families “despite conflict and heartbreak.” The authors discovered among the respondents a sense of what they term “compulsory kinship,” the idea that family bonds should be maintained at all costs. Some respondents expressed a feeling of social obligation, some repeated the language we commonly associate with family, but had a hard time explaining how they personally related to it, and some had financial or practical reasons for maintaining ties. I can definitely empathize with all of these responses, but for me, being able and willing to cut ties if I needed to was the only way I could safely keep a line of communication open. Any degree of dependence on my parents resulted in enmeshment (an absence of boundaries) and regression (backsliding into a headspace where I feel powerless, without privacy or control).

I graduated in the winter and the next fall I moved to Lubbock, Texas (think North Dakota but dustier and even more conservative) for a masters program that had awarded me a tuition waiver and $1300/month living stipend. I lived in a run-down studio apartment and took out student loans to supplement my stipend. I lived on canned food and cheap booze. I started drinking more, drinking alone more, and drinking to black out. I slept with a lot of “straight” and curious women, and started questioning my gender.

The summer between my masters and PhD, I started dating a woman who, after knowing me for just a few months, would uproot her life and follow me to Kentucky. To say our relationship was dysfunctional would be an understatement. We both had all the indicators of insecure attachment (and at least in my case, addiction), which quickly entrenched us in patterns of abuse and retraumatization. She would later say that moving to Kentucky was the worst decision she’d ever made. I believe her.

At the end of my first year in the PhD program, I decided I was miserable in academia, and dropped out. Philosophy degrees don’t have much use outside of academia, so I went back into the field where I had the most experience: the service industry. My first job was at a coffee shop where starting pay was $7.25 plus tips. My girlfriend’s job, at the dog daycare, started at $9 an hour.

We had different spending habits, which bothered me as much as it did her. She wasn’t frivolous, but she wasn’t frugal either, at least not by my standards. She loved a nice dinner out, and when she could, she liked to treat herself. She grocery shopped on a budget, but generally bought quality ingredients and no item was inherently off limits. In other words, she was reasonable. I, on the other hand, was militantly frugal (some might say cheap), only willing to pay for the barest essentials: rent, electric, cheap booze, and the cheapest foods on the shelf. Whether I was looking at produce, a menu, or a pair of shoes at Goodwill, all I could see were price tags.

The National Center for Healthy Housing and APHA defines a healthy home as a “dwelling that is clean, safe and sanitary; without hazards or pests; and with safety and security measures in place to maintain occupants’ well-being.” (2) For my girlfriend, this was the bare minimum. Needless to say, she was not impressed with my living conditions when she got to Kentucky. The apartment had roaches, blood stains in the hallway, bullet holes in the windows, and serious structural issues that were lawsuits waiting to happen. There was no decor, no TV, and no furniture but a bed and a kitchen table. The neighbors were always fighting (but then, so were we) and the police showed up on a regular basis. I witnessed more than one drug bust in our building and tripped over garbage and syringes that littered the parking lot.

For reasons I could not understand, she insisted on us moving at the end of our lease. Technically, yes, we could afford a higher rent. But why would we spend money that we could save? This principle–the scarcity principle, let’s call it–at this point determined all of my financial decisions, however large or small. But she wasn’t budging. I offered a compromise: I would move with her to a nicer place–if I could sell my vehicle and share hers. I was a real charmer.

We moved into a nicer one-bedroom in a nicer part of town. I sold my car and got a job at the bar across the street: a setup that made drinking to the point of oblivion even easier. I worked there for two years, the darkest two years of my adult life. I was on Medicaid, which paid for therapy, but I was far from ready to acknowledge my drinking problem, my gender dysphoria, or my unresolved family issues, so that was mostly a waste of time. Our fights raged into the early morning hours, or until I blacked out, whichever came first.

I had started to research transitioning, a dirty secret that soon became all-consuming. When I finally came out as trans, my girlfriend tried to be supportive, but felt like she was grieving the loss of her girlfriend (a title I detested) and thus her lesbian identity. I tried to be patient, but it hurt to hear these things, and I was desperate to start transitioning. Like so many poor and working class couples, financial insecurity was the glue that held us together. In our case, it held us for nearly three years.

