I had just about reached a point where matters of self-loathing, doubt, and anxiety were no longer overwhelming. I had just about been able to embrace genderqueer, to be able to go there and stay there without a need to resurface in desperation, like a person holding his or her breath underwater. I had thought that the pain I felt within myself was nothing compared to that of the outside world. I had read the stories of others and begun to think I might escape unscathed in every way. I had thought wrongly.

Part of the treatment of hypogonadism in men involves lowering Estradiol (estrogen) levels. As I’ve written about, my testosterone levels have been abnormally low, so I have been injecting testosterone into my body to compensate. To make a very long story short, my body believes that these low levels are normal, so it’s only willing to process some of that which is injected. Believing that the rest of the testosterone is “excess”, it promptly converts the significant remainder into Estradiol. High levels of Estradiol prevent me from reaching a therapeutic level of testosterone and cause other unwanted side effects.

I was recently prescribed Femara, a drug originally designed to assist women suffering with breast cancer. Off-label, however, it has been quite effectively used for men, as it prevents testosterone from being converted wholesale into estrogen. After my latest endocrinologist visit, I was handed the prescription, then visited a pharmacy to have the script filled. When I dropped it off, I had a brief discussion with the pharmacist that seemed to be relatively perfunctory and uneventful at first. My only worry initially was that the insurance company might balk at the cost or might reject the claim outright because its official use is still only indicated for women.

However, while correcting some basic patient information that had been incorrectly entered into the pharmacy’s computer system, the pharmacist made a very hurtful remark. Due to the nature of his work, he surely knew about the particulars of the medication, and likely found it unusual that it would be prescribed to a biological male. His response, however, was unexpected and unwelcome. Establishing the precise context is difficult to convey since one would have really had to be there to understand. But nonetheless, his exact words were, “…or however you choose to identify yourself.”

Out of context, this remark would appear to be benign. Yet, as only inflection and body language can adequately convey, it was said contemptuously and deliberately. He may have been choosing his words carefully, but he was not masking their meaning.

At first, I thought that he was referring to my bisexuality. I’ve gotten criticism like that before, particularly because I tend to partner and be intimate with women more than men. In that sense, it means, “you say you’re bisexual, but I rarely see you with men.” But that didn’t seem appropriate to the context. I thought, “How would he know my sexual orientation? And how would that be relevant to my prescription?” Then it hit me. “He thinks I’m transgender!” And along with anger came those same feelings of loathing and shame. In that circumstance, he meant, “gender identity isn’t nearly as complicated as some make it out to be, but I guess you can be male or you can be female. It’s all in your head, but I guess you can be male or you can be female.” Hello transphobia!

I know now some of what a person undergoing transition or maintaining a desired state goes through on a constant basis. But I don’t fool myself into thinking that one incident is sufficient to understand the full experience. These remarks, offensive though they were, were nothing compared to the hatred that still spews forth, largely unchecked or unchallenged. That I received them from a pharmacist, who one might think would be more understanding, due to the nature of his vocation, only shows how deeply the discrimination goes.

This regrettable event has been another in a long procession of humbling experiences. When I was considering transitioning myself, potential incidents like these were always at the back of my mind. Though my reasons for opting out go well beyond the fear of being treated this way, I’m sure that there are others who desire transition and are afraid to risk the consequences. I am once again reminded of the bravery and courage of trans people, particularly for those who make a conscious decision to be public with who they are and what they have to go through. Yet, as I write this post, I advocate for increased awareness, not rage and righteous indignation. A particular anecdote I recall seems most pertinent here. It concerns a violent act that happened to the well-regarded Democratic politician Adlai Stevenson II.

In Dallas, Texas, woman carrying an anti-United Nations sign hit Stevenson in the head. A man spat on him and on a policeman. Amid the furor, Stevenson said of his assailants: “I don’t want to send them to jail. I want to send them to school.”