Picture this: You have a chest cold and you’re going to the doctor. You arrive expecting to discuss a few things including your symptoms, your health history, and, if applicable, your insurance. The medical professional treating you asks about your gender identity, including possible complications and side effects of medications they aren’t sure about. If all goes really well, they use your correct name.
If that scenario starts to feels off-script for you, consider yourself lucky. Because for many trans people, accessing medical care requires them to teach their doctors. It also involves being misgendered, misnamed, and possibly denied care. And as Sasha, a 24-year-old trans advocate living in Brooklyn, New York, stressed in a phone interview with Daily Kos, none of this is okay.
“When dealing with the trans community, there’s very often an incorrect assumption that our medical needs begin and end with gender-affirming care,” Sasha, who requested anonymity to protect herself from repercussions in her professional life, explained during our call. “There is a perception in the medical community that only specialists can deal with trans patients in any capacity.” Sasha noted that in her New York City area, “often times it’s easier for a trans person to get hormones than to get treated for a cold.”
For Sasha, this problem isn’t just theoretical. She described an instance where, after she began receiving hormone treatments, she experienced chest pains. As most anyone would do, she went to the emergency room. Sasha recalls the professionals checking her for heart issues, then coagulants in her blood (blood clots are a risk when taking hormones) but ultimately not finding them.
Instead, they suggested she might have anxiety. The implication is that because she’s trans, and there’s a high level of anxiety and depression reported among the trans community, that’s the simple answer. They sent her home.
The next day, Sasha remembers receiving a call. After looking at her MRI again, they later realized she had a spontaneous pneumomediastinum, which is (basically) an air bubble in the chest. What it isn’t? Related to gender.
“This is is a medical situation that was treated differently on account of my being trans,” Sasha explained, “in spite of the fact that it’s not related to my gender identity.”
Even if you're lucky enough to access care as a trans person (almost 20% of trans people live without any form of insurance), the experience can be degrading, if not outright dangerous.
And while many people in the general population leave medical situations feeling frustrated or dismissed by their doctors, it can be chronic for the trans community. In a survey conducted by Lambda Legal, for example, 70% of transgender and gender non-conforming patients reported experiencing discrimination when seeking healthcare.
While there are a growing number of medical professionals who are explicitly trans-friendly or specialize in trans-related care, that’s far from adequate to serve the needs of an entire community.
”There simply aren't enough specialist doctors to go around,” Sasha noted, “and therefore the expectation that trans people go to specialists for a routine medical need is becoming more and more dangerous.”
“We are about as common as Type 1 diabetics,” Sasha added. “If a Type 1 diabetic had the flu, they would be able to go to a general practitioner for treatments, no questions asked.”
At one point, Sasha says she went to a local clinic in New York. She tells me that the medical professionals treating her didn’t initially realize she was trans. When they did, she felt forced into the role of teacher.
“They asked a lot of very 101 questions,” she remembers, including what side effects or complications came with her hormones. Ultimately, she left the visit with a prescription for antibiotics—and the nagging frustration that she shouldn’t have to educate her doctors.
The numbers back up Sasha’s experience, too. In a 2015 U.S. Transgender Survey, 33% of respondents who had visited a health care provider in the last year reported having one or more negative experiences. What did this look like? According to respondents, this included verbal harassment, physical or sexual assault, and being refused treatment. It also involved having to teach providers how to give them the correct medical care.
That’s one burden patients shouldn’t have to carry.
“Bodily autonomy is important for people of all genders,” says Signey Olson, a nurse practitioner at Columbia Fertility Associates, in an email interview with Daily Kos, “and this has been increasingly discussed as a focus of healthcare. Having access to both a trans-knowledgeable provider as well as gender-affirming care is an essential core part of respectful healthcare.”
“Gender-affirming care does not fit neatly into a box,” Olson continued, “which is why it’s necessary for clinicians to receive training in these areas. “
For medical professionals who feel overwhelmed or don't know where to start in offering inclusive care, Olson stresses that it’s ultimately their responsibility to educate themselves—and also, not to overthink it.
”Medical providers take care of people,” says Olson, “not body parts, and these body parts are not inherently gendered. Ethically speaking, all medical providers have an obligation to learn how to provide the best care for the people who walk in their office doors, many of whom are trans or non-binary. Every medical provider has interacted with a trans or non-binary individual, whether they are aware of that fact or not.”
”Trans people get colds, trans people have allergies, trans people get cancer and heart disease,” Sasha added, “and if a trans person receives substandard care, that’s part of the same issue as not having vaginoplasty covered.”