Beyond The Binary: Trans People Without Dysphoria Must Recognize Their Privilege

Initially, when I decided to start this series of columns on the nonbinary experience, I knew it would be a challenging task. I’m frantically checking my word count as the paragraphs stack up, attempting to explore dense concepts surrounding gender, identity, and the binary that a couple magazine pages can’t begin to contain.

I also understand that I’m speaking from my very specific lived experience as a nonbinary person. I’m white; I’m a millennial; I’m able-bodied; I live in a very liberal city, and I very rarely experience gender dysphoria.

There are still conflicting ideas in the community as to what it means to be trans. By definition, being trans is when one’s gender is different from the gender they were assigned at birth. The conversation has opened up in recent years, recognizing that if we begin to police gender based on someone’s need for gender-affirming medical care, we might be missing the point of gender liberation entirely. 

Trans elders didn’t necessarily have this middle-ground to explore. There wasn’t the visibility we see today to explore gender on one’s own terms; transitioning and seeking medical care was (and still is) about survival. Yes, the community has expanded, but my lack of consistent or significant gender dysphoria as a trans person is a privilege.

I was assigned male at birth, and by societal standards at least, my presentation is perceived as “masculine.” I rarely wear makeup; I have facial hair, and I’m not currently pursuing any gender-affirming care as part of my gender journey. A lot of my style and expression meshes the “feminine” and “masculine” in what I wear. I’m also patiently waiting as my hair grows out, eager to have additional styles to explore as soon as it’s long enough.

But dysphoria? It happens in slight spurts, but it’s very fleeting for me. Most of the time, I’m comfortable with my body and don’t feel like my anatomy has any bearing or hindrance on my gender as I understand it right now.

While people in public rarely recognize my nonbinary gender, or I might get an ugly stare as I wear more feminine clothing, that’s generally where it ends. The fact that people still perceive me as a man, even though I’m not, still dictates how I navigate the world. I can walk around Hollywood at midnight, and my 6’1’’ stature, broad shoulders, and my face generally read as “man’’ regardless of what I’m wearing.

Gender dysphoria is incredibly taxing and challenging for many folks to navigate, especially when they might not have the support networks to connect with while they seek out additional care. Of course, that process is far from clean-cut: There are a slew of barriers surrounding access to gender-affirming care.

Research on gender-affirming care access is still limited, but a 2017 study published in the journal Sex Res Social Policy explored the trans folks who seek medical care and the barriers they encounter.

Hormone therapy was more commonly reported among transgender men (76.8% of respondents) and transgender women (80.3%), but more than a quarter of genderqueer (28.6%) and nonbinary participants (33.3%) also received hormone therapy.

The study notes that financial elements of seeking gender-affirming care were the most commonly reported barrier among respondents. To pursue hormone therapy, individuals must account for the cost of co-pays (even if it’s covered by insurance), lab work, and doctor’s visits, along with the costs of therapy to provide a letter of support to start treatments or seek out surgeries.

One respondent noted they weren’t able to keep up with their therapy appointments regularly due to financial issues.

“Due to not seeing him as regularly as I should, I have not been able to get a letter to state that I am ready for top surgery. I also have not been able to save enough money for top surgery,” they say.

Trans people seeking gender-affirming care also have to sacrifice other important experiences and parts of their lives to account for the financial burdens of receiving such care. One participant noted he couldn’t go to college until he was done saving for surgery.

Insurance was the next most commonly cited barrier. Folks might be unemployed, uninsured, unable to afford insurance, or on a family member’s plan which limited them from pursuing care. Even for folks with coverage, insurance companies may have limited providers or trans-specific exclusions in their policy.

Finally, there is the availability of care and lack of access to services. 

One participant noted that, due to where they live, their only option was working through urgent care, which couldn’t prescribe them hormones because “I haven’t been there before and have no history with them,” they say. In their previous state, they noted every doctor’s office replied with, “We don’t do that here,” when they inquired about hormone therapy.

This lack of access means that many trans folks must travel to receive gender-affirming care. For hormone therapy, participants in the study commonly noted having to travel to nearby cities, potentially multiple-hour commutes in one direction, to receive care. This is exasperated when discussing gender-affirming surgeries: top surgery often meant traveling even longer distances or crossing state lines, and bottom surgery often meant traveling outside of the U.S.

This lack of access also means that competent professionals might have long waitlists to navigate, and this is of course on top of the financial burden of travel, lodging, and missing work for the surgery and recovery process.

I’ve said it before—The wide array of people in the LGBTQ community constantly amaze me, and our diversity is worth celebrating. There’s something so magical about the fact that our different cultures and experiences can so heavily shape the way we navigate our queer and trans selves. We have so much that we can learn from each other in sharing our similarities, differences, and experiences with one another.

My privilege does not invalidate my experience as a trans person—the same is true for any trans person with little or no dysphoria—but it matters. We should talk about it and understand our role in exploring these differences in our experiences. 

Trans and gender-nonconforming folks like me—just like white folks, able-bodied folks, or cis people in the broader queer community—must use this reality to empower and uplift the others in the community who aren’t afforded the same privileges.