TL;DR: I'm unsure if I'm a trans guy because I'm also chronically ill, and I'm worried I'm only imagining being a guy because, in that future, I'm not ill. Every time I have a flare up or feel generally ill, I think I should just stay a woman. Every time I feel better or my illness barely impacts me, I feel like a man again.
Medical context:
I'm 18 (FTM?) and developed POTS in spring 2025. I was diagnosed that September, and while my symptoms improved, I was diagnosed with moderate ME/CFS this June (though I personally think I'm mild). Since then, my mental health has plummeted, and I've been questioning my gender more than ever. I've also had depression since 2021.
Trans background:
Around August 2025 I started wondering if I might be trans, but I pushed the thoughts away because my school wasn't a safe place to explore them. By January, I started researching gender identity and dysphoria seriously, and by April I felt sure I was a trans guy. I'd come out to a few close friends and my cousins and had planned to come out to my parents this summer.
Before my ME/CFS diagnosis, I had all these silly dreams about spending my last two teenage years doing dumb boy stuff, working out again, falling in love as a guy, and eventually starting T.
Then I got diagnosed with ME/CFS, and it felt like that future disappeared.
Now, whenever I get sick or have a POTS flare (even if it's not PEM), I feel like I'm reliving some sort of trauma. I'm terrified that this will become my new normal because that's not the life I wanted.
This is where my confusion starts:
When I picture my future as a woman, I can imagine being disabled. I can imagine working as my dream job (therapist), my parents accepting me completely, and feeling safe. It isn't the future I want, but it's one I can picture.
When I picture my future as a man, I struggle to imagine myself as disabled. The future I imagined as a man always involved hiking, travelling, working out, exploring the world, and generally being active. I also wish I could have had a typical guy friend group through my teenage years. Since getting ill, I almost can't separate "being a man" from that life I'd hoped to have.
At the same time, I only started imagining a future outside of just having a career once I “allowed” myself to picture living as a man. Before that, my future was basically just "have a job." Suddenly, I can imagine hobbies, relationships, friendships, and travel.
Before getting ill, I felt very sure I was trans. I genuinely love it when my friends use a male name and he/him pronouns for me, even though I still feel awkward asking for them. Wearing a binder and masculine clothes feels like coming home. I get intense gender envy, sometimes to the point of crying or screaming into a pillow after watching a movie because I wish I looked like or could be one of the male characters. I've cried reading MLM stories because I felt like I'd never get to experience that as a guy. I get jealous of random guys on the street and hate when groups of guys suddenly change how they act because "there's a girl here now."
I also hate the idea of being pregnant and always have. Even now, if I'm bloated and my stomach looks pregnant, I feel disgusted and wish I had a flat, masculine body instead. I mourned losing all the gym progress I'd made before getting ill because I loved feeling stronger and more muscular.
At the same time, there are moments where I desperately wish I could just be a pretty girl. I think maybe if I tried harder to be feminine and attractive, I'd finally feel comfortable. Maybe all of this would go away.
I've also spent the last few years being angry at men (read: patriarchy) because of how many make women and minorities feel unsafe, and I worry about becoming part of that group. I'm also scared of disappointing my family and making my life harder by transitioning.
My therapist asked me a couple of months ago whether this could all just be a form of escaping my reality now that I'm chronically ill. Ever since then, I've been overthinking everything.
When I'm ill, I start thinking maybe I should just stay a woman because it's safer and easier. Maybe I only want to be a man because I'm attracted to men (I'm bi). Maybe I envy their strength because my body has become so weak.
But every time I convince myself I'm "just an insecure cis woman," the thoughts about being trans always come back. I honestly don't think a day has gone by since January where I haven't thought about my gender.
I also don't think I ever consciously wanted to be a boy as a child. My parents never enforced gender roles. I wore dresses, have always had long hair, and I've always been very sensitive and soft-hearted. On the other hand, I also don't think many cis women spend months questioning their gender every single day.
I feel really lost :/
Has anyone else with chronic illness or a disability experienced something similar?
How did you figure out whether you were grieving the life you thought you'd have versus experiencing genuine gender dysphoria or euphoria?
Did your feelings about your gender change depending on how ill you were?