The Journey of Transgender Recovery

Transcript

Eleanor Pike: We've all felt out of place at one time or another. That sensation that you simply don't belong and are not being understood. It's no fun and if it goes on for long enough, it can truly drag down your lifestyle. Just imagine if you felt that way even in your own skin. That the actual physical container of your person just doesn't mesh with [00:00:30] who you know you actually are. It would mean that every time you changed your clothes, met new people or went into public, the world around you reminded you that while you may identify as one way, you definitely look another. Well, today we're sitting down with a very brave person, Ryan Sallans. 

Ryan Sallans: My name is Ryan Sallans, and I'm a national speaker and author of the book Second Son. My work and my book explore my transition from female to male, [00:01:00] and also my recovery from anorexia nervosa. 

Eleanor: Ryan's gone through a lot of ups and downs over the years, and at times felt completely lost when trying to move forward. Yet over time and with the help of committed friends and professionals, he has found his place with his identity as a transgender man in recovery from anxiety, depression, anorexia, and suicidality. His story highlights that destructive coping is not a long-term solution. That cultivating awareness offers a practical way forward without minimizing emotions, [00:01:30] and the uniqueness of eating disorders in the trans community as a way to look more masculine. You're listening to Mental Note podcast. I'm Ellie Pike. Maybe just describe to me a little bit about your background, what it was like to grow up in your body at a young age. 

Ryan: I was born and raised in a small farming town in Nebraska. [00:02:00] Our family was a traditional family in the sense of gender roles. From around age two and a half to three years old is when I began having a sense that my gender was male. That took place when I was standing outside one summer, we had a swimming pool in our backyard and my mom had put me into a bright pink bikini. I was standing around the pool and this bikini, and I was looking at my dad, my brother, and I was looking at my mom, [00:02:30] my sister. I proceeded to take the top part off of my bikini, so I could have swimming trunks like my dad and my brother. That was my first memory of gender. It's my first memory of looking out and seeing something in a role in trying to align my own forms of expression with what I saw. 

Eleanor: Ryan, couldn't talk about this with his parents or anyone. He says the F-word in his family stood for "Feelings." He felt alone and very afraid. How did that affect your sense of self and your relationship to your body, [00:03:00] growing up and all of a sudden realizing you're female, but feeling more male and identifying with more males? I remember you mentioning you wanted to be a lot like your dad and idolizing this male role or male identity. How did that affect you? 

Ryan: Well, at age seven when I realized that my body was female, I was standing in front of a bathroom mirror washing my hands and I was just looking at my reflection and it hit me that I was female. I remember just having despair [00:03:30] wash over my body at that very moment, and I wanted to actually crawl out of my skin. I remember just looking at myself and saying verbatim, "I've got dealt a bad deck of cards. I need to live with this the rest of my life", and I don't know if I can. 

I started becoming extremely depressed at that point and actually started thinking about suicide, because I was so terrified about moving forward in this world knowing that my body was female when inside I knew that I wasn't. This was back in the '80s. [00:04:00] We didn't have the conversations and awareness about trans identities back then than we do today. I didn't know that I was transgender at that time. I didn't even know it was an option. I just felt very confused and alone. As estrogen started to wash over my body and my body started to change more and more into the feminine shape and form that it was just doing naturally, I became further depressed and anxious about myself at that time and also fear for the future. 

Eleanor: At what point do you start to notice more [00:04:30] distress or needing to cope with this in a different way? 

Ryan: I was trying to figure out ways to try to work with my body, to try to find comfort in it. For me at this time, I decided that to be comfortable in my body I should be a female body builder. The reason why is because I saw female bodybuilders on TV, and I was really impressed by the fact that they didn't really have breast development. Because they're pectoral muscles were so large from bodybuilding and their body fat percentage was so low for their competitions, [00:05:00] that I thought if I could do that with my body then maybe I'll be able to make it in my life. 

Eleanor: Wow. Did you start exercising at that point and working out? 

Ryan: I remember going down to our basement and asking my dad to start showing me how to lift weights. That was around age 12. I started to become really obsessed with lifting weights and then also exercise in general. I would say I was very obsessed with it. If I'd be hanging out with friends, I'd be doing set ups when we're hanging out [00:05:30] or doing like leg raises. I just could not sit still. I had so much anxiety bumping around inside of my body. 

