Facing healthcare as a transgender person

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When you walk into a clinic, a hospital, a doctor’s office, you might have some anxiety or trepidation. Maybe you don’t like needles. Maybe the too-clean smell and all the hand sanitizer sets your nose off. You might recall stressful times in the ER or waiting for someone in surgery. It could be the thought of vending machine dinners or hospital cafeterias that drags you down.

But what do you expect when the medical professional comes in to talk to you or treat your symptoms? Do you expect them to address you respectfully? Do you know you’ll be safe and cared for? After all, every one of us is vulnerable when we submit to exams and ask for diagnoses and help with our bodies.

As a transgender human, my experience is probably not like yours.

I do not know what pronouns they will choose for me. Am I sir? Or ma’am? Are they looking at my face to decide? Or are they reading my chart? And which part of my chart? The part that says my biological sex or the one that lists my legal gender? And which legal document are they even asking for?¹ As we converse, will they slip up and say the wrong pronoun? Will they intentionally de-gender anything they can to avoid the issue altogether? Will they use statistics for my sex at birth or for my current hormone panel? And really, what should they use for any of that?

They are unlikely to be trained in providing transgender healthcare. And this isn’t just for hormone replacement therapy (HRT), it’s also for things like headaches, depression, high blood pressure, diabetes, and any other healthcare concern I could take to them. I recently watched an interview with a doctor who revealed just how little most doctors learn about women’s healthcare, how the medical industry in the United States excluded women from testing pharmaceuticals and procedures until the 1980’s, and I wanted to laugh at the bitter irony there. If you haven’t learned about women’s health, then what the hell would you have heard about transgender healthcare? So did this doctor take an hour-long seminar once? Did they watch a YouTube video? What do they actually know about the things my body is going through?

Wait times for an appointment could be outrageous. And good luck finding anyone who actually specializes in trans care, let alone a provider with any level of experience treating real transgender patients. But if you do find one, be prepared to wait for months to get into their office. Current medical needs either have to wait, or you’ll need to visit a provider who has no training or exposure to transgender healthcare. And still wait.

I don’t know if their personal opinions will inform their professional behavior. And maybe none of us knows that about our doctors and healthcare providers. But with trans identities being torn apart in the media, in congress, and in the courts, it’s nothing more than a guess as to how that one physician might feel about a trans person sitting in their office under a blue gown.

Am I even safe in that office? Sure, they took an oath. But who were they envisioning when they repeated it? Was it someone like me? I'm not convinced. And I think we all know that there is an uneven power dynamic between doctor and patient. If something happens when they are alone with me, will anyone believe me? Will I have the courage to speak out about it? And what if it’s not even about physical safety, but more about the emotional safety you need to tell your doctor the truth, to ask for help with something that’s really difficult or impossible to handle without them? Trans people, in particular, are vulnerable in ways that others are not, and we are often targeted.

Will they listen to me? Maybe this is just a holdover from so many years of being perceived as female (and ignored, not listened to, dismissed, disregarded), but as a transperson I have not had a good track record of medical professionals listening to my words at all. That’s not even touching on the topic of how any kind of hormone can make you feel and whether someone will believe that those feelings are real in any way at all.

I should be more than just my parts or even the sum of them, but I won’t be in that office. It shouldn’t matter whether you’re seeing a specialist or a general practitioner, that doctor is treating a whole person, and they should ensure that you know your entirety is being cared for.

It goes without saying that these things are not okay, that no one should have to put up with this kind of treatment or worry about their safety when THE ONE THING we need above all else is to be cared for. But I don’t know what I will get when I sit down in that exam room. And as I walk down that hallway, I must consciously work to calm my racing heart, to control my blood pressure, and to hide my shaking hands.

Do you?

Your trans friend,

Robin

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1. For reference, I have three different sex/gender markers on three different identity documents, and I never know which one will be accepted.