health

The true story of transgender people accessing health services is not pretty. And, it needs to change.

“I am transgender – my gender is different from the sex I was assigned at birth…”

Your name is Sam.

You’re unwell and so you go to see a doctor.

You arrive at the waiting room and wait to be seen.

The doctor calls you through and asks you what the problem is. You introduce yourself as Sam and describe what you’ve been experiencing.

Image Supplied: Rachael Dols

The doctor takes a look at you – momentarily, but longer than just a glance – and finally says “Well, Sandra…”

You remind the doctor that your name is Sam. The doctor smiles at you and tells you that, really, you look like a Sandra. They go on calling you Sandra and outlining all the treatments available to Sandras. You try to point out, again, that you’re Sam and you’re not interested in treatments for Sandras. The doctor stops you and patronizingly explains how there is a difference between your feelings of Sam-ness and the doctor’s assessment of you being Sandra.

The doctor suggests you access mental health services because you’re so adamant that you’re Sam.

You leave the appointment feeling utterly dejected, voiceless, and questioning whether you actually ARE Sam if the doctor is so convinced that you’re Sandra. You realise the appointment ended without a resolution for your ill-health but instead of booking a follow-up appointment, you go straight home because you just can’t deal with the idea of a repeat of the experience you just had.

Albeit a crude and simplistic example, this is often the experience of transgender people trying to access healthcare. It’s colloquially known as ‘Trans Broken Arm’: you aren’t a person with a broken arm, you’re a trans person with a broken arm. Doctors, regardless of specialisation, training or jurisdiction, love to give their opinions on your gender even when it has nothing to do with your medical complaint.

“You leave the appointment feeling utterly dejected, voiceless…”

I am transgender – my gender is different from the sex I was assigned at birth. My gender is non-binary: I am neither female nor male, and my pronouns are gender-neutral, singular ‘they’.

I have endometriosis (endo, for short).  It took four years between first reporting my symptoms to a doctor and obtaining a diagnosis through key-hole surgery. Oddly, I was quite lucky to have a diagnosis in a relatively short time frame: the UK average time for a diagnosis is seven years, eight in Australia and 10 in the USA.

There is a normalised expectation that menstruation causes pain and discomfort, which leads to many suffering in silence until their symptoms are too severe to be ignored any more, and the only truly effective diagnosis method is through visual confirmation of growths during key-hole surgery.

Endometriosis affects five to 10 per cent of people born with a uterus: there is no cure and even a hysterectomy or the menopause can prove ineffective at stopping the recurrent growth of lesions.

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As many of you with chronic illnesses will know, you can often end up becoming a pseudo-specialist in your own particular field of ill-health: partly out of desperation for more information than your GP is able to impart, partly due to frustration with the limited treatment options presented. I started my own research into endo when my symptoms started to return with a vengeance, about a year and a half after having key-hole surgery.

The pain and fatigue I experienced was worsening and had a huge impact on work and uni. I felt like I was dancing a fine line between being disabled by pain and being disabled by prescription painkillers that messed with my ability to concentrate and think clearly. I was desperate to know more about my condition.

To see celebrities who are transgender, scroll through the gallery (post continues after gallery). 

As a person with an illness that is gendered (based on the incorrect assumption that reproductive organs determine your gender) differently to me, researching information can be horrible. Every single website, journal article, news and piece of educational material on endometriosis, or any other gynaecological illness for that matter, makes the assumption that if you’re suffering from endo you’re a woman.

Doctors and nurses often make the same assumption and will assert it over any information to the contrary you may provide them with – including medical observations of endometriosis occurring in cis-gender men.

So why is this such a bad thing if the majority of people with gynaecological-related issues are women? What’s wrong with using female-specific language?

For trans people, being misgendered (e.g. referred to by incorrect pronouns, descriptors, or being told you’re wrong about your inherent gender identity) chips away at your self-esteem and emotional wellbeing. Misgendering makes you feel erased, like your identity is false and you’re wrong for ever having listened to your feelings on the matter.

Mental health concerns within the trans community are a huge deal: estimates show that up to half of all transgender people have attempted suicide at some point in their life, and rates of suicide/self-harm among LGBTQIA folks are between 3.5 to 14 times that of their heterosexual, cis-gender peers.

But why are trans folks so sad? Is it because they’re transgender?

Watch Laverne Cox, a transgender model and activist, speak about the transphobia she experienced and her message for others (post continues after video):

It’s more to do with how society makes you feel about being transgender. Personally, I have no issues with my gender – I am perfectly secure about who I am – but I do get hurt when, after explaining my gender identity to someone, they ignore everything I’ve said, make their own decision about who I am, and proceed to treat me based on their assumptions.

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Transgender people are treated like we don’t know ourselves; like we’re mentally unwell and unable to make decisions with regards to our bodies and health. Access to gender-related medicine is tightly guarded: you have to prove to at least two psychologists that you are trans.

These psychologists then must diagnose you with the mental disorder ‘transsexual syndrome’ before you’re able to obtain hormone therapy or surgeries, which are seen as treatments for this condition.

Many transgender folks don’t want hormones or surgery, many more would love to have them but can’t gain access due to prohibitive costs, gate-keeping by medical professionals and outdated ideas on gender presentation (such as not looking masculine or feminine “enough” can have you marked as not taking it seriously).

The dominant narrative of being born in the wrong body, always knowing you were a different gender than that assigned at birth, and going from one binary gender to another (male to female, female to male) works for some trans folks, but the bigger picture contains oft-ignored kaleidoscopic variation.

“The dominant narrative of being born in the wrong body, always knowing you were a different gender than that assigned at birth…”

Transgender people don’t choose to be trans: we don’t choose a life of microaggressions, higher rates of suicide, depression and anxiety, higher rates of street attacks and violence, higher rates of intimate partner violence, and lower life expectancy. We’re not trying to be different and we’re not attention-seeking. We’re just trying to survive.

When you research your illness and everything you read is for a different gender to you, it’s a form of misgendering and can make you feel wrong, aberrant and dysfunctional – even more so than having a chronic illness already does. A change in language to become more inclusive is such a simple step towards making a huge societal difference for those who would really benefit from it.

For my part, I have been working with EndoActive: an Australian national not-for-profit organisation that aims to bring endo out of the shadows and into the community. They organised a conference on the 16th of May in Sydney, to bring together folks with endo, medical professionals and researchers, to kick endometriosis into the limelight and have it taken as seriously as the impact it has on lives.

I shared my experiences with them in a filmed interview as part of a collection that will be shown at the conference. I am hoping that, through greater visibility of endo sufferers and their experiences, the medical community will understand that the current one-size-fits-all approach is lacking, excludes a whole swath of the population, and can contribute to the erasure and pain of transgender folks.

Have you had or heard about any transphobic experiences? 

Want to read more about transgender experiences?

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