I was born blind. I can see some, now, with thick correction and certain lighting conditions, but I am severely visually impaired and I have been my whole life. I am also neurodivergent, visibly trans, genderflux, and nonbinary. Each of these is part of how I move through the world. Each of them shapes what I see, what I cannot see, what I am read as, and how I am treated. They are not layers I peel apart. They are how I am, together.
This post is for anyone who lives at the intersection of trans and disabled identities. It is a post I wish had existed when I was younger. It is written by someone who lives this, not about someone who lives this. If you are trans and also disabled, chronically ill, neurodivergent, Mad, or mapping any of these words onto your own body, you are who I am writing to. If you love someone who is, I hope it is useful to you too.
What the world does with two identities it does not know how to hold
Most of the world is not built to hold either being trans or being disabled well. When you are both, something specific happens. People frequently try to reduce you to one identity, usually the one that feels easier for them to process. In queer spaces, sometimes the disability disappears from view. In disability spaces, sometimes the trans identity becomes the thing everyone is careful not to talk about. In medical settings, either identity can become the entire frame for your visit, depending on which provider you are in front of and what they have been trained to notice.
The result is a specific kind of tiredness. You are constantly translating. You are picking which part of yourself to foreground depending on the room. You are calculating whether bringing up your disability will derail the trans conversation, or whether bringing up your trans identity will derail the disability conversation. This is not a flaw in you. It is a flaw in a world that has not built rooms big enough.
What the research says about us
Trans PULSE Canada, the largest national study of trans and non-binary people in Canada, released a report in 2023 focused specifically on disabled trans and non-binary people. The numbers are stark. Among disabled trans and non-binary participants, 63 per cent had past-year unmet health care needs, compared with 26 per cent of participants without a disability or chronic condition. Thirty-eight per cent were avoiding diagnosis of a health issue out of fear that a diagnosis would affect their access to gender-affirming care.
What this data points to, for those of us who are living it, is not news. It is confirmation of what we already know. The medical system is often one of the most unsafe places for disabled trans people, because it is the place where the two identities intersect most acutely, and where the consequences of a provider getting it wrong are most concrete. Missing hormones. Delayed surgeries. Denied accommodations. A gatekeeper who decides you are not competent to consent, or not stable enough to transition, or not disabled in the way they expect.
What this actually looks like, day to day
For me, some of the daily texture looks like this.
The way medical appointments take more energy than I can explain to people who do not need them for anything. Filling out the forms when the forms are in tiny print. Explaining my trans identity, my visual impairment, my autism, and my medication list, often to someone who is hearing one of those for the first time. Leaving the appointment needing a nap, regardless of what was discussed.
The way public space registers me differently depending on which part of my presentation a stranger notices first. If they see the white cane before they see me, they often treat me as a child, regardless of my age or how I am dressed. If they see me as trans before they notice the cane, the treatment sharpens in a different direction. The intersection is not additive. It is its own thing.
The way community spaces, even community spaces that mean well, sometimes make it hard to be both. Queer events in venues I cannot navigate. Disability events where gender is treated as an afterthought. Being the only visibly trans disabled person in a room often enough that I have developed an entire internal script for it.
The way my nervous system has adapted to the cost of all of this over decades. How much bracing I do before appointments. How much it takes to settle back down after a bad interaction. The quiet vigilance that never fully turns off.
Your version of this will be different. The textures change depending on which disabilities, which access needs, which kind of trans identity, which location, which class background, which race, which community you have or do not have. What stays the same is the reality of moving through a world that has not yet made enough room.
What I have learned, from inside it
I am not going to write a listicle of advice. Those posts exist and most of them were not written by people living at this intersection. What I can offer are some things I have come to know by living here.
Being trans and disabled is not a problem to solve. It is a fact about who I am, and I have stopped treating it as something I need to explain or justify. The energy I was once spending on translation has mostly gone into being with the people who already understand.
The phrase "crip time," drawn from disability community writing, has been useful. It names the reality that I move through time differently than a non-disabled person. Tasks take longer. Recovery takes longer. Some days are for doing; many are for resting. Crip time also names something more than a pace. It names a refusal of the ableist timeline that says you are behind, you are slow, you are not keeping up. I am not behind. I am on my own clock.
