It’s Not ‘All Psychological’: How the Medical Establishment Fails Transgender Patients

Seeking health care when you’re sick or injured can sometimes be a confusing, nerve-racking, or frustrating experience. Patients, already in a compromised position, may not know how best to advocate for themselves or what rights they have. But for transgender and gender nonconforming people, just going to the doctor means risking mistreatment, misdiagnosis, hostility, or aggression.

A number of professional medical organizations, including the American Medical Association and the American Psychiatric Association, have drafted resolutions in recent years affirming equal treatment for trans* and gender variant individuals. And according to M. Dru Levasseur, transgender rights project director at Lambda Legal, 17 states and more than 150 jurisdictions now have protections regarding gender identity. “These are all great steps,” Levasseur told RH Reality Check. “But one of the things we still hear is that, when people are at their most vulnerable moment of need, like going to the hospital for emergency care, horrible things still happen.”

Indeed, while medical protections for transgender patients may be gradually increasing, many in the trans* community continue to experience disturbing levels of discrimination from health-care providers.

“Every once in a while I get really anxious about what would happen if I had a major accident and had to go to the emergency room,” Kara Baker, a researcher in plant pathology, told RH Reality Check. “I constantly worry about upcoming appointments with doctors or clinics I don’t know.” Baker, who identifies as genderqueer and prefers the pronouns “they/their,” says most of their negative experiences with medical care have been relatively minor, like a doctor or nurse using non-preferred pronouns. But those interactions still cause uncertainty, anxiety, and self-blame.

That anxiety can lead some transgender people to avoid seeking medical care when they need it. According to a 2011 survey of over 6,000 trans* Americans, a third of respondents had put off or avoided seeking preventative care, and 28 percent had avoided seeking necessary care. Patients may be flat-out denied treatment, and not just for transgender-related health needs—8 percent of people surveyed as part of a 2009 survey were refused emergency care, with another 8 percent denied necessary surgery. In the same survey, a staggering 70 percent of trans* patients had experienced abusive language, physical abuse, blame for their health status from health-care providers, or providers refusing to touch them.

For MJ, who sought medical treatment for recurring physical symptoms, including trembling, blackouts, fatigue, and migraines, trying to get care felt overwhelming and silencing. After blood work and an EEG failed to lead to a diagnosis, MJ’s doctor began to focus on the patient’s mental health. “When I disclosed that I was a recent rape survivor, that was all he needed to be convinced it was all psychological,” MJ said. “He then referred me to a therapist.”

MJ wanted to see another doctor for a second opinion, but he was a student relying on campus health services. “I wish I had a kick-ass story about how I put my women’s and gender studies to use [and] just went off on him for being so quick to tell me my health issues were ‘all in my head,’ but I did not say anything,” said MJ. “I was scared; it was my personal health and I was so overwhelmed at the point that I was willing to do anything he told me if there was a chance it would make me better.”

So MJ went to the therapist the doctor recommended. At the time, he identified as queer, but was not yet openly trans*. He talked with the therapist about feeling isolated due to his politics, sexual orientation, and learning disability. “She seemed fascinated with the fact that I entered my first relationship with a female after I was raped with by a man,” MJ said, adding that he felt the therapist was implying that his sexuality was some sort of coping mechanism. “It was only with my queer sexuality in question that I opened up about being trans*.”

After that, things with the therapist got worse. Even though MJ wasn’t out as trans* at the time, he told the therapist that his close friends weren’t using his birth name and pronouns. “The therapist then asked me if I was sure that I was actually trans* or if I was just so used to being an outcast that I did not know how to function when I actually fit in for a change,” said MJ. “At this point I stopped going to therapy altogether.”

Levasseur says MJ’s experience is not uncommon for trans* and queer patients. “That kind of pathologizing is rampant,” Levasseur said. “Being told that there’s something wrong with you mentally is something trans* people face on a daily basis.” Although there are internationally recognized standards of care, he says, many licensed therapists are not trained in how to properly treat trans* patients.

This problem is even more urgent, Levasseur emphasizes, because of the increased risk of suicide for trans* people. More than 40 percent of trans* individuals in the United States have reported attempting suicide, compared to about 1 percent of the country’s population at large.

“When we’re talking about a therapist getting it wrong, the threat is very real,” said Levasseur. “You’re in the hospital because you need help. You are in a very vulnerable position.”

“I have never been to talk to a doctor or therapist about being trans*,” Jamison Bradshaw told RH Reality Check. While Bradshaw admits that this is partially due to being busy and feeling generally positive about how things are going, it’s also “in very large part because I’m scared that they would tell me it’s all in my head, try to convince me that I should just keep working at being more feminine, or that it’s clearly because there’s some underlying problem with my brain that needs to be ‘fixed.’”

At the same time, Bradshaw knows that there are doctors who really can provide support for the trans* community. “There are supportive and understanding ones out there, and ones that have gone through similar things themselves.”

As a trans* medical student, Bradshaw has some experience working on inclusive policies at his school, like changing intake forms so patients can state their gender and preferred name and pronouns. “While it did take some thought, it didn’t take that much time and was overall a pretty smooth process,” said Bradshaw.

Many medical providers are interested in improving their policies to better treat trans* patients, says Levasseur, but don’t always know how to do so. That’s why Lambda Legal, along with the New York City Bar Association’s LGBT Rights Committee, authored a guide to facilitate providers’ implementation of gender supports and protections. Creating Equal Access to Quality Health Care for Transgender Patients: Transgender-Affirming Hospital Policies outlines specific practices for treating trans* and gender nonconforming patients. Like Bradshaw, the document emphasizes the need for more inclusive admitting procedures.

