It was 2018, and we’d been in the U.K. for just a few months when J said the words that changed everything.
I was in bed, having just woken up, and J was heading toward the bathroom. “Hi, love,” I said. “How are you?”
He turned around slowly. He was completely pale. “I don’t want to live anymore,” he said blankly, before turning away. I was devastated. This was my life partner — the person I loved most in the world — and moving to my country of origin had driven him to this.
Right then, I couldn’t have gotten us out of the U.K. fast enough.
A year before, living in Britain had been our dream. When we realized J had the right to a visa, we danced around the kitchen of our Massachusetts home. That said, we knew it would be a big transition for both of us. J had always lived in the U.S., and even though I had lived in Britain for the first three decades of my life, I had been in Massachusetts for over 10 years. Now, as a dual citizen, I had never planned to leave. But every time J and I visited England together, I would see how the place lit him up, and when he shared his dream to live there, I found I longed for it, too.
There were so many reasons to make the move. Among them was Britain’s National Health Service, which is paid for through taxes. We knew the NHS had plenty of problems because of countless budget cuts, but it also provided what was effectively free health care and had deeply committed staff. As freelancers, utilizing the NHS would mean we would no longer have to spend over a thousand dollars per month on health insurance.
Even so, we were especially careful about researching whether the NHS would give J access to his testosterone, which he couldn’t even think of living without. I called a U.K. activist help line about this, just to make sure. “I can’t see any reason why J would be denied,” we were told. “It’ll just take a doctor’s appointment.”
We were relieved. It seemed the move would be a safe one.
How wrong we were.
Once we arrived in the U.K., we booked an appointment with a general practitioner who was well-respected by trans patients. However, this doctor told us that when it came to J’s prescription, her hands were tied. Legally, if she were to prescribe gender-affirming hormones, she would have to get permission from a gender dysphoria clinic. “It’s all right,” she said. “We’ll fax them today.”
J knew a red flag when he saw one. He had read all about the U.K.’s gender dysphoria clinics (which were then called gender identity clinics), so he knew there were just seven across England and Wales. Whether using the NHS or private insurance, the specialists at these U.K. clinics were the only ones who could diagnose trans and nonbinary people with gender dysphoria. Without this diagnosis, there is no legal access to gender-affirming hormones, surgery and more. However, waitlists for these clinics were huge. At the time, it was taking trans and nonbinary people a horrifying two years to get the initial appointment. (These days, the wait is three to five years. No wonder activists are pushing for change.) So when exactly would such a clinic have time to respond to our GP’s fax?
We waited anxiously. We called our doctor’s office every day. More faxes were sent to the clinic, but there was no answer. We contacted J’s U.S. doctors, who were hugely supportive, but because of U.K. laws and the fact that testosterone was a controlled substance, could do nothing to help J’s cause.
Meanwhile, my husband watched his remaining supply of testosterone dwindle more and more every week. It was as if he were disappearing along with the precious liquid in that vial. J had known he was a boy when he was 5, even though he was told he wasn’t. He had waited decades to build up the courage to come out and live in his true gender. Then, because of the way the U.S. operates, he had to jump through undignified hoops just to prove that he was who he said he was, so he could access trans health care and more. But all this was meant to be over now. He’d seen the U.K. as his “fresh start.” Yet here he was, being ignored. Nobody seemed to care.
During this time, I kept frantically phoning the NHS help line, but with no success. Then, one day, I got into a conversation with someone who was prepared to have an argument. “So just to confirm,” I said, “the only reason my partner is having to experience a break in his medication is because he’s a transgender immigrant?”
For a moment, there was silence.
Finally, I was asked to email someone and repeat what I’d said. I did so immediately. The gender dysphoria clinic faxed its permission to J’s GP within 24 hours.
Still, the battle was far from over. J had been told he couldn’t be given more than a “bridging prescription,” until he was “assessed” by a U.K. gender dysphoria clinic. In other words, just to prove he was who he said he was, he’d be forced back into the invasive “assessments” he had endured in the U.S.
“It’s as if my whole transition is invalid here,” he said. “They’re acting like I haven’t even started.” What questions were they going to ask J during that assessment? What were they going to make him talk about or do? The mere thought was invasive and triggering, like something from George Orwell’s “Nineteen Eighty-Four.”
As we discussed whether to stay in England, I remembered what it had been like when J was first transitioning. I’d watch him walking into a public men’s restroom with his hood pulled down low over his face and his head bent low, while both of us hoped he would blend as male and escape any danger. I’d wait outside with my phone in my hand, my heartbeat sounding in my head, trying not to think about the very real threat of anti-trans violence.
Such restrooms had started to feel safer once J had started blending as male. But now, years later, the U.K. felt riskier than those restrooms had. How could we be sure that J would emerge unscathed?
So we packed up our stuff, gave away all our furniture, got on a plane and didn’t look back. That’s not to say that leaving wasn’t hard. Before we wheeled our cases into Heathrow Airport, I remember taking one last look at the cool sun sloping onto the streets. Around us, we could hear the warm, familiar accents that were so like my own. It hurt that we didn’t fit here.
Given that J is trans and I am nonbinary, we were both aware that the United States is oppressive, too. In the U.S. if you need to medically transition, you are also put through dehumanizing “assessments” to prove your gender dysphoria — and that’s assuming your health care provider agrees to treat you.
Trans youth experience oppression, too. For instance, we often deny trans and nonbinary youth hormone blockers, which studies suggest are actually life-saving. All these affronts also slow down or prevent trans and nonbinary access to gender-affirming care, even though studies suggest quicker access could substantively reduce widespread suicide and depression.
Here’s what I’d like to see: Instead of making trans and nonbinary people wait for gender-affirming hormones, surgeries and hormone blockers at their own risk, we need to focus on the dangers of delaying and blocking such support — and we need to do so with urgency. After all, according to The Trevor Project, more than half of trans and nonbinary youth have considered suicide over the past year. Yes, trans and nonbinary people are literally dying because they can’t access gender-affirming care. So if our governments and medical professionals truly believe that trans lives matter, it’s time to put those words into action.
Star Williams (they/them) is a freelance writer who lives in Massachusetts. As well as publishing fiction and nonfiction in numerous magazines and journals, they’ve been an editor at Narrative Magazine and a writing instructor/manuscript consultant at Grub Street. Star has won writing awards for their nonfiction, fiction, and screenwriting from Glimmer Train and Screencraft, among others. They adore their queer stuffed animal, Duck, who has his own blog at www.chuckleduck.life. Star and Duck are also on Instagram at @ducking_ace.
If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for free, 24-hour support from the Crisis Text Line. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.