I’m feeling hopeless. Of course I have depression. And no, I don’t take medication for it. In fact, I’m also due for an E injection next week. In the last three months, I’ve been wondering whether it’s the circumstances that have hurt so much, or if it’s just the events in question occurring at a particular point in my hormone cycle. (When I see my endocrinologist the next time I’m going to find whether I might be able to take care of some of these feeling just by adjusting the frequency of hormone injections rather than trying to combat the side effects of one medication with the main effect of another.)

In November, it was the conjunction of my birthday, fucking up my estrogen injection, not having enough money to get the prescription refilled so I could have a do-over, and not having enough money for the mortgage payment. I think most of the stress is self-explanatory. The birthday might need some explanation. I normally like my birthday. I get free stuff from Sephora, I usually take the day off work and go shopping. I did that this past year, too. Except this year I received a card from my Mom and Dad. More properly, Joshua* received a card from his parents. After I spent the better part of a week (two weeks?) crying about it, cutting myself, and crying some more, I put the card in the shredder at work.

December was a pretty miserable month. I spent the first few weeks recovering from the most recent bout of cutting, and then Christmas Eve was excruciating. I spent most of Christmas Day in the shower, letting the water run through my hair and over my face. Long after all the hot water ran out, I was still sitting in the bottom of the bathtub, crying. The water was freezing, my toes numb. I was crying for the parents I wasn’t seeing, for the twisted parody of the holiday that I was participating in, something that tried and failed to feel like Christmas. I was crying for church, the way people treat one another, especially God’s people. It may not have seemed like a bad Christmas if you were outside looking in, but it was the worst I’ve ever had.

Since the new year, I decided I would try and work on a financial plan, something that would help me reach my goal of getting surgery before I hit 40. I figured out that if I wait four more years, I might have enough money in my 401(k) at work that I can borrow enough money out of it to pay for everything. That’s a big “if” but I need that hope. And we’re changing health insurance at work: Blue Cross. In some cases, Blue Cross is rumored to pay for GRS. I checked online, and their clinical guidelines do state that it can be medically necessary and therefore, covered. I really got my hope up, I’m sorry to say, and crashed hard when I realized that all of our policies at work will exclude coverage for GRS. The clinical guidelines are just that, guidelines. There’s no requirement for a procedure to be covered just because it’s medically necessary, and the exclusions in the policy can trump the good judgment of the three doctors I see regularly.

That whole process feels hypocritical, and it’s the thing that pisses me off about people expecting health care to get better without public options and without government interference. The situation we’re in right now is what the free market does sometimes: companies realize that with a commodity like insurance that the insurers can charge more and cover less, treatments get excluded not because they’re not medically necessary but because it’s too much hassle to cover, or not enough people take advantage of the coverage. If less than 1% of the population in the US is transgender, is it any wonder the insurance companies don’t feel a lot of pressure to cover our care? Why exactly would we expect them to correct this particular oversight on their own? Because they’re all such good people?

That certain coverage is excluded doesn’t surprise me anymore, but I realized something: whether you expect it or not, being slapped in the fact still hurts, and that’s what I’m reeling from. I’m left with a feeling of hopelessness and the sense that I deserve the misery in which I’m now mired. I alternate between that, blaming God for doing this to me in the first place, and blaming society for making things so inconvenient, so hard for me just to be myself and live my life and move on.

Placing the blame on other quarters is an easy way to absolve myself of any responsibility, but it’s not worth very much. Proving that I’m being treated unfairly doesn’t allow me to improve the quality of my insurance coverage, it doesn’t increase acceptance at work, church or with my family. It doesn’t change the fact that I have a penis and sometimes I think that I’d like to get the chef’s knife out of the butcher block and cut the fucking thing off myself**.

At my company’s benefits fair yesterday, it took our medical insurance rep half a minute to get over the word transsexual in the Blue Cross clinical guideline when I was asking about transgender coverage. I felt a little bad that he was so uncomfortable, but then realized that I didn’t exactly have the option of being uncomfortable about outing myself to him—I either had to go up and ask my question or let his employer, my insurance company, take my money and invisiblize me as a trans person at the same time.

