It sucks to go to the doctor if you’re trans

June 22, 2019 8:21 AM

The health care system is rife with transphobia. While there has been an expansion in trans training programs for medical providers in recent years, trans people still struggle to find competent basic care, much less trans-specific care. “Trans broken arm syndrome” — a phenomenon where every little ailment, from an infection to a broken arm, is blamed on the hormones many trans people take as a routine part of their transition — is a common occurrence within the medical community....Trump’s proposed ACA rule, and an earlier proposed rule that would allow doctors to make religious objections to providing certain medical treatments, will only exacerbate the medical knowledge gap when it comes to treating trans bodies. Instead of doctors attending training on how to treat trans people with competence, Trump’s rule will allow them to just deny service altogether. Doctors could also condition care on a trans person detransitioning in any state that doesn’t already have trans nondiscrimination protections on the books.
posted by Homo neanderthalensis (19 comments total)

I had a much milder but clearly recognizable version of that “do you know what this medication is for” story when I picked up my first testosterone prescription — in California, a hundred feet from my insurance’s outstanding dedicated gender clinic. It’s very, very easy to imagine how that could have gone under less optimal conditions or less happy medical circumstances. Removing these protections is monstrous.
posted by thesmallmachine at 9:21 AM on June 22, 2019 [13 favorites]

Robert Eads was refused treatment for ovarian cancer, not not informed he had breast cancer.

This is also your obligatory reminder that non-discrimination protection is only as useful as it is enforceable. We pretty much lost federal protections when Trump took office--even the most well-intentioned career civil servants can't do much enforcement if they have no budget to do it with and those budgets were, to my understanding, gutted.
posted by hoyland at 9:29 AM on June 22, 2019 [28 favorites]

Power to Burns for being willing to retell these stories and presumably in some part relive the feelings.
posted by PMdixon at 9:30 AM on June 22, 2019 [5 favorites]

Yup. I just had an appointment that was pretty much a doctor trying not to call me crazy for taking hormones for 8 years while she asked a bunch of ignorant questions while I had to baby her ego and pretend that she knew more about it than me. I think I'll still be able to get my prescription but I'm back in New Patient Appointment Hell while I wait to see someone else with a clue.

That is maybe one of the worst parts of being trans-- I know who I am, but nobody wants to believe me, they only believe a judge or a cop or my ID or the Feds or a doctor. Nobody gives a shit what I think about it until someone Who Knows Better will tell them with authority.
posted by blnkfrnk at 9:51 AM on June 22, 2019 [39 favorites]

Flames. Flames on the side of my face.

Transphobia among (some of) the professionals who specifically “work with” the trans community is real.

The fucking stories, y’all.

In trying to get access to the proper hormones a few years ago, I chose two places from the very short list of “trans-friendly” providers in my state.

At the first office, the receptionist argued with me repeatedly and loudly about the pronoun I used on the intake form and outed another patient in the waiting room to me as trans (“one of you”).

Remember, this was at the only “trans-friendly” provider in my city.

Once I spoke with the doctor, he proceeded to talk a bunch of transphobic bullshit about how he viewed other (anonymous) trans patients as unaesthetically pleasing and tell me I would never “pass” without subsequent surgeries, before stating he didn’t prescribe without a fresh letter of recommendation from a local therapist.

This was news to me. I’d spoken with the front desk when I made the appointment and was assured that having an older, out-of-state letter wouldn’t be a problem.

The hormone fairy would not be arriving that day. This whole indignity cost $200+ dollars, as insurance sure as Hell didn’t cover it.

(It also cost a huge amount of whatever it is that makes people actually want to get up in the morning.)

At the next closest “trans-friendly” provider – a two-hour bus ride away – I was repeatedly misgendered during every appointment.

Appointments that I was going to because I was trans and I was looking for hormone therapy. Appointments at a practice that dealt mostly with trans clients.

Luckily, even though I wanted to die every time I left one of those appointments, they would take my letter in exchange for sweet, sweet hormones. I could (and did) live with that.