III. (Stress) Hormone Therapy

We broke up in the winter, with six months left on our lease. Because I was the one to initiate the breakup, I agreed to move out while we sorted out housing. I crashed on friends’ couches, hauling my overstuffed duffel bag across town, through snow banks and over icy streets. Not knowing where I was going to sleep from day to day, combined with my ex’s hostility, my lack of transportation, my transphobic employer, and the daily onslaught of microaggressions kept me locked in survival mode. Meanwhile, I was also in the midst of a legal name change: a process consisting of endless red tape, appointments I traveled to on foot, and stressful encounters with customer service representatives who made little effort to gender me correctly.

I was too stressed to eat or sleep, a recurring theme throughout my twenties. Chronic insomnia and poor nutrition resulted in weak immunity, neuropathy, chest pain and heart palpitations, among other health issues. Later I’d learn that these were effects of minority stress (effects that were certainly made worse by heavy drinking), a type of chronic stress that’s caused by frequent or prolonged prejudice-based adversity.

Because the stressors that minorities face are not random, but symptoms of larger structural inequalities that they can’t escape, minority stress is chronic and damaging to both one’s mental and physical health. (3) It is well documented that prejudice events (like assault, homelessness, or being fired from a job) predict the onset of physical health problems such as influenza, hypertension, tendonitis, and cancer. (4) Hence the many health disparities that inflict minority populations. For example, 42% of trans and gender diverse people meet criteria for PTSD and 41% of have attempted suicide; while the rates for the general population are 4.7% and 1.6%. (1) In a 2021 survey, 70% of trans respondents had elevated blood pressure levels, 29% had high or acute levels of chronic inflammation, and asthma was almost three times more prevalent among trans respondents than cis respondents. (5)

Given the data, it is clear that transgender health (and working class health as a whole, I’d argue) is a multifaceted social, economic, and political issue. As stated in a 2021 report, “Protecting and Advancing Health Care for Transgender Adult Communities”:

For transgender people, social determinants have concrete effects on health. High rates of poverty make medical care unaffordable. High rates of housing instability disrupt the continuity of care. Discrimination by medical providers leads to mistreatment and avoidance of care. Discrimination by employers leads to unemployment and consequent uninsurance. Criminalization and incarceration disrupt the continuity of care and expose transgender people to violence and trauma. Addressing the health disparities faced by transgender people requires addressing the many structural forms of exclusion, discrimination, and violence they endure

As I struggled to stay afloat on a single income, I quickly realized just how financially independent I wasn’t. I started having spontaneous panic attacks, sometimes at work. Work was its own nightmare. My boss, the owner, was a transphobic bully who misgendered me relentlessly, and found countless other ways to erode my self esteem and invalidate my identity. He was a master manipulator, exploiting my vulnerability and capitalizing on my precarious housing situation. Like any skilled abuser, he managed to convince me that I needed him, that my transition was a burden no employer would want to put up with, and that his shitty pub and grill was the best I could do for myself. In a way, he wasn’t wrong: I did need him, in the sense that I needed one thing to remain stable while my personal life turned upside down. I also couldn’t afford a pay cut, and while I wasn’t making a lot in my current role, I knew how to make it work.

In the past, when my mental health suffered, I’d turn to alcohol. But now I was afraid to drink. I needed to stay in control. Finally, after weeks, my ex found a place, brought me her keys, and moved out. I didn’t have time to feel relieved. I had to figure out how I was going to pay rent this month, and fulfill the rest of my lease.

I had three separate roommates over the course of those six months. I also started hormone replacement therapy, in the form of testosterone injections, but I’m pretty sure the main hormone I was running on was the primary stress hormone, cortisol. The first roommate stopped paying rent after the first month. The second roommate, after getting settled, started exhibiting signs of heroin addiction, nodding out while sitting up and standing, regularly oversleeping and missing work. I wasn’t in a mental or financial place to deal with this at the time, especially once they got fired and I couldn’t rely on them to make timely payments anymore. The third roommate was my new girlfriend (third time’s the charm), who is still a foundational part of my chosen family, and one of the reasons I’m alive and well today.

