This post discusses trans healthcare, chronic illness, disability, medical assumptions and transphobia.

I am a trans man. I am also someone who experiences health problems.

Apparently, those two things are enough for people to assume that every symptom I experience must somehow be in relation to the testosterone I’m taking.

I have bowel problems.

“It’s probably the testosterone!”

No.

Sometimes, people just have bowel problems.

Something else is wrong with me? Have I considered that it might be the testosterone?

I’m surprised I haven’t stubbed my toe and had someone ask whether I have thought about coming off testosterone because, apparently, testosterone isn’t just a hormone. It is the explanation for everything that could possibly go wrong with my mind and body from this point onwards.

And honestly? I am so fucking tired of it.

I have bowel problems. I have been experiencing faecal incontinence that has gradually been getting worse for around 4 or 5 years now. These are real symptoms that affect my life, I am undergoing tests now and am trying to navigate these symptoms like anyone else would when they’re experiencing ongoing health issues.

But, inevitably, people jump to two conclusions: the first is that I just enjoy shitting my pants for the sake of it and am attention-seeking, the second is that testosterone is the culprit.

I’m not even going to entertain the first assumption because, frankly, you’d have to be a pretty diabolical person to assume that someone would rather spend hours sitting in their shit while they wait for their carer, because they like the process of a carer cleaning them up, to even arrive at that destination. The testosterone assumption, however, is something I get from multiple people. And not because they have examined me, not because they’ve looked at my medical history, not even because they’ve conducted any investigations or spoken to the doctors involved in my care, but simply because I am trans and I take testosterone. That seems to be enough.

I understand that medication can have side effects, of course I do. I am not for one minute suggesting that testosterone is incapable of affecting someone’s health, or that it should never be considered when investigating symptoms. It should be considered when medically relevant.

But there is a significant difference between considering something as a possibility and deciding that it is the answer before you have even looked at the evidence.

One involves actually investigating what is going on.

The other involves making an assumption about my body because of a medication I am taking and I am becoming increasingly frustrated with people confusing the two.

Here’s the thing: I am not expecting my friends, family or anyone else to know exactly what is wrong with me. I’m not asking them to diagnose my bowel problems, or expecting them to understand every aspect of my medical history or know everything there is to know about testosterone.

What I am asking for is just a little bit of common sense.

If I tell you I am experiencing a health problem, you don’t immediately need to come up with an explanation for it. You don’t need to connect it to my hormones. You don’t need to speculate about whether my transition somehow caused it. You don’t need to insist that all of the medical doctors involved in my care are wrong, and you are somehow the only one who is right.

Sometimes, you can simply acknowledge that I am struggling. Not attention-seeking, not seeking sympathy, just struggling.

Sometimes, you can trust that I am seeking appropriate medical advice (from trained professionals) and that the people investigating my symptoms are far better placed to assess the possible causes than someone who is simply making assumptions from the sidelines.

And sometimes, you can just listen.

I know that people often make these comments because they think they are helping. They might genuinely believe they’ve identified something worth considering. They might even think they’re “looking out” for me.

But good intentions don’t automatically make an assumption helpful.

And when the same assumption keeps being made, despite the fact that I am already navigating my health and seeking answers, it stops feeling helpful altogether and starts feeling dismissive.

I think one of the most frustrating things about these comments is how easily they can make you feel responsible for your own suffering. Because when someone repeatedly suggests that your symptoms are caused by testosterone, there is an implication that can be difficult to ignore:

Well, you chose to take it!

As though the fact that I have made a decision about my own healthcare somehow makes me responsible for every health problem I experience afterwards.

As though taking testosterone means I have forfeited the right to have unrelated medical issues investigated without my hormones being dragged into every conversation.

As though I should have anticipated that any future symptom would become a debate about whether my transition was the right decision.

That’s an incredibly frustrating position to be put in.

I am already dealing with whatever is happening inside my body. I am already trying to understand my symptoms, manage their impact on my life, find out what is going on and defend myself for said symptoms.

Why should I also have to defend my decision to transition while doing all of that? Why should I have to reassure people that taking testosterone was a considered decision, or explain why I am still taking it, or justify my healthcare choices every time something goes wrong.

I shouldn’t have to…

Being ill is difficult enough without feeling as though you have to defend yourself for being ill.

And there is something particularly uncomfortable about feeling that the treatment which has helped you live more comfortably in your body is being treated as evidence against you whenever you experience a health problem.

Don’t get me wrong, I am not saying that testosterone is beyond criticism or that medication should never be reviewed. I’m just saying that those decisions belong in a proper medical conversation, informed by evidence and my individual circumstances, rather than in a cycle of speculation by people who don’t have the information, or knowledge, to reach a conclusion.

I deserve to have my symptoms taken seriously without my identity becoming the first thing people use to explain them away.

I think the thing that winds me up the most about it is that people can be remarkably confident about things they know very little about. They hear that I’m taking testosterone, know that hormones can affect the body, and suddenly seem to feel qualified to explain what is happening to me medically. But knowing a medication exists is not the same as understanding its effects.

Knowing that testosterone can cause certain side effects doesn’t mean you know which symptoms I am experiencing, what is causing them, or what the appropriate investigations might be. And knowing I am trans doesn’t give you a complete picture of my health.

I’m not a doctor either. I am not pretending to be. That is why medical professionals exist and why I seek medical advice when I need it. But neither are the people making these assumptions. They aren’t familiar with my medical history, they haven’t necessarily read the relevant evidence, and they don’t know what my doctors have considered, ruled out or investigated.

Yet, somehow, their assumptions can be delivered with the confidence of someone who has personally reviewed my entire case. That confidence is baffling.

