That’s fine if that’s what you’d choose. I was never forced to be homeless to get away from them, I didn’t need their money to afford medication or all of my access to food and shelter.

It isn’t fair to tell women like us that it is really even a choice that you can be yourself or be homeless. It is not materially possible for many of us to cut off those resources; unless we want to start pretending that trans women receive a ton of support in society, even if you live in a small city in the rust belt or a rural town where everything you know could be gone with a twenty minute drive. The most common cause of death for trans women is suicide; how isolating do you think it would be to lose everyone and everything to be homeless?

You’re valid for saying that you would make that choice, as many women do, but we don’t have to say that it is the easiest or most likely choice to encourage trans women to be certain that they need the resources that they need before choosing to cut off harmful people in their life. Very often, it is not materially possible, and that is a completely other thing that we all have to help each other manage.

I’m glad somebody posted something this blunt so that we can cut through to the point.

No, it isn’t a libertarian argument, because this isn’t under the principle of access to realize individual freedoms, it is an argument that recognizes that any regulation for access of trans people to the care they deserve is indeed a vector for violence from a system that regularly targets them for genocide. To reduce this to an argument for open access to cigarettes or opiates because “the government can’t tell me what to do” ignores the reality that we are talking about a vulnerable group of people and their access to necessities.

Yes, it would be ridiculous to apply this logic to other medications or drugs, because it is exceptionally rare for that regulation to be directly linked to genocidal policy.

I’ve seen this point come up many times, and it is incredibly dangerous exactly because it makes intuitive sense to people who think morality is universal instead of relational, which most of us are socialized to believe.

Oh yes, I didn’t think you were against DIY HRT generally based on your comment.

I do think systemic violence is very much on topic, especially following my comment. We have to be real, every trans issue is a topic related to a group of people who are regularly targetted for genocide. This is why I’m a bit confused about this final point again, about wider access being definitively less effective and more harmful than alternatives, since we don’t really have alternatives.

Every act of cooperation with a liberal-capitalist system is “kicking the can down the road,” since that system fundamentally desires the eradication of queerness. As far as violence goes, I’m not sure how you could argue that, again, an increased generalized risk to the benefit of trans people is in any way more risky than simply continuing the current path, which is civil recognition, when that literally resulted in the current moment of trans genocide and is concurrent with the consistently high rate of self-harm and suicide among trans people. As far as I see it here, your point is that a potential threat to the general population is more of a concern than the very real and immediate threat faced by trans people today.

As you’ve stated in other comments, there already is HRT misinformation, and the systemic oppression that we experience has necessitated community responses and education campaigns. So, I don’t really see how this would be a problem for trans people specifically, whom already have an information network via the preexistng ones within the trans community. I also don’t see how this would be any more or less difficult to implement in the current cultural moment within the US (and anglosphere) and/or EU contexts, since, again, we are already dealing with the negative consequences of cooperation in the first place. I’m not sure what strategic value there is in foregoing campaigns that can codify trans access to HRT without explicit trans rights in mind, and therefore protection against the repeal of policy on the basis of anti-transness alone.

So, could you please explain what alternatives you’re referring to?

Really good addition, yes. If a healthy space with resources is available, that is a huge improvement. I’m not sure what kind of options are available for that where OP is, and my comment didn’t address that as much as the therapist as one seemed to be a more immediate factor.

I’m so sorry you’re experiencing this, and these are manageable problems. I had some very similar experiences in my early 20s (definitely related but not consciously to transness), and it can be very difficult to pick out exactly what the issues to start with are. I know this is a long response, so I understand if you are not able to get through it all in a single sitting, but I do encourage you to engage with it and see if any of it rings true.

On Cannabis Use

Okay, there’s a lot to cover here that your therapist is definitely responsible for neglecting; if I were you, I would keep this one on the line as a backup while you find a more capable one. There have been decades of research that indicates cannabis misuse is highly correlated with mental health disorders like anxiety and depression, but very very little to suggest that it causes those disorders or inhibits treatment (let alone that it serves no use to patients who develop a dependence on it). That your therapist refused treatment on those grounds alone is anti-scientific malpractice.