“I don’t know what to do half the time!” said Baker, of filling in the “gender/sex” portion of medical forms. “I am an assigned male at birth, genderqueer-identified, trans* femme. Basically I could put anything on that selection, and I would technically be right in my head. But what info does the medical personnel need to adequately treat me?”

Making forms more inclusive will also make them more accurate. Restrooms, room assignments, privacy laws, patients’ rights, and protocols for general interaction with patients are all covered in the document, which Levasseur hopes is an important step toward addressing the pervasive discrimination and mistreatment of trans* people seeking health care.

Alongside specific policy changes, Bradshaw hopes to see an increased “cultural competency” with how health-care professionals talk about, and talk with, queer and trans* communities. “Hearing things from other medical students and doctors, the problem isn’t that they’re discriminatory, it’s that they are uneducated about that population and the correct way to talk about LGBTQ health issues,” Bradshaw said.

For MJ, the negative experience from two years ago is still with him. “I am still very distrusting of doctors and have the tendency to self-medicate when possible,” he said. After college, he started therapy, and is planning on starting hormones soon. “I’m privileged enough to live in an area where I have access to a nonprofit clinic that specializes in LGBT care,” he said. “I feel much more comfortable there.”

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  • Sharon Diane

    Those of us on government payments don’t have a chance to self-identify. We get what the computer says we are. Social Security requires surgery ($20,000) before they will change gender marker. My psychiatrist says I have met all the requirements for gender transition but, that’s not good enough. It has to come from a surgeon saying that a “procedure” has been preformed between my legs. Never mind my name change, breast implants and living full time. New York even provided me with a new birth certificate with my new name but, sadly, they to won’t change that one letter from M to F without changing my crotch. I can get a correct passport but not a NC driver’s license. Go figure. How about making gender marker change requirements an action-item for 2014? Or maybe get Medicare coverage to correct what I consider a birth defect.

    If you need a warm body for any reason, just let me know. My U.S. Senator’s aid for Medicare issues has told me that Medicare has told her (on two separate occasions) that surgery is covered but won’t tell her how. Again, go figure. If you need a fighter for a test case, you’ve got one!

    • disqus_ok9xndxFPu

      What’s worse, many people who were assigned the wrong gender at birth don’t want to, or physically cannot, go through the surgery. I know one girl who has a couple medical issues resulting from cerebral palsy, and surgeons have agreed that she would likely die or be left permanently incontinent were she to receive corrective genital surgery. She’s so desperate to be able to legally identify as female that she is considering visiting an unethical Thai doctor she heard of.

      • Sharon Diane

        Actually, there are many excellent Thai gender docs in Phucket. Lots of M-t-F woman have reported wonderful results at about 1/2-2/3 the cost of U.S. docs. And that includes airfare!

        • disqus_ok9xndxFPu

          Oh, I didn’t mean you can’t find a wonderful doctor in Thailand! I meant that she happens to have heard of a doctor in Thailand who will perform the surgery despite the fact that she’ll be left incontinent and in constant pain at best, and likely will die. I do know a couple girls who have great results from surgeries performed in Thailand, but the reputable ones would not perform surgery on this particular girl because its simply not safe.

          • Sharon Diane

            And some people still think that gender conformational surgery is a choice. How can that be when the desire is that strong? I sincerely wish all the best for your friend.

    • Lois Simmons

      Hi Sharon Diane, I changed my legal name, including the name on my Social Security card 13 months ago. At that time, evidence of surgery was required by SSA to change the gender marker. That policy was changed in May 2013 so there would be consistency between SSA policy and State Department policy, which did not require evidence of surgery to use your preferred gender marker on your passport.

      I went back to my local Social Security office and had to school them on the new policy (6 months after it was implemented!). But the clerk checked with a supervisor and five minutes later they processed my gender change without another hitch.

      My Obamacare application also reads F, and I very much wanted everything consistent because I will be eligible for Medicare in less than 4 years.

      • Sharon Diane

        Lois –

        REALLY?!?! Could you give me some clues how to approach the SSA? Anything at all would be most appreciated. Here in NC they might not be up to speed.

        Sincerely –

        – Sharon

        • Lois Simmons

          Hi Sharon,
          A couple of days ago, I attempted to post a detailed list of instructions on what you can do to make the process easier with SSA. RH chose not to post it. I don’t know if it was for content (I included the SSA web address). Or maybe it was too long. A condensed version would be for you to go the Social Security web site, fill out the SS-5 form, search for gender and read the FAQ on how to change your gender with Social Security, print that out and have it with you, then click on the link for identity and follow it so you can find out what they will accept as proof of identity.

          I didn’t want you to think I had ignored your request. I would send you the more detailed instructions if I knew how I could get them to you. I don’t know if e-mail addresses can be included in a post.

          I hope it works out for you,

          • Sharon Diane

            I got everything I need! THANK YOU! THANK YOU! THANK YOU!

  • Tom Was Saying

    The medical establishment will soon address the denial of White Genocide.

    Flooding ALL & ONLY White countries with non-Whites and telling everyone to “assimilate” to create a “brown future” is White genocide.

    Africa will still be full of Africans.

    Asia will still be full of Asians.

    Read the UN genocide conventions: Targeting a group for harm or destruction is GENOCIDE even if done through social engineering.

    • crash2parties

      Thanks for the attempted thread-jacking. You do realize that trans people come in every skin color, right? Or are you too busy trying to promote your own cause to realize that while the story is about the medical establishment, it’s not all about you?