This post is part of Outward, Slate’s home for coverage of LGBTQ life, thought, and culture. Read more here.

Roger Severino, the director of the Department of Health and Human Service’s Office of Civil Rights and the apparent architect of the trans-erasing draft memo revealed by the New York Times on Sunday, once called the Obama-era protections he’d like to reverse the result of “radical gender ideology.” Embedded in this phrase is an idea—a pernicious one﻿—that trans people are an intellectual exercise, an argument from queer theory made flesh. To put it bluntly, that becoming trans amounts to an aesthetic choice. Worryingly, I think more people than Severino, even LGBTQ-supportive ones, believe this, or at least sort of wonder about it.

In light of that, as my right to exist is under attack, I feel the need to say: I never wanted to be transgender.

Gender dysphoria—the clinical term for the distress a trans person feels when forced to present as the wrong sex—was a crippling, painful fact of my life for 26 years. Having breasts and hips felt like a gross slime was covering my body and I could never get it off. When I looked in the mirror, the girl I saw seemed like a stranger. I developed an eating disorder, I was depressed, I barely left the house. If there was any way at all I could have gotten over it without transitioning, I would have done so. Please, believe me. I don’t even like doctors! I’m afraid of surgery! I didn’t choose to be transgender.

Transition is the only known effective treatment for gender dysphoria. With a doctor’s help, after months of gender affirming therapy, I started testosterone injections because I hoped to recognize my own face as really me and to walk through the world without a constant feeling that my body moved wrong. I intentionally put off coming out as trans until after I was sure testosterone was working, just in case I found out I was mistaken. But once I finally began to recognize the person I saw in the mirror, after I stopped having any nagging feeling that I wasn’t real (a serious psychological condition called depersonalization) or that the world around me was colorless and two dimensional, it was unavoidable. I had to come out as transgender because I was transgender, not because I wanted to be.

People around me, even those who were skeptical at first, have noticed I’m more present, more engaged, less anxious and self-conscious. But, there’s a big downside. In order to treat my medical condition, I had to accept myself as a member of one of the most mocked, hated, feared, and misunderstood groups in America. I didn’t—wouldn’t—ask for that. I am so hated that the U.S. government appears to be moving to re-define sex to make it easier to discriminate against me. I am so feared that some people want to make it impossible for me to use a public restroom.

I didn’t ask for any of this, and if I could have avoided it I would have. If I could be cisgender—whether as a man or a cisgender woman—I would be.

In the 1990s, I remember a common form of persuasive essay in which a gay person—most often a gay man—would heartrendingly explain that he didn’t choose to be gay, would never, ever in his life have chosen to be gay, then beg mainstream America not to persecute him for something that he had no control over. That sort of essay has rightly fallen out of favor in the LGBTQ community. It undermines our pride to explain, in painful detail, how desperately many of us once wished not to be who we are. It undermines our liberty, because there’s no good reason to forbid people from choosing a gender, even if gender was a choice. And, it undermines our dignity to have to beg for scraps of tolerance, to perform this ritual of saying that it’s better to be straight and cisgender, that we just can’t help our differences.

I don’t enjoy writing an essay in this old-fashioned mode, but I am writing this one because I think you need to read it. With every joke about trans people’s appearances, with every snide remark about someone identifying as a helicopter or an animal, with every suggestion that Democrats abandon transgender rights for the sake of mythical white working class moderates, and with every pseudoscientific article that attempts to re-re-re-open the question of whether trans identities are legitimate, it’s been made clear: Cisgender Americans just don’t get it. You don’t get how crippling it is to experience gender dysphoria. You think being transgender is about wearing different clothing or preferring different pronouns. It’s not.

I don’t know what the biological basis for transgender identity is, but I know there must be one, because I tried for more than a quarter century not to be trans, and nothing worked. My gender dysphoria didn’t go away with years of talk therapy, from several different therapists. None of the dozens of anti-depressants and mood stabilizers I was given helped either. Trying yoga and other forms of physical activity to feel more present in my own skin backfired—I felt more trapped, and more dysphoric than ever. Transition—only transition—has given me the life I wanted, not because I’m now a man but because, living as the man I always was, I’m finally able to be a normal, healthy person.

I tried to be cis and pretended I was cis for 26 years, but it didn’t make me any less transgender. It did, however, make me miserable, unemployable, and prone to depression and thoughts of suicide. I would never have chosen to be trans, but in the end I had to accept the truth, and so do you. Transition is the only known effective treatment for gender dysphoria. Trans people are real. As much as some of us might wish we weren’t trans or that gender dysphoria wasn’t a condition at all, that’s not reality. We are here, and we cannot be erased.