dear doctors: it is really fucking obvious in a page-long letter when you’re trying to avoid using pronouns for me. or my name, for that matter. “the patient” gets really repetitive when it’s used multiple times in every goddamn sentence.
I could go on for pages about the problems faced by trans* people accessing treatment, but at the core are two main problems. The first is the fact that gender is seen always and exclusively as a binary. It is assumed that if you were assigned male at birth and are not male, that in asking for any form of treatment you are asking the medical staff to make you as close to their idea of cis female as possible. For some people that’s what they need, but for others their gender identity doesn’t resemble what their doctors think of as correct, and the pressure that can be laid on them to conform to what is expected can be immense, and treatment that they need to eliminate their dysphoria can be denied because, for example, a trans woman would like to have a pixie cut, yet their doctor believes that all women should have long hair in order to present as properly female. There are a significant number of people who feel that their gender doesn’t fit neatly into either male or female, and would like medical help to change their presentation to more accurately fit their gender. At the moment, it seems that the only option available for these people is to lie, as if they tell their doctors the truth, it may be taken as evidence that they are not serious about transitioning, and they could forever lose the chance to access the medical care they need to cure their dysphoria.
The second problem is that so much of the process seems to serve the sole purpose of stopping you from making ‘a hideous mistake’. The process is lengthened by multiple appointments with psychiatrists and therapists whose role is to assess the mental health and sanity of those seeking treatment. Tweets yesterday on the @TransDocFailAno account and the #transdocfail hashtag made it clear that, for many medical professionals, depression and other mental health problems were considered to be barriers to treatment that in some cases were used as excuses to delay treatment for dysphoria, and in other cases only the dysphoria was treated and other mental health problems ignored. Mental health issues blocking treatment for dysphoria is dangerous when dysphoria creates those mental health issues, and depression is immensely common in trans* people.
Charlie Hallam, “As the #transdocfail hashtag showed, many trans people are afraid of their doctors - Trans patients should not have to please medical staff before they can access treatment, writes Charlie Hallam.”
Please stop pushing things onto me that I don't want
I really hate it when doctors, councillors and other trans people treat me as if not wanting genital surgery is something I’ll “grow out of”. I don’t appreciate people who are supposedly experts on trans issues trying to tell me what they think I should get out of my transition. Surely gender specialists of all people should be capable of recognising that gender identity is not just limited to those who have penes and vaginas, and those who want penes and vaginas.
I’ve said many times before that HRT is all I’ve ever wanted, and I’m happy to stop there. This seems to always be completely dismissed by my doctors and councillors though, as I’m often criticized for not looking at the bigger picture and preparing for any future surgeries.
This is actually quite worrying, because if medical specialists are incapable of understanding that genital surgery isn’t a requirement of being trans, then I could easily have my current treatments withdrawn on the basis that I’m “not really trans”.
I can understand that a lot of people get genital surgery, so I can understand why it would be initially assumed. However, I shouldn’t have to find myself questioned or ignored for not being part of the majority. More importantly, I shouldn’t have to find myself being pushed into body-altering treatments that I don’t want simply because people can’t understand that I’m content where I am.
So yesterday I was not very functional socially and I was pretty tired, but I had an appointment booked for a pre-operative assessment for tubal ligation (sterilisation). I had my casual-worky PA with me, just to help me get there and back safely. I also worked out in the last few days that it’s possible I might be able to have a hysterectomy on medical grounds, and then I wouldn’t have to wait 3 years for the gender identity clinic to say it’s alright. I went to the pre-op anyway, because it was very short notice to cancel and because the nurse might be able to help me.
She did help - sort of. She offered to call and ask about an appointment with my gynaecologist. While she was on the phone she referred to me as a young lady and called me “she” the entire time. When she got off the phone she told me that she had made an appointment for me on [day] at 9:20am. I immediately said “I can’t do that” and she got a cross face on. I explained that I can’t do anything before midday, and (as she already knew) I was autistic and needed a PA to help me get to and from appointments, so any appointment had to be okay with my PA too.
This is where it gets weird. I said that before we go any further she needed to know that I’m transgender (which I had already mentioned pre-phone call in passing), and not to call me a lady or “she”. She immediately got really snippy and said yes, she had read my notes thoroughly before I came in. I pointed out that she called me young lady on the phone and said “she” repeatedly on the phone. She called it a slip-of-the-tongue. Ummmmm?
