While in the media it might seem as though awareness of the trans community has never been higher, that’s a fallacy. Case in point: Doctors, nurses and other health-care professionals still have little to no access to adequate knowledge about caring for trans patients.
In fact, aside from a program at the University of Louisville School of Medicine, which is meant to “serve as the nation’s pilot site for training future physicians on the unique health care concerns and issues encountered by people who are lesbian, gay, bisexual and transgender,” a lot of medical schools haven’t prioritized integrating trans-inclusive lessons into their curriculum. Meanwhile, the few working physicians who are experts in trans care have often sought out and cultivated those skills themselves.
This causes a lot of discomfort and trauma for trans individuals seeking health care, many of whom feel they must educate their doctors about how to treat their bodies with each visit, if they feel comfortable trusting them at all. If anything, many trans and gender non-conforming people expect to be misunderstood (and misgendered) during their visits, which can make avoiding the doctor altogether feel like the best option (never a great a thing for a person’s health).
To get a better sense of this experience, I spoke to two men knowledgeable in the field:
- Sam, a 20-year-old trans man in Central Illinois who’s a board-certified medical assistant, pre-med undergraduate and recent father to a baby he delivered in 2017.
- Zackary Berger, a cis male doctor, teacher and researcher at the Johns Hopkins University School of Medicine. He’s also the treasurer for Clinicians for Progressive Care, a political action committee advocating for universal, comprehensive health care that respects the needs of “vulnerable and victimized subgroups.”
Here’s what they had to say…
Sam: On most of the medical school tours I’ve been on, gender and healthcare for transgender folks, like myself, don’t get brought up. I haven’t seen any coursework or heard of any inclusive curriculum yet either. And when I see the incorrect use of sex or gender in my textbooks or on worksheets, I white it out and fix it myself. I know that sounds silly, but I want my education to be accurate.
It’s frustrating because even in my undergraduate classes, a lot of my professors will talk about gender as synonymous with genitals. I try to correct them whenever I get a chance, but I hate being that person who always has to jump in and say, “You’re wrong here!” I also feel like by correcting them, I’m basically outing myself to the class. If no one else says anything and I’m the only one calling out gender stuff all the time, the thought becomes, Oh, he must be trans.
Receiving health care can be hard as well. Besides Planned Parenthood, the paperwork at most clinics and facilities don’t honor gender fluidity or diversity or leave any space for transgender identity. They don’t ask for both our sex and gender. These environments make me feel like a burden. As a trans person, it makes me feel unimportant to these providers; if they cared about people like me, they’d take the time to learn about our needs.
For example, it’s just as important for trans men to have gynecological care as it is for cis women. But a lot of gynecologists don’t know how to work with trans men, whether we’re medically transitioning or not. That’s a big problem. I remember asking a gynecologist about combining my birth control with my testosterone, and the minute I saw the look on her face I knew she had no idea.
There have been times I avoid — or feel awful — about going to the gynecologist because it’s so uncomfortable. I’ll often get misgendered, and just because care for people with uteruses has been cultivated as such a feminine environment, I’ve experienced a ton of dysphoria at the OBGYN. It’s one of those places where I don’t feel comfortable going by myself. People give me very uncomfortable looks and glares. I’ll take my husband with me just to feel safer. I’m sure he feels awkward in the space, too, because we know the women in the waiting room are like, “Why are these two men going to a gynecology appointment?” People don’t realize that some men have vaginas too.
Being pregnant as a trans man was definitely interesting, especially because I wasn’t out at the time. I started transitioning soon after my daughter was born. I wanted to have a child with my husband, and we knew this was going to be the only time I would do so. It felt alien, and in a way, it affirmed my gender identity, because afterwards, I was certain I wasn’t meant to be a hormonal woman.
Berger: At our institution, our medical students do get some instruction on gender, including trans people and gender nonconforming people. So it’s not a completely absent topic, but there’s progress to be made. In general, doctors tend to be more conservative than the general population. That said, in surveys about how ready physicians are to treat trans patients, a lot of younger doctors and trainees tend to be more liberal and more ready than older doctors.
Still, we’re stuck in these old models for now, and that’s part of the reason why we’re not delivering good care for all sorts of people. Trans people are part of it, but health care doesn’t do a good job of caring for any disadvantaged or dispossessed people in very tailored ways. As health-care providers seeking a just society, one piece of our responsibility is to study and understand past injustices and use that information to rectify present injustices.
The other piece is realizing that there was a lot happening in the past that we don’t know about because non-normative identities have largely been erased from history. We have to understand that whatever happened in the past to marginalized groups that’s now under our radar is probably happening in the present to marginalized groups, too. We always have to say, “Okay, we’re operating as the status quo, which means we’re complicit in that societal control. We have to get ourselves free from that limited approach and really listen to the needs of patients so we can cater to them.”
To do so, we need to restructure our health-care system and diversify it. Doctors should look like every sort of person and embody every sort of identity.
And while we do have the Center of Excellence for Transgender Health, the focus there is the procedural aspect, meaning gender-affirmation surgeries, which is revenue generating. For primary care providers like myself, getting acquainted with treating transgender folks comes from our own self-directed learning. That’s not something anyone told me to do; it’s something I wanted to do to be able to care for these folks.
Plus, I’m still no expert. I’m actively learning as I work with new patients. As a doctor, there’s hardly any regulation on what you’re supposed to learn as part of your continuing medical education, and when there is, it mostly focuses on activities instead of groups of people. So as a doctor, especially for older doctors, it’s easy to get by without ever having to be accountable for your knowledge or ability to care for these patients.
That must change.