I was lucky. I eventually got transition-related care. And no, insurance didn’t cover any damn part of it.

The kicker: I recently moved and now I’m trying to find a provider all over again. Big love to all the other trans folks in this thread.
posted by Bubblegum Maserati at 10:18 AM on June 22, 2019 [33 favorites]

Also, here’s an exciting wrinkle to all of this:

Even though the ACA has protections for transition-related care, providers who focus on the trans community have often built their practices on not taking insurance.

No big deal? Just go to a regular doctor for your trans stuff? Well, they frequently won’t provide transition-related care – which is, as far as I can tell, 100% legal even without any Trump fuckery.

In my experience, if your regular doctor is hip and with it and woke (i.e. knows there’s a trans-focused practice anywhere 1-2 hours from you), your regular doctor would much rather you go to “the trans place” for your transition-related care. Then your hip regular doctor doesn’t have to, y’know, get training.

Doctors who aren’t actively trans-hostile are still likely to claim “we don’t do that stuff,” apologize, and hang up when you call everyone within a 15 mile radius trying to find someone who takes your insurance and will give you medical treatment.

(Please, somebody, I just want my hormones.)
posted by Bubblegum Maserati at 10:40 AM on June 22, 2019 [11 favorites]

I, too, like everyone else here in this thread, have had problems upon problems when going to the doctor. It makes me exhausted to recount. Current gripe: the two "permission slips" I need from mental health therapists to continue with my current plans for trans-related medical care and what feels like a part-time job in obtaining said documentation.

A surprising but welcome change was when I moved from my college town in the Midwest (most liberal area in the state) to my current city (small, major city on the East Coast) was that all the problems I would have when I would show up to the doctor's office... vanished. There were so many opportunities to make me uncomfortable at the office and they just... didn't take them. I had to go for a CT not long ago and it was listed that I was there for abdomen and pelvis (it said something like "pelvic, including uterus") on my paperwork. I remember watching the woman at intake's face and bracing myself for a look of shock or disgust as she read my paperwork and... there was none. I was treated just like a normal human being with medical concerns like any other human being. It was incredible -- and I am not exaggerating for effect, I was honestly so surprised and grateful. I had a particularly ~memorable~ ER visit once in the former Midwestern city involving nursing staff saying obnoxious and transphobic comments while I was right there getting bloodwork done and had gotten used to every freaking medical visit being some kind of unpleassant wildcard.

Sometimes I wonder if there would be any interest in a "buddy system" of sorts for trans folks going to medical appointments. My deep anxiety over getting healthcare has abated some since moving to my current city, but I know how dehumanizing the whole experience can be and continues to be. Not everyone in this city has been lucky enough to have the same experiences. I stood up for myself and for the trans kids the staff were shittalking that day in the ER but I know I wouldn't have had the courage if my good friend (who is also trans) wasn't out there in the waiting room to debrief with after the worst was over. (I did so via text even though he was right next to me because I didn't want to endure weird stares and gaping from everyone else in the crowded waiting area for the next number of hours before they took me back.)

And also, like Bubblegum Maserati, I have an excellent primary care doctor who is happy to handle all of my medical care... except hormones. I am not even a complicated case and the training it takes to be adequately competent is minimal. I am hoping as our patient-doctor relationship continues I can maybe push her towards reconsidering. Likewise, in Midwestern city, my primary care doctor could not initiate hormone therapy per the University clinic's BS protocols and there was no one in the area who did informed consent. The endocrinologist I saw while I was living there was a real stand-up guy and in his office was the only place I never experienced problems, but like odinsdream alludes, I for some reason had to drive a half hour our of the city to get there. (The medical campus was huge and his main office was in the city.)

