“But you’re so pretty. Why would you do that?”
As those words left his mouth, my body immediately tensed up and a pit of nausea sunk into my stomach. All the questions I prepared in my head prior to the appointment disappeared. Suddenly I felt unsafe — not physically, but emotionally.
At the time, I was considering medically aligning my body with my trans nonbinary gender identity. All I wanted was to learn more about testosterone.
This was the first step I took to gather information about the effects of cross-sex hormones after questioning my gender and struggling with gender dysphoria for over two years. But instead of feeling a sense of relief and progress, I felt defeated and hopeless.
I was embarrassed by how I overestimated the training and experience that the average primary care provider has on the topic of gender and transgender health. He was actually the first person I ever told — before my parents, before my partner, before my friends. He probably didn’t know that… and still doesn’t.
Most doctors don’t have any training when it comes to caring for transgender people
A 2017 study found that of 411 practicing (medical) clinician responders, almost 80 percent have treated someone who’s transgender, but 80.6 percent have never received any training on caring for transgender people.
Clinicians were very or somewhat confident in terms of definitions (77.1 percent), taking a history (63.3 percent), and prescribing hormones (64.8 percent). But low confidence was reported outside of the hormonal realm.
When it comes to gender affirming health care, our concerns aren’t just about medical interventions. Gender is about so much more than medicine and our bodies. The practice of using someone’s affirmed name and pronoun can be an equally as powerful and important intervention as hormones. Had I known all this five years ago, I probably would’ve approached things differently.
Now, before I make an appointment with a new doctor, I call the office.
I call to find out if the practice and provider have experience with transgender patients. If they don’t, that’s okay. I just adjust my expectations. When in the doctor’s office, it’s not my job to educate. When I walk in, the odds are that office personnel will only see me as male or female.
This isn’t an isolated incident. In the 2015 U.S. Transgender Survey, 33 percent reported having at least one negative experience with a doctor or other health care provider related to being transgender, including:
- 24 percent having to teach the provider about transgender people in order to receive appropriate care
- 15 percent being asked invasive or unnecessary questions about being transgender, not related to the reason for the visit
- 8 percent being refused transition-related healthcare
When I fill out intake forms and don’t see options to indicate my nonbinary gender, I assume that means the provider and medical staff may have no knowledge about what nonbinary gender even is, or are not sensitive to this issue. No one will ask about my pronouns or affirmed (as opposed to legal) name.
I expect to be misgendered.
And in these situations, I choose to prioritize my medical concerns over educating providers. In these situations, I put my feelings aside to have medical concerns addressed. This is my reality at every medical or mental health appointment outside of the clinics that specialize in gender.
We all have the power to make small changes and a big difference
I wish all health care providers recognized the importance of language and the acknowledgment of gender differences when dealing with the trans community. Health is all encompassing, from the ego to the body, and affirmed name to hormones. It's not just about medicine.
We are at a time in history when our culture’s awareness and understanding of transgender and nonbinary identities far exceeds our systems’ ability to account for and affirm their existence. There’s enough information and education available for people to be aware of trans and nonbinary gender. Yet there’s no requirement for this awareness and sensitivity to be applied in health care settings.
What would motivate professionals, and not just in the health care world, to change?
It’s not a complete reconstruction. Even with a professional’s best intentions, personal biases and prejudices are always present. But there are ways to demonstrate empathy. Little things in the world of gender make a big difference, like:
- Placing signage or marketing materials in the waiting room that demonstrate all genders are welcome.
- Ensuring forms distinguish assigned sex from gender identity.
- Providing dedicated space on intake forms for name (if different from legal name), pronouns, and gender (male, female, trans, nonbinary, and other).
- Asking everyone (not just transgender or nonbinary people) how they like to be referred to.
- Employing transgender or gender nonconforming people. Seeing oneself reflected back could be invaluable.
- Correcting and apologizing for accidentally using the incorrect name or pronoun.
I look back on that interaction with the doctor and can more clearly see that what I needed in that moment wasn’t information about hormones. I needed my doctor’s office to be a safe space during a time when I wasn’t ready to share this information anywhere else.
I needed the doctor to acknowledge that who I am may be different from the “sex” listed in my medical record. Instead of asking why, a simple statement such as this would have made all the difference: “Thank you for coming to me with your question. I realize it’s not always easy to come forward to ask these types of things. It sounds like you’re questioning some aspect of your gender. I’d be happy to support you in finding information and resources. Can you tell me a bit more about how you came to consider testosterone?”
It’s not about being perfect, but making an effort. Knowledge is most powerful when put into action. Change is a process that can't begin until someone institutes its importance.
Mere Abrams, MSW, ASW, is a gender specialist, researcher, educator, and consultant in the San Francisco Bay Area, providing gender affirming services to trans, nonbinary, and gender-expansive children, teens, and young adults. As a clinical researcher at the UCSF Child and Adolescent Gender Center, Mere works on the first NIH sponsored research, studying long-term medical and mental health outcomes for trans youth starting puberty blockers or cross-sex hormones. Mere was a contributor and editor of “The Transgender Teen: A Handbook for Parents and Professionals Supporting Transgender and Non-Binary Teens” and speaks publicly on the topics of ethical considerations for working with trans youth and their families, nonbinary experiences, and gender diversity and inclusion.