In 2002 I wrote an article called Mental Health & Transitioning for the FTM Australia website. This and a number of other articles were included in the handbook Transitioning Female to Male in Australia developed from the articles on the FTM Australia website.  

The whole article can be read here

Mental health and transitioning

You’ve got a handle on that feeling of disquiet, of discontent, of not feeling at home in your own body, psyche and the world. You have a name for it, maybe many names: transsexual, bi-gender, transgendered, man, transman …YOU.
You can do something about it too: you can transition. Testosterone will change your body and you might begin to feel more connected to it; you may change your name and pronouns; you can present yourself and the world will see you and treat you as the man you know yourself to be.
You are doing something about this now – after months, years or possibly a lifetime searching for understanding. You are being true to yourself and everything is coming together. What could possibly be better for your mental health?
This article considers some of the mental health challenges a transgender person may confront before, during and after transition… and makes some suggestions for ways to think about and deal with them.

Redefining You
Connecting your past with your present and future can be challenging in light of a cross gender identity. You have established roles, relationships and identities with family, friends, partners, sexuality, work, study.
At times, you may feel great relief as the gender pieces fall together and begin to make sense of who you are; at other times, you may find a range of different emotions when you reflect on the years spent not being the person you now know yourself to be. It can seem like a roller coaster ride full of ups-and-downs, highs and lows; frustration at things moving too slow and other times too fast.
Support is important: friends, family, partner(s), animals, spirituality, long drives, thinking and feeling time and more. Support can come from a number of places … but the starting point is always YOU. Forming or strengthening a positive relationship with yourself is the ‘best medicine’ when it comes to mental health.
Transition is a process that takes time and has many interconnected layers. Making sure you have time, space and capacity to think, feel, reflect, discuss and take different actions are important elements. This can be done simply – a journal, regular chats with friends checking out your perspective on things, reading, trying different strategies to deal with situations, and being open to understanding yourself and the world differently. Transition can be a process of getting to know you and being you. Feeling good about you is an aim of transition and ongoing growth.

Connecting With Your Body
Given the critical attention to bodies in western culture, its hard for anyone to have a positive self image. For transgender men, this can be even more difficult as the body you have doesn’t match your desires, expectations or wants.
However, it is your body and the more you take care of it, the more you will benefit.
Depending on where you are in Australia, access to hormones will be more or less dependent on health care providers and their assessment of your overall mental health. Many people have written about the unjustness of this arrangement, how gender is pathologised, and how health care providers act as the gatekeeper of people’s access to changing their bodies as they see fit.
Notwithstanding these critiques, a prescription of hormones requires a visit to a general practitioner or a gender dysphoria clinic.
A good doctor can be more than a way of getting safe hormones. They can provide support, offer information and be a sounding board for you; they can help you monitor your health and the impact of testosterone. Not all of the hormone-induced changes will necessarily bring joy and relief – and a doctor will be able to assist you with managing all these changes.
As your body changes, you will have an opportunity to reconsider your relationship with it. Do you like and enjoy your body? Are there parts of your body that you ‘hate’? How do you receive physical, sexual and emotional pleasure? Hormones will change your body in some ways but not all. Finding ways to accept and allow pleasure can assist with mental health.

Intimate Relationships
As you change, so too will your intimate relationships. Given that transition can be a time of great self-absorption, it can be tricky to balance the needs of others. This can put some strain on relationships. It is not your place to meet the information needs of friends, family, partners and work colleagues.
Accessing support groups and services can help take the pressure off you and provide others with their own space to ask questions and talk about how they feel.
Transition isn’t an exclusive experience for the trans person, it is also experienced by significant others. Not all partnerships end because of transition, however, you may have heard of a few ‘horror’ stories of terrible relationship break-ups.
Maintaining safe, comfortable and honouring boundaries during transition can be difficult. The trans community is small and personal information can become urban myth (or gossip) quickly. Having trustworthy, confidential friendships can minimise this risk of your private life becoming too public.
Transition can affect your sexuality, desire and expression of that desire. There may be some general expectations you can watch out for but not everyone experiences these ‘common’ effects.

So once again, a strong relationship with you is the most important starting point. Getting feedback from your partner and friends might help too.
Seeing things from a different perspective may help keep things in balance. Talking about your relationship and your sex life with your partners is a good start. If you need some ideas on how to get these discussions going, a counsellor may help; so too might a good book (erotic, educational, pictorial) or a workshop or a visit to a sex shop (on line or in real life).

Living in a Man’s World
The role, status and expectations of men in Australian culture are complex and not always reasonable or healthy. Gender is deeply felt (or assumed) set of qualities. Research shows that women are ‘permitted’ to express gender in many ways, however, acceptable gender behaviour for men is much more limited. Living as a man will expose you to customs and expectations that you may not have been aware of – everything from bathroom etiquette, to the ways men bond and support each other, and to romantic and sexual expectations of women and men.
It can be useful to have other men to check out your understanding of the norms of men in groups; to bounce ideas with and to ‘reality check’ your perception of yourself.
In my experience, it is common for transmen during their transition to have a heightened sensitivity to the reactions of people in the community. While this is a totally ‘normal’ stage, keeping things in perspective will help keep the impact of this time to a minimum. Correcting legal and identifying documentation may go some way to assist with this.
The man that you are is for you to sculpt and create. Hormones may go some way to modifying your body… the rest will take your time and effort. Your relationship with yourself, your strength and courage, your honour and your capacity for joy and happiness are all part of being a man too.
There is support available. It might not be easy to find… but transition hopefully, won’t add further trauma or distress. Your mental health is yours to nurture and take care of. Make and take the time you need and deserve.

©2002 Vikki Sinnott

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