What you’ve described is a very common form of dependence, which is as a form of pain relief. Cannabis is not physically addicting in the same way that opium, nicotine, and caffeine is, which means that when people develop a reliance on it, it is largely due to its ability to meet some need that is currently neglected, and they do not have a functional alternative to turn to. The fact is, cannabis is highly effective at pain management (https://www.nationalacademies.org/read/24625/chapter/1 ; https://pmc.ncbi.nlm.nih.gov/articles/PMC11940634/), but that efficacy is complicated by the potentially dysfunctional side-effects, such as the sleep disturbance and reliance that you’ve expressed here. There is an additional problem in the fact that cannabis’ ability to manage pain is not exclusive to physical pain, as the specific ways that CBD and THC bind with neuron receptors allows it to mitigate emotional pain as well. In fact, its use as a coping mechanism for emotional pain is extremely common, and is often an indicator of some underlying disorder (Dana B, Elkana K, Ariela H, et al. CBD-Rich Cannabis Therapy in Children with Autism Spectrum Disorder May Improve Symptoms of Hyperactivity and Attention Deficit: An Open-Label Study. Current neuropharmacology. 2026, 24; Iza-Fernández C, González-Roz A, García-Pérez Á, Weidberg S, Secades-Villa R. Positive emotional dysregulation as a mediator between cannabis use and emotional disorder risk: Sex-specific pathways. Psychiatry research. 2026, 361:117180. [this one uses “female,” but clearly does not address the conflation between “female,” and “woman,” which is a major problem considering the evidence that disorders like ADHD does often manifest with “female” symptoms in trans women]). With all that being said, it is perfectly understandable why you would develop a dependency on it with lack of adequate psychiatric or psychological care, and/or emotional support networks. For this reason, I think it is important to question whether the cannabis use itself is the first issue to resolve, since that is not consistent with the medical research on dependency or the many conditions that are associated with cannabis dependency.

Speaking from my own experience with depression, general anxiety, ADHD, and PTSD, there is a reality that cannabis is , quite frankly, more effective at relieving my symptoms than any other medication. That isn’t because it’s “better,” at relieving pain, but because my symptoms often require immediate relief to be effectively addressed. So, when I was much younger, it was literally impossible to reduce my reliance on cannabis (smoking especially, with how immediate of a relief it truly is), because that simply made the pain of my underlying conditions that much worse. Even to this day, with the relief of HRT, anxiety medication, and a healthy life, I require cannabis from time to time as it is the most expedient way to address severe symptoms (which I will never be rid of anyway). It is substantially more exhausting on a regular basis for me to address flashbacks and severe rumination with the daily dose of anxiety medication I already take (many of which medications also come with a litany of more harmful health effects) or even the very effective management strategies that I have developed over my treatment. The question in my case was not how to quit cannabis to get better, but how to use it responsibly in a way that both relieved my pain and afforded me a window to breath and then apply those other coping mechanisms. It is extremely rare for any emotional or psychological condition to be managed with a single strategy, and this is simply what I require.

I want to emphasize that I am definitely a special case compared to the general population, and much of the reason I do actually need cannabis is the specific combination of conditions I manage. I mention all of this to ensure that you are aware that this is a real possibility so that you can more effectively evaluate your needs. If this is indeed the case for you, then it is the questions of delivery method, and dosage. This may be questions like: do you need to smoke a high THC flower, or is a weak CBD edible sufficient? And, being honest, it may really be that you need the high THC flower until you develop better coping mechanisms for your symptoms.

Now, as far as actually addressing the dependency on your own, believe me, I understand how much of a barrier this bureacracy is not only to receiving treatment, but even believing that improvement is possible. The questions I just listed also apply in this case. It is a good idea to switch to a lower dose of weaker strains, and to do so with the understanding that, as you well know, it will likely be boredom that initiates the urge to smoke as much as any pain that comes from your underlying conditions. You’ve mentioned switching strains already, but if even if that not possible or doesn’t help, then you can also start with switching up what you do while you’re high. Video games and weed are great together because you’re both calmed down and activated (tbh, the combination is a big indicator of ADHD coping mechanisms as well), but video games are very stimulating, and could very easily be boring without the weed. So, if one is a hobby with the other, they can easily become interdependent. I’ve had multiple periods where I was concerned with my cannabis use, and each time it has been easier to adjust when and how I use it, rather than calling on a level of will and fortitude that I have never known myself to have, and merely hoping for the best. Weaker flower, weaker edibles, and doing the dishes or taking a bath while high may be a great start to managing this even before you get to treatment, and you may even find that is an effective way to manage these conditions once you do have treatment, as I have.

