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Navigating the Health Care System

LBTI Health Care Concerns

Male or Female? The Gender Binary and Transphobia in Medical Settings

For those of us who do not identify as male or female, who are not legally recognized as the gender we identify with, or who are medically transitioning from male to female or from female to male, the box labeled male or female on intake forms can create an even greater feeling of anxiety. One 35-year-old Puerto Rican, transgender lesbian of color avoided going to the OB/GYN for years:

The spaces are so gender-specific that just being in the waiting room makes me feel weird. People at the waiting room usually stare at me trying to find out if I am a woman or a man. In an OB/GYN office that is a big issue for me.

Even a simple trip for an eye exam can become complicated for those of us whose gender presentation is different from our biological sex, as one trans man explains.

I began my physical and legal transition to male when I started hormones this January and had a chest reconstruction this March. Since January I have avoided health care that is not related to my transition because I have to go by my female (legal) name to get things covered by my insurance. Since taking hormones, my voice has changed, my fat distribution has changed and I am mostly seen as male in my daily life. I have gone to lots of effort to educate my family, employers, friends and people I know that I prefer my chosen (male) name and male pronouns. Thus, it is painful to seek care when I know I will be related to as a person of a gender I do not identify with. This makes even an annual eye exam a headache...

As a trans man seeking health care I worry about problems with my female "plumbing" (ovaries, uterus, cervix, vagina) that may arise before I can afford to get a hysterectomy and oophorectomy (removal of all the plumbing).

Those of us who have intersex conditions may distrust providers based on childhood surgeries performed on us without our consent. (Such surgeries are still a standard practice in the United States for babies born with ambiguous genitalia, but intersex activists oppose nonconsensual surgeries.) We are often made to feel that no one else is like us and that it is okay that some providers do not know how to treat us.

I come out about my surgery in carefully selected ways. I have seen the response of too many twisted faces telling me that they have never heard of such a thing. They show me pity...One medical practitioner told me I was "just too weird."

Financially, we often face many obstacles. Those of us who are transgender face the risk of losing our insurance, if we have it, and the surgeries for gender transition are extremely expensive. Most companies will not cover any procedures related to gender transition. Further, if we legally identify as a male, most insurance companies will not cover an annual Pap smear. If we legally identify as female, our insurance will not cover prostate exams.

There is much intolerance and lack of understanding and the chance that I will be dropped from my insurance plan if the provider finds out that I am a transsexual. Fortunately, my legal name change will be complete soon and I will be able to change my medical records with the insurance company. The male name on my records and my physical appearance should be enough to get treated in accord with my identity and feelings about myself and my body. I am very fortunate that all this is working itself out in a matter of months...

If we have an intersex condition, our insurance company may not cover follow-up care regarding our condition or cover surgery necessary to our condition once we become an adult. This mirrors the medical establishment's discriminatory practices against transpeople.

In addition, those of us who have partners are often unable to get health insurance through our partners because many employers and insurance companies will not honor spousal benefits to unmarried couples. Fortunately, that is changing.

What We Can Do

Given all of this, what can we do to get the health care we are entitled to? As health consumers, we need to get annual exams and be willing to keep looking until we find a provider we can trust. We can change the system by advocating for ourselves, and by sharing resources, information, and our experiences with others in our community. We can also foster change by supporting organizations that are doing work on behalf of LGBTI people, and by keeping up to date on the work that must be done. We can communicate openly with our providers and we can seek and find an LGBTI-friendly provider.

I am a 49-year-old, Caucasian, post-op male-to-female transsexual. I have lived as a woman since 1975. We all can be proactive with regard to health care. Medical practitioners are not infallible, and we can avoid "The Cinderella Complex," i.e., not waiting for the doctor to "save" us from bad health.

Many LGBTI health organizations have made information widely available on the Internet. See LGBTI Health Resources on page 5 to find out more about the resources and information that are available to us.

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