Eleanor: The exercising was actually a way to cope with your anxiety? 

Ryan: Definitely. The compulsion become louder inside my brain as I moved into college and into my eating disorder. 

Eleanor: Yes. Describe that to me a little bit, about what was happening with food and body image and exercise all in one. 

Ryan: Well, if we're still in the high school range, I started to engage [00:06:00] in restrictive eating behaviors that would not take me to the point of being classified as being anorexic. But I would try to control how much I was eating, because I felt like it made me a better athlete. That's not a fact, that's just how I felt at the time. I had to be lighter, to have less weight on me. I wasn't even thinking about masculinity or femininity or really gender at that time. 

I was just trying to figure out how I could feel comfortable in my skin. For me to feel comfortable in my skin, [00:06:30] I just wanted my shape to be prepubescent. Essentially. I didn't want it to form into a female shape at all. I was scared of that. When it started to form into a female shape, as I started to see curves or even breast development, I would just classify that-I'm going to put this in air quotes, even though nobody can see it, but I'm putting it in air quotes-classify that as my fat. I saw that word as a negative word. I saw it as something that I feared. [00:07:00] 

Eleanor: Let me ask you this. At what point did overexercise and manipulating your food and your eating disorder, at what point did it turn destructive? 

Ryan: That took place the summer between my freshman and sophomore year of college. As I mentioned prior, my freshman year I was really struggling, because I didn't know where I fit in. I also had this belief that I needed to find a man that would marry me. Because I believe that if I married a man, [00:07:30] then everybody would see that I was lovable and I would finally feel okay in my skin. I actually started dating someone. It was someone I knew from my hometown. He was older than me, but we reconnected, because we were both on the anthropology program. We dated for eight months and I recognized that when I dated him, it was like dating the guys I had in high school. I truly enjoyed the companionship, in the sense that I had a friend to hang out with. 

But I always felt wrong in my skin [00:08:00] and I didn't want intimacy, because intimacy also felt very uncomfortable for me. After eight months of dating we hit May, and in the month of May, he graduated and I was moving into my sophomore year. We decided to go on a camping trip to celebrate his graduation and after the camping trip, he dropped me off at my house and never called me again. This was pre cell phone. I couldn't call him on a landline, because it cost money. It was just gone. 

I just said, moving into my [00:08:30] sophomore year, that I had to change. That I had to become more feminine, because if I wasn't, people wouldn't love me. I couldn't find a relationship and I wouldn't be able to find a job. I told myself I had become more feminine, and when I thought about that word the first descriptor that popped into my head was the word skinny. I just set on a journey to become skinny. I did it, unfortunately that led to anorexia, but I thought that's what I needed to be able to be accepted [00:09:00] and loved. 

Eleanor: Wow. I like how you are able to put words to that. The acceptance and love was at the core of all of it. I noticed that theme and pretty much anyone who's gone through an eating disorder. 

Ryan: Definitely. I've even seen the research articles that's looked at lesbian, gay, bisexual, transgender identities, and the coming out process. They suggest that with the coming out process, there may be an increase in eating disorder behaviors, because of this belief that if you change your appearance [00:09:30] to be acceptable within societal terms, then family will not reject you. They will accept you more. 

Eleanor: To dive a bit more into the research on LGBTQ plus dynamics. I sat down with Zach Rawlings. 

Zach Rawlings: My name is Jack Rawlings. I work on the admissions team for Eating Recovery Center. I'm a licensed professional counselor and a [unintelligible 00:09:53] candidate doing research in gay men and eating disorders and their mental health. 

Eleanor: [00:10:00] Zach could you explain to our listeners the difference between sexual orientation and gender identity? 

Zach: Yes, absolutely. Those terms often get used interchangeably and there's some pretty important key differences between the two of them. When we think about sexual orientation, it's usually thought of as three different things. It includes someone's sexual self-identification. How they identify, whether gay straight, bisexual or something else. It includes their sexual behavior and then it also includes their sexual attractions [00:10:30] and fantasies. 