IV. A Transphobe and a Plastic Surgeon Walk into a Pub

Around 20% of trans people are uninsured in the U.S., where gender transition can cost over $100K even with insurance. Despite the fact that most major medical organizations confirm the existence of an “established body of medical research” that “demonstrates the effectiveness and medical necessity” of transition-related treatments (6), many health insurance plans exclude these treatments, stating that they are “elective” or “cosmetic.” Lack of access drives many trans people to seek out dangerous alternatives, like buying hormones on the black market, having surgeries performed by non-professionals, and misusing or overusing body modification equipment and apparel.

Doctors recommend binding (using compression garments to flatten the chest) for no more than eight hours a day, as wearing a binder for any longer than that can cause sores and infection, chronic chest and back pain, bruising and fracturing of the ribs, shortness of breath, nerve damage, and overheating. I’d been living with chest dysphoria for years, and was now binding 24/7, taking my binder off only to shower. Between my dysphoria, the physical discomfort, and the permanent damage I was likely causing, I was in urgent need of top surgery.

I lay awake, mentally calculating and recalculating surgery expenses. I was devastated to learn my insurance would not cover it. Even with a successful GoFundMe campaign, I would be forced to use my savings. I had spent the last two years busting my ass and pinching pennies to grow my emergency fund, which was the one thing standing between me and a nervous breakdown most days. The idea of seeing its balance decrease, even by one dollar, was like seeing the number on the scale go up, even by one ounce, in my anorexic days. I planned on moving to Louisville in a year, where my girlfriend would start grad school. Money and schedules would be tight once we got there, which would make surgery even harder to coordinate and finance. In my world, requesting time off was a fireable offense, and I wasn’t about to risk upsetting my new employer. It was now or (what felt like) never.

My first consultation was with a plastic surgeon in Lexington. At the time, he was the only surgeon in Kentucky who performed top surgeries. My gut told me something was off about him, but having surgery locally would be significantly cheaper, so I decided to ignore the red flags. Besides, as a trans person, bad experiences in medical settings were commonplace. According to the 2022 National Transgeder Discrimination Survey, which was released last month, one in five trans folks has been refused care outright because they were transgender or gender non-conforming. Half of us have had to teach our medical providers about transgender care. And nearly a third of us have been subject to harassment in medical settings. So yeah, the guy was a little weird, but I was used to that.

When I called to schedule my surgery, the nurse informed me that there would be no general anesthesiologist fee. “Oh–that’s included?” I asked, surprised. “No,” the nurse clarified, “Dr. Gerstle won’t be putting you under.” Her words stunned me. I became instantly queasy. “Are you still there?” she asked. “Uh, yes. What dates do you have available?” My therapist urged me to get a second opinion. I didn’t want to. I didn’t wanted to get this surgery done as soon as possible. But thankfully I listened. The second opinion concurred with the third: Dr. Gerstle was trying to attract desperate trans clients by cutting out that large “extra” cost, anesthesia. This was medical negligence, if not malpractice. A year later, he went to jail after showing up to surgery drunk.

I was back to square one. The next closest surgeon was in Cincinnati. I booked a consultation, and waited anxiously for the day to come. The consultation went well, and I was able to schedule my surgery at the end of the next month. It seemed too good to be true, and unfortunately, it was. Due to a mention of seizures on my medical record, the nurse practitioner who performed my pre-op assessment wouldn’t clear me until I saw a neurologist. I’d have to postpone surgery.

I wept myself to sleep that night. In the morning I got up, washed the dried snot off my face, and started calling neurologists. The next available appointment was months out. I called the hospital twice a day everyday for the next two weeks. Finally, I got lucky. There had been a cancellation that day, and I was able to get in.

