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"Now, I realize that I always knew and that it was always a part of me..."

"A while ago I had shared a popular infographic from Pink New on my Instagram story. It was a pie chart of what people *think* trans issues are and then the next page was a chart of what trans issues *actually* are. I had seen multiple people re-post this same infographic on their story. As I continued to see the graphic, I realized that it was important for me to share my experience with the medical industry, so that other people can understand that it is annoying when I have to continue to correct people when they use the wrong pronouns (what people think trans issues are), but on a daily basis 10,000 other things I am battling (what trans issues actually are).

I identify as non-binary and my gender expression is very masculine leaning. I wanted to start hormone therapy so I started by asking my primary care doctor, and they were admittedly like, “I don’t know. We aren’t well versed in that… Here are some resources.” It was downhill from there… So I had shared some of that on my Instagram and from there I was introduced to Diagnosis: Queer and decided to share my story.

At what point do you feel like queer started being part of your identity?

The more I have become comfortable in my identity, the more I reflect on that question. I think if you had asked me that when I first came out, I would have been like “I was just thinking about it and now here I am!” Now, I have been in therapy for quite a while. Thankfully, I work with a therapist who is very well versed in LGBTQ+ resources and issues. That is what she focuses on. We will be talking through things and she will pause me to say, “Sam, that was a very early sign that you are trans.” This might be TMI, but recently I told her that when I was a young kid I would try to go to the bathroom standing up. Obviously, as someone assigned female at birth (AFAB), that is not how you use the bathroom. So in my mind, I was just a stupid tomboy. I have two brothers so that would be a cool thing to try, right? When talking about this in therapy, my therapist said, “That is actually on this list of very early signs before children have the language to describe signs that they may be trans. You just didn’t have the words as a kid.” Now, I realize that I always knew and that it was always a part of me. There were lots of little things like that throughout my childhood with the most outwardly expressed sign being that I was very tomboy-ish. I was never the girlie girl.

I think the point where it clicked for me, where it wasn’t something that I could ignore anymore, was in my senior year in college. During that year I had just gotten out of a long term relationship with a man. We were very happy. There was no need for me to question anything as life was good. When you are a senior in college and your boyfriend dumps you and your world is crumbling, you start thinking! Oh, here is this thing I have been thinking about forever, and here is my opportunity to actually pursue it.

When I first came out, I was still identifying as cis female, but now as bisexual. I feel that for a lot of women who come out that can be the segue to being able to say that they are gay. I didn’t date men after that! Like see you later *throws up peace out signs*! From there, I came out and thankfully, despite the fact that no one was throwing me a coming out party by any means, my family and friends were like, ‘Yeah, cool, alright, we don’t care.’ I think that helped a lotMy mom and I have revisited this conversation a handful of times since as it almost was a disheartening experience for me. I remember that we were sitting in the living room talking and I said, ‘Mom, I like boys and girls.’ She responded immediately without hesitation, ‘Are you sure?’ I was like, ‘Yeah I’m sure! Like what do you mean?’ Mind you, I figured if anyone was going to understand, it would be my mom. We are best friends. I grew up near Cape Cod so going to the carnival in PTown was our big summer excursion. She was always saying, ‘Be who you are! Love who you love!’ So I assumed that she would say, ‘Alright honey, love you! Wanna make some cookies now??’

But that isn't how things went. Looking from the outside I realize other people might be like, ‘oh she questioned you? Whatever.’ To me, though, at the time that was earth shattering. She was the first person I told and I assumed it would be a piece of cake, so when I told other people I thought I would at least have mom on my side. At that moment, I shut down and thought, ‘What did I just do?’ After I said that I was sure, there was an awkward silence so I got up and went to my room. A couple minutes later she came upstairs and said, ‘I’m sorry. I know that was not the right thing to say. You caught me off guard. I obviously love you and you are going to love whoever you love. I do not care who that is!’ I was like, ‘You’re good! It’s fine’, but internally I thought, ‘Can this just be over now?’

Since then, we have revisited that moment, I have said to my mom that I thought she was the one person that I thought would be immediately supportive. It took me a long time to work through. She is so heartbroken and has apologized for it many times.

