CA and the Trans Community

Right now, I’m procrastinating on composing an email. Instead, I’m writing this blog. The email that I should be writing is to my family and friends who don’t know that I’m trans. I’ve been trans for years, but since I started hormones two months ago, and surgery is around the corner, it’s time. How will they react? I’m not sure. I suspect many will be supportive and some will not. I’m grateful for my community who already knows, because they have all been incredibly wonderful and supportive. I have been brought to tears with the love and generosity I have already experienced, and I suspect this will continue to happen as my community continues to be the amazing community that it is.

I’ve been thinking about community acupuncture and the trans community. About how, at PCA in West Philly, home to a huge population of trans folks, our paperwork gives folks more than two options (M/ F/ transgender (FtM/ MtF) and preferred pronouns: M/ F/ other:______. I’ve been thinking about the argument I’ve heard against offering more than two options–that might confuse “the rest” of our patients. The normal patients. The majority. And you know what? That fucking pisses me off! That makes me, and so many of my friends and comrades, invisible. And you know what? No one has ever said anything negative about our paperwork. No one has ever said, “I’m sorry; I’m confused, and therefore uncomfortable. I don’t want to be in a place that might welcome everyone, regardless of their gender identity.” You know why? Because that would be an asshole thing to do.

The truth of the matter is that it isn’t enough to simply have paperwork that acknowledges that there are more than two sexes. Our paperwork, for example, doesn’t include “intersex”. That just occurred to me. And why not? Maybe because no one has ever said, “Hey, I’m intersex–why isn’t that on this form?” But why should that be the responsibility of the person who has been made invisible by most forms their entire life? My new mission: include intersex on our forms.

So, I have been thinking about this, not just in relation to my own transition, but because Philadelphia is home to a national Trans* Health Conference every year in June, and PCA has been talking about tabling at this conference. And I thought, “Wouldn’t it be neat if we could represent, not just PCA, but POCA?” Because conference attendees come from all over the country, and wouldn’t it be cool to be like, “Here’s this amazing, affordable resource, and maybe there’s a POCA clinic in your city!” So exciting! But… how many POCA clinics have paperwork that reflects the existence of trans* people? And not just paperwork, but the ability to respectfully interact with trans* people, to, for example, use the pronouns that the individual prefers? How many people attend Michelle’s workshop on gender, and don’t actually make any changes in their clinics? I don’t know the answer to these questions, but I’m concerned. Talk to me. Also, read below, for a document I wrote to be included in volunteer training.

Trans 101/ Let’s make sure everyone feels welcome here.

(a work in progress)

Dear volunteers:

We want PCA to be a safe space for anyone who might walk through our doors. You are key in facilitating this! One way that we make PCA a safe and comfortable space is by being mindful and respectful around language and gender identity.

You may have noticed that our intake form doesn’t limit gender/sex to simply “M” or “F”. That’s because not everyone identifies with the sex they were assigned at birth. Beyond our intake, we haven’t been doing as much as we can to make sure that volunteers are respectful of patients’ preferred pronouns. We want to fix this!

First, some terms, explained:

Assigned at birth: Basically, this is what happens when a person is born, a doctor looks at their genitals, and makes a pronouncement: It’s a boy! It’s a girl! Sometimes, if the doctor isn’t entirely sure, they will make a decision and perhaps perform some surgery, without the consent of the tiny being, obviously. And then the gender socialization begins.

“Assigned at birth” is a phrase that’s preferable to language like, “female-bodied” or “male-bodied,” which gives the idea that your body is something other than your identity. So, if someone is male identified, but assigned female at birth, we wouldn’t say that he is “female-bodied,” because what does that even mean? Our bodies are more complex than that. So are our identities.

Trans*: This includes transgender, transexual, gender-fluid, genderqueer, two-spirit, genderfuck, and more. What it essentially boils down to is people who don’t identify with the gender they were assigned at birth, and what this can look and feel like is different for everyone.

Preferred Pronouns: How a person prefers you to refer to them. For example, I, Zem, prefer “they”. So, if you were talking about me (because I know you talk about me all the time), you might say, “Oh, Zem? You know them? Oh yeah, they’re super rad and great at training volunteers.” (That is what you would say, right? ;-)) While I don’t think you need example sentences for all the staff, for the record, Ellen and Sarah both prefer “she,” and Billy and Bob both prefer “he”. If a patient misuses any of our pronouns, don’t correct them, but please do use the pronouns we prefer when talking about us. Thanks!