My girlfriend cheered me to the finish line. She drove me to my pre-op and follow-up appointments, stayed the night in the hotel with me after surgery, and cared for me as I recovered, dressing my wounds, bringing me food, helping me shower. We aren’t together anymore, but I am eternally indebted to her. I can’t overemphasize how essential it is to have reliable assistance in the days and weeks following an invasive procedure like top surgery, and how few trans people have access to that kind of support. It is the reason why the majority of trans people have not had gender affirming surgery, despite wanting it someday. (7) 

I still had no furniture except for a bed and kitchen table, so my girlfriend lent me a bedside table to hold my meds, snacks, and other necessities. I was completely bed-ridden the first week following surgery. I recovered in the makeshift bedroom I’d set up in the “living room” of my shotgun one-bedroom. Roommate #2 stayed in the actual bedroom, which I had to walk through to get to the bathroom and kitchen, and which housed the apartment’s only window unit AC. My room stayed between 75 and 80 degrees. I had to wear a compression vest (essentially a poorly designed binder) 24/7 for the next six to eight weeks, which the heat made insufferable. But I had no right to complain. I got to have surgery. It was over. I was free.

During my recovery, a fluid sac formed on the left side of my chest. My surgeon wanted to see me again before approving my return to work. This greatly irritated my boss, who was filling in for me while I was out. He was starting to suspect that, with surgery now behind me, I wouldn’t stick around to put up with him. I hadn’t intended to quit before the move, but his suspicion became a self-fulfilling prophecy. When I returned to work, his harassment escalated. With my therapist’s help, I decided I deserved better, and wrote my letter of resignation.

V. Letting Go of Scarcity

When I quit my job at the pub, I went from making $12 an hour plus tips, to working two minimum wage jobs that paid under $8 an hour after taxes. The next six months were exhausting, but filled with hope. I worked as many shifts as my employers would give me, and my girlfriend and I took one day off a week to go apartment and job hunting in Louisville. It’s a miracle we found a place, considering we couldn’t afford any overlap in rent. The apartment we found was small, old and drafty but to us, it was perfect. We started at our new jobs the day after we moved in.

I had decided to to “go stealth,” or intentionally conceal my transgender status. I could not afford to have panic attacks on the job, which meant I couldn’t risk my new employer discovering I was transgender. I kept my head down and climbed that corporate ladder like my life depended on it. Unfortunately, as studies show, successful passing does not necessarily alleviate minority stress. (2) In my case, it resulted in a preoccupation with hiding, which itself became a significant source of stress. I have elsewhere heard of this referred to as “trauma of concealment.” After nine months I was tired of the double life, and decided I was ready to be visible.

My bosses were nothing but supportive. They promised to have my back, and they did. They even fired one of my coworkers for refusing to gender me correctly once he learned I was trans. According to him, I’d deceived him about my gender. He told me that despite my appearance I was really female, and that using my pronouns would violate his religious beliefs. I will always remember the day my boss terminated him. I cried from relief, and from disbelief. It was the opposite of how I was used to my boss treating me. Instead of gaslighting, it was justice.

Eventually I’d be promoted to a manager position that provided stable income for the next four years. I was no longer living paycheck to paycheck. My mental health improved significantly in that time. With job security, I slept better. I had an easier time relaxing. With my benefits, I could afford therapy. I started to heal from my trauma and learned to better manage my social anxiety. I regained confidence. I found multiple avenues in which to advocate for trans employees in my workplace. I made friends. I started writing again. I started working for QueerKentucky. I got sober. Thanks to sobriety and my side hustles, I was actually saving quite a bit of money. Within a couple of years, I was financially stable enough to buy a used car. Two years after that, I put down a down payment on a condo. I struggled to justify these large expenses (which were actually investments) since technically they were unnecessary: I could live without them. But I’m so glad I went forward with it, just for the sense of security they provide alone.

As most Americans know, renting in the U.S. is a nightmare that is only getting scarier, especially for renters, and buying is less affordable than ever. Nearly everywhere in the country, rents are too high to be affordable to low-paid workers, seniors, and people on disability. The price of a safe and clean place to lay your head costs the majority half their income, forcing the urban poor to “double up” and share housing with other families or other disposable ties to split the cost. Even then they are subject to the whims of their landlord, out-of-the-blue notices to vacate and hikes in rent. The standards are even lower if you are trans, especially in states like Kentucky, where landlords have the right to evict you at any time, for virtually any reason. At least 30% of us have experienced homelessness, a number that increases to 51% among Black trans women, and trans people are four times less likely than the general population to own a home. (10) These odds don’t stem from a lack of hard work, but from an economic system that rewards greed and systemic discrimination. It’s no wonder the trans community is known for its resilience.