Community is not optional. Other disabled trans people are the people who get this without me having to explain it. Peer groups like Chronically Queer and Queerabilities in BC have been quietly important to a lot of people I know. So have informal kitchen-table friendships with one or two people who live at similar intersections. You do not need a huge community. You need a few people who already understand.
The both-and frame matters here too. I am proud of who I am and I am also tired of navigating a world that was not built for me. I love my life and I grieve what has been hard. I am grateful for the trans disabled elders who came before me and I am angry at the conditions they lived through. These are not contradictions. They are what it is like to live honestly at this intersection.
Refusing to educate people who have not done their own work is sometimes the most important thing you can do for your own energy. You do not owe a provider, a colleague, a family member, or a stranger the labour of explaining both identities to them from scratch. If they have not done any reading on their own, they are not entitled to your unpaid class time.
On therapy, specifically
If you are looking for therapy, the question of whether a therapist can hold both matters. A therapist who is trans-competent but has no disability analysis will eventually miss something that matters to you. A therapist who knows about disability but treats being trans as an interesting side note will do the same from the other direction. What you want is a therapist who is already thinking about these things as connected, not as two separate clinical topics.
At our practice, gender-affirming therapy is built with this frame. Accessibility is not a feature we added to a finished therapy. It is part of how the therapy is shaped from the ground up. I have written elsewhere about what accessible, affirming care actually looks like in our work, and it is worth reading if you want more specific detail on what we do.
For practical Canadian resources, Trans Care BC has a page specifically for disabled trans people navigating gender-affirming care, including peer support groups, advocacy organisations, and information on assessments, surgeries, and care planning. It is one of the more useful single pages I know of on this subject.
What I want you to know
If you have spent years feeling like there is no space where you can bring both of your identities, you are not wrong. That space is still being built, piece by piece, by disabled trans people who refuse to be cut in half. You are not the problem for not fitting easily into the rooms that exist. You are part of the reason new rooms are getting made.
You do not need to perform wholeness, resilience, pride, or recovery in order to be welcome here. You can be tired. You can be grieving. You can be flourishing. You can be all of these in the same week. This is what it is like to live at this intersection. You are not the only one.
I am here, in a body that has carried both of these identities its whole life, and I am still becoming. You are allowed to still be becoming too.
Frequently Asked Questions
I am disabled and questioning my gender. Is transition going to be even harder because of my disability?
Transition does involve navigating medical and social systems that are often ableist, and that is a real factor to weigh. It is also true that many disabled people have transitioned and are living full, dignified lives. The presence of a disability is not a reason to delay exploring your gender. What matters is finding providers, therapists, and community who can hold both at once. Trans Care BC's page for disabled people is a concrete starting point for BC readers, and the peer support groups named there exist precisely because you are not the first person navigating this.
I am trans and recently became disabled. How do I hold both?
This is a common story and it can be disorienting, especially if you built an identity as a trans person in a non-disabled body. Give yourself time. Grief is often part of acquiring a disability, including grief for the body you had and for the version of your trans life you pictured. That grief is real. It is also possible to build a full trans life inside a disabled body, and many people have. Peer community with other disabled trans people is one of the most useful resources here.
Are there specific things to ask a therapist before starting, if I am trans and disabled?
Yes. Useful questions include: have you worked with disabled clients before? Do you consider disability justice part of your practice? How does accessibility show up in your work, including for online sessions? How do you think about the intersection of disability and trans identity? A therapist who has to pause and improvise answers to these may still be a good fit with work. A therapist who seems confused by the questions probably is not.
What if my disability affects my cognitive processing or communication?
You deserve therapy that meets you where you are. This might mean slower pacing, alternative communication methods, written summaries between sessions, breaks, different session lengths, or modalities like art therapy that do not rely solely on verbal processing. A good therapist will collaborate with you on what your access needs are, not just accommodate them once you have fought for them.
Do I have to disclose my disability to a therapist if it is not immediately visible?
Not if you are not ready. Many invisible disabilities, chronic illnesses, and neurodivergences are disclosed only when they become relevant to the work. What matters is that you do not have to pretend your access needs do not exist. A therapist who creates the conditions for you to disclose when you are ready is doing part of their job well.