Above is the barest bones of a lesson, so if you’d like some further reading, I highly recommend you check out:

And if you want to read something less concrete and more beautiful when you’re done reading, a friend of mine wrote this:

Author: POCAGuestBlog

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  1. Oh Zem you wrote the blog!! Yay!! This has been so heavily on my mind and heart. I have been trying to wrap my head around what I want to say about this in terms of the space that clinics offer to the world around them. Because, ya know, what I want to say is obviously very important. Ugh. But. I think the link to keeping the space of your clinic open, safe, welcoming to all sorts of folks who may come in and want to try acupuncture is still the same thing when it’s trans folks. I do believe we have uncovered the same old fractal as opposed to inventing or changing it to something new. I know this because I work at PCA West Philly and as it turns out treating folks is treating folks regardless of their sexuality, sexual orientation, personal sexual understanding, sexual partners, sexual life, or complete lack there of. Also I would just much prefer not freaking out about this idea that word of mouth may send someone into a clinic that is not open, welcoming, and safe but embarrassing and another place to battle for dignity and self. Not that any clinic is doing this on purpose or out of spite or bigotry (at least I don’t think or hope so). That’s the thing about POCA. “My” patients are gonna be “your” patients too, as well as their friends and family. And usually that just melts my heart and makes me so proud to be. But in this instance it really scares me.

  2. *or regardless of gender, race, religion, class, status, prettiness, likeness to me personally, etc. I wrote this too quickly to get that sentence to where it really needed to be. Bah.

  3. Thanks for this post Zem. What do you think about leaving gender off the forms entirely? That’s what we did at Poke, and what I plan to do at GCA, for a few reasons: I don’t want to imply that someone’s gender can be captured or summarized on a form, I don’t want someone to feel pressure to come out to me (or any other punk who treats them) if they don’t want to, and mainly because I just don’t need to know someone’s gender identity in order to treat them.
    That being said, I do like that West Philly’s form makes trans* identities visible to everyone who reads the form. That’s powerful. Can you let us know how the Trans 101 receptionist training goes?

  4. we just ask folks for the preferred gender pronoun on our intake form and they get to write it into the blank space, that way we make no assumptions about which one the wish to use.

  5. Lisa B., what I worry about when people leave gender off of their forms entirely are the situations when, for instance, someone who identifies as male and passes as such but has a vagina and periods is going to feel way more comfortable having had the opportunity to already explain that he is a FtM transgender person, and can more easily tell you that he has cramps at that moment — or any other number of conditions — without having to have a whole uncomfortable conversation about it. Know what I mean?

  6. Also — I have to mention that we have received an immense amount of appreciation for having those options on our paperwork. It’s, on a basic level, a good way to communicate that people at the clinic have a certain level of understanding of trans/gender issues, which makes it feel very safe, I think. I hope. Of course, if that’s on the paperwork, it should also be the case that people at the clinic have educated themselves about those issues.

  7. Thanks Ellen, I definitely see your points, and I’m not at all surprised to hear that people have been really appreciative! I still feel a bit uneasy about asking someone to out themselves to me on a first meeting. I wonder if Tatyana’s approach of giving folks the option of indicating a pronoun preference would also communicate a certain level of understanding around trans* issues.

  8. I think that it does communicate that fine, it was suggested this way by one of our former punks who is genderqueer / gender non-conforming and prefers “them” as their pronoun. In terms of sexual / reproductive health issues there are a bunch of them on our form listed separately and clients can circle whatever applies to them regardless of their gender / pronoun. I think the main thing is to show that your business understand these issues and to make folks feel that they are safe and can count on good care.

  9. We’ll be re-doing our forms soon and though we do not ask people to identify their gender in the basic info section, we have a section that says FOR WOMEN and FOR MEN. It makes me cringe writing that. Similarly we have a single check box that says HIV/AIDS.

    The articles you posted Zem were really helpful, I feel like I was able to dislodge a blind spot of my own and I while I feel a bit like an ASS for letting those forms linger in our clinic for so long (but they cost money to print….blah blah blah) I will make it a priority to get rid of those forms asap.

    I can see how unwelcoming our forms are to trans* people, and that has to change.

  10. This is a great post and a great discussion, and ditto the post & comments in your first link, Zem. Thanks so much for writing this!

