More than Pronouns and Good Intentions: 5 Ways toward decent and affirming trans healthcare

In the past few years, trans rights and social policies that take trans lives into account have seen exponential growth. This is largely due to the decades-long work of trans people, especially those organizing for their safety and survival. Critical progress has been made under the leadership of trans women of colour, trans people doing sex work, and trans parents; however, these contributions are so often devalued and minimized. Thanks to the hard work of trans communities before us, we now have increased protections, more visibility, and service providers who are scrambling to meet our needs. This sense of urgency to engage with us is even more pronounced with sexual and reproductive wellness—an area of health where vulnerable parts of our bodies and selves come under scrutiny by cis (non-trans) society and where cis providers have much to learn about sexual and gender diversity.

There is a great deal of variation in how providers deliver trans healthcare. Thus, instead of looking at specific actions that providers can take (which can vary depending on context), here are 5 values-based perspectives to consider as a provider.

These perspectives can contribute to dignified and affirming healthcare experiences, whether it be primary or specialist care, sexual and reproductive health, or mental health services. Above all though, we hope anyone involved in trans health is looking to their own local community for meaningful engagement[1] and up-to-date information on health care needs.

Depathologize gender and sexuality

As of 2012, Gender Identity Disorder (GID) has been replaced by Gender Dysphoria in the DSM-V[2]. However, transgender people continue to be pathologized in a variety of ways. Depending on where we live, psychological assessments and psychotherapy are often prerequisites to hormones, surgeries, and identification papers. Sometimes we must also adhere to prescriptive gender presentations, report specific sexual orientations or hide sex practices to meet a provider’s requirements. These pathologizing practices and other negative experiences with providers are communicated from peer to peer and have an impact on how, when, and if we use available services. As a provider, being mindful of how underlying biases and choices can affect our anxiety and avoidance is critical to quality care.

Respect self-determination and bodily autonomy

We have the right to make our own health decisions. This right to choice includes which interventions, treatments, and medications we want to access. We also have the right to label our own bodies and functions based on what feels comfortable or least problematic to us. To this end, follow our lead when it comes to terminology. Also, in order to avoid assumptions, check-in with us about what words we like to use, what parts we have (or don’t), and how we use those parts. Only ask intimate questions when relevant to our care. Communication about physical examination is also essential. Consent is important before touching another person, and some trans people prefer not to have a health practitioner touch certain parts of them. Reminding trans people they have the right to refuse treatments or ask for a second opinion are some ways to encourage our autonomy.

Cultivate safety and trust

Have practices and policies that explicitly show that you value trans people’s privacy and confidentiality. Very rarely are trans people encouraged to establish boundaries based on what feels right to us. Our privacy requirements should be addressed, and early on. For example, in Ontario, physicians are entitled to assume they have their client’s implied consent to share personal health information with other providers in the client’s circle of care. Assuming implied consent in this situation could cause harm and damage trust. The ethics of sharing personal information about our transitions and how these stories are told needs to be discussed.

Having clear policies that are made available to everyone will help trans people navigate services better and decide if the limits of confidentiality are acceptable to them. Knowing who has access to our files, what information goes on record, and how these records are stored helps us build confidence in our providers. Included in this type of explanation would be any mention of our histories of “gendered” health care (e.g. pap smears, menstrual cycles, testicular discomfort), and, importantly, which names are on file and which names get called out in the waiting room. We have the right to receive accommodations and to be addressed by our actual names regardless of whether or not these names are also on our identification documents. Taking these steps can go a long way in creating a safe environment.

See the unique person in front of you

Recognize that trans people are a diverse, complex, and often contradictory population—like all communities. This includes the people who wrote this article, who most definitely were not elected to represent the whole trans population! Trans people, like all people, come with different life baggage, worldviews, bodies, spiritualities, class backgrounds, and relationship networks. We also have our own intra-community conflicts, challenges, and strengths. Keep this in mind and do your best to show flexibility when collaborating with trans people. There is no “right way” or “wrong way” to be trans, nor is there any test to prove or disprove one’s trans-ness. Each individual comes to trans-ness through a unique life path, with different struggles and successes along the way.

Support trans knowledge, leadership and empowerment

Recognize that trans people have historically been, and continue to be, over-studied, under-consulted, and dismissed for their trans-ness. There are many papers about experiences of discrimination, risk-taking, mental illness, suicidality[3], and oppression of trans people, but very few concerning sexual and reproductive wellness. There are even fewer by trans researchers and/or in collaboration with trans communities.

Trans people are the experts on their own health, and on trans health broadly speaking. We have been doing comparative analyses of surgeons, medications, side-effects, therapeutic approaches and aftercare for as long as we have been accessing these services. Given the huge number of obstacles we have faced, we have been creative and efficient in navigating complex, often hostile health services to attain our wellness goals and support each other. To only credit cis (non-trans) people for advances in trans health is to ignore a whole wealth of knowledge and best practices based on years of community development and information gathering. Encouraging trans leadership and trans knowledge development is not only ethically better, it is also a more efficient use of resources.

We are indebted to trans people who came before us, those who will come after us, and everyone else who contributes to the collective work of trans liberation. To everyone making efforts to encourage meaningful involvement of trans people in reproductive and other forms of health: thank you and keep going! The conversation is just getting started.


 

[1] Much of what we know about meaningful engagement comes from principles which emerged from the HIV movement. Please visit the Canadian Positive People Network (CPPN) for more information on movements led by and for HIV positive people, and their contribution to many spheres of health advocacy.

[2] For a global resource on trans health and information on history, check out “Trans Bodies, Trans Selves”, a book developed by and for trans people: http://transbodies.com/, which includes a fantastic chapter on sexual and reproductive health.

[3] Check out TransPulse research findings on access to health care in Ontario: http://transpulseproject.ca/research/