What It Means To Be An Addict + Trans

Stories, Mind + Spirit, Home + Community, Social, Intervention Support, CommunityMJ Eckhouse
Image by Rebecca Lieberman

Image by Rebecca Lieberman

By MJ Eckhouse

My interest in drugs began at age 11. My classmates had begun tormenting me for my masculine appearance, and I was terrified of impending puberty. So when an older kid offered me weed, I jumped at the chance for some escape.

Over the next ten years, I watched myself do literally whatever it took for another hit of meth or crack cocaine. By then, I had already come out as trans, but that wasn’t enough to motivate me to stop using. It wasn’t enough being hospitalized, or threatened with jail time. Finally, after an experience getting high with the only other trans person I knew, I finally became ready to quit. There I was, still feeling paranoid and alone, despite the company of someone who actually understood me. It was time.   

While considering treatment, I ran into a problem: Inpatient rehabs are segregated by gender—restrooms, locker rooms, and even activities. I knew these programs probably wouldn’t be the safest places to be trans. Though I found “LGBT-friendly” rehabs over the course of my research, I felt skeptical that the “T” was anything more than an afterthought.

Ultimately, I didn’t go to rehab. Fortunately, I haven’t used drugs or alcohol since 2013. Instead of inpatient treatment, I decided to try 12-step meetings. As a queer agnostic, the “God” language concerned me at the get-go, but now that it’s been more than three years, I can say confidently that it hasn’t been a problem. Belief in a monotheistic religion hasn’t been a requirement for support from the 12-step groups, and I’m still as queer and agnostic as ever.

A First Step: Do I Have A Problem?

Studies show that trans people are more likely to use substances. And in a way, substance use seems built into queer culture. Most cities have several gay bars, but rarely have LGBT homeless shelters. Queer sex and drug use have intertwined for decades. Many trans folks end up doing sex work as a response to discrimination, and that might include drug use. With substance use so prevalently positioned in the community, it can be hard to determine if you have a problem with substances, or if it’s just habit. If you think you might have a problem, or if the question seems worth exploring, here are some questions you can consider as a starting point:

  • Do you frequently think about drugs/alcohol?
  • Does your use of drugs/alcohol interfere with work, school or relationships?
  • Do you use/drink alone?
  • Have you ever stolen or had sex to obtain drugs/alcohol?
  • Do you use/drink to change how you feel or escape reality?
  • Has your using/drinking gotten progressively harder to control?
  • Do you still use/drink despite legal, financial or other consequences?  

Before I quit, I would have answered “yes” to all those questions—that is, if I answered honestly. For years, my friends, family and therapists told me I had a drug problem, but I denied it, always finding a way to rationalize my way out of coming to terms with it. “I’ll stop eventually,” “I still have a job,” “l’ll just get another job,” “I don’t shoot up, so it’s not a big deal”—the list goes on and on. Fact is, I put drug use first. I didn’t need to live under a bridge and share needles to have a problem.

What Might Be Next: An Overview of Treatment Options

Inpatient Rehab

Residential treatment centers are a well-known method of addiction recovery. However, they pose some drawbacks for trans people. Plus, the costs of private facilities can be prohibitive. But if you’re still deciding, it may help to consider the “pros” and “cons.”

There is one trans-exclusive rehab in Philadelphia. Unfortunately, it has only eight beds and only welcomes Philadelphia residents.

Advantages of Inpatient Treatment:

  • Takes you away from your environment, dealers and drinking/using buddies.
  • Provides structure and routine to your daily activities.
  • Constant access to support.     
  • May include medically-supervised detox.

Outpatient Treatment

Outpatient treatment also provides structure and guidance for staying sober but on a part-time basis. Instead of living in a facility, people attend individual and group counseling. This allows time for work or school and might relieve some of the problems trans people face in gender-segregated rehabs.

Many areas have state-funded inpatient and outpatient programs, which can help with the cost.