Other Mental Health Concerns

Now, with all that being said, there are some signs of derealization here (https://www.mayoclinic.org/diseases-conditions/depersonalization-derealization-disorder/symptoms-causes/syc-20352911). They are common symptoms in people with familial trauma and trans people generally, so it is also not surprising symptoms to see in your context. I am more concerned over those symptoms than I am the cannabis use, as they could either indicate an unidentified underlyng condition, or be a major barrier to treatment in of their own. You’ve experienced a traumatic event through the severance of your parents, and that is a perfectly reasonable thing to need to process before you feel safe moving on with your life. Oftentimes, this kind of experience is the start of a longer process of addressing childhood trauma, and that is another thing exceedingly common for trans women. It is not fair that you’ve experienced this, and it is wrong of your parents to neglect you in this way.

Speaking from my experience with this, I didn’t even realize that I had derealization symptoms pretty much my entire life until I was an adult and in a place where I could safely process and manage that trauma. You don’t have to be scared that you’re experiencing those symptoms, and if your fear is that they are caused by the cannabis, that would also be highly, very highly unlikely given the context of this situation. However, this is something that can be a major barrier to managing yourself and not having even more disadvantage inflicted on you by a system that punishes disability as much as transness. If you’ve already found that this is interrupting your education, that is a very good reason to prioritize these symptoms and receive treatment for them. I honestly do not know what sort of access you have, but it is quite common for universities to have on-site supports for queer students, or mental health supports for students generally. This likely will not look like a dedicated psychotherapist, which is typically what you require, but even being able to talk with a social worker/counsellor or any empathetic ear can go a long way in bringing you more in touch with yourself and the world around you.

Conclusion

I hope that none of this comes off as telling you what to do, I truly can not know your situation or your needs, but I spent a very long time learning what I needed, and I could not help but find your experiences relatable. I don’t expect all of this to be helpful, but I do hope that it at least helps you decide what to do next with the power that you have. It isn’t fair that you’re experiencing any of this, and I wish you all the best.

Oh, I’m glad to hear that it did validate you <3

It’s definitely one of those thngs that people take for granted, which, to me, emblemizes how trans-misogyny effects both our self-perception, and what language is afforded to us to develop self-understanding. I’m more butch than I ever was as a “man,” but it in no way resembles a man’s masculinity. I found it really difficult to assert that for a long time; there’s a lot of risk that comes with being a trans woman, and acceptance of our own sexual needs and desires is one of those risky things to assert to others.

Patriarchy in this specific context no, since we are still living in it and it is quite literally cancerous. As far as whether societies moved away from patriarchy generally once subscribing to it, that’s tougher to say. Certainly, there are many instances of patriarchal systems oriented around property (a defining feature of what we currently have) also experiencing massive challenges to that way of life before being reinforced by some external patriarchal power. There are also many instances where matrilineal property inheritance coincided with more equally shared power in how society is conducted, such as with the Haudenosaunee and Ansihinaabe in “North America.” The Mississippian civilization that built starkly hierarchal ways of life like what is seen in Cahokia also collapsed very much due to the inequities created by that hierarchy, and historians like Kathleen Duval have argued that the lesson of that collapse is reflected in more egalitarian oral histories and cultural practices in surviving nations.

It’s important to remember that, even though these are certainly not usual cricumstances, the exceptionalism of this particular form of patriarchy is truly limited to its context, not its durability. The fact that these systems can’t exist without challenge tells us that they really can’t survive no matter how much violence they inflict, even if simply because there is no world without women or queerness, or the consequences of refusing that reality.

Thank you for this comment.

I agree, material safety and security is often difficult to rationally prioritize when transition is often more necessary to survive for many of us. This woman was out for several years, and her material insecurity was a more recent development, but is none the less consistent with the disproportionate rates at which trans people experience shelter and material insecurity.

From my own experience, there was no such thing as material security before transition, even if just because there was no space that wasn’t traumatic, which meant that my health was at risk in every setting. So, I really don’t know whether I could advise someone to delay transitioning unless it really is an existentially threatening situation where coming out would literally introduce a substantial risk of bodily harm (y’know, relative to what it is for simply being trans). These are things I think are just difficult to advise on for that very reason, and really anecdotal evidence is the only way to ensure there’s a chance of relatability that provides some genuine help for someone’s decision.

