As a transgender or genderqueer person, you know that seeking and receiving health care is often associated with negative experiences. As a physician who provides gender-related services for children and adolescents, I’ve heard many stories of negative experiences from my patients, and recognize the challenge of assuring that health care spaces are safe and affirming.
Even in presumably safe spaces such as a clinic or hospital, trans and gender diverse people commonly experience misgendering, refusal to accept their gender identity and gender expression, discomfort with their anatomy, and the “trans broken arm syndrome” (when unrelated medical problems are attributed to a patient being trans). Gender diverse people are often expected to remain resilient in the face of both overt and covert discrimination.
Seeking to prevent negative experiences, I urge my patients to expect to be treated as a partner in their own care. Here are some suggestions for taking on that role, in five different healthcare settings.
1. What to keep in mind when meeting a new health care provider
With a new provider, you may have already sought out others’ experiences through personal contacts, social media ratings, or online listings (check out the gender diverse providers’ listings of the Gay Lesbian Medical Association, for example).
If you’re worried about disclosure of your gender identity and your gender journey, remember that your safety, privacy, and confidentiality are among the ethical foundations of health care, and are legally enforced in many areas. You can make sure your new provider has all pertinent details by giving permission to obtain copies of your medical records.
You aren’t responsible for educating your new health care provider (or their staff) about transgender health, but consider aspects of your personal story and journey that will help them understand you.
If you know that medical forms, questions, and exams exacerbate dysphoria or trigger past trauma experiences, let someone know what you’re feeling. Providers may have additional difficulty in understanding genderqueer or non-binary identity and expression, but it’s okay to remind people—even doctors—if you are misgendered or feel disrespected.
Give comments about your treatment—good and bad—on patient satisfaction surveys that are now often on-line, or sent to you after an appointment. You can give details, and name the healthcare provider or the clinic where the treatment was received. You can even give comments directly to a provider through the patient portal of your clinic’s electronic health record—you have to sign up for this, so ask for details at your first visit. You can speak directly to a patient representative whose job is to help safeguard your safety and wellbeing as a patient. Health care providers take your comments very seriously, especially if they are part of large practices or health care systems.
2. What to keep in mind in an ongoing relationship with a health care provider
Like any relationship, those with health care providers require some upkeep. Periodically reaffirm your name, pronouns, and gender marker if you are in transition. Legal name and gender marker changes are especially important because your entire medical record is linked to you by that information, as is any insurance coverage you may have.
If you aren’t “out” to your provider, consider the circumstances where this information would be useful or necessary as part of your care and respectful treatment. For example, some kinds of medical tests are for conditions that don’t match your identity but are still part of your body. Information about hormones and surgeries is almost always relevant to ongoing medical care.
3. What to keep in mind when being referred to other health care providers or services
Your optimal care—even from a well-known, trusted provider—often requires referral to other providers with different skills and expertise. It is important to ask your provider to explain the expected outcome of the referral, and how that will affect your health in the future. Ask about the new provider’s “trans/queer-friendliness”, and give feedback to your provider about your experiences with the referral.
Referrals can also be part of your gender journey. Gender-affirming surgery, for example, may require referral letters by mental health professionals as well as referral to a surgeon. Here, it’s useful to communicate to your healthcare provider about your overall gender affirmation goals, and make sure the referrals are consistent with those goals. Make sure that your healthcare coverage is accepted by the provider you’re referred to; if not, ask for a different referral.
4. What to keep in mind when you’re admitted to a hospital
Things that your healthcare provider knows about your gender journey may not be communicated to the hospital, so anticipate readdressing issues of your name, birth-assigned sex, gender, and pronouns. Documents such as drivers’ license and insurance cards are important, but it’s likely that disclosure of birth-assigned sex will be relevant in some aspect of your care. Here are some examples why–in particular for individuals assigned female at birth–this might be relevant.
First, discussions about the possibility of pregnancy are critical if you’ve had penetrative vaginal sex with a person with a penis and testicles during the 3 months before hospital admission. If you're taking testosterone, it is possible (although fairly uncommon) to become pregnant while taking testosterone. You may have to help your providers here with personal information about your sexual activity, as providers may assume you’re lesbian, fail to ask about the possibility of pregnancy, or believe testosterone is fail-proof contraception.
It’s possible that you will be asked for a pregnancy test, even if you have no possibility of pregnancy. Pregnancy care (for example, for a delivery, after a miscarriage, or for a termination) for transmasculine people continues to challenge many health care providers, so it may be useful to identify an ally on the staff to explain to others that you deserve respect, support, and privacy, just like anyone.
Issues of personal comfort and self-care such as chest binders or menstrual bleeding may require discussion with nursing and other personnel, especially if you need assistance with things like bathing and toileting (for example, after a surgery). Again, you can ask for and expect the care and privacy you need. Some hospital stays can be scheduled between hormone injections, but you may need to arrange to have your injection—perhaps with prescription hormones brought from home—while in the hospital.
5. What to keep in mind when you need urgent or emergency health care
Health care received in settings labeled “Urgent Care” or “Emergency” often follows acute severe illness, or traumatic injury (for example, from car crashes or physical assaults). The combination of loss of control, stress, fear, and pain can be physically and emotionally overwhelming.
These are situations where you encounter multiple unfamiliar health care professionals (that you didn’t choose) in not-very-private spaces. Questions and examinations seem repetitive and invasive, and may indicate a lack of understanding of your body and gender. Some gender diverse people avoid going to emergency departments for any reason, because of negative past experiences and discrimination (1).
Suggestions for patients in emergency health situations:
Help the providers distinguish your gender identity from the birth-assigned sex.
Help providers differentiate your name from names on documents like medical records or insurance cards (even if you consider those as dead names)
Don’t withhold information about your body, hormones, medications, substance use, or surgeries.
You might also consider medical alert jewelry, in case you’re unable to provide accurate details. Products are available that allow first responders or medical personnel to retrieve your pertinent medical history through use of a QR code or USB port, or by calling a 24/7 hotline.
Substantial progress has been made in ensuring healthcare of transgender and genderqueer people that is responsive, respectful, and confidential. But, we still have a lot to achieve. Your care shouldn’t be skipped or postponed because of concerns for discrimination and privacy. By thoughtful communication with healthcare providers and by becoming a partner in your own care, you can continue to support your best health and wellbeing.
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Updated on June 17, 2020.