Anyway, then I called in my PA, and she proceeded to make another phone call to rearrange the first appointment, again at no point pausing to check whether the date and time she’d arranged for me was alright with me or my PA. If it hadn’t been okay, she would’ve had to make another phone call. Why didn’t she just ask us while she was arranging? If she knew I was transgender, why did she wilfully misgender me while I was right there?
She then started discussing my health and the risks of various procedures, with my PA, and pretty much acted like I was a bystander. WHAT EVEN.
Surely, now, even those with little or no direct experience of trans issues must realise that the real problem is not the chimera of regret and regretters so eagerly sought after by the tabloid press, but the diet of mundane disrespect dished out daily by doctors the length and breadth of the country.
I’ve really grown to resent gender identity clinics over the years. After being pretty much ignored for years while I badly needed them, and now essentially being talked over while being expected to go through a bunch of shit that clearly isn’t necessary for me now, I’d really rather just not bother.
If I were actually capable of funding my HRT prescriptions outside of the NHS (which I really am fucking myself over trying to pay for), I wouldn’t even bother getting involved with a GID clinic at this point… The most irritating part about it all is that a prescription is literally the only thing I want from them. Everything else is something I’ve either already dealt with, or am not interested in, so I’d really rather just come in, pick up what I need and not have to ever come back, rather than go through 6 fucking months of therapy when it’s already clear from both my visit and from the letter that my GP wrote to your clinic, that I’ve already been diagnosed, had sperm banked (although the status of said sperm is incredibly dubious), ran an official name change, been referred to 4 gender clinics, started HRT on medical record, and done most of this 3 fucking years ago!
Also, it really pisses me off that I never seem to be able to say that I don’t care about any type of surgery to a specialist. The last time I mentioned this, I just ended up getting a description of the lead-up and recovery process for genital surgery, which I don’t remember asking for, and really only served to even further put me off something I already didn’t want… Also, every therapist, doctor or specialist I’ve ever mentioned this to (Except my GP, curiously enough), has ALWAYS given me the exact same response: “Well you could change your mind later.” Well yes, and I’ll be sure to let you know if the idea of hacking apart a functional part of my body that I have no ill feeling toward becomes suddenly appealing to me - after all, it really seems like the kind of thing that people would be on the fence about. But even with that aside, surely the option to do so isn’t going to go away, so I don’t understand why this sort of thing is even worth mentioning. If I really do later decide that I’d rather have my penis on the inside, then we can just talk about all the details then, while I’m interested.
There really is something wrong when my GP, someone who has no prior experience in gender-related issues, serves my needs far better than every single clinic I’ve ever seen, even though a lot of his solutions are compromised options, since he’s pushing against a system that’s extremely reluctant to facilitate my treatment outside of a clinic.
This post wasn’t even meant to be a rant, but I got angrier as I wrote it…
I will run out of estrogen this week. The endo won’t renew the prescription without a new appointment. The clinic screwed up my last appointment. I went through hours of pain on the bus and in the waiting room to find out they had cancelled my appointment while I was waiting there for my appointment. I don’t have the mental energy to try again, and will have even less energy when my estrogen runs out. I can’t deal with the hours of pain and I can’t be sure that they won’t cancel my appointment again.
If we as trans people had better access to health care, this wouldn’t be so hard.
If we as autistic people had better access to health care and public accommodations, this wouldn’t be so hard.
If you consider yourself a cis or neurotypical ally, ask yourself and us how innaccessible such things are, and ask yourself and us what you can do to change things.
way back when, like over ten years ago (hey HBIGDA or wev y'all call yourselves any more i think i’ve demonstrated my commitment to sparkle motion beyond question here), i was looking for people who worked with trans folk
who are, you may imagine, not all that thick on the ground in texas
but i did!
and it got like super weird super fast
therapist kept pronouncing my name wrong and got upset when i tried to correct, insisting i’d told therapist the wrong pronunciation and why was i making an issue of it
but the most bizarre part was
the person i’d sought out specifically for transition-related stuff
KEPT FORGETTING I WAS TRANS
and tried laughing it off as no big when i brought it up