Due to medical gatekeeping, trans people are often familiar with therapy. Over the years, I’ve seen several therapists. Unfortunately, most of them didn’t know how to help me with transition or addiction. However, some are knowledgeable, and often, finding the right therapist comes down to just finding the right fit. Therapy is worth considering—it may just take patience, and a willingness on your part to ask around for references for therapist who have experience working with trans people and/or substance users.

If there is an LGBT clinic or community near you, it’s worthwhile to ask other trans people for suggestions. “Find A Therapist” sites list therapists who describe themselves as “LGBT-friendly,” which may be better than not.

12-Step Meetings

I maintain my recovery with a 12-step program. The “God stuff” in the 12 steps worried me, but the people are far more accepting and open-minded than I expected. At meetings, I speak openly about being trans and I’ve never encountered hostility.

12-step meetings are:

  • Free.
  • Widely accessible.
  • Sometimes designated as LGBT-friendly or for agnostics/atheists.
  • Based on suggesting abstinence from all substances.

Other Peer Support

12-step meetings aren’t the only non-professional recovery option. Other programs include Smart Recovery, Moderation Management, LifeRing Secular Recovery and Secular Organizations for Sobriety.

These nonprofit programs,

  • Don’t use religious language like “God” or “Higher Power.”
  • May or may not emphasize complete abstinence from all substances.
  • Have fewer in-person meetings.       

Recovery coaching is a professional form of supportive mentorship, usually with a coach who has personal experience with addiction recovery. Through early recovery, I spoke with a California-based recovery coach over the phone. A new practice, recovery coaching is growing in coastal states. This may benefit trans people, since many of these states are strong champions of trans rights.

Along the Way: Consider Harm Reduction

Two years ago, a close friend of mine died of a heroin overdose. Naloxone is a medicine for harm reduction, which immediately reverses the effects of opiate overdose. Other harm reduction strategies include,

  • Safe injection sites
  • Hiding your keys or giving them to someone if you might drink and drive
  • Needle exchanges
  • Opioid replacement treatments (Suboxone, Methadone)

Bottom Line: Know You’re Not Alone

Society misunderstands trans people as well as people with addictions. So, as a trans addict, it’s easy to feel isolated. I can’t say it’s easy to find community, because it’s not, but it’s also not hopeless. In early recovery, I told people I was trans, expecting them to reject me.

To my surprise, people welcomed me, respected my gender and even told me about other trans people in recovery. We’re out there and if I can do it, so can you.



MJ Eckhouse is an activist, writer and student of political science. Though he's still in Ohio, MJ dreams of someday being able to afford San Francisco's cost of living. Contrary to popular belief, MJ regularly uses public restrooms without attacking anyone or provoking societal downfall. He's also the editor-in-chief of Kent State's LGBTQ magazine, Fusion.




When Crisis Calls

Mind + Spirit, News + Politics, Community + Allies, CommunityJames Blake

It was late one evening, and my wife and I had had a pretty rough day. She had been in physical pain all day, and we hadn’t much money left to last until payday. We were hungry, broke, exhausted and ready for a break. As we were driving, our tire blew, and it was the final straw. Our spare was already flat. We felt hopeless and didn’t know what to do. Perhaps that’s the definition of a crisis.

Hello, My Name Is Natalie. I Am Transgender And I Am Proud

Questioning, Gender Fluid, Coming Out, Stories, Female-To-Male, Fitness + Diet, Mind + Spirit, Medicine, Confirmation Procedures, In Transition, Men's Style, For Kids + Teenagers, Work + School, Community + Allies, Social, Personal Branding, Continuing Education, Job Boards, Know Your Rights, Suicide Prevention, Intervention Support, Allies + Volunteering, CommunityNatalie Egan

As many of you know, and as many of you do not know, I don’t go by Nathan anymore. My full name is Natalie Jane Egan and today is kind of a big day.