That’s a very sweet notion at the end as well, which I think is part of why I’m struggling with this so much. I understand this woman’s pain deeply, and I also know how much of that pain can be relieved with even just a little happiness. I don’t doubt at all that if she had lived longer, she would have found relief, but for many of us, that pain truly is unbearable. This is why I want to emphasize just how crucial it is to recognize the gravity of our own actions, it’s possible that simply a text to check in would have been enough happiness to relieve that pain for her long enough to have lived a full life.

I’m sorry to hear about your friend, that’s a very sweet thing you shared.

I’m sorry this did trigger you :/ I’m very sorry to hear about your friend, thank you for sharing that.

That’s part of what I’m struggling with, but I wasn’t especially close with this person. I am very used to losing people, and understand how that pain scars over, my struggle here is with the regret of not having helped more even if I didn’t have to or when it wasn’t safe enough to. This is what I’ve found much harder to move on from without simply punishing myself into trying to help every trans person I know, which can certainly be a problem in its own. It’s hard to understand exactly what kind of pain this woman was in, as well as the knowledge that I couldn’t actually know how bad it felt for her, and know that it would have taken very little to at least improve how she felt even if she was going to die anyway.

That is honestly very unusual if they know you’re trans. What exactly is their reasoning? It seems like fun to go kill babies?

*so long as that is materially possible, of course.

Ahh okay, bringing it up in this context made it appear as though the motivations of either people who subscribe to that misinformation, or the groups that propagate it would align in some way with a potential misinformation campaign that would effect trans peoples’ ability to access information. The systemic violence described below suffices, so I’d be surprised if there was such a campaign that actually worked on what is a substantially different target audience.

I’m privileged to have had that money and time, many trans people do not. It’s important to remember that many of us experience shelter- and other forms of material insecurity at disproportionate rates, and that is not disconnected from the overwhelmingly high suicide and self-harm rates for young trans people. Slow delivery of care with the caveat of privilege for access does literally constitute the systemic violence that perpetuates those rates.

I mentioned this in another comment on this thread, but I think it is a perfectly acceptable cost to introduce a potential generalized risk by expanding access and substantially mitigating the preexisting and specific forms of violence that trans people experience. I don’t see how it is reasonable to argue that a less immediate and threatening risk to a general population which regularly refuses us care is an unacceptable cost to address the needs of our own community. We already have information and support networks in place within our community for this very reason.

I wasn’t aware that small children were able to purchase any medication.

So, I understand the points you’re making about medication regulation. Certainly, ibuprofen carries enough risk with abuse for the ease of access to be questioned, for example, but I’m unsure of the claim here that there are other ways for open access to HRT.

It seems that the conclusion here is that liberal civil rights campaigns are more effective with less risk, but I’m unsure if that’s the point, since, y’know, that would require trans people to even further risk their safety by cooperating with institutions that are largely dedicated to the genocide of trans people. I’m sure that would carry a less general medical risk since, of course, it is not only trans people making use of these medications, but I don’t see how this could be argued as more dangerous for trans people specifically.

I think it’s also crucial to note here that even the non-violent actions that are necessary to fight for that protection carries the risk of incarceration, and therefore, significantly high chances of sexual violence given the disproportionate rate that trans people experience sexual violence in those cases. Even more, in the US, there are many cases where we’d be asking trans people to risk forceful “detransition” to participate in said campaign, as that is an accepted policy within the US carceral institution.

I do hope I’m misreading the last part of your comment for that reason, as I think that kind of point would ask us to ignore the trans people who died to secure what access we do have (very many of which suffered the consequences I listed above), as well as the reality that these institutions only conceded rights to that access as part of a longer campaign against transness, the consequences of which we are witnessing through the current wave of genocidal policies targetting trans people. With all that in mind, I find it difficult to weigh the valid concerns over medical safety against the specific needs for some of the most vulnerable people in our society. Surely, there is an acceptable risk I’m willing to generalize should that mean fewer trans youth die because they refuse to live without access to themselves.