I also think the timeline of my coming out process was challenging for my family. I was dating a man for 5 years, we broke up during my senior year of college. I was very feminine presenting, trying to fit the ‘going out with my girl friends to party and to get attention of the boys’ role. Back then it was assumed that if I am going to be with a boy, they are going to want me to look a certain way. So I went from tomboy to dressing girly for special occasions, to hyperfeminine. Looking back, part of that was me stuffing the gay down as I wasn’t ready to confront that yet. Soon after I came out and was in a same-sex relationship. In that same-sex relationship I started to explore my sexual orientation, my gender identity, and my gender expression. I slowly, but surely, started dressing more masculinely. My go to look for the longest time was a button down shirt, khakis, and a backwards hat with my hair pulled back so tight in a ponytail that it looked like I didn’t have any hair. I was totally the baby lesbian stereotype.

I was very hesitant, with both other folks and myself, to use the word trans. I struggle with that whole other aspect of my identity, particularly around the thought of being trans enough. Do I and can I even use the identity label of trans because I am not going from one end of the binary gender spectrum to the other? I am very much in between. I don’t fit either box. If people look at me, I certainly present more masculine, but I don’t want to be a man. That is hard for people to understand.

At the tail end of my previous relationship, things were not going well. We were broken up, but not living together. I was ready to move on from the relationship so I set up a new dating profile on bumble. On the profile, I put non-binary as my gender. My ex who was also on the app saw it and called me out saying, “Um… why does your profile say this??” That is really the first time that my identity was known to someone else without me necessarily saying it directly to them. When I started dating my current partner, I was identifying as female, but was presenting masculine and expressed to her that I was exploring my gender identity (and everything else that entails). We have now been together for just over two years now, and this has always been a part of our relationship- from me exploring my identity all the way to starting hormone therapy and exploring surgeries.


There were certain things about my body and myself that I was so uncomfortable with, which prompted me to explore medical options related to my gender. I feel like so much of my journey was realizing that many of these things were there for so long before I had the words to describe them or the resources to understand them.

Now I know that I have been experiencing dysphoria related to my chest, and previously my voice, for quite some time. Even my hair! Cutting my hair was a huge step in my social transition, and was the first time that I felt a relief of dysphoria. As I mentioned before, I would consistently have my hair pulled back into a ponytail. The change around cutting my hair, going to a barber (instead of a salon), and styling my hair short, helped me so much. In what other ways can I be doing these things? It was then that I started to realize that other people have to be experiencing and doing these things. I obsessively started following people on YouTube and Instagram. One of my favorite people is Miki Ratsula who is also non-binary and recently had top surgery. Another is a queer artist, Meg Emiko (@megemiko on Instagram). They are someone I enjoy following on YouTube as they were documenting their experience starting low dose testosterone. They also included the language they used when speaking with their doctor and research they did before. All of the things they were talking about were things I wanted to change. I felt seen and heard. They were doing it so I started questioning how I could also do it. It almost felt like a tutorial! Meg did this on their YouTube channel, now how do I go do these things? What really helped me is their perspective as another non-binary person rather than someone who was transitioning from one end of the binary to the other. They helped me build the knowledge and confidence to realize that what I was experiencing was real and that my doctor wouldn’t think that I am crazy.


I called my primary care doc and I told them that I was interested in starting hormone therapy and I had some questions. I got the appointment scheduled and from then on it was an absolute nightmare.

I don’t do well with doctors in general. I get anxious and worked up. So when I went in they had my legal information and my full legal name, which is Samantha. They were calling me Samantha, and I asked if they could call me Sam instead. At least they were okay with that. At the same appointment there was a nurse that came to take vitals. She was also asking about sexual orientation and things like that. I am almost positive that I told the nurse that I was using they/them pronouns. She told me that they/them pronouns are not an option in their computer system to officially mark it, but that she would make a note so that they have that information recorded. I was feeling somewhat hopeful that they would note that somewhere in my chart.

The doctor finally came in. They were using Samantha and she/her pronouns right off the bat. Immediately I realized that the appointment was not going to go well. I was not feeling good at this point. I told her that I am non-binary and I do not want to transition from one binary to the other. I said that I am interested in starting low dose testosterone for hormone replacement therapy because I would like to move to an androgynous appearance and for my voice to lower. I had a whole spiel that I fired off. First she gave me a 30 or so second pitch saying, ‘Just so you know this is not my forte. I am not super well educated in this area. Blah, blah, blah.’ Had she stopped there and referred me to someone with more knowledge, I would have understood and it would have been fine.