Often when someone is conflicted with their sexual orientation, they might be having sex with someone of the same sex or gender and have fantasies of someone of the same sex or gender, but they might not feel comfortable self identifying as gay or bisexual. There might be some conflict there. Now, when we think about gender identity, it's separate from sexual behavior or fantasy or sexual self-identification. Rather, gender identity is looking at a person's internal [00:11:00] sense of whether they are masculine, feminine, male or female. We can think of gender as being on a spectrum. There can be gradations of maleness, femaleness, masculinity, femininity. 

Eleanor: A lot of people will talk about Tinder as non-binary. Can you explain that a little bit more? 

Zach: I think it's always helpful to think of examples. I love David Bowie. He might be this common example, when we think of someone who might have flirted with the roles of gender before [00:11:30] maybe we even had the term 'Gender queer.' He would've probably fit within that category, because he was anatomically male and biologically male, but he would often flirt with that male female look. Where he would wear eyeliner, he would dress in some female clothes. When we talk about non-binary, it's usually referring to someone who doesn't want to fit into those two extremes of purely masculine or purely feminine, rather they might be somewhere in the gradation in the middle and flirt with both of those. [00:12:00] Maybe not even take on either of those names, but my considered themselves to be gender nonconforming or androgynous or something of the sorts. 

Eleanor: Could you tell us a little bit more about the transgender community and their relationship with disordered eating? 

Zach: To be honest, it's something that there's not a lot of strong clear data on, so I want to preface it with that. But there's been a lot of case studies, and with some of these case studies we've seen that a lot of members of trans community control [00:12:30] their body shape with disordered eating. I think we saw that in Ryan's case. He would often use the compensatory exercising in order to control the shape of his body to some degree, in that seemed to assuage some of his anxiety. 

The studies that we do show one particular study found that when individuals were evaluated for self reported eating disorder behavior, that among cisgendered and transgendered individuals, transgendered had significantly higher rates of self reported disordered [00:13:00] eating behaviors than their cisgender counterparts, no matter what the cisgendered counterpart's sexual orientation was. 

Eleanor: For those who aren't familiar with the term, cisgendered simply means the opposite of transgendered. It's someone whose sense of personal identity corresponds with the way that their body was originally formed. A cisgendered girl, for example, would have been born genetically female and also identify as a girl. A transgendered girl might've been born genetically male, but identifies as a woman. That's all. [00:13:30] 

Zach: Then the third point I think I would want to make is that body dissatisfaction among trans individuals is linked to disordered eating and attempted suicide. What that tells us is that it's a risk factor. That being dissatisfied with the body for a trans individual opens them up to some degree to having more mental health problems. Specifically, what we know is that we've seen a higher rate of disorder eating and attempted suicide 

Eleanor: By the time sophomore year rolled around, [00:14:00] Ryan's anorexia was in full swing. While he was feeling better about his body looking less feminine, he wasn't really in touch with what he had to give up in order to make that dream a reality. That awareness didn't come until later that year and a jarring visit to his sister's house. 

Ryan: I remember I went to her gym at her apartment complex, and I got onto a stair stepper. I was working out on it, and my sister came to the door, because she wanted then to work out with me, but the door was locked and I refused to get off that [00:14:30] machine to let her in. I'm just seeing her face being, one, concerned about me and also just really sad that I wouldn't even take two seconds to let her in to join me. It started to hit me at that point that maybe there is something going on that I should seek help for. 

Eleanor: Ryan finally confided in his sister about his health, and at her suggestion, he went to the campus counseling department. 

Ryan: I had the appointment and we went through everything, and I was diagnosed with anorexia nervosa, but sadly, [00:15:00] I went home and I did not get better. I actually got worse at that point. I was so depressed, I had no energy. That after that appointment, I knew labor day break was coming, and I had made a suicide plan over that break, because I was just so tired. I didn't want to move forward anymore. I just wanted to die and to rest. 

Eleanor: Wow. Dying would feel more like rest than recovery. Recovery would feel really hard and you have to work for it. [00:15:30]. 

Ryan: Absolutely. Plus, I didn't want to go back, because I was scared of going back at that time. 

Eleanor: Yes. What were you scared of? 

Ryan: One, the menstrual cycle. I did not want that to begin, ever again. Two, having my body start to become more curvy again. I didn't want that. It just didn't feel right for me. 

Eleanor: Sure. Did anyone know what was happening internally at this time? [00:16:00] Your depression, your fear, your gender identity questions? 