The first negative trans-related experience in medical care I had was even before I started medically transitioning or asked people to call me by the correct name and pronouns or anything like that. I just looked very androgynous/boy-like. I was at the University clinic and the doctor called my first name (which was female) and I walked up and said hello and she said, "you're [name]?" And I said, "yes." And like the author of the article, I had UTI symptoms and she tried to tell me I had an STD even though I told her I had not had sex in over a year. She could barely look at me and I could tell she would rather be absolutely anywhere else than sitting across the desk from me. She then sent me to the women's health clinic upstairs which I suspected was more of an attempt to erroneously out me as a trans woman than anything else (in future visits, I learned this was not a necessary step). I was shocked and upset as it was my first experience of transphobia really. It was just hard to handle the visceral knowledge that you're still the same decent person but people are going to treat you like a freak just because you're trans. I remember writing about it later that day and described how I felt like "a walking sideshow."

For cis people reading, these are universal experiences. I have it prettyyyy easy in the world in the sphere of "all possible trans experiences" and yet these have been my experiences in healthcare. No matter how privileged one is otherwise; being trans brings on the same discrimination for all of us, though even worse for those who are most marginalized. I can only speak for my experience personally, but friends who deal with the intersections of race and of disability and of lookism have an even harder time finding compassionate and competent medical care.
posted by sevenofspades at 11:53 AM on June 22, 2019 [26 favorites]

For some historical context, I read "AIDS Doctors: Voices from the Epidemic: An Oral History" a few years ago and some of the parallels with the experience of trans healthcare struck me. Doctors who volunteered (there was no mandate) to treat AIDS patients had to see them at a completely different clinic or had to see them during a designated time slot in which only AIDS patients came in, per the hospital higher-ups.

Basically, it's like people have as much fear and disgust over us today as they did over patients with AIDS during the height of the epidemic.
posted by sevenofspades at 12:25 PM on June 22, 2019 [11 favorites]

Oddly enough, dentists have been super cool about it. My most recent one was like "Huh, testosterone, eh? You got a PCP keeping an eye on it? Sweet. Let's look at those teeth." Casually trans-friendly dentists has got me so motivated to floss like nothing else ever has.
posted by blnkfrnk at 1:25 PM on June 22, 2019 [36 favorites]

I spent my whole relationship with my ex trying to get him to go to a doctor for all of his various health problems. Then he started HRT, which we had to go two states away for, six-hour drives and three-day stays for every appointment, because rural georgia, and where he got weight-shamed, because doctors. A while after that, I stopped bothering him to see a PCP because, again, rural georgia, I realized he would not have a good experience because of stuff like this and I couldn't bear to have yet another fucking person in a position of power distrusting or disrespecting him.

And I'm jealous of his results from HRT, but my god, the process to get it. Planned Parenthoods with informed consent are a blessing, but the aforementioned weight shaming, they put him on an incorrect dose at first that made him Dangerously depressed, he got misgendered by a nurse, they charged him three times for the same appointment he paid in full for, they were almost completely unreachable, even by the pharmacy. And that's not so bad as far as the average healthcare experience, even. I already don't see a doctor for anything for preemptive anger of getting misogynied, let alone adding transphobia into the mix. Fuck.
posted by gaybobbie at 2:26 PM on June 22, 2019 [2 favorites]

I don’t know how helpful this is everywhere, it’s worldwide but started in Portland OR so there’s far more listing here, but Ample is like a Yelp search that was created by a trans designer and fat programmer — I have met the folks behind it a few times and finding competent healthcare for those two populations and other marginalized identities was a big driver behind the concept. It can be used to warn people about shitty experiences but the hope is that it also “amplifies” good healthcare providers.
posted by the thorn bushes have roses at 2:38 PM on June 22, 2019 [6 favorites]

I am a trans man married to a trans women living in the Midwest. Both of us have disabilities. And I could tell you dozens of stories about the terrible medical care we have received. Sometimes we do encounter people who will treat us well, but those are exceptions to the rule. It's especially bad for my wife, because transmisogyny is a powerful thing.

So, I will tell just tell one story--not about us trying to find competent care for one of the serious medical issues we face, but for a small thing.

