The Story of D

The story of a MTFTM transgender patient from my Psychiatry clerkship.

Posted by Abhi Desai on July 5, 2018

D was an inpatient on the Dual Diagnosis unit when we met. He had been admitted for suicidal ideation and alcoholism. This is his story, distilled from an interview inspired by the Madison VA’s My Life, My Story project.

D was born a few miles north of Providence in the late winter of 1994 to a young couple in a sleepy town. His memories of early childhood are blissful and nostalgic; warmth, sunlight, rustling green grass, the young family puppy.

“Didn’t last long though.”

His mother and father were married, living together in a trailer park between a gas station and Burger King. They were young, barely into their twenties, and overwhelmingly unprepared for the responsibilities of parenthood. As familial support began to fall away when D was four years old, his parents’ relationship began crumbling. His father took physically demanding work in a warehouse to make more money, and his mother got a part-time job as a cashier. Both were maintaining florid addictions; his mother smoked crack and his father drank at least a liter of clear liquor every day. Within months, the fabric of their marriage completely disintegrated. His parents would regularly have fights so loud and vitriolic that D would lie awake shaking in his bed, hoping no one would remember he was even there.

His parents divorced when D was eight years old. He was initially assigned to live with his mother by the court. In that trailer alone with his mother, he was exposed to the full brunt of her narcissism for the first time. He remembers being beat with the curtain rod she kept beside the kitchen unit until he couldn’t stand because he had spilled milk on the carpet. He remembers being fascinated by a wax candle his mother had lit to try and combat the stench, until it dripped a hot bead of wax on his arm - she proceeded to mock him for days because he was dumber and weaker than a candle.

It was around this time when D was first made aware of his gender. He exhibited non-gender-conformational interests from a young age; he wanted to grow long, wavy hair, he wanted to paint his nails, he wanted to wear eyeliner. This behavior quickly became a target for his abusive, narcissistic mother, who would berate him constantly for “being a fucking pussy”. When he was ten years old, D confessed to one of his schoolteachers why he had not done his homework the previous evening: his mother had kicked him out of the trailer so that she could be alone with a man, and did not allow him back inside until almost midnight.

The teacher informed DCYF; their investigation quickly uncovered the severely abusive relationship between D and his mother. He was sent to live with his father at eleven years old.

“My father is my best friend. But he’s the reason I drink so much. I hate my dad.”

At this time, D’s father was working 9am-8pm at the warehouse, drinking from the moment he woke until he fell asleep. After years away from his son, D’s father was interested in rekindling their relationship but lacked the parenting tools and emotional maturity to develop a functional parent-child relationship. Instead, he attempted to be D’s friend, sharing intimate details of his adult life, sharing alcohol, sharing cigarettes. His father was also unable to reconcile D’s feminine behavior and interests, and also constantly berated him for “acting like a goddamn girl”. Over the next few years, D and his father would routinely fight (“just like I used to hear him fight with mom”), and D developed significant dysphoria about his non-conformational interests. His distress culminated in a suicide attempt at 14 years old.

Desperate, confused, and frustrated, his father asked the inpatient psychiatrist what they could possibly do to “make [D] a normal boy”. The psychiatrist suggested that D might be transgender, and recommended D and his father visit a gender specialty clinic for evaluation.

“The transgender clinic fucking ruined my life.”

D presented to the transgender clinic for initial evaluation when he was 15 years old. During his time in counseling with the clinic, he was “brainwashed. They convinced me I was a girl trapped in a boys body. I was just a boy who liked makeup! They’re destroying an entire generation with their lies. Noone there is interested in actually helping us, they just want to rack up numbers for kids they’ve ‘fixed’”. He began hormone replacement at 16 years old. He underwent SRS and facial feminization surgery at 19 years old.

During this time, ages 16-19, D was entirely convinced he was transgender, and firmly believed that SRS would finally allow him to feel comfortable in his own skin. After surgery, he quickly began to have doubts. The clinic was far less interested in him now that he was post-op, and he no longer recieved therapy through the program. He was required to dilate his new genitalia twice a day; an excruciating and bloody task lasting 45-90 minutes each time. He could not urinate without wetting his legs and buttocks. He could no longer easily masturbate or achieve orgasm, and began experimenting with autoerotic asphyxiation in order to climax. He was unable to insert anything into the orifice without significant pain. Nothing was going according to plan.

On top of all of the physiologic complications, D quickly began to realize that he did not identify with his new genitalia; the operation and hormone replacement had done nothing to alleviate his psychiatric distress, and in fact made it significantly more severe as he was now routinely misgendered and hence became exceedingly embarassed to leave his home. Despite legally changing his name and beginning to dress as a woman, he did not feel like a woman at all. He was fired from three jobs on the first day, when the manager who had only previously spoken to him on the phone saw him in person. He became severely depressed, and began drinking heavily. He was sexually interested in women, but the few who reciprocated his advances quickly balked when he confessed that he did not have a penis. His depression worsened, and he began to think about suicide.

Throughout this, his father began to distance himself from his son, unable to cope with his emotional turmoil and lack of improvement following SRS. The screaming matches continued; both D and his father would routinely threaten the other with self-harm, violence, and suicide, often while seriously drunk.

His father met a new girlfriend when D was 21, three months before this interview. The new girlfriend immediately disliked D and the dynamic between her boyfriend and his “faggot son”. The arguments, including threats of violence and self-harm, continued with near-daily frequency. One day, in the midst of a several-hour long fight which included D posturing at his own throat with a kitchen knife, she simply called the police and told them D was threatening to kill himself. He was brought to our care, and admitted to the psychiatry service. On his third day, during discharge planning, the team social worker was informed by a lawyer that D’s father had filed a restraining order against him. D was no longer allowed to return to his former home, which still contained all of his possessions, or interact with his father in any capacity. He has not spoken to his mother since he left her home at eleven.