This is not a Trans* Patients 101 blog post; I’m not equipped to write that. If that’s what you’re after, check out the excellent posts written by Zem Chance (https://www.pocacoop.com/prick-prod-provoke/post/ca-and-the-trans-community) and by Asher (https://tranarchism.com/2010/11/26/not-your-moms-trans-101/). Michelle Faucher wrote a really great post about GLBT inclusivity in general: (https://www.pocacoop.com/prick-prod-provoke/post/5-easy-things-to-make-your-clinic-shine-more-brightly).
So, you’ve got inclusive forms in your clinic. You’re not asking anyone to tick either a Male or Female box, nor do you list prostate problems under The Men’s Section nor PMS in For Women Only. Great! But, wait, there’s more.
Specifically, I want to speak to cisgendered practitioners like myself and address the topic of hormones and the CA clinic. You may treat a trans* patient who is choosing to alter their body with the use of hormones. If they decide to tell you about this, I hope you’ll bear in mind that the power dynamics at play here are no small thing.
Firstly, you are in some position of power as a healthcare practitioner relating to a patient. Added to that is the fact that you are cisgender and they are transgender. Added to that is the fact that many, many trans* people face some pretty horrendous transphobia in their attempts to access healthcare. The degree depends on the individual situation (and of course, race, class and many other markers of difference play into this) but I feel confident in saying that accessing healthcare – any healthcare – as a trans* person tends to be really fraught.
So when you’re listening to your trans* patient tell you that they’re choosing to alter their body with the use of hormones, what do you say?
… Not much.
You indicate that you’re listening, in whatever way that works for you.
You may have opinions about whether this is the right thing for them. These opinions may be based on an article you read or your concern about their Liver Yin or your past experience treating a trans* person. But I really hope you’ll keep your opinions to yourself, unless they specifically ask you for your knowledge or expertise on hormone use in gender transition.
I especially hope that you won’t ask them if they’ve thought this decision through – and I’m assuming that if you did have the impulse to ask such a question, it would be coming from a place of genuine care for your patient. The problem is, the question: “Have you thought about how this will change your body permanently?” simultaneously echoes and ignores the many, many hoops that a trans* person has to go through in order to get access to hormones.
Lots of doctors’ appointments. Lots of referrals to other experts. Lots of questioning by medical professionals who are mostly cisgender, like you. To give this added context: in most provinces and states (this is changing slowly) a trans* person has to get a diagnosis of a mental illness (gender dysphoria) in order to even get a prescription for hormones.
As practitioners, we serve our trans* patients best if we function on the assumption that trans* folk are not sick, that they are the experts on their own bodies, and that if they have made the decision to alter their bodies, they’ve thought about it a lot already. Let’s not make it their job to reassure us about that.
Thanks to Beckham Ronaghan for his feedback and insight.