Ryan: No. No. I wouldn't talk to anybody about it, even my therapist. It was just too hard. I think for me, my recovery began, because I was at that rock bottom with the suicide plan. I remember laying on the floor, feeling my heart pace reduce in rate and just saying to myself, "It's not time for you to go yet. It is now time for you to begin your recovery." I called my parents up. I went [00:16:30] down and saw them and I started to schedule regular appointments with my therapist to try to work on a recovery process. 

Eleanor: What did that recovery process look like for you? 

Ryan: Difficult. [laughs] Essentially to begin the recovery process, what needs to happen in my case, is that I needed to stop working out altogether and I need to consume high levels of calories, so that my body could finally catch up and actually start adding weight [00:17:00] on top of it. Doing that was the hardest thing I've ever done in my life, because number one, I couldn't work out. Number two, I had to put things into my body that I didn't want to put into it. 

Eleanor: Yes. It's causing you anxiety and you're not dealing with your anxiety at that moment through exercise, which would be extremely hard. What were the ways that you learned to cope with that anxiety and start to accept the body changes? 

Ryan: I started doing yoga, which [00:17:30] helped me. I wasn't doing power yoga or anything like that. I was doing more of the mindful stretching and breathing. I started to sit with the emotions more, which is very, very difficult to do just because all the voices start screaming your head. Until this day it's hard to sit with the emotions. I also worked with my therapist every week. I was part of an eating disorder support group, and I also had a nutritionist that I met with every week. I was really trying to dedicate [00:18:00] time outside of school to working on understanding feelings, emotions and my relationship with my body. 

Eleanor: Through the steps of recovery awareness became a large part of Ryan's process. Sitting with his emotions and anxieties and examining them, why was he feeling anxious? What was the cause? It was a lot of work and it still is. Aside from the mental aspects of recovery, Ryan had to face the physical aspects as well. [00:18:30] What was it like as you were regaining your weight, which was natural in the recovery process, what was it like to regain that feminine form again? 

Ryan: For me it was devastating, to be honest. Just because I felt like all that I did, I lost. 

Eleanor: Let's talk about that then. What was going on within you of taking on this feminine form, [00:19:00], but then inside you weren't feeling like a female. At what point did you start to confront those emotions more or ever talk about them or consider doing anything different about your gender identity? 

Ryan: For me, when looking at sexuality, the first place I tiptoed into was sexual orientation. My recognition that I was having a lot of crushes on the women, especially the older I got. Four years into my therapy, my [00:19:30] therapist gave me this book called, The Dark Side Of The Light Chasers by Debbie Ford. Debbie works off of Carl Jung's, Theory of Shadows. When we struggle with addictions or other issues, it's because of the shadows that are in our life that we're not bringing forward and facing and naming and exploring. 

I came out as lesbian and when I did that, I started noticing my behaviors around food that were disordered to decrease. It was that first moment in my life-- At this point I was 24-years- [00:20:00] old, where I just had this epiphany of, "Wow. Look how healing it is to actually name something that's part of you and not run away from it", regardless of what other people are going to say or how they're going to judge you or even you're going to be rejected. Just honoring it and claiming it and just knowing that it's part of you, it's an amazing experience to do that. 

Eleanor: Wow, I think you're really speaking to that. To find your truth, it takes a lot of courage to let other people know that. At what point did you start to identify more with the [00:20:30] LGBT community and then also recognizing more of your gender identity not just your sexual orientation? 

Ryan: After that month of coming out is when I aligned with the LGBT community. When I came out, all those people that were prying into my life to figure out if I was lesbian or not, wanted to celebrate again. We went back out to the bar, I met a woman that night, and within a week we began dating. For me, [00:21:00] it finally felt right to be in a relationship with a woman, because I understood at that point that when we look at orientation, orientation has three different prongs to it. It's not just who we're attracted to sexually. 

For me, I learned at that point that I am romantically oriented towards women, in the sense that for me to be partnered and have a long term relationship, I do not have a romantic orientation with men. I have an erotic orientation or a sexual attraction [00:21:30] towards men, but that romantic piece isn't there. I felt really affirmed finally to date someone, understand that, "This is right for me." 

