A few months back, during a follow-up appointment with the surgeon who’d given me a hysterectomy, she started showing me photographs of my insides. I’d put off getting this surgery for years, but after Trump was elected again, I rushed to arrange it, leaping over the requisite insurance hoops as swiftly as possible. It was a moment when many trans people like me were rushing to do things like schedule surgeries and change paperwork while we still could.
My surgeon, herself trans, had been phenomenal: professional, compassionate, clearly expert. During our appointments, I relished the chance to chat with another trans person during this hellish era—even if it was just for a few minutes and strictly business. I privately admired her eye shadow and her nails.
Oh, here’s your liver! Looking good, she noted cheerfully. This sparse exam room was decorated with illustrations of uteruses, fallopian tubes, and ovaries. My own former uterus, fallopian tubes, and ovaries looked nothing like these diagrams. (Image-search an actual uterus if you want to see what I mean—don’t do so if you’re squeamish or eating lunch.) Confronted with my own interior, it dawned on me that I am just a bag of guts.
As my surgeon flipped through the images, her tone grew somber. During my surgery, she said, she could see that my bladder was distended. This was the visible result of a life spent holding my pee. Oftentimes in public, I just can’t go, I had explained to her and her colleagues the day of my surgery. Patients who have surgery near the bladder are often made to go before they can be discharged, so the situation turned into a nightmare, me shaking post-anesthesia on the hospital toilet.
I am just a bag of guts and yet I’d damaged myself holding my pee. I started weeping. As my surgeon and I talked, trans person to trans person, she didn’t need much context to understand the struggle. Bathroom access for trans people has long been politicized and jeopardized. Things have gotten even worse recently as politicians like Representative Nancy Mace seek to make transphobia their brand and ban the lone trans member of congress from using the appropriate bathroom.
I am just a bag of guts and yet I’d damaged myself holding my pee.
If a bearded, square-shouldered, flat-chested trans person like me were to use a women’s room (now the law in some states and also the rule on Capitol Hill), I would almost certainly face confusion and likely hostility or outright violence. Even before I came out as trans and started testosterone (which I’ve been taking for four years), I reported a podcast story about how public bathroom segregation is a public health emergency that disproportionately impacts trans and gender nonconforming people. Attacking our bathroom access is an effort to exclude us from public life—and it works. But segregated bathrooms aren’t good for anyone. Cisgender men contract UTIs because of urinal-related anxiety and women’s rooms tend to have disproportionately long lines (what builders term “overload”).
Now, even though I do pass as male (as my surgeon assured me) my body still just won’t go. How do I convince my body I’m safe, when nowadays as a trans person, I just do not feel so? I asked through tears.
Here is what happens if I leave the house for any number of hours (which, for some years after starting T, I just avoided altogether): I’ll eventually try some public bathroom and, unable to go, I will start feeling ashamed. After waiting a while, I give up, wash my hands, and exit red-faced. My partner might ask, “Any luck?” And I’ll be like, “No!” and get back in the car, beating myself up now, however audibly, for failing at a bodily function that should be so simple, so basic.
We might try somewhere else. Maybe there’s a bathroom 30 minutes out of our way with a gender-neutral single-occupancy stall or a particular Starbucks or Trader Joe’s I’ve had luck with once before. I’ll try again; oftentimes, again, nothing. I’ll drown in even more shame, feeling awful about my body, about how I am. This is what annoys me the most: Even when I do find a perfect-seeming public bathroom—one that’s not-too-quiet and locked and private, even in a visibly queer-friendly establishment—my body just won’t comply. If nowhere works, we now have to just get me home or to my hotel room or a friend’s house, somewhere private, however far away, however much pain I am experiencing.
After listening to me describe my agonizing routine, my surgeon explained something I’d never considered. Holding it so often and for so long had probably damaged the nerves in my bladder. It’s not just my anxiety holding me back. I literally have less control. I also probably have less sensation, meaning it’s likely hard for me to tell when I have to go. I nodded that this did track.
Even when I do find a perfect-seeming public bathroom, my body just won’t comply.