Besides coming out “online” as Natalie and now being openly transgender on the Internet, I am also announcing my new company: (more on the biz in a bit).

I realize many of you know me for different reasons. Some of you are my brothers and sisters; others are friends, professional colleagues, or acquaintances at some level and for some reason. If you’re getting this message, chances are we somehow know each other, or know friends in common, and I want to thank you in advance for your support. And, if I don’t know you at all, I hope my message helps you or someone you know find their true identity.

So yeah, I am transgender. Oddly enough, I really didn’t even know this until pretty recently. But before you jump to any conclusions, let me answer some commonly asked questions, and address some reactions I anticipate:

What does being transgender mean? To me, being transgender is a matter of my identity. Despite the fact that I was biologically born a boy named Nathan, my gender identity, the way I want to express myself, is female. This has been a profoundly personal realization for me and shouldn’t matter to anyone. I want to live my life as me—not as the person society wants me to be. Don’t we all deserve that right? I am not hurting anyone. If anything, I am setting people free. If you have a problem with me being “me,” you should really think about why that is the case.

“But Nathan was so manly!” Well... sort-of. You’re right that my outward appearance was “manly.” You may remember me as a rather large, hairy, OCD / hyper-controlling alpha-male that at times could be quite uncouth. But if you really knew me, you knew that inside I was a very nurturing, sensitive, open, and colorful person that loves shopping and art and flowers and doing “feminine” things like going to the spa. I also always wished I was pretty and that I could be a mom. If you are confused, imagine how I felt! Until recently, I never even knew I had a choice to express my true self, nor did I realize anyone else felt similarly to me… I’m grateful that I do now, so I am going to live the rest of my life like it is the only one I have got!

So, how do I identify? To be clear, I identify completely as a woman. Genetically, I was not born as a woman and yet I have the right to identify as one. Please use the pronouns “she and her” with me. I also don’t mind words like babe, girl, girlfriend, sister, and woman as long as you have a little class in your delivery.

What bathroom am I using? When I look like I do in the middle picture above (which, for now, is still about 80% of the time), I simply try and avoid using public bathrooms. It really sucks. But the good news is that I am making great progress with my transition, and eventually I will look much more like the Natalie on the right! Hopefully, by the time that happens (about 12-18 months), this whole bathroom debate will be over and no one else, no matter how they identify or what they look like, will have to suffer from not peeing.

How could I not know I was transgender? The truth is I always knew I was “different.” But I didn’t yet have the vocabulary to pinpoint why exactly. I didn’t know why I wanted to be pretty or why I was drawn to the color pink when I was younger. I just did. And no one readily used the word “transgender” when I was growing up—and don’t forget, there was no internet. So I felt totally alone, which left me feeling alienated and unsure of what was “wrong” with me. It was only about 9 months ago that I finally accepted that I was transgender and not just a “crossdresser” (although that took a very long time for me to accept, too).

Do I think I was born in the wrong body? No! But I definitely went through a phase where I thought that was the case. I now truly believe that I was born in the right body and all of this was meant to happen. I was meant to meet Nancy and make our kids. I was meant to start and you were meant to read this. Together we will change the world.

What about my kids? Van, Brook, and Teddy are all fine! Seriously. If they were older, it would be harder for them to process for sure. This a transition for them too. But they are all at a good age for acceptance, and as a family we love each other totally unconditionally. So while all of this isn’t easy, what my kids “get” is a happier more loving parent who is more present and connected than ever before. That is all that matters.

What about Nancy? This has been really hard for everyone, especially Nancy. And through it all, she has been unbelievably supportive of me and the kids and I love her so much for it. We are deeply committed to helping one another live happy and healthy lives, but again, that doesn’t make this easy. The bottom line is that we have a foundation of mutual respect, love and support. Every day, we look forward to helping each other be the best versions of ourselves, and to being great co-moms for our kids.

