Editorial Note:
This piece discusses suicide and suicidal ideation, and some people might find it disturbing. If you or someone you know is suicidal, please, contact your physician, go to your local ER, or call the suicide prevention hotline in your country. For the United States, the numbers are as follows:
The National Suicide Prevention Lifeline at 800-273-TALK (8255), or message the Crisis Text Line at 741741. Both programs provide free, confidential support 24/7.
For further resources and information regarding gender-affirming care and other helpful resources, please visit the following websites:
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https://www.phoenixchildrens.org/gender-support-program/programs-services/resources
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https://www.acesdv.org/wp-content/uploads/2014/06/PhxTransResourceGuide15-5.pdf
Ashley Moni is a trans woman who has kindly elected to share the details of her journey through transition. She works as a software engineer and engages in LGBTQ+ outreach in both physical and virtual spheres.
Tell me about yourself?
My name is Ashley / Aishwarya Moni. I was born in Bangalore (India) but grew up in Dubai as an NRI (a non resident Indian). My parents had jumped to the Middle East to join the booming tech sector, which left me studying and socializing in a Dubai private school from ages 4-17.
Eventually I started to figure out that I was queer, which led to me jumping to Canada for higher education because I wanted to escape to a queer friendly world. A few years later my gender dysphoria caught up with me, and I transitioned to living as a woman.
I’ve been on HRT for the last seven years, and I’m firmly integrated into a happy “post transition” life as the new female me. I’m done, I’m a girl, and I move in communities of friends and peers that have only ever known me as Ashley. As someone who’s “made it”, I want to give back: I do a lot of trans outreach and support, and I also build and maintain safe spaces on the internet for trans people.
Can you tell me a bit about your experience with transitioning?
Transition is… complicated. There are a lot of layers, and everyone’s experience is subtly different. For context I’m a pretty classic dysphoric MtF transgirl. I can’t really meaningfully talk about transition without talking about where I started and what was at stake, so let’s talk about that.
In the very beginning, there was just raw dysphoria. Nowadays there’s this ongoing conversation about transpeople in society, but back then (2005ish Dubai) I’d never heard of them. Nobody had. I didn’t have any reference frame to parse my feelings – I didn’t know it was even possible to change gender (or what that even meant), and mental illness was treated as weakness anyway. So I just sank into this impossible-to-pin-down sense of misery.
Still, let’s pin it down with the benefit of a decade of hindsight: I was dealing with a combination of physical and social dysphoria.
The physical dysphoria was the raw mental health tax of my body masculinizing outside my control – it manifested as this deep sense of dissociation. I felt disconnected from my self, like I was piloting someone who wasn’t me. People come to me for help with figuring out if they have dysphoria too, and one of my standard questions is “when you look in the mirror, do you not see a person? Do you just see a collection of body parts to maintain instead?”. If they relate, that’s a pretty big red flag.
The social dysphoria was the increasing sense of disconnect from my gender role in society. I was a man, and the world never let me forget it – it came with a lot of advantages, but it also came with this sense of being dangerous that deeply depressed me. I was a threat. When I moved to Canada, I became a distinctly Middle Eastern man, which made me even more of a threat. Am I walking too close to the girl on the street? If I play with the kid on the bus will her mom start a scene? If I’m alone with someone in an elevator, do they feel safe?
All these factors interlocked and slowly destroyed me. I felt asphyxiated. I felt trapped in my own life. I was piloting someone I didn’t know and didn’t like, the sole watcher in a movie theater playing someone else’s daily routine. I didn’t wish the guy any harm, but I also wished I could just… leave.
So: I was depressed.
I was already going through suicidal ideation, and I felt like… hey, if I’m gonna kill myself, I may as well do something stupid. And transition felt really stupid! The thought of fully acknowledging my gender feels and telling someone about it absolutely terrified me. I was terrified of trying to transition from male to female and… not making it. Exhausting my body’s genetic potential to make the leap all the way to the attractive normal girl I wanted to be, and becoming something altogether abnormal and disgusting. I desperately wanted to “pass” – to look like any other unremarkable girl on the street to strangers.
Everyone knows that passing is an unhealthy metric now, but back then it was a lot scarier. Out and proud trans people who publicly owned their trans status simply didn’t exist. The existing trans communities at the time built all their support around going “stealth”, around perfectly blending into the life of a fake cisgirl – you cut ties to everyone you know, run away to a new city, craft a fake history for yourself, and get really really good at makeup. Passing was vital for survival. I couldn’t imagine a life of being seen as some half guy / half girl freak, some “dude in drag” like all the Hollywood gags made us out to be.
So when I committed to transitioning, it was a bit of an all-in. I told myself I had nothing to lose: if it didn’t work out and I didn’t like the me I became… well I was already thinking about killing myself.
It took me eight years from my first trans feelings to reach that day where I finally told my university counselor that I was trans. It felt monumental – saying it in real life made it feel real, made it feel like something I could no longer take back or reverse. Something snapped and I pursued HRT obsessively, desperate to get on medication as soon as possible so I could stop testosterone from permanently damaging me any further.
But it all worked out! Happy ending!
So, uh. Answering the original question: what was transition like?
It was honestly really nice. It was super life affirming in the long run, even if there were some hiccups along the way. A year and a half after I’d taken my first pills, I knew that I’d picked the right path for myself and embraced the new me wholeheartedly. Things just… got better.
Right off the bat: I want to stress that transition is primarily psychological. The physical changes are a means to a mental end, a way to clear psychological stressors. And one of the biggest stressors dysphorics face is a sense of decay. Before my meds I had a clear vision of what I wanted to be, and everything about growing up was an exercise in seeing that vision torn to smaller and smaller pieces every day. I hated growing facial hair, I hated getting taller, I hated knowing that it was all permanent and I was moving further and further away from… me.