My truth is: Long before I came out as trans, I had struggled to pee in public. In my 20s, I was deeply closeted and wore dresses and makeup, but I still shudder remembering a particularly awful 15-hour bus ride over the Andes Mountains from Chile to Argentina when my body wouldn’t pee. The whole 15 hours. I kept trying, kept crying there on the toilet, as the bus vibrated over the mountains through the night. I remember tired bus drivers handing me ham sandwiches as I cried quietly next to my helpless ex-boyfriend.
Or, as I’ve only lately remembered, in 7th grade I pissed my pants while waiting for a ride home after school. The details are sketchy, shame-shrouded. I recall in flashes the light-colored jeans I was wearing, the white sweatshirt I wrapped around the stain.
As an adult, I understand why I would go out of my way to walk to the single-occupancy bathroom on the far side of my middle school. I was called a “tomboy” and feared anyone knowing that I wasn’t a “girl” inside, although I didn’t know (other) trans people existed. I avoided the girls’ bathrooms because when I used them, my body just wouldn’t pee. I’d learned the hard way in first grade that I couldn’t just hold it all day. In hindsight, I can see that I was just a lonely trans child, doing my best despite a cruel reality.
My surgeon discussed my situation with her urology colleagues and suggested I take this all up with my therapist. My therapist, in this case, is a trans man who’s roughly my age and look and height but he’s been on T much longer—which I only mention because he assured me he has used men’s rooms for a decade or so and had zero problems. In other words, though not uncommon, my pee anxiety isn’t a universal trans problem nor is my fear of entering men’s rooms a universal trans male fear. I knew this. Which left me feeling beyond help. Wasn’t I too old to be learning how to pee?
We were going to retrain my bladder.
After patiently listening to all my complaints and self-recrimination, he suggested some rules I could follow. First, we decided, no men’s rooms. Nothing with multiple people. No other humans who could just make the whole process more treacherous. And when I’m out in public? Just try my best. If one place doesn’t work, no problem. Try another.
Second: We were going to retrain my bladder. At home, during the day, I would pee every three hours.
This made sense in theory. In practice, it was impossible. We’d decided I could set a timer, which I often forgot to do and then beat myself up about not setting a timer. Or I got tangled up trying to remember how long it had been since last I went.
And even when I did remember to set the timer, when the alarm sounded, I would sit down and still…nothing.
It felt like training a puppy and I realized that, in some ways, I, too, am just a helpless being trying to meet my own basic needs.
With alarms going off every three hours, I was becoming aware of how my first impulse was often to ignore them. My prior tendency was to hold my pee, even when I did have to go, even when I was safe at my own house. I was becoming more conscious of how I had played a role in this negative loop: holding my pee and then becoming less sensitive to my own feelings and therefore being less capable of peeing.
Sometimes I’ll even sing, “Let’s have a kiki” as “Let’s have a pee pee!”
I meditate daily. I try to cultivate inner peace and chill. And so my therapist proposed that I breathe out when I’m trying to go to signal to my nervous system we are relaxing. I’ve started taking deep breaths before I even walk to the bathroom, breathing out slowly, sometimes with pursed lips, thinking, Now we are chilling out. Sometimes I’ll even sing “Let’s have a kiki” as “Let’s have a pee pee!” which is what I used to sing to my puppies. I might even play the original Scissor Sisters song.
I’m not going to pretend I’m all better now. This is about me being in the messy middle, to borrow a phrase from Glennon Doyle. This is a story about slow progress, very hard fought.
A few weeks back, I stopped to use a typically safe-feeling rest stop bathroom but found the space crowded with men from a telephone company in uniforms and work boots. My body immediately leapt to fearful conclusions, perhaps memories of times groups of men catcalled me when I was closeted and high-femme or stared and made me feel unsafe in another way when I was nonbinary-identified and butch-looking. I sat on the toilet for a few ragged breaths, heart loud, and then exited fast, eyes down, wondering whether they could tell I was trans, wondering what, if anything, they thought of me. (In hindsight, I know they probably thought nothing.)
I got back on the highway and contemplated just holding it in the 40 minutes home. Instead, a few minutes later, I pulled off at another spot I calculated I could try, a diner, one with several single-occupancy stalls and good locks.
Somehow, I went.
