Recently, a nonprofit known as MyTransHealth, which connects patients with Trans-friendly lawyers, and medical, mental, and dental health care, prompted transgender patients to tweet about their #TransHealthFails. Ironically, the promo was a success: Trans patients tweeted up a storm, exposing the horrific realities of medical care gone awry. "The current state of health care for trans people is downright terrible and failing our community every step of the way," says Amelia Gapin, a transgender woman and co-founder of MyTransHealth.
Advocates agree that medical and mental health care has a long way to go — and you'll agree too, once you get a load of the shit you have to deal with when you're a transgender patient:
1. You're humiliated in the waiting room.
I stepped into the gynecologist's office for my appointment and the receptionist says "you've got the wrong place". #transhealthfail— Ivan Coyote (@ivancoyote) August 5, 2015
Many trans patients, before changing their legal birth names, go by names that fit the gender they identify with. But some doctors insist on keeping the patients' legal names on medical records.
When a nurse or receptionist gets a hold of the paperwork and yells out "Julia!" to call a trans man with a full beard, it exposes him to the whole room. This can be embarrassing and unsafe, because it opens him up to violence, aggression, hate crimes, and queer bashing, explains M. Victoria Albina, a registered nurse practitioner at One Medical Group, a national primary care clinic. (She classifies herself as queer and has been out for 24 years.)
Another thing: You never know how a receptionist will react if your voice, name, or appearance doesn't match the sex listed in your medical records, and it's huge source of anxiety for many patients.
Clinics don't necessarily educate their receptionists and nurses on how to make transgender patients feel most comfortable. "There's a lot of cultural competency that's not taught," Albina says.
2. Office staffers disregard your gender.
#transhealthfail was reassured by doctor that they have lots of trans patients... And we all have to use the wrong gender marker.— Aya McCabre (@Aya_McCabre) August 15, 2015
Whether you're seeking medical or mental health care, you usually have to disclose your sex when you make an appointment and again when you're filling out forms. But people who are just starting to transition may not know whether to share their birth gender or their gender identity — and many medical personnel don't bother making that distinction. "Doctors don't understand that being misgendered is exhausting and negates who you are," Albina says.
While it does matter if a transgender man's birth gender was female because it can sometimes help guide a patient's treatment, it's important to differentiate between gender (how you identify yourself) and sex (what sexual organs you have), and respect proper pronouns. That goes for interactions that take place in front of the patient and in conversations among office staff, in paperwork, and in emails.
3. Doctors refuse to treat you.
Finding a doctor can be a tough task for anyone, but it's extra scary when you're trans. "We've heard stories about doctors suggesting that trans patients simply go to church more," says Gapin.
My former family doctor refused to see me because of religious reasons what do you expect @BaylorHealth in Texas #transhealthfail— Trans Girl Gooner (@AmberTransGirl1) August 11, 2015
The risks are compounded in emergency rooms, where trans patients can be denied basic health care because the gender they put forth IRL doesn't match the sex listed on their insurance. If you consider yourself a transgender woman and you're not extremely feminine, sometimes just proving your identity can be a struggle, Gapin says.
4. Doctors have no idea how to treat you.
told my doctor i was trans after getting an xray for my sternum and they all suddenly forgot how to care for a patient #transhealthfail— Li'l Stinky (@pisscoffin) August 20, 2015
While Albina is a trans patient specialist with LGBT training, some doctors aren't trained in medical school to treat trans patients, and they don't know how to prescribe hormones and estrogen blockers, which can change a patient's voice and body and feelings to create an overall safer and happier life.
"When it comes to things like hormone replacement therapy, there is no formalized process for administering that," Gapin says. "It's kind of like the Wild West."
The burden falls on the patient to school their own medical teams — which could lead to missteps. No wonder 50 percent of trans patients polled in The National Transgender Discrimination Survey reported having to teach their doctors about transgender care — a little awkward (read: terrifying) for any patient who lacks a medical degree.
(Resources are available at University of California San Francisco's Center of Excellence for Transgender Health.)
5. You're not screened for life-threatening diseases.
I'm worried that my life will be in danger once I transition, because of prejudiced and ignorant health care staff. #transhealthfail— Nanya Bizness (@Antarctica1982) August 8, 2015
When doctors make incorrect assumptions about your sex organs, they can neglect to offer health tests that detect life-threatening illness early on. For instance, Albina says lots of trans men never get necessary mammograms or pap smears, and aren't offered birth control (even though they may have sex with men). Meanwhile, trans women sometimes go years without a prostate check.
6. You're forced to field irrelevant questions about your gender.
Dear Nurse Practitioner, you don't need to know whether I've had "My Parts cut off" to tell me if I have strepp throat. #TransHealthFail— Alaina Kailyn (@AlainaKailyn) August 13, 2015
Trans people find themselves constantly having to explain and defend their genders just to receive care — even when their medical issue has nothing to do with their gender. "We've heard stories of doctors asking invasive questions about patients' genitals while seeking care for the flu," Gapin says. As if anyone wants to talk about that while suffering from muscle aches, nausea, and fever.
7. Your own doctors treat you like you're bizarre.
"It's not uncommon for emergency room doctors to call over medical students to look at the 'freak' or for nurses and doctors to refer to a trans patient as an 'it,"' Albina says. "Clinicians may not realize how incredibly painful these comments are."
In auto accident to hospital since I am transgender I was segregated from all patients I'm ER put in "special room" #transhealthfail— Trans Girl Gooner (@AmberTransGirl1) August 11, 2015
"Providers struggle to see trans people as actual humans who should be treated as such — they see us as science experiments," Gapin says.
8. Seeking treatment could get you classified as mentally ill.
My psychiatrist made me convince her my gender identity wasn't a bipolar mania delusion before she'd renew my psych meds. #transhealthfail— KimKardashianMidWest (@LetsHearItForMe) August 11, 2015
Because Gender Identity Disorder was considered a certifiable mental illness up until a few years ago, many health providers still treat trans people as mentally ill, Gapin says — even if you only have the sniffles.
9. You could be accused of lying about your gender.
Counsellor: so what's your _real_ name? #transhealthfail— Padfoot (@Marmoniel) August 17, 2015
Gapin says many mental health providers try to convince trans patients that gender confusion is a figment of the imagination, or disregard gender identity because a patient doesn't look uber feminine or masculine, Gapin says.
10. You could be billed for medical expenses even though you have insurance.
Trans-inclusive insurance isn't a super common offering among employers, so many trans patients aren't reimbursed for things like hormone replacement therapy — even though it's considered the best way to mitigate gender dysphoria, Gapin says.
I have trans-inclusive health care, but pay for my estradiol entirely out of pocket because it’s just fewer headaches. #TransHealthFail— Amelia Gapin (@EntirelyAmelia) August 12, 2015
Even trans patients who do have trans-inclusive insurance can encounter annoying barriers to turnkey medical coverage. For instance: Trans-inclusive insurance policies that cover gender-confirming surgeries might have a sparse network of super-slammed doctors, so you might have to wait years for gender reassignment surgery. And good luck getting any cash toward facial feminization or breast augmentation: They're almost universally excluded from trans-inclusive insurance, even though they can help trans patients feel at home in their bodies, which is a vital part of health and wellness, Albina says.
#TransHealthFail 3 words that make me crazy "It's considered cosmetic".— Elle (@crickets_muse) August 7, 2015