Several years ago, before I passed as male, I went to a clinic for a routine sexual health check-up. I stated I was a trans man on the registration form. The nurse, an upbeat, chatty guy, was intrigued by this.
“And how would you describe your sexuality?”
“Bisexual? It’s funny isn’t it, though?” he mused.
“Gay, lesbian, bisexual, what does it all mean?”
He gave me space to answer, I didn’t.
“Because you’re like . . . a woman who’s a man . . .
So what do you think about when you masturbate?”
This was not the route I expected the conversation to take—and what it had to do with my sexual health I wasn’t sure. I know I should probably have been outraged, but part of me was weirdly pleased at least by part of what he’d said.
Before I started taking testosterone (T) to masculinize my body and appearance, I was used to telling medical professionals I was a man, and having them look at me like I was insane. Despite his clumsy definition of what it was to be trans, and his wildly inappropriate question, at least the nurse had acknowledged my identity. This made him better than the majority of healthcare providers I’d interacted with.
“I met a man who used to be a woman in Paris,”
he later confided,
”and I had no idea...
but you know like when you’re just like,”
—here he practically fluttered his eyelashes—
I had to laugh as he handed me the anal swab, though I can understand how upsetting this interaction could potentially be.
Despite negative pre-testosterone experiences, I’ve actually found going to clinics harder since taking hormones. Passing as male gives me privilege in so many respects:—I no longer get misgendered, and I’m read as a cis man in a world that is set up to favour white cis men. But, prior to passing, my trips to the sexual health clinic were actually more simple. I was regularly misgendered by staff, but in general they still knew how to treat me, and got on with it. My anatomy never came as an unpleasant surprise.
“The nurse looked like I ruined her day”
About a year ago, I had unprotected sex with someone with a penis, and was concerned about the possibility of getting pregnant. The thing is, I wasn’t completely sure I could—by then I’d been on testosterone for a couple of years, and was also on hormone blockers. I explained my dilemma to a pharmacist, who looked pretty horrified by this dude asking if he needed the morning after pill.
She said I couldn’t get pregnant if I wasn’t still menstruating, and hurriedly sent me home—where of course I looked on the internet. In my experience, health information shared amongst trans communities online is often far more informative than the doctor.
The internet held conflicting views.
One forum said you could not get pregnant on T, you had to stop in order to do that, certainly not T and Decopeptyl, the hormone blocker I was on. Another said you could. One guy said he’d been on T for years and his periods had stopped and he still got pregnant. A cis guy I’d had sex with said you definitely couldn’t. My friend said you could on T, but not Decopeptyl. The leaflet for Decopeptyl said, “This is not birth control”.
Reluctantly, I decided to go to a clinic.
Given my track record of bad experiences, I made a special effort this time to find a trans-friendly clinic. A nonbinary friend mentioned one where they’d had a good experience, so I went there.
My appointment started off well enough until I told the nurse I was trans. Even though I’d put this on the registration form, it seemed to come as a shock. She was silent for a moment, then asked, “Are you becoming a man or a woman?” I detachedly explained to her the specifications of my body and gender as best I could. We tested for STIs.
“And the men you sleep with, do they just sleep with women
or do they sleep with men as well?”
I asked her, “Do you mean do they sleep with men who aren’t trans?”
and to her credit she did correct herself.
I asked her if I could get pregnant, and she looked freaked out.
“I’ve never encountered this before,” she said curtly.
A senior nurse was summoned, who was a lot nicer, but still didn’t know. The two of them looked through a book of medications, then rang a doctor. The doctor concluded it was technically possible that I could get pregnant. Fortunately, when I finally did a pregnancy test, it was negative. The nurse looked as though I’d ruined her day.
[Editor’s note: We did some digging and can confirm that it IS possible to become pregnant while on T. But...it’s complicated. We’ll publish a scientific deep-dive on this topic in future.]
A turning point
After that I started going to CliniQ, a dedicated sexual health clinic for trans and non-binary people. I knew of CliniQ when I was still going to the “regular” clinics, but the clinic is only held for a few hours one evening a week, and I was always working. Worn out by my experiences elsewhere, I found ways to get out of work when I needed to go, but not everyone is able to do this.
For me, CliniQ was a godsend. On the pre-appointment form, they ask how you identify, what pronouns you prefer, and what terminology you would like them to use regarding your body. The nurse I saw never questioned my gender and was extremely knowledgeable about the way hormones affect the bodies of trans people—and how this can relate to sexual health. This was unprecedented in my experience.
Of course, I was very lucky to be living in a city where such a service was available. Many trans people do not have this privilege, and even where such clinics are available, they are generally over-stretched and underfunded.
I don’t expect all GUM (Genito-Urinary Medicine) clinics to become flawlessly trans-inclusive overnight, but I would like it to be a normal experience to go to the doctor or clinic, and not to be met with bewilderment or worse. That shouldn’t be too much to ask.
Trans-friendly healthcare resources
There are some excellent individuals and organisations advocating for trans health. Here’s a list of my personal recommendations (UK-focused), including guides to share with your healthcare provider.
CliniQ London-based health and well-being service for trans and non-binary people. Also advocates for trans health, provides trans awareness training and organises Trans Health Matters conference.
Clinic T Sexual health service for trans and non-binary people in Brighton. Also does advocacy work around trans healthcare.
Terence Higgins Trust UK-based organisation providing services and advocacy work around HIV and sexual health. Web site includes some resources around sexual health for trans people.
Dr. Ruth Pearce Sociologist, specialising in trans studies, feminist theory and practice. Author of "Understanding Trans Health." She does lots of great writing, research, and advocacy around trans health, much of which can be found on her website.
General Medical Council’s “Trans healthcare guidance” Guidance aimed at doctors for providing trans-inclusive healthcare
BMJ’s resource: “I am your trans patient” Aimed at medical practitioners, describes issues encountered receiving healthcare from the perspective of a trans patient. Very accessible and comprehensively written.
Check out these guides to trans health from Clue:
How to find a trans-friendly OB/GYN
What to expect at the OB/GYN when you’re trans
Testosterone and the menstrual cycle
Tips for tracking your cycle when you’re trans
What it’s like to have endometriosis or PCOS when you’re trans
Why trans men, nonbinary, and genderqueer people use birth control
Download Clue to track your cycle.