TW: Discussions of cissexism, biological essentialism, interactions with healthcare providers, etc.
This story started innocently enough: I met a cool girl, and we eventually started dating. As we spent more time together and realized how compatible we were, we decided to take things to the next level. We’re now girlfriends, and are doing swimmingly. That being said, I have a rule about any new (sexual) relationship I enter: no penetrative sex without an STD panel. For me, it’s not an issue of trust; it’s an issue of personal and emotional safety. I can neither prepare for nor work around what I’m not made aware of, and it’s almost impossible for me to enjoy sex if I feel even mildly unsafe. With that in mind, I sent my first email: to my endocrinologist.
While this may seem like an odd choice, I actually have a better relationship with my endocrinologist than I do with my general practitioner (GP). Aside from the simple fact that I see my endocrinologist more often, he’s also given me a lot less trouble with regards to being non-binary (e.g. filling out government paperwork when other doctors wouldn’t, etc). I sent him a hopeful email, asking for the standard STD panel, but he emailed me back asking what a, “standard panel,” constituted. I then gave him a few different tests (HIV, gonorrhea, etc), and once again asked to have my tests processed. His response was, “I can’t find the coding (e.g. what allows the patient to go into a lab and have their samples taken); I’m going to forward this to your GP.”
I was less than thrilled about this development, but ultimately, I didn’t object because my desire to take the test was more influential than my very, very low BS tolerance. The problem was compounded by the fact that my girlfriend had already received the results to her STD test from a free, local clinic. Mercifully, my general practitioner ordered the tests without fanfare. I was worried that I’d have to deal with triggering discussion about my body or slut shaming; those fears were unfounded. I went in for testing a day or two later. Then, I waited. Two weeks rolled by without an email notification of the results (I’ve gotten an email for virtually every other test I’ve taken with this insurance company); fed up with waiting, I decided to go to the same free clinic my girlfriend went to weeks earlier. That’s when things got rather awkward.
My girlfriend recommended this particular clinic because it met two important criteria: they work for free, and they work fast. Most other clinics either A) don’t test for a broad spectrum of STDs (e.g. are HIV-only), B) don’t provide the results as quickly, or C) aren’t free. I was able to find the clinic without issue, and was pleasantly surprised by the number of services they provided, including mother / child care, an immunizations clinic, and an STD-specific clinic. I was feeling cautiously optimistic about the entire experience, until I received my first intake form. After blowing through the usual privacy / release forms, I came on a question I was loathe to answer: “what is your gender?”
The answers were: male, female, intersex, transexual (MtF), and transsexual (FtM). I froze for a moment: none of the options really applied to me. I eventually settled on female, but only because I wanted to move on. To make matters worse, a different form asked, “what’s your gender?” I was relieved by the fact that I could write in my own answer, but confused and irritated by the fact that the very next question was, “what was your gender assigned at birth?” There were only three choices: male, female, and intersex. Honestly, I just crossed out gender and wrote sex, and then didn’t bother to answer. After all that was said and done, I turned in my paperwork and waited.
Eventually, I was called in to talk with a counselor. We talked a little bit about my (decidedly short) sexual history, including my sexual partners. This was all done under a seemingly reasonable pretense: “it’ll help us determine what tests you should take.” I filled out yet more paperwork, and was sent back out into the waiting room in short order. To be completely honest, nothing really stuck with me about this interaction except the fact that the counselor kept saying, “transgenders,” rather than, “transgender people.” I tried to correct her with little success; if nothing else, my experience with the counselor raised my hackles for what was to come next: speaking with a provider.
The provider in question was a nurse practitioner. She was probably in her 50s or so, with a caring, if somewhat forceful demeanor. She asked me fairly routine questions at first: “when was your last menstrual cycle,” and then moved on to more targeted questions, “when was the last time you had penetrative intercourse in the vagina?” I may have told a white lie or two, but I did so for my own emotional safety. Things got really surreal, however, when the provider A) gave me an explanation about how to use tampons (given my lack of vaginal penetration), and B) wanted to do a pelvic exam (wherein I would lay on my back and she would check for genital warts and the like). She even recommended a pap smear for me, as, “all women over 21 should have one.” In the end, I passed on the pelvic exam (even the idea of being on my back in stirrups sort of ruined it for me), but I couldn’t look past some of the things she said.