That is not where she stopped and this is where I started to think, ‘Get me the frick outta here!’ She then took it upon herself to give me an at length lecture in regards to my weight and essentially try to pitch and sell me a referral to bariatric surgery. That went on for quite some time. So there was that 30 second disclaimer of saying this isn’t my forte, BUT let me tell you what is!

After this whole lecture she asked if she could give me a referral. I was in absolute shock and disbelief. I did not know what to say so instead I said, meekly, ‘Yeah, sure…’ She was like ‘Okay great! We will get that paperwork in the process.’ Through the same practice they have someone who comes in once a month to work with trans patients, so she said that she could set me up to see them. In summary, I get immediately shut down, I get this weird lecture, I feel bamboozled, I don’t really know what is going on, and then a glimpse of hope at the end of it.

I ended up filing a formal complaint and spoke with the manager of that practice. I expressed that this was absolutely not okay and someone followed up with me multiple times. I went for hormone therapy, and instead got a referral for bariatric surgery. It was ridiculous.


When I look back I can’t help but laugh. Making jokes is certainly one of my coping mechanisms. So I go back and tell friends that this is what happened to me while I am laughing hysterically. They are like, ‘Sam are you okay? We can’t believe that happened! What can we do?’ I just respond while laughing, ‘Eh, it’s fine! We will figure it out!’ That is so messed up!

I think that this experience is where I got the fuel to start following up with people and give critical feedback. I was in a place in my life where I had my people, I had my partner who is on my side and is my biggest support, and I was already in therapy. Yes, it was a horrible experience and totally disheartening. Yes, it was the worst experience I could have asked for, particularly in the beginning of my medical transition journey. That being said, I had the network to be supported and rebound from it all. I was so motivated to follow up because God forbid I was a younger queer person without those support systems...that could have been it. Someone in that position might think that medical transition is never going to work and this is what it is going to be like talking to every doctor. It could be the end of the road for them. That is so dangerous, and is a devastating reality for trans folks in medicine that is very prevalent today.


I was able to pursue hormone therapy after that. I have been on testosterone for over a year now. I actually get my hormones through Planned Parenthood,

which I am so thankful for as they are a fantastic resource. It is a starkly different experience. Since moving, I have moved my care to a closer P.P. office. Their language is significantly more informed as this is what they are set up to be doing. I am extremely thankful for Planned Parenthood.

Hormone therapy is going well. I have been on a low dose. Originally I was on a 0.1 dose, and for the past couple of months I have been on 0.3 so it is a small dose. I actually am now in a place where I am feeling good about where testosterone has brought me. I would rather now maintain the changes testosterone has brought rather than continue seeing more change.

My biggest medical transition goal is to get top surgery. Hopefully I will have that by this coming fall or soon after. I think that will alleviate a lot of my dysphoria. That combined with where I am with testosterone has me in a place where I am comfortable with my body. A portion of that is also about how people are perceiving me, right? For example, I have had conversations with people in public and someone will refer to me as sir. Obviously, still not the correct gender, but I would much rather be misgendered on the masculine side instead of the feminine side. If someone calls me ‘Sir’ I am like, alright bet, I look masculine enough today! That is affirming for me. Versus if someone misgenders me on the feminine side, I think, ‘What is my tell? Is my binder not fitting correctly? Are my boobs sticking out? Are my hips still too wide?’ It is that weird in between that is still so challenging, but so rewarding, to navigate.


If I could give my past self advice, before my journey of understanding my identity started, I would say this: ‘Stop second guessing yourself. Believe in what you know to be true about yourself.’ This is advice I still need to this day. I look back and I can now process all of the signs, clear messages, and language that I was using in my head. If I could go back, I wouldn’t second guess myself and I would have more faith that I knew who I was then and now. If I had the words and/or confidence to speak that outwardly sooner, who knows what my journey would have looked like? At the end of the day, I also think that going through this journey now with the people and resources I have in my life is what is right. I think that is both challenging and beautiful.

I don’t often think about how far I have come. Having top surgery in the fall is not that far away! As I mentioned before, that is currently my biggest goal in my medical transition. To think that I am almost there is wild! -Sam Buote, New London, CT (they/them/theirs)

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