The one problem was is I still felt wrong in my body. Intimacy was a turn-off for me, because I felt so wrong in my body. I was also severely depressed and still struggled 24-7 on suicide ideation. Eight months into a relationship together, eight months into being identified as lesbian, I was in a bookstore in Boston and I found a book about [00:22:00] transgender men. Looking at the photographs and reading the stories, I instantly knew that I was a transman. The lights got turned on that day when I saw that book. 

Eleanor: Was it something that you had just never really encountered before and it was a new concept to you? 

Ryan: Yes. For me, the word 'Transgender' was a word I knew. I took human sexuality in college. I was actually a sexuality educator at that point [00:22:30] at our health center. But it was never a word that I thought was real, in the sense I didn't know that any person could actually transition, I thought that you had to be a Millionaire or a trust-fund kid to be able to have access to the medical resources that would be required or necessary in a person's transition. Reading this book and seeing individuals in the book, I understood that that's not the case. That transitioning is [00:23:00] possible and that there are providers out there that will help you. 

Eleanor: Wow. What did you decide to do once you-- I know it's not this like a drastic change in that moment, all of a sudden you have an answer to all your questions, but what was your next step? 

Ryan: That day when I was looking at this book, I was so excited, and my girlfriend looked over my shoulder and just said, "Yuck. You don't want to look like that, do you? She pointed to the transman that I was [00:23:30] looking at, and I reverted back to a child that was being rejected by my family when I was trying to express myself in a more masculine way. I just said, "No", even though I knew that wasn't true. I remember at that point just having this question pop into my head of, "When will I find someone who will unconditionally love me?" 

Eleanor: With the memory of that conversation with this girlfriend still ringing in his ears, Ryan was cautious about moving forward with his transition. It even took courage to bring it up with his therapist. [00:24:00] 

Ryan: But I was also really fearful about this, because while I knew I was trans, there was this one thought that popped up into my head of, "Am I really trans or is this my eating disordered brain speaking? Is this my distorted body image that's influencing these decisions?" I became really scared, and I was actually really scared to come out to my therapist, because I was working at the same therapist for the six years. I was worried that if I came out to her she would also invalidate my transit identity and say that was just because of my eating disorder. 

But I took in this [00:24:30] folder that had all these pictures of my childhood, and near the end of the therapy session I started studying everything out and describing my feelings and she just said, "You're a boy?" I said, "Yes." She just said, "I've never worked with a transgender before, but I'm willing to learn." That's all I needed from her. She validated my identity, she recognized where her weaknesses were around knowledge, but that she was also willing to work with me in what I needed to move forward. [00:25:00] 

That was life-changing for her to say that. It was terrifying and amazing at the same time. It was a dichotomy happening, because on the one hand I had parents that were not accepting of this transition. I felt even further rejected from them, but then on the other hand I was starting to take steps and undergo a process where I was finally finding my true self and my body. I was having a relief of anxiety around different body parts with each step that I took. 

Eleanor: Tell me how your family has grown and the way [00:25:30] that they are able to connect with you. 

Ryan: First, let's say they've grown thanks to I think, time. I think sometimes we really expect people to change within a second or within a minute or within a day or within a month, and that's just not the way humans work. With my family-- Again, it took my parents three years before they were able to use my name and pronouns full-time after my transition. But then with each year that passed, it continued to grow [00:26:00] in ways that I could sense they actually wanted to be connected with me as their kid and also just as a human being. 

I'm just really grateful for them to be able to take that time to let go of fear, I think also let go of pride issues. For me, it's not only that I am a transman, I am a national-international speaker on trans identities, and I share really intimate and vulnerable aspects of my life and my family's life [00:26:30] with complete strangers. I think for them to be to let go of that control as well as help them develop a relationship with me. 

Eleanor: Yes. I remember asking you if it felt like there was a grieving process for you or your family, like they lost their daughter essentially and gained a son. I remember you talking about grief being a really big part of your process, but maybe not in that same way. 

Ryan: Families can naturally go through a grieving [00:27:00] process when someone comes out as a lesbian, gay or bisexual or when someone comes out transgender. Essentially, you are telling them that you are not who they thought you were, but they assign those labels to you. You never even have the space to be able to let them know who you are. We just assign labels to everybody based on what genitalia you see when they're born, and then we have heteronormativity happening where we just then assign them as girl-boy heterosexual. 

