Seeking healthcare while transgender is often difficult. Transgender patients face a range of healthcare challenges, many of which stem from the stress of discrimination. These health issues, plus a high demand for transition-related care, should make us frequent flyers in doctor’s offices.
However, these spaces can feel unsafe. Since medical providers can direct the course of our health care, disclosing our status as transgender to a discriminatory provider places us at risk of information breach and personal harm. In one survey, 28 percent of trans patients reported experiencing harassment in medical settings.
Even providers who are not intentionally discriminatory but are unaware of the intricacies of transgender healthcare can provide poorer treatment. “Trans broken arm syndrome” describes the propensity of providers to misattribute the cause of any ailment in a trans patient to their medical transition. In the survey cited above, half of trans patients reported teaching their doctors how to provide transgender care.
The expectation of mistreatment and a range of other healthcare disparities contributes to health care anxiety that keeps us from accessing healthcare despite keenly needing it. While there’s been an increase in trans-friendly healthcare providers out there, we still have a long way to go.
Trans and queer-aligned NGOs are a first port-of-call for trans patients looking for healthcare, and some are taking steps to partner with medical institutions for referrals, outreach and provider education.
For now, I break down what types of information you might want to talk about with your medical provider if you identify as transgender.
Opening up
There isn’t a single transgender body. Your identity as a trans person is bound up in a complex web of sociocultural, physiological, emotional and political factors that vary from person to person.
Some trans people have obtained sufficient treatment and surgery to be effectively indistinguishable from cisgender people. Others forgo medical transition, whether or not by choice. Still others have intersex conditions (a difference between the external and internal genitals) that can affect their gender identity.
Dr. Anastacia Tomson, an LGBTQ+ rights activist and trans woman based in South Africa, says that healthcare anxieties for trans patients “can be manifold.” Still, if you’re a trans patient meeting with a new doctor, “Ideally, you should always disclose medical information, particularly if you have received medical or surgical interventions.”
Before you even enter the doctor’s office, however, you’ll often have to navigate billing and insurance. This can be especially challenging for trans people whose documentation does not match their presentation or identity. Sometimes it’s necessary to disclose your transgender status to the doctor’s office to avoid bureaucratic confusion and receive care. This may include presenting assigned sex at birth or a dead name to the office, potentially in the presence of other patients and unrelated staff. At minimum, this can out a patient and be a distressing experience, and at worst can result in stigma or mistreatment. This is one reason why the right to change gender markers and identity documents is so important.
Once you’re in the room, you’ll want to talk to your doctor and assess whether they’re a good fit.
If you don’t feel comfortable being fully honest with your provider, that might mean they’re not the best fit, Tomson advises. Assessing whether doctors are queer-friendly, or a good fit can be fraught with uncertainty. Often, doctors who advertise themselves as queer-friendly become a go-to resource for queer patients. These doctors attract queer patients who feel safe seeing them, and the doctors then develop experience in treating queer communities. Local branches of national nonprofits such as Planned Parenthood can also make referrals to known queer-friendly doctors, or provide care themselves. There are also databases of queer-friendly healthcare providers, such as Outlist.
Whatever you do, you shouldn’t lie to your provider. “To be fair and get the best outcomes, it is helpful for the medical team caring for a patient to know everything that makes up their body,” says Ilene Corina, a patient safety advocate in New York.
Despite the challenges we encounter in healthcare, the benefits of lying rarely outweigh the risks incurred to our health. Let’s get into what parts of your medical history you’ll want to discuss with your doctor to the best of your ability.
Past transition care
It’s important to talk about any past transition care, such as hormone replacement therapy, with a new doctor. “Having access to more information allows for better clinical decision-making and rational medical care,” Tomson says.
This is also pertinent when switching providers or seeing multiple providers. Tomson notes that it’s helpful to “furnish your new provider with as much of the clinical history as possible.” “This allows for better continuity of care, and avoids unnecessary duplication of investigations or gaps in management of ongoing medical concerns,” she adds.
Being honest about past treatments also prevents certain misdiagnoses. For instance, some effects of HRT may present diagnostically as a hormone imbalance in someone who presents as the opposite gender. For example, a masculine-presenting trans woman on feminizing hormone therapy will develop breast tissue. This may be misidentified as gynecomastia.
Likewise, the effects of masculinizing HRT on a patient read as a woman may be misidentified as an effect of polycystic ovary syndrome or other hormone disorders. Disclosing to prevent misdiagnosis or the deployment of unnecessary procedures (pregnancy tests or prostate screening) can save money and ensure quality care.
Anatomical information
A range of healthcare risks and conditions affect anatomy independent of gender identity. “A trans woman will still need a prostate exam, and a trans man might still get pregnant,” says Corina.
However, providers may not always be aware of a patient’s internal anatomy. They might not ask a trans woman about prostate health, for example, if they’re unaware of the sex they were assigned at birth. It’s often up to the patient to disclose this information in order to get the care they need.
Gender transition is a journey. The road we walk to become our happiest selves is seldom free from uncertainty and risk. Still, positive change is happening. The quality of healthcare for transgender patients improves with each passing year. More and more providers receive better training on caring for LGBTQ+ bodies.
Hopefully someday, trans patients will be able to confidently talk about their medical history with not just select medical providers but all of them.