My spouse developed a salivary stone, and it was making her very uncomfortable. We looked into it, and tried the standard suggested home treatment--sucking on a lemon to try to induce a burst of saliva that will dislodge it. But it was too large. So we looked into the standard medical treatments: a doctor massages it out, making a small incision in the mouth if necessary, or--if you have fancy healthcare--a tiny endoscope is inserted into the salivary duct to visualize and remove the stone. OK.

I will pass over the months of work it took to get our ostensible primary care provider to agree to give my wife a referral for treatment. Eventually she got one. As usual, while our primary care clinic was affiliated with various nice shiny suburban specialty clinics, her referral was to the run-down facility serving "undesirables" like folks who are trans and/or of color. Also as usual, despite my asking our primary care clinic to explain in the referral that my wife is trans, and although I called ahead to make sure her name and gender marker were correctly recorded, things did not go smoothly. Our medical insurance had a policy against changing gender markers up until a couple of years ago, and this always led to problems with misgendering. And indeed, the receptionist referred to my wife by her correct name, but referred to her as "sir" when calling for her to sign in. Running interference, I went up to talk to the receptionist about correcting the record, and got a huffy lecture about how there was a note in the chart about "the transgendered thing," but that the medical record had to list her "real sex" to treat her. Ugh.

Eventually we were taken back to meet the doctor we'd been assigned to. He seemed nice enough, and nodded when I explained I was there because his patient was my wife. Then he conducted his exam, and told us his treatment plan. He would schedule my spouse for surgery, where he would make a four to six inch incision in her neck and extract the salivary stone. We were taken aback and mentioned the much less invasive treatment options we'd read were standard when researching the topic. He just said that neck surgery was how he'd proceed. My wife asked where he planned to do the incision, as it sounded like something that would leave a significant scar, and people tended to stare at her more than she wished already. And he told her she should just grow a beard to cover the scar if she didn't want people staring at it.

We gaped at the surgeon. I reminded him that this was my wife, that she had gendered transitioned, and would not be growing any beards. He stared back blankly for several seconds, then said, "OK, but if he doesn't like scars, he should grow a beard."

Was the man threatening my wife? Clueless beyond all comprehension? Incompetent? Who knows. What I can tell you was that we left and she never got any treatment.

This was not one of the major health care incidents we've faced. But it's possible that if we had just said OK and my wife had gone through with the surgery, it could have been. I myself nearly died years ago from a postsurgical infection when treated by an overtly transphobic, homophobic surgeon, who seemed repelled by my intersex anatomy. His response, when I called in the day after being released from the hospital to tell him something seemed to be terribly wrong, was that surgery is supposed to hurt and he wasn't giving me any more pain meds. I tried to tell him that I was experiencing swelling and a fever and felt very ill, but he brushed me off. Eventually I wound up in the ER with a florid infection, had to have my abdomen reopened to remove necrotic tissue, followed by a repair surgery, and I wasn't fully clear of infection until 18 months later.

That was one of our big medical incidents. But any minor medical issue has the potential to be transformed by bias into tragedy. The tiny intra-oral incision you were expecting turns out to be a slash halfway across your neck. There are vital structures that could be severed, infections that could take hold, when members of a treatment team consciously or unconsciously don't value your life.

And that's why even trans people who do have health insurance so often don't access care. It's simple rational behavior: the risks outweigh the benefits when you factor in transphobia.
posted by DrMew at 8:12 PM on June 22, 2019 [43 favorites]

as a trans health care provider who just became an NP i'm excited to work within a system that needs work, but is totally top down supportive. but it makes me wonder if i would better serve my people by moving somewhere that doesn't have as many dedicated clinics and programs (i'm in NYC)...
posted by emirenic at 6:39 AM on June 23, 2019 [3 favorites]

How frightening this all is.

That is maybe one of the worst parts of being trans-- I know who I am, but nobody wants to believe me, they only believe a judge or a cop or my ID or the Feds or a doctor. Nobody gives a shit what I think about it until someone Who Knows Better will tell them with authority.