What happened with PeopleLinx? As many of you know, PeopleLinx is the software company I started in my basement in 2008. As CEO for six years, we put more than $8M to work in the US economy, and created 35+ full-time jobs in Philadelphia. In mid-2015, I voluntarily resigned for personal reasons (which may be clearer to you now - haha), and today the team is being led by my good friend and our former Chief Operating Officer, Kevin O’Nell. So to answer the question, PeopleLinx is doing great and I am still an active member of the Board of Directors.

Where am I in my transition and how far will I go? Let me start with a friendly reminder that this is not really an appropriate question to ask a trans person, especially if you don’t know them well. Everyone expresses their gender identity differently, and is a matter so personal it just isn’t other people’s business. That said, I don’t mind sharing. I have started hormones, which is amazing, and is connecting me with my body and humanity and the earth in ways I never knew possible (BTW: I love to talk about the hormones part, so always happy to chat about that one). I am also currently doing hair removal procedures, which are super painful but I love the way they make me feel afterwards. Other than that, I am taking all of this very slowly and my only basic expectation is to feel a sense of progress towards being my real self.

Am I happy? Healthy? OMG yes! In fact, I am both the happiest and the healthiest I’ve ever been. I have lost 40+ lbs in the last nine months, simply by becoming more mindful of what I put in my body (regular exercise helped too). I also quit smoking cigarettes completely (I was smoking a full-pack-per-day!), and cut my drinking and any other unhealthy activities by at least 80%. I am also no longer dealing with depression, or the suicidal thoughts that plagued me over the last year. Those dark days were especially hard as I lived in fear of being outed or blackmailed and ultimately rejected by society because someone “knew” I like to do things that women do (which is totally ridiculous now in retrospect). Today, I have a ton of energy, am super focused, and I know I am making a real difference in the world. I also know that I am a great parent for these kids. What else could I ask for? Well sure, there are a lot of other things I want, but you get my point.

So what is my new business? is an information hub for both consumer and institutional audiences related to a broad range of transgender issues. I started because I myself really struggled to find good, up-to-date information about being transgender. It was even harder for my friends and family, all of whom immediately Googled the word “transgender” when I first said it, and still felt in the dark about the nuances of what I was going through. Furthermore, I found corporations have no tools, language, or metrics to handle the growing number of both employees and customers that identify as transgender. That fact is that everyone deserves access to current, high quality information about trans issues and that is what we are doing. Our vision is to change the way the world thinks about identity and being who you want to be.

*Please note, I don’t claim to be an expert on being transgender or plan on being the authoritative voice of transgender people. That’s an impossible feat, as there’s no such thing as a homogenous “transgender community.” I am, however, an expert in building digital platforms and connecting communities so they can share their experiences and self-identify with what matters to them.

So what else? What can you expect? To be honest, I don’t know really know. I am learning more and more about myself and my transition everyday and it is super exciting. Please know that you will probably keep seeing subtle changes in me and I will try and keep you in the loop on important matters. Most importantly, know that I am working really hard to support my family as best I can.

How can you help? All I really need is your love and support and ask that you respect my right to identify with who it is I really am. My family needs your support too. It means so much to me and to them to know you care, please show you do by sharing this article with your friends and loved ones! It would also be super helpful if could spread the word about as a resource for consumers and corporations on trans related issues.

In closing, remember this: being transgender is about more than gender. It is about identifying with who you want to be—not who others want or expect you to be. If you want to change your life: DO IT!

Big love to all of you. Thank you again for your support. There is so much more to come!



PS: Please remember to call me Natalie (or Nat, or even Natty) if / when you respond or comment. Also, please also use the pronouns she / her and try to avoid declarations like DUDE and bro! If you make a mistake that is fine but just keep trying. You will get it!

* Note - we intentionally keep comments “off” for because of the broad range of readers (from kids to parents to corporate professionals) and encourage you to continue an authentic conversation on your social media networks. You can also reach out to me or the company directly if you want to chat!