That experience sets me to wondering what it was about me made that insurance agent so uncomfortable in the first place: some kind of transferred castration anxiety? Or is it homophobia that has trans-misogyny and oppositional sexism at its root? I start to internalize that reaction, start thinking there’s something wrong with me, something within from which I ought to recoil. That process speaks to my possible self and says I’m never going to be a real woman, that I’ll never bear my own children or wear my own white dress at a wedding. It says to not-yet-me that I can be, at best, a facsimile of real women, but I’m not even there yet. It is painful and humiliating to want something you know you can never have.

A novelist named William Styron said, In depression… faith in deliverance, in ultimate restoration is absent. The pain is unrelenting, and what makes the condition intolerable is the foreknowledge that no remedy will come– not in a day, an hour, a month, or a minute… It is hopelessness even more than pain that crushes the soul.”

That sums up how I feel right now. Last night my wife said to me, “But you have a plan, we’ll get there someday.” Though I’m sure we will, I couldn’t help but remind her that she’s not the woman with a penis in our family. Every day there are a million subtle reminders that I’m not right, that there’s something off, and every hour of it feels like a life sentence.

One of my aunts (one of the two that still talks to me) shared a quote from the book of Lamentations with me: Because of the Lord’s great love we are not consumed. It occurs to me that I’d like it better if God stopped doing me so many favors. I realize that sounds petulant, and to an extent, it is. In a discussion of Romans 9:20-21 I’m not ashamed to admit that I’d say to God, “Why’d you have to go and fuck me up so badly?”

That good things can come from bad experiences doesn’t make suffering into a good thing. It’s still a bad experience, just one that doesn’t end completely badly. Suffering is always an unfortunate thing and it disgusts me the way that some people try to portray it as noble or Christ-like. To pretend that suffering is God’s will is inconsistent with the God that says “I will give in my house and within my walls a monument better than sons and daughters.” It’s even inconsistent with the God who said, “Be of good cheer; I have overcome the world.” Things might be difficult, but that doesn’t automatically make it God’s will.

The process of suffering does matter, or at least it should. Writing it off as God’s will just because something good might eventually happen feels like missing the point, just like all those people who suggested I wait longer to transition missed the point. How long is long enough? How much suffering is enough? Or that it’s all going to be okay just because I’ll be a girl when I’m all done? I call bullshit. The ends don’t always justify the means, and things aren’t always sunshine and roses and puppy dogs at their end.

I don’t know that I would say that transition is worth it– it seems a lot of people imagine it will bring less suffering than what’s been left behind, but I don’t think that’s true. It’s more like all the problems get brought out to the surface, made visible for people to see (even if you don’t want them to), and you have to deal with all of it one by one. It may not sound that bad, but speaking from my own experience, it’s excruciating. Worth it? I don’t know. I do know that I couldn’t have kept on the way I was; it was unbearable, and trying to stick it out wasn’t going to work.

I have a way of going over these things in the dark before I sleep. I’ve had bouts of theodicy in the past several months (as you might be able to have guessed), cursed and cried at God, confident that if He truly is God then He is not hurt by my cursing, my petulance, or my blasphemy. He should understand hurt and understand that sometimes feelings must be voiced, regardless of what one says, or even whether one expects an answer (c.f Mark 15:34). I do not know, for example, why I am transgender, or why I was never cured, but I believe that God ought to be able to reach me in that questioning pain.

* I hate talking about myself in the third person, but there are certain points where I will do it, primarily issues of timeline. After the point where I got my name changed, and people direct communication at me with the name Joshua, it feels to me like they’re trying to talk to someone other than me. In those instances only, I refer to myself in the third person.

** It’s a common misconception that the penis is amputated in GRS. It’s actually cut lengthwise and inverted, the tissue being used to create a neo-vagina. Part of the glans is used during clitoroplasty. Cutting the penis off would actually be counterproductive since the nerve endings need to be intact for clitoral sensation. It’s the only reason I still have the damned thing.