“Don’t come out; you won’t get in anywhere. But if you do come out, look as straight as possible on your interviews. Makeup, skirt suit, long hair. If you don’t, you won’t get in anywhere. You need to pass as straight.” 

This was the advice I received as a 20-year-old, queer, assigned-female-at-birth pre-medical student from the leader of my university’s medical school LGBTQ group. Notably, I had not asked her whether or not I should hide my sexual orientation on my medical school applications, which had never even occurred to me prior to our coffee meeting; rather, I had asked for advice about LGBTQ-friendly programs to apply to. 

Her response, strongly cautioning me against letting my sexual orientation be legible in the picture I portrayed to potential medical schools—on paper or in person—screamed the mutually exclusive nature of the labels “queer” and “doctor.” She did not even bother warning me not to come out as trans explicitly, because—I can only presume—a trans doctor would have seemed all the more fantastical. Her physical description of professionalism drew an inexplicit line: to “pass” as straight really meant to be legibly NOT gender diverse, gender variant, or gender non-conforming. 

College presented my first exposures to out trans individuals. With that, the 15 years of feelings—or rather knowledge?—that I wasn’t a girl had been steadily rising towards my tongue. It was quelled only by paralyzing fear of what the resultant societal rejection would mean for my dreams: being a doctor, being a researcher, being an artist, being a parent, being happy—being anything implied survival. With each of her words, I swallowed that bile back down.

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“Look as femme as possible. Don’t let anyone see your leg or armpit hair. People are fine with queer for the most part, as long as it’s invisible. Grades are super subjective; I don’t want you to fail, and I know people who have paid that price.” 

Fast forward three years: a more senior medical student gave me advice for entering my clinical clerkship year, an all-encompassing 50-week tour de force of medical specialties. In addition to the mental rigor of providing patient care for the first time, clinical clerkships presented the much more daunting hurdle of impersonating the “professionalism” required by my short, white coat. 

Though I pride myself on my ability to meet (and exceed) expectations, I could not reconcile the subjective image of a “student doctor” with the authentic self that I expected to see reflected in my mirror; how the letters “MD” would look emblazoned on a transmasc–divergent–body eluded my wildest imagination. I had cut my hair short in college when I couldn’t take it anymore, but forced myself to keep it closer to Emma Watson than Kristen Stewart, let alone James Dean. I remained most comfortable in flannels, jeans, and Doc Martens—or really anything that could help me forget about my chest for a few minutes. I wore sundresses too, for the only joy I could find in women’s clothing: the double-takes from strangers on the street in response to the bright orange fuzz covering legs and armpits. I convinced myself this was enough, and that I was succeeding at my most difficult daily task of pretending to be a girl. 

Shifting to the full-time clinical stage of my education meant building a professional wardrobe. Not just that, this senior student told me, but a femme professional wardrobe, as the first descriptor was baked into the coding of the latter. I knew my size and shopped sales online for my two criteria: 1) doesn’t make me more aware of my chest, and 2) doesn’t need to be ironed. I dissociated from the rest.

Within a month of the amplified charade, I began fainting and developed chronic daily migraines—but my grades were superb. When I looked in the mirror, I saw the woman I was expected to be. A perfectionist at heart, I tried to take pride in my successful masquerade. But, unable to recognize her, felt increasingly numb and hollow.

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“Being trans will categorize you as controversial. You need to address it and present yourself as a finished product. They will be wary of choosing someone who might need to take time for medical care, or who might disrupt their program. And don’t use the word ‘transmasculine.’ It could prevent you from matching.” 

A year and a half later, it was time to apply for residency. At the end of my clerkships, I made two life-changing announcements: 1) I was going to pursue psychiatry, and 2) I was (am) trans. I say announcements because neither felt like much of a choice. 

Three hours into my psychiatry rotation the previous year, I felt this profound sensation that I had come home. Providing psychiatric care requires acknowledging individuality, ambiguity, complexity, and humanity, which perfectly aligned with the questions that I was constantly whittling internally—of identity formation, mental health, body image, and interpersonal relationships. Naming my desire to pursue that career path came with a flood of both relief and joy. 

Finally coming out as trans—while marked early by relief, and later euphoria—felt much more like admitting personal failure: I could no longer bear to maintain that expected woman façade. A question echoed in that deflation: how can my mold-breaking trans body fit into such narrow understandings of what professionalism can look like, and with that, what a doctor can look like? 

I had always understood life as a work in progress. Was the opportunity to change and grow throughout my life the cost of gender deviance? Was the opportunity to admit imperfection the cost of remaking my name and body, in order to survive? 

While there are many costs to transness, I refuse to accept that as one. As I embark upon residency interviews in my suit, tie, and James Dean haircut, I hope that my presence—out, loud, and proud—might clear the path slightly for future cohorts. I dream that I will someday have the privilege to mentor medical students who feel able to pursue their training and career while presenting unapologetically as themselves, visible leg hair and all.