    I will say that regarding forms, I’ve been more a fan of the “fill in the blank with whatever” approach (and a glommed-together genito-urinary section with a note: “check all that apply”). I figure if someone writes “male” in the box labeled “sex/gender” and then checks “painful periods,” I have before me a man with a uterus. Not the first time, won’t be the last; and if he doesn’t complain of dysmenorrhea, etc., he could *still* have a uterus – but he might not feel like sharing that because his chief complaint is an ankle sprain and it doesn’t feel pertinent (or even feels traumatic). But I appreciate the point you make, Ellen, about trying to pre-empt awkwardness and establish a sense of safety and visibility. I’m not sure forms are the best way to do that – they’re certainly not the only way – but they can *easily* do the opposite (right on, Cris, for prioritizing changing yours).

    So now I’m wondering about this: there’s really not any other demographic info I solicit on our intake forms (neither “race,” nor ethnicity, nor religion, nor sexual orientation; etc.)…so why do we ask at all? I suppose *I* mostly ask so that a) I can make a better guess as to which of the new patients is which (which could still obviously be wrong) and b) I can ask about preferred pronouns, if the person ID’s in some way that is not obviously indicative. But how often do I really refer to patients in the third person anyway – so why not remove all those boxes and lines? I’m not actually trying to be rhetorical, and don’t want to derail. I’m just honestly wondering. I feel like this post is another one for the file labeled “why we don’t ask for so much information right away”; there are cases to be made for various approaches.

  11. Also learning a bunch from this blog/comments along with material from Michelle River’s awesome past POCAFest workshops.

    Thanks to all for the continued education….and Zem, thanks for writing.

  12. When Zem was on the Zem tour (was it only a year ago?), I wondered about whether we should change our forms. I remember thinking “I’m such a completely uninformed person about so many things, this gender thing being only one of many, that I probably would not even know if there were trans* or genderqueer people even living here in Mayberry.” So I didn’t change the forms. But this is a good reminder and I’ll be following the discussion here to help me decide what changes to make.

  13. We at CommuniChi follow Nora’s method in terms of our forms – “Sex” with a very long blank underline space after it where people can communicate in whatever way they choose (or not) regarding their sexuality/gender preference.

    Of course, there is always so much to learn, and this post is a helpful piece in my education. I’ll share two experiences I’ve had (amongst many) with trans patients here:

    On one occasion, a person with a male first name had been a patient for 3 or 4 years when he decided to switch to female gender. One day he handed me a check before his treatment and without thinking I said “thank you sir”. My words were very upsetting to him. I immediately apologized and though he stopped coming in to see me, he continues to see other practitioners at the clinic.

    Obviously a part of my psyche was still relating to the male patient I had known for years and was possibly a little bit stuck on a fixed personality/gender identity instead of being able to make the switch instantly and fluidly.

    It’s very important for me to keep looking at all the ways in which I hold privilege – white, male, heterosexual to name three – and to unlearn all the stereotypical behavior and oppressive mind sets which perpetuate harmful attitudes. It’s a process and meanwhile, I do my best to hold a compassionate attitude towards all, accepting present moment limitations with respect to my cultural blind spots.

    Second situation was with a transgender patient who has a name that includes both a male and a female pronoun. This person’s identity wasn’t explicitly communicated on her paperwork and I was confused, so I just asked – “do you prefer if I call you by A or B?”

    They replied with a good natured smile – “either one is okay”.

    I share this second story to perhaps reassure people who may be reading this and feel new to GLBTQ education (like me)that it’s not so complicated to talk to people with genuine respect and ask them how they would like to be spoken to, etc.

    Jordan Van Voast

  14. Thanks for the blog and the discussion. Quite awhile back at WCA we went through our intake forms and took out a lot of things that we figured we didn’t need to know in order to treat people. The line that said “Sex M/F” disappeared. We have nothing at all that asks about gender. We consolidated all symptoms and disorders having to do with genitals and/or hormones under the heading “if applicable”. That was great because it made the list of symptoms shorter. And pretty much in the clinic it has worked out fine; patients who were dudes got treated for PMS with no more explanation required than patients who were ladies.

    But I had an experience today where I had cause to wish that I knew what a patient’s preferred pronoun was (because I realized that I might have used the wrong one at the front desk when the patient was late. Patient wasn’t there for that, but still.) It wasn’t convenient to ask during the treatment. So now I’m thinking about how we can put that on the form. Nora, I’m totally with you about how much forms suck. I guess I am thinking about putting the pronoun question in because it’s something I’d like to know without having to ask in the course of the treatment. And as Ellen and Taty said, it’s a welcoming gesture. But I wish there were a way to clarify and welcome that didn’t require the damn form.