This is why you need to allow people to check a gender box of their choice when renewing their license at the DMV. It's really, really important.
posted by Sterros at 9:12 AM on June 23, 2019 [3 favorites]

A quick note for anyone who happens to be in Pittsburgh: we do have a trans health buddy/advocate program here! I picked up this flyer at People’s Pride and had a brief chat with the people running the table, and they seemed lovely.
posted by Stacey at 10:24 AM on June 23, 2019 [3 favorites]

If you're in Nashville, Vanderbilt Medical Center has a Trans Buddy Program, including a phone number on that page if you need immediate help while in the Medical Center. (Full disclosure, I have ties to this program but do not work for them)
posted by Is It Over Yet? at 1:52 PM on June 24, 2019 [2 favorites]

but it makes me wonder if i would better serve my people by moving somewhere that doesn't have as many dedicated clinics and programs (i'm in NYC)...

For the record, I have not been impressed by the quality of care available in NYC in comparison to either Austin or Minneapolis. It's probably more constructive to go elsewhere in the country, but NYC is not that impressive. (Yes, I'm kind of bitter. There were things I didn't love about my doctor in Austin, but at least he knew what he was doing.)
posted by hoyland at 4:36 PM on June 24, 2019 [1 favorite]

This phenomenon extends beyond the US borders, too; even here in Feminist Queer Paradise, aka Iceland.

This country has been getting some good press because of a new law on gender identity (warning: self-link) that they just passed, which allows for a third gender option in the National Registry, takes up an informed consent model for getting access to trans-specific healthcare, and other changes. But it also completely ignores intersex people, for the most part, and if you happen to be in the middle of the old system, you're kind of outta luck.

I'm a trans person in the middle of the old system. The old system—which gatekeeps changing your legal gender, getting access to HRT and other services—is six interviews stretched out over a period of several months, or longer. You speak with three different people: an elderly psychiatrist (who used to be the sole member of the Trans Diagnostic Team), a psychologist, and a social worker. They ask you questions that run the gamut from the reasonable to the absurd, but all of them are deeply invasive, and there's no small element of coercion at play here: you need these people to approve that you are who you say you are in order to get the health care you need. I could spend thousands of words talking about those interviews.

After that, you'll have to demonstrate and perform your trans-ness, being required to "live as your gender" for 18 months until you can get access to HRT. What does "live as your gender" mean? You tell me. If Megan Fox goes out wearing a hoodie and jeans, no one believes she has suddenly become a man for it, but for some reason the T Team requires performative displays of gender-typical wardrobe and mannerisms for this arbitrary length of time. Once you've gone through that hoop? You've got an appointment with an endocrinologist, some weeks or months down the road. Then more waiting for results so you can finally get your medication.

The justification for all of this has been that they don't want people to suddenly realise they're not trans after it's too late, or to have bad reactions to HRT that would necessitate stopping treatment. I once asked just how many times that has ever happened in the history of transness in this country, and was told: exactly once.

Now that the new law is passed, with language specifically stating that this all goes into effect immediately, you'd think we'd be in the free and clear. But no; the National Registry says it could take them up to 2 years to add a third gender option to their data sets, and the Trans Diagnostic Team (who, to their credit, supported the law in its form as a bill) have told me they will also need to take some unspecified number of months or longer to fully adjust.

Which honestly? All sounds like gatekeeping bullshit to me. It is absolutely unnerving to have someone who doesn't even share your lived experience tell you that you need to prove one of the most basic elements of your identity to them. It's even more unnerving when these same people have power over you, and have the power to grant or deny access to the health care that you need depending on how nice you play with them.

Any further legislative changes will only be possible once the cis get it in their heads that the right to the determination of your own body is a fundamental human right that needs to be vigilantly protected and defended, all the time. This can only happen by us refusing to play nice anymore.
posted by Aya Hirano on the Astral Plane at 5:00 PM on June 24, 2019 [8 favorites]

i am a superfat and as such have been treated abhorrently by medical professionals. but jesus. the stories here and elsewhere on the web are awful. i don't understand the hatred.
posted by misanthropicsarah at 7:01 AM on June 25, 2019 [3 favorites]