VI. Toward Revolution

figure a.

Today, I still carry trauma. It manifests as anxiety dreams about public restrooms or my old employer; as the multiple hustles I require to feel secure; as the belief that I don’t deserve the same respect and consideration that others deserve. It masquerades as thriftiness and minimalism, traits that are nearly universally regarded as positive. It’s is why I find myself working when I’m sick; why I struggle to relax or be “unproductive;” and why I’ve only taken two brief vacations in the last decade, both of which were gifted to me. It’s why I still panic and fear for my livelihood when I drop the ball at work, even though I now work for myself and cannot get fired. It’s how even though I’m making the most I ever have, and am the most financially secure I’ve ever been, I still automatically scan the grocery store shelves for the cheapest item, without considering what I actually want to eat. My relationship with money is a bit like my relationship with food: functional but still a bit compulsive, a bit disordered.

I’ve made strides in detaching from the scarcity mindset, and my mind and body thank me for it. But it’s impossible to detach completely when the cause of that mindset, insecurity, is all around me, in my community and beyond. The real task is to eliminate insecurity itself. This is no small feat, since those in power–our bosses, landlords, government leaders, even scientists (see figure a), our oppressors–know that their wealth depends on our insecurity. They praise our resilience to deflect suspicion about their role in . And while we wait for the reforms they promised, they wait for us–to adapt, to give up, to die off.

Why do diversity-equity-inclusion workshops focus on interpersonal injustice (microaggressions, misgendering) and never systemic injustice? After all, many systemic injustices are connected with employment. For example trans people in the U.S. are paid 32% less than cisgender people on average. We are twice as likely as cis people to be unemployed, 42% more likely to work part-time jobs, and 2.4 times more likely to work in food or retail industries where workers often make minimum wage, or less for tipped positions. (8) 90% of transgender workers have experienced harassment or mistreatment on the job, and 47% have experienced an adverse job outcome because they are transgender. (9) Where are the employers who are putting their money where their mouths are to correct these and other systemic injustices?

“That’s out of our wheelhouse–we’re business people, not social workers” they say, which is corporate for “not our fault, not our problem.” But then whose problem is it?Who is responsible for changing these outcomes, if not those who set the prices and wages, who choose the policies and benefits, and who steal from their workers in the name of maximal profit? Here the capitalist will respond: “To survive as a business you have to maximize profit. We didn’t choose capitalism, but we do operate under it.” Again I ask: Who could possibly be responsible for the continuance of capitalism if not the few who benefit from it, who possess the vast majority of the wealth, land, buildings, machinery, and goods in this country, and therefore control everything from election outcomes to the media to the dominant narratives about our role in foreign affairs? And if these power-holders are so quick to blame capitalism (which they did not choose, mind you) for the world’s problems, then why do they participate in it? Why do they not take their wealth and resources, their power and privilege, and create an alternative?

If those in power praise our resilience for self-serving motives, those without power praise our resilience because doing so is easier than standing up to the boss or landlord, or organizing their neighbors or coworkers to demand real change. They don’t want to rock the boat or put too much skin in the game. This approach just prolongs everyone’s suffering, including their own, since, as studies show, it’s not just trans people, or even minorities that suffer under capitalism. It’s the working class as a whole.

We all know the saying: “If you give a man a fish, you feed him for a day. If you teach a man to fish, you feed him for a lifetime.” But what if the man fishes for 12 hours a day, six days a week, and barely catches enough to feed his family? How can he help is neighbor, a homeless trans woman of color who hasn’t eaten in days? By lending her his fishing rod for an afternoon? No. If he really wants to help her, and help his family, and help himself, he should be asking what’s going on upstream. 

Like many in my community, and like many poor / working class people in America and across the globe, I am resilient. But resilience implies hardship. Collective resilience implies structural hardship. It cannot be the case that structural hardship (e.g. gender or race or class-based hardship) is necessary or inevitable for the majority of Americans. It is, however, inevitable under capitalism. A better world is possible, and everything we need to build is is within reach. We just have to take it.

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