So when I first got my meds, I immediately had the bone-deep sense of relief of having meds at all. Suddenly, a huge weight was lifted off my shoulders – the clock was now on my side. Every day I waited, I was becoming more feminine, more repaired, more… me. My skin would get softer, my hips would get rounder, my body hair would get thinner. I woke up one morning feeling pain in my nipples, and that was one of the happiest moments of my life. Even my brain started growing in the direction I wanted – jumping from testosterone to estrogen upped my general emotional sensitivity. As a guy my emotions felt dulled, but as a girl I cried at the drop of a hat.
While my body sorted itself out, I had to put in a ton of effort into socially transitioning too, starting with how I treated myself. I struggled a lot with seeing myself as a “real woman” and negotiating my need for other people to treat me like one. I had a lot of identity crises that didn’t really fully resolve until some three years after I took my first pills. There was also just a lot of actual moment-to-moment work too – constant voice training, coming out to my family, building a new wardrobe, etc.
I mentioned earlier that I knew I’d picked the right path for myself after a year and a half. That year was crazy busy and high stakes and sometimes felt like one step back for every two steps forward. On testosterone, dysphoria was a dull abstract kind of pain. The heightened emotional sensitivity + newly calibrating neurochemistry + being forced to be honest about myself made the dysphoria worse before it got better. I was acutely aware of how much I was suffering, and being submerged in a whole new set of teen years made me moody and immature.
So that was my transition: a wild all-in with my entire life on the line, for the grand prize of getting to be alive in the first place. Fun!
What was your interaction with physicians like before you transitioned?
The general consensus in the trans community (both at the time and still kinda now) was that medical professionals fundamentally didn’t have our best interests at heart. They didn’t actively dislike us, but they were still more invested in maintaining society’s status quo than actually helping us?
Back when I transitioned in 2013, it was during the denouement of a medical paradigm where doctors got to judge whether we were allowed to transition or not based on… I have no idea. Them eyeballing our ability to integrate into polite society? We called them the “gatekeepers”. I know transwomen who’ve had to fake being straight and lie about wanting to be housewives to husbands before they were given access to meds.
It’s why a lot of trans people do DIY hormone replacement therapy. And honestly? I can’t blame them. For some, there just isn’t a reasonable chance of them getting the care they need through the official system… yes they endanger themselves, but living untreated is an ongoing danger too.
My personal experience with physicians was a lot more positive, but equally eye-opening. I knew the rest of my community treated them as scary, or at least filled with a large faction of gatekeepers, but I tried to not let it discourage me. I grew up as a nerdy guy with a STEM background, and that gave me a healthy respect for doctors and medical professionals. I already had a history of fighting my family on alternative medicine and general quackery, I’d watched House, I knew the score: don’t lie, trust what doctors tell you to do. It’s their job to have the expertise and emotional distance to chart the correct course forward.
I ended up finding a psychiatrist who was absolutely wonderful to me – we clicked right away and she was fully in my camp, doing her best to support me. But something scary I realized during my years with her was that… there honestly wasn’t much she could do. There was very little external insight she could bring into whether I was “really trans” or not, all she could do was reflect my questions back at myself and ask me how I felt. I was also the first trans patient she’d ever helped through transition – she’d been assigned to me because no other counselor at my university had ever treated a trans patient at all. She was the most qualified therapist on hand and she didn’t have any training or experience to help me.
It was mind-blowing to realize that she was as lost as I was. Even if she was a medical professional, she had no tests or protocols or deep knowledge about my condition that I didn’t already know myself. Worse than that – I arguably was a better expert than she was, because I was the one living through the trans experience myself
I had an epiphany after one of my sessions with her, that I may actually be my city’s expert on the psychiatric care of trans people. That even if there were other trans people in the city who knew more than me, I knew more than every doctor in it. That if someone came to me asking questions, the best person to be on the frontline and try and help them was… me. All my psych could do was write a referral to an endocrinologist for HRT.
That was extremely scary. Those “other trans people” in my city were pure hypotheticals too – I hadn’t found any trans mentors or other transwomen trying to pioneer a non-stealth life of being openly trans (a plan I had committed myself to). For better or worse, the lives of every new trans kid that passed through my life since felt like it became my responsibility – a responsibility I’ve tried to live up to.
The trans community has a much better equilibrium with the medical community these days. The informed consent model of trans care is starting to take the world by storm, and trans people can simply ask for HRT without having to explain themselves. There are actually loads of fully-out transpeople now! Being openly out and proud is a new normal that transgender children are transitioning into, which itself reduces the need for medical intervention in the first place.
And in the background, I’m continuing to help as many trans people as I can. I used to hang out at my university campus’s LGBT center and speak at panels hosted by LGBT support organizations. Nowadays I build online support spaces and try to be a cool visibly-trans role model as I move through my daily life. On some level, I feel like I’ve levered myself into an ad hoc position as a piece of the medical care pipeline for countless girls like me, and it’s part of why I readily agreed to this interview.
I’d love to help doctors do what I do.
Mohammad Khan is a fourth-year medical student in The University of Arizona College of Medicine – Phoenix, Class of 2021. He graduated from Arizona State University in 2014 with two bachelor's degrees in biochemistry and biology. He then worked as a teacher and completed a Master's in biomedical diagnostics in 2017. For fun, Mohammad (who also goes by Mokha) likes to practice at the archery range, work on calligraphy, game, and fountain pen writing, and read science fiction novels. He is interested in medicine with a focus on educating patients.