The connection between politicized medical disinformation surrounding COVID-19, and potential disinformation campaigns targetting trans people is interesting. Is there something in particular you’re referencing, or is this more speculation on a potential issue?

I know my biggest barrier to care was indeed medical clearance and medication/tools restriction. Even with socialized coverage, it was about a thousand dollars and five months of my time to get started; let alone the years I spent waiting to even start the process because I knew that would be the most expensive hurdle. Hardly had to go through the same process for ibuprofen, which also carries fairly severe side effects if abused.

Yeah I mean, I think that is a very important thing to explore if you’re in a safe mental space to do so; it can be surprisingly grievous in my experience.

Like you, I never really complained about having a penis, and since I was always kind of annoyed with having one, I thought everyone elso also simply tolerated their penises. I’ve always felt like it gets in the way, gets uncomfortable, annoying to piss with (seriously, why tf do we still let men piss standing up in any other place than a public urinal?). So, it came as a bit of a surprise to me when I heard that men actually enjoyed having one, especially after the insane shit I could see cis women do for sexual pleasure, like you mentioned above.

I didn’t mind topping, I didn’t mind being the one that leads during sex, or takes on more aggressive/dominant, masculinized roles, but never once did I feel fulfilled by that. Obviously, penetrative sex can still feel very good strictly in terms of physical sensation, but yeah, it’s nothing I go for except for exceptionally rare cases.

The reason why I said “grievous,” is because this realization actually hurt a lot when it came to me. It wasn’t that I was just exceptionally sexually deviant, or desensitized by porn and sexual violence, I just had an entire lifetime of sexual understanding and fulfillment kept from me. It honestly gets deeper down into your psyche than you realize.

I completely get the kinks (I seriously don’t think piss counts as weird or gross, especially for people who may have very deeply rooted discomfort with anything associated with their genitals). But yeah, I discovered that a lot of my own sexual tastes were rooted in a fundamental dissatisfaction and neglect, and even though I may enjoy many of the same kinks, the way I used to enjoy them more closely resembled self-harm than sexual pleasure; which comes with its own sort of grieving.

This isn’t to say you’re engaging in self-harm yourself, but just to put it out there if you’re worried that this may be the case. It’s completely normal to question your enjoyment of "male-"coded sexual acts, and you may even continue to enjoy them once you understand how they relate to yourself rather than what you’ve been socialized to use a penis for.

Well, I’m sure that’s all they care about erasing – for safety, of course – and this won’t set a precedent of marginalizing “disgusting,” or “deviant” representations of sexuality that could pose a harm to others.

Remember, they think queerness is a kink, and refuse the difference between self-defense and harm.

This is very true, no amount of suffering is worth committing yourself to injustice, even if the suffering they experience could even be as bad as they seem to think it is. I think it is also important to specify that they enjoy the power patriarchy affords them while still understanding that they aren’t satisfied with this system. Many men resort to anti-feminist, conservative talking points merely out of recognition that their only vectors to a (potentially) more fulfilling way of life is to either implement substantial and fundamental changes to society, or capitalize on preexisting inequities and wrestle away what little is afforded to those beneath them in the hierarchy. They’re not lying when they say that this is miserable, trans women certainly know that the way we raise men is brutal and dehumanizing, even if they access privilege through the process.

The existence of transness also tells us that privilege is indeed not an insurmountable barrier to self-reflection and change, which means the men who choose to be disatisfied and take it out on those whom they know are more vulnerable really are just pieces of shit who could simply not do what they do. God knows they’d suffer less for defying patriarchy than trans women do, and even that is too much of a cost for many of them.

I don’t know if we need to reconstruct it from scratch, even if just because I don’t think we should have a cultural understanding of masculinity that doesn’t remember the harm that came from the social and material relations that the current hegemonic masculinity emerged from. Whatever comes next will always exist with a relationality to this patriarchal system which has caused monumental degrees of harm to human life, and all life on this planet. I also don’t know if I’d call this form of patriarchy a continuity from what preexisted capitalism and European settler-colonialism, since so much of hegemonic masculinity is defined by white supremacy, commodification of nature, property, and so on.

It really is a uniquely – pathologically – violent way of life. I think that is reflected in how obvious it is that men would rather have something different, and simply call misandry because they resent the fact that they don’t have the power to do that while still getting to be disgustingly fixated on dominating others.

That does always sting.