  15. Hi all,

    Thanks for reading and for sharing your thoughts. I have a few brief thoughts (or maybe long thoughts). When I first became a patient at PCA (four years ago), the paperwork said sex: male/ female/ transgender and preferred pronoun: M/ F.

    At the time, I circled both female and transgender, and next to preferred pronoun wrote in them/them/theirs. Now, if preferred pronoun hadn’t been on the form, I might not have communicated that; I probably would have been referred to as “she” at some point (which, to be honest, probably happened anyway), and without that gesture (having a space for preferred pronouns), I probably wouldn’t have said (written) anything, just felt silently disgruntled. I probably would not be where I am today in terms of PCA and POCA, if not for that simple act, even if it wasn’t perfect. Do you get what I’m saying here? Because someone before me said, “hey, p.s., there are lots of trans folks in west philly, you need to make them feel welcome,” I later felt okay saying, “hey, we could make this section better, even more inclusive.” And yes, that’s important, even if you don’t have “lots” of trans folks in your community (that you’re aware of).

    Also, River Jordan, when you continue to refer to someone who has “decided to switch to female gender” as “he”, (which you just did in the telling of your story), you are definitely not respecting her. She is no longer “he”, even if you once knew her as such. And that is so important, even when someone has barely begun transitioning. If someone has the guts to communicate to you that they are a woman, or a man, or genderqueer, even if you don’t see that, you have to respect that, and use the right pronouns for them.

    You (any cisgender person reading this) have SO MUCH PRIVILEGE in that people see you and aren’t going to mis-pronoun you. Being a good ally means using the correct pronouns if you know them, and making that your responsibility. It is not the responsibility of the trans person to remind you every time you fuck up.

  16. And that, Lisafer, is why having preferred pronouns on your form is a good idea. Because people who don’t know WTF you’re talking about are going to ignore it, and people who get mis-pronouned all the fucking time are going to be so grateful that you are clearly making an effort.

  17. That makes lots of sense. It seems like “preferred pronoun” should just go in the demographic section, next to “email address” and things like that. Thank you for having this conversation here, Zem.

  18. yes, thank you for starting this conversation, Zem. And thank you, Jordan, for sharing your story so honestly. In CA and in life we have our moments of grace and then we have our moments where we face right on our faces.

  19. Thanks, Zem! I’m still in process, getting my forms where I want them to be. I need to re-print next week, and I’m definitely going to include:

    “Pronoun F/M _______” and remove the “Sex” demographic info.

    Another thing I learned the hard way (hard for the patient, regretful for me) is that I don’t want to ask for legal name anymore. I’ve got a spot for legal name and one for preferred name/nickname. That legal name bit is such a major “out-er” of folks, and I don’t need it. In the incident I had, the patient introduced herself as “Andrea” in the reception room, and just a few short moments later, I pulled up to her chair, glanced at the form where it asks for legal name, looked up and called her “Charles.” ugh.

    I was recently on the receiving end of homophobic healthcare, which is really rare for me, since it wasn’t even about my gender presentation; it was just focused on my being a lesbian. That has otherwise been such a mainstream component of my identity (thanks, 70’s sisters, I appreciate it!) that it came as a real shock. What I can say about the experience of seeking healthcare from someone who neither fully saw nor respected me is that it felt like a layer of skin had been taken off. I felt raw and exposed, like I was susceptible, vulnerable, and missing an entire layer of protection. I felt nauseous to the point of dizzy, and I had what felt like a complete pair of gym socks in my throat. It took a full day to get my sense of solidity back.

    All this to say that the payoff to getting this shit right is big, and the cost of getting it wrong – for our patients – it enormous.

  20. Michelle,

    I’m sorry you had those experiences, but glad that they’ve helped you come to the understandings you have come to. It’s a process for everyone–even the queer health center in town here used to ask for legal and preferred name, but still call me by my legal name (they still ask for legal name, but have gotten much better about not addressing me as such). Personally, I think it’s better to just ask for “name”, and not make a distinction between legal and preferred.

    I also wanted to add that after doing some reading, Ellen and I have decided to add “intersex” to our list of possibilities. Some links I found helpful:

    If you don’t have time, what I took away from my reading was that intersex is used to describe medical conditions of not fitting neatly into “male” or “female” categories, and while some intersex people identify as male or female, some identify as intersex, which is why we have decided to include this category on our paperwork.

    Thanks to everyone who has been (and continues to be) part of this conversation.