I do remember that when I first came out to them as lesbian, they were more [00:27:30] accepting, because I think they'd had more time to sit with this idea of me being a lesbian just because of their assumptions. I remember and I came out as trans, my mom cried and told my brother, "Why couldn't she just stay a lesbian?" To try and do bargaining in that sense as well. 

One thing I do want to push back though on families is when they say like, "I'm losing my daughter. I'm losing my son." They are not because they never technically had a daughter or son. That was just assigned to them at birth. I was never a daughter. [00:28:00] I was raised a socially reared female, because that's what I was assigned, but that was never who I was, and I struggled so much as a kid and then as a young adult trying to find the answers to understand who I was. I was giving them the opportunity to actually learn more about me. 

I am the same person I was before. My voice being lower in pitch, because of testosterone, I talked the same, my personality is the same, my interests are the same. They did not lose me, they've actually gained me, and they've actually been able to now [00:28:30] be introduced to all of who I am. 

Eleanor: What is something that you would like to provide other people with? Just this little nugget of education that would help people like you who are in the midst of transition or a part of the LGBT community. 

Ryan: Number one, again, we have to love ourselves. We can't move forward in our relationships with other people if we can't move forward in a relationship with ourselves. We have to start working on breaking down our own fears, our own assumptions, our own stereotypes that we may have around an identity [00:29:00] or a label. We had to be able to start exploring all of who we are and start to embrace all who we are. Next, then with our family and our society, you have to recognize that when they say things that are hurtful or harmful, it's really not about us, it's about them. It's about their own fears, their own misunderstandings, their own ignorance. 

Next, how can we find support to assist us when we're going through those really scary times? It's a scary time with employment, a scary time with family acceptance and rejection, a scary time in our [00:29:30] own recovery process. Who can we lean on and actually use our voice to say, "Hey, I'm actually really struggling. Can I talk with you now?" 

Eleanor: It sounds like this process has been so worthy for you. One thing that has really stuck out to me is the amount of time that you put into your transition, surgeries and hormone therapy and money that you put into it. You mentioned it to me at one point, losing some experiences. Now you're in a state of regaining experiences. [00:30:00] Tell me a little bit about what you're doing in discovery now. 

Ryan: Well, for me, I am looking at the four and zero on the birthday cake. It's just-- As you age you start to have more recognition of your true mortality and this feeling of actually wanting to live your life as fully as possibly and to be able to integrate all forms of things that bring you joy. I started playing piano again, because music is a really important [00:30:30] part of my life. I'm writing again. I have released my first book, Second Son, but I'm currently working on my second book about life post transition and my eating disorder. 

My wife and I do backpacking. I introduced her to backpacking and she fell in love, and I created a monster to the point where she is going to have us do 110 mile backpacking loop overseas this winter or this fall. I'm just trying to find all these different things that go outside of a specific identity, that just bring me joy [00:31:00] and make my life feel much more full. 

Eleanor: Awesome. Look, thank you. Thank you. 

Ryan: Yes. Thank you. 

Eleanor: We covered a lot of ground on Ryan's story, but there's still a whole lot of it we couldn't fit into one episode. If you'd like to dig deeper into his story and how he discovered healthier ways to embrace his identity, you can pick up his book, Second Son, or explore his website, ryansallans.com. That's [00:31:30] R-Y-A-N-S-A-L-L-A-N-S.com. You can check out his Instagram, Twitter, Facebook and Tumblr. They're also under the same name, Ryan Sallans. 

Thanks for listening to Mental Note podcast. Our show is sponsored by the incredible work of Eating Recovery Center and Insight Behavioral Health Centers. To talk to a licensed counselor and see if treatment is a good idea for you, call 877-411-9578. [00:32:00] Also, want to write us? We are on the hunt for more recovery letters and can't wait to hear from you. Simply email your recovery letter to mental [email protected]. Today's episode was produced by Sam Pike, edited and mixed by Meredith Turk and Erica Prather. I'm Ellie Pike. See you next time. 

[00:32:59] [END OF AUDIO] 

Presented by

Ellie Pike, MA, LPC

Ellie Pike is the director of alumni, family and community outreach at ERC & Pathlight Behavioral Health Centers. Over the years, she creatively combined her passions for clinical work with…