Every time I walk into a health-care clinic I have major anxiety. I’m usually experiencing a variety of feelings regarding whatever it is I’m at a clinic for to begin with, but as a trans person there are systemic problems to navigate.
Within the first five minutes, I have to decide if I’m going to explain my pronouns and gender to every provider approaching me. Nurses who call my name do not expect me, a tiny femme, to respond to the name “Jack.” I’m infinitely drained by the curious looks I get when they double-check my file for my sex marker and ask me if they’re saying my name correctly.
As I enter the exam room, I am wondering, how much emotional labor will I have to provide today? Am I going to add a small Gender 101 workshop into my intake? Will this nurse even bother to relay the message about my pronouns to the doctor? Do I want to have a separate mini-workshop for my doctor?
Mostly, I just want my medical issue handled, but by the end of the visit, I’m always exhausted and disheartened because of the time I had to spend affirming my identity.
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Sensitivity classes for health-care providers generally brush over LGBTQ patients and unfortunately lump each identity together. There are issues specific to each community that can’t be completely covered or comprehended in one half-day workshop. You can’t simply treat cisgender women in the same way one would treat trans men or nonbinary people. Our needs are not the same.
Education on treating LGBTQ individuals is an ongoing process and depends heavily on the patient teaching their provider, which is an injustice.
Even as more providers are being trained on queer-inclusive health care, previous negative experiences keep trans patients from coming back. A survey released this week by the National Center for Transgender Equality found that 23 percent of trans people avoided going to the doctor because they feared discrimination; one-third of respondents had at least one negative experience with their provider, including having to educate the provider on trans people in order to receive appropriate care; and 13 percent were “denied coverage for services often considered to be gender-specific, including routine sexual or reproductive health screenings,” while 7 percent were denied coverage for other routine health-care services. This means transphobia in health-care settings is literally preventing us from receiving potentially life-saving care.
The memory of being misgendered at the doctor’s office is deeply ingrained in my abortion story, having the effect of undermining an already stigmatizing experience.
It’s true that some providers are making strides in this area. The Allentown Women’s Center in Pennsylvania recently incorporated trans health care into its abortion practice, which involved retraining staff and changing some practices to make them more inclusive. It is important that providers proactively educate themselves and their peers, and that our allies support us in our advocacy with their own providers.
For health-care professionals, or anyone looking to create a safer and more affirming environment for trans and gender-nonconforming people, here are some starting points that can help guide you toward better meeting the needs of your patients or other people in your life.
Check out your intake forms. Is there a space for a preferred versus legal name? Insurance cards and some government IDs only reflect a person’s legal name, but many trans or gender-nonconforming people might not go by their legal name anymore. If you want to make sure a patient is comfortable, you can start by creating space for them to put down their preferred name. Next, you should make sure to use that name when calling them into the exam room. Also, don’t make assumptions about a person’s pronouns based on the name called. Make sure there is either a space on the intake form for a patient to write in their personal gender pronouns or ask when you’re in private. For all patients, this will create a welcoming environment where their needs are centered, and patients who are early in their transition will feel like they have the space to be their most authentic selves.
Think critically about the way you discuss bodies and barrier methods. Keep in mind that referring to someone’s body parts incorrectly can be triggering. You want to make your language inclusive and supportive. Invite the trans or gender-nonconforming person you’re providing care for to tell you how they would like their body to be referred to. Simply ask them if they would prefer more neutral terms like “genitals” when discussing their body or if they have a specific way of referring to themselves that you could adopt. Additionally, checking in before touching someone during an exam can make a world of difference to their emotional well-being after their visit. This is quite important for survivors of sexual trauma as well, so it’s a good practice to implement overall.
Offer resources. If you use social media, you may have seen hashtags like #TransLawHelp providing interested trans people with resources on how to change their legal name and gender markers before Trump takes office. Just like the people who are rushing to get long-acting reversible contraception, some trans or gender-nonconforming people are rushing to update their passports. Share these resources with your colleagues and make them available to your patients in your office’s waiting area or in each of the patient rooms. Even if no one you know utilizes those resources, displaying your support for trans and gender-nonconforming people helps to shift our culture and educate cisgender patients.
— Kendra Albert (@KendraSerra) November 10, 2016
Offer mental health support. Mental health care is just as important as our physical health. Over 40 percent of trans and gender-nonconforming people experience depression or have attempted suicide, outpacing the national rate of nearly 5 percent, and even more live with untreated mental health issues. If you’re willing and able to provide emotional support to people in your community, open yourself up to those that need to vent or a listening ear. You can also share the following resources to counseling services specific to LGBTQ healing:
Acknowledge how the fight for reproductive rights and trans rights are intertwined. With the incoming Trump administration, advocates expect abortion rights to be dismantled, and queer and gender-nonconforming people to be ever increasingly the targets of restrictive legislation, particularly around our ability to access health care. It shouldn’t surprise anyone that the anti-choice Trump administration nominees include people with a history of supporting so-called conversion therapy; legislation that forces individuals to use toilets based on their birth sex, not their gender identity; the use of “religious freedom” as an excuse to discriminate against LGBTQ people seeking basic services; and efforts to outlaw marriage equality, employee nondiscrimination protections, and the repeal of “Don’t Ask, Don’t Tell.”
With this kind of influence in the White House, it’s only sensible to expect many of the protections put in place by the Obama administration to come under threat. If you’re able, consider donating to this list of organizations that can provide direct support and combat anti-civil rights politics. If monetary support isn’t in your budget, try volunteering as a clinic escort, with your local abortion fund, or with the American Civil Liberties Union. At the core, the fight for trans liberation and reproductive rights is about bodily autonomy, and we’re stronger together.
Keep learning. There’s always more to learn. Just like providers must stay on top of best practices in health-care services as technology advances or regulations shift, you should continue to learn about the best ways to support trans and gender-nonconforming patients. Make a point to seek out interviews and videos discussing their access to health care, including the resources in this document I created, and listen to what patients in the very diverse community are saying. We know what we need better than anyone else. You can help create change by educating yourselves and your peers, which ensures we have a safer, more supportive health-care experience.
UPDATE: This piece was updated to include new data from the National Center for Transgender Equality.