According to this nurse, having sex with a trans woman is considered: “MSM,” or men having sex with men. If you give a pre-op trans woman oral? Congrats, you get a throat swab. If she penetrates you anally, you’re getting an HIV test, pronto. While I can appreciate the fact that trans women are an “at-risk,” group, I was floored by the fact that, to this clinic, a trans woman is the equivalent of a cis, presumably gay or bi male. It really didn’t help that the provider kept saying, “transgenders,” much like the counselor; she said it no less than 6 times after she found out that piece of my sexual history. When I spoke up to point out how othering the term is, I was literally told, “it’s all part of the lingo.” Once all that was laid out on the table, I really couldn’t get out of the room fast enough. Providing a urine sample (read: having a few minutes to myself) helped me calm my nerves; I ended up back in the waiting room, ready to (finally) get my tests done.
Waiting for the tech to draw my blood felt like the longest wait, but it might have just been my apprehension. My time eventually came, however. Unsurprisingly, the banter the tech and I shared was the least awful of the visit. Thankfully, we didn’t talk about anything difficult or polarizing, and she never gave me the side-eye (unlike many of the other patients in the waiting room). I was sent on my merry way, and told to return for my results in a week, or any time thereafter. As I walked out, I couldn’t help but reflect on the fact that my gender and sex were never questioned. I was, presumably, seen solely as a cis female. This had me wondering, though: what if I had put a different answer on some of the forms? What if I had been more open about my gender non-conforming status?
When I got home, I immediately started reaching out to some of my closest trans friends. Most of them had never gone to the clinic; the one that had received less than optimal treatment. She was, in essence, treated like a cis male. For example, even though she marked the, “transsexual (MtF)” option on the intake form, her medical record card simply says, “male.” Her provider was also much more forceful about the, “visual inspection,” portion of the test. I think its worth noting that when we go out in public together, I get misgendered more often than she does. This tells me that a large part of the reason she received poor treatment was because she outted herself. This raises an extremely important question: why should trans women have to choose between their emotional safety and their desire for competent, compassionate care?
This should go without saying, but trans women aren’t cis men. For example, while trans women and gay men might share some risk factors (e.g. a statistically higher probability of having an STD), they certainly don’t share every risk factor. Their experiences are different. The forms of oppression they experience are different (even if there is some overlap). Hell, even their bodies are (often) different. Lumping trans women and cis men in the same group does a disservice to both. It leaves less room for both groups to access said services, and it prevents trans women from receiving care tailored to their needs.
I was especially trouble by this in light of the fact that the clinic’s counselor took pains to point out to me how, “transgenders are at risk.” Why then, would they potentially force so many out of the system through emotional violence? Moreover, why would they force the ones that do stick around into an inadequate one? Perhaps the MSM label is a route to additional funding. If that’s the case, a new label can’t come fast enough. Ultimately, trans friendly doctors need to move from a rarity to the reality. Better services need to be provided. Trans people should no longer be reduced to their genitals.
This is what transphobia looks like, and it needs to change.
For better or for worse, the test results from my current healthcare provider had actually arrived two days prior; I didn’t find out until after the fact. All of this has shown me how lucky I am to have coverage; without it I would be in a much more difficult situation. The privilege has allowed me time to educate my doctors, and to either A) ensure they know how to respect me or B) me to find someone new. Not everyone has that luxury. In the end, if what’s above isn’t strong enough evidence why US medical institutions need more trans* and queer-specific training, I don’t know is.
With all of that being said, I am still planning on going back to the clinic for my results. I want to find out what my ongoing experience with the counselors will be like (apparently, they’re a real “treat”). After all, it’s one thing to administer the tests; it’s quite another to report the results. We’ll see … in about a week.