What We Wish Providers Knew About POTS and Dysautonomia
Living with POTS and Dysautonomia: A Daily Battle for Belief
Living with POTS (Postural Orthostatic Tachycardia Syndrome) or dysautonomia means navigating more than just physical symptoms. For many trans, nonbinary, and neurodivergent people, it also means battling medical gaslighting, misdiagnosis, and/or being told “it’s just anxiety.”
At OutPsych, we frequently work with clients who’ve spent years trying to get answers—years of dizziness, fatigue, heart palpitations, nausea, heat intolerance, and brain fog—only to be told it’s all in their head.
But it’s not. And we believe you.
What Is POTS and Why Is It Misunderstood?
POTS is a form of dysautonomia, a disorder of the autonomic nervous system that affects functions like heart rate, blood pressure, and digestion. Symptoms can include:
Lightheadedness when standing
Rapid heartbeat
Nausea or GI issues
Fatigue
Brain fog
Exercise intolerance (difficulty exercising at all, difficulty doing intense exercise, and/or difficulty exercising for extended periods of time)
These symptoms often overlap with other complex chronic illnesses like Ehlers-Danlos Syndrome (EDS), MCAS, fibromyalgia, chronic fatigue syndrome, and long COVID.
Because these conditions are multi-systemic, poorly understood, and harder to test for, patients—especially those who are trans, nonbinary, BIPOC, or neurodivergent—are frequently dismissed or misdiagnosed.
The Problem: Dismissal and Fragmented Care
Many of our clients have been called “complex” not because their bodies are confusing—but because the system isn’t equipped to listen. In fast-paced, 15-minute appointments, nuanced conditions get boiled down to a single symptom. Patients are told to hydrate more or try CBT. Meanwhile, the root problem worsens.
Often, they’re referred to multiple specialists—none of whom talk to each other—and each only treats one part of the picture.
This kind of care fragmentation is especially harmful for LGBTQ+ patients with chronic illness, who are already navigating higher rates of trauma, minority stress, and systemic medical bias.
The Intersection of Dysautonomia and Marginalized Identities
People who are trans, nonbinary, neurodivergent, or disabled often face compounded barriers when trying to get care for dysautonomia.
Some of the most common experiences reported include:
Being told symptoms are “just stress” or “just anxiety”
Not being taken seriously because of mental health history
Being bounced between specialists without coordination or answers
Feeling gaslit or dismissed when asking questions or requesting tests
This is often referred to as medical gaslighting—when someone’s symptoms are minimized or explained away without proper investigation. It’s not always malicious; sometimes, it comes from gaps in provider education or unconscious bias. But the impact is the same: patients don’t get the care they need.
The Importance of Trauma-Informed, Affirming Care
It’s important to recognize that medical care is relational. And when someone has been dismissed or disbelieved over and over, it’s not just frustrating—it’s traumatic.
A trauma-informed approach means understanding that a person’s nervous system may be sensitized—not just by their condition, but by years of invalidation. It also means creating a clinical space where patients don’t feel like they have to prove they’re sick in order to receive care.
For patients who are trans or nonbinary, affirming care includes:
Using correct names and pronouns without hesitation
Understanding how gender-affirming care might intersect with physical health
Being mindful of the historical harm psychiatry and medicine have caused to trans communities
Not assuming that someone’s gender identity is relevant to every medical issue—but also not ignoring its significance when it is
A Note for Providers
If you’re a healthcare provider, here are a few things we wish were taught more widely in clinical training:
"Normal" labs don’t mean someone is fine. Listen to patterns, not just numbers.
Multisystem symptoms are often connected. Don’t assume different organs = different problems.
Trans and neurodivergent patients aren’t inherently unreliable narrators. Bias in clinical interpretation is real.
Chronic symptoms don’t mean someone is fixated on illness. Often, it means they’ve been forced to become their own expert.
What We Wish More Providers Knew About POTS
Dysautonomia is real—and it is not rare.
Trauma and chronic stress can dysregulate the autonomic nervous system.
Being trans or nonbinary is not a reason to disbelieve someone’s symptoms.
A good treatment plan starts with trust, not dismissal.
POTS and dysautonomia are real, complex, and life-altering conditions. Getting a diagnosis shouldn’t require years of advocacy and self-doubt. And patients shouldn’t have to shrink their stories to fit into a 15-minute visit.
Whether you’re living with these conditions or treating them, the call is the same: believe people. Listen longer. Be curious.
Because healing isn’t just about the right medication—it’s about being seen.
You Deserve to Be Believed
If you’ve been brushed off, told your symptoms are psychosomatic, or made to feel like a problem for needing more time, we want you to know this: you are not too much. You are not imagining it. You deserve real care.
At OutPsych, we provide care that is evidence-informed, trans-affirming, and radically compassionate. We know how much harm the healthcare industrial complex and unquestioned biases can do—and we’re here to do things differently.
Ready for Care That Gets It?
If you’re navigating POTS, dysautonomia, or another complex chronic illness and are looking for a provider who gets the intersection of physical health, trauma, and identity—we’d love to hear from you.
Let’s build a care plan rooted in trust, respect, and belief.