I’m not for a second suggesting that doctors are infallible. They aren’t. Patients should be allowed to ask questions, seek second opinions and challenge medical decisions when something doesn’t feel right. But there is a difference between questioning medical advice constructively and assuming you know better than the professionals involved in someone’s care simply because you have decided that hormones must be responsible.

If there is a genuine concern about a possible side effect, I welcome a proper discussion. Let’s look at the evidence and investigate it together. But, please, let’s stop treating speculation as fact.

There is also a transphobic element to this assumption. Now, I am not saying that everyone who suggests testosterone might be responsible for a symptom is consciously transphobic. Some people are simply misinformed, some are trying to help, some have perfectly reasonable questions about medication and its possible side effects.

But I do think we need to talk about the wider attitudes that can underpin these assumptions because, as trans people, we live in a society where our healthcare choices are frequently questioned, where our bodies become subject of public discussion, and where people who know very little about our lives can feel entitled to tell us what is best for us.

For some people, the fact that we take hormones becomes the most important thing about our health. Suddenly, every symptom is a potential consequence of transitioning. Every medical problem becomes an opportunity to question HRT. Every unexplained illness becomes another reason to wonder whether we should be taking testosterone at all. And I can’t help wondering if people would be so quick to make these assumptions if I wasn’t trans.

Would every symptom automatically be attributed to a medication if I weren’t taking testosterone as part of my gender-affirming care? Would people be so quick to question my healthcare choices? Would they be quite so confident that they had identified the cause of my symptoms without any proper investigation?

I can’t know how every individual would respond, but I do think it is a question worth asking. Because when someone’s gender identity repeatedly becomes the starting point for explaining away their health problems, that isn’t necessarily a neutral process. It can reflect an underlying belief that being trans itself is the problem. That transitioning is inherently suspicious and that HRT is something to blame whenever anything goes even remotely wrong.

And that is where these assumptions can intersect with transphobia, even when the person making them doesn’t recognise it in themselves. Transphobia doesn’t always announce itself through slurs, hostility, or someone openly telling you how being trans is ‘wrong’. Sometimes, it looks like someone treating your healthcare decisions as inherently questionable. Trans people don’t just wake up one day and decide they are trans, or that they should take hormones; it usually comes after years of self-hatred, self-exploration, research and confusion.

Sometimes, it looks like someone assuming they know what is best for your body because they don’t agree with, or understand, the medication you’re taking.

Sometimes, it looks like your symptoms being taken less seriously because people have already decided that your transition must be responsible. The impact can still be harmful, even if the person making these assumptions meant no harm, and I think that is important to recognise.

The fact that I am trans is only one part of my life. My health is another. Sometimes those things will intersect and sometimes they won’t. Testosterone can have effects on my body. Of course it can. It is a hormone after all and taking it is a medical decision that deserves the same consideration as any other medication. And that is exactly what I did. For years. But that does not mean that every symptom I experience must be caused by it.

I can be a trans man who takes testosterone and have bowel problems for reasons that have nothing to do with testosterone (I have had bowel problems longer than I have even been on testosterone, so there is also that!) I can experience chronic illness or disability without every single aspect of my health being interpreted through the lens of my gender identity. I can need medical care without that care becoming the ballot of whether I should have transitioned, and I can make an informed decision about my own body without then having to defend that decision to everyone who has an opinion on it.

These things should not be controversial, yet I feel as though I have to constantly explain them and that is exhausting.

Living with a number of health problems can be frustrating, frightening and overwhelming enough on its own. When you’re already trying to make sense of what is happening to your body, the last thing you need is a chorus of people telling you what they think is wrong with you before anyone has established what is actually going on.

I don’t need everyone around me to understand every aspect of being trans. I don’t need them to know everything about HRT. I just need them to understand that the choices I have made regarding my body and my health were not made on a whim. I heavily weighed-up the pros and cons before commencing anything, and I did what I believed – and still believe – is right for me in the long-term. I also need them to understand that they do not have all the answers. In fact, most of what they have is prejudice. And it is exhausting constantly having to defend myself against those prejudices.

Please just stop assuming you know everything. Nobody knows everything! Even medical professionals learn new things every day – I have literally been to the doctors before and had them google my condition right in front of me (which is a little concerning considering Cerebral Palsy is one of the most common disabilities in the UK, but you get my point; no one knows everything, no one is perfect, and if you have nothing helpful to contribute than please be quiet!)

Ultimately, I am not writing this to say that testosterone should never be considered when investigating a health problem. I’m writing this to recognise that considering a possible cause is not the same as assuming you’ve found it. Trans people deserve proper medical investigations, just like everyone else.

Our healthcare choices don’t make us responsible for every illness we experience, and we shouldn’t have to defend those choices – or our identities – when seeking help for our symptoms. But most importantly, I want people to acknowledge that ignorance can cause harm, even when it comes all wrapped up in concern. If I tell you I am experiencing a health problem, you don’t have to solve it. You don’t have to offer me a theory. You don’t have to tell me “it’s probably the testosterone”.

Instead, you can ask me whether I am getting the support I need or how I am coping. You can lend an ear when I tell you I’m struggling. And if you genuinely think there is a potential connection worth exploring, you can suggest I take it up with my healthcare team without pretending you have already worked it out, because I deserve to have my symptoms investigated without assumptions being made about my body.

I deserve to be taken seriously.

I deserve to be unwell without being blamed for it.

And I deserve to exist as a trans person without every health problem being a conversation about hormones, or how you think I have made a big mistake by transitioning.

I am a trans man. I am taking testosterone. I have bowel problems.

Those three things can all be true without one automatically explaining the other. So, the next time you’re tempted to tell a trans person that their symptoms are “probably caused” by their HRT, perhaps take a moment to consider whether you actually know that or whether you have made an assumption fuelled by your own prejudices and ignorance.