Next Thursday, I will get a vagina. The procedure will last around six hours, and I will be in recovery for at least three months. Until the day I die, my body will regard the vagina as a wound; as a result, it will require regular, painful attention to maintain. This is what I want, but there is no guarantee it will make me happier. In fact, I don't expect it to. That shouldn't disqualify me from getting it. [...]

Many conservatives call this crazy. A popular right-wing narrative holds that gender dysphoria is a clinical delusion; hence, feeding that delusion with hormones and surgeries constitutes a violation of medical ethics. Just ask the Heritage Foundation fellow Ryan T. Anderson, whose book "When Harry Became Sally" draws heavily on the work of Dr. Paul McHugh, the psychiatrist who shut down the gender identity clinic at Johns Hopkins in 1979 on the grounds that trans-affirmative care meant "cooperating with a mental illness." Mr. Anderson writes, "We must avoid adding to the pain experienced by people with gender dysphoria, while we present them with alternatives to transitioning."

In this view, it is not only fair to refuse trans people the care they seek; it is also kind. A therapist with a suicidal client does not draw the bath and supply the razor. Take it from my father, a pediatrician, who once remarked to me that he would no sooner prescribe puberty blockers to a gender dysphoric child than he would give a distemper shot to someone who believed she was a dog. [...]

Buried under all of this, like a sober tuber, lies an assumption so sensible you'll think me silly for digging it up. It's this: People transition because they think it will make them feel better. The thing is, this is wrong.

I feel demonstrably worse since I started on hormones. One reason is that, absent the levies of the closet, years of repressed longing for the girlhood I never had have flooded my consciousness. I am a marshland of regret. Another reason is that I take estrogen -- effectively, delayed-release sadness, a little aquamarine pill that more or less guarantees a good weep within six to eight hours.

Like many of my trans friends, I've watched my dysphoria balloon since I began transition. I now feel very strongly about the length of my index fingers -- enough that I will sometimes shyly unthread my hand from my girlfriend's as we walk down the street. When she tells me I'm beautiful, I resent it. I've been outside. I know what beautiful looks like. Don't patronize me.

I was not suicidal before hormones. Now I often am.