Pride 2020: Trans Care

This Pride post is from  A.J. Lowik (they/them/theirs) - PhD Candidate, Institute for Gender, Race, Sexuality and Social Justice, UBC.

Trans Non-Binary Flag

Often, the T is silent. People say “2SLGBTQ+," and lump all Two-Spirit, lesbian, gay, bisexual, queer and trans people together in a way that does a great disservice to our diverse communities –today, I remind you, the T is not silent.

Trans and non-binary people have unique needs that merit focused consideration. Barriers to health care based on gender identity and expression are not the same as barriers based on sexual identity. Sometimes you need to tease these letters apart and consider different parts of our communities, one at a time. Trans and non-binary people need medical providers to see us, to anticipate our arrival in your waiting and emergency rooms, your clinics, and your care spaces.

We are struggling – the limited research into our lives shows that we are less likely to have a family doctor than cisgender people[i], and when we do have one, less likely to feel comfortable with them[ii]. Many trans and non-binary people delay or avoid health care, both out of fear of what will go wrong, and because we have personal and collective horror stories about the plethora of things which have gone wrong already[iii],[iv],[v]. We have had to educate you about our lives and health-care needs and how you can better serve us[vi], while having our expertise about our own bodies and needs questioned, challenged, and dismissed. We have had to make ourselves small and invisible in your presence, not disclosing our gender identities because visibility comes with risks that we are not always willing to take. Some trans and non-binary people do not have the privilege to make themselves invisible and more palatable. We do not see ourselves reflected in your policies and practices – instead, we are an afterthought, and feel like a nuisance you are forced to accommodate. We have been denied care, when we have been brave, or desperate enough, to ask you for help[vii].

Many of us fear you and the power you have. But we need you – and not just for hormones and gender-affirming surgeries – we also get colds and break our bones and have eye infections and need vaccines and support. We have pelvic pain and fibromyalgia and cancer and undiagnosed conditions. We have children, parents, and partners and so even when we are not your patients, we still need you to see us as you care for our loved ones. Some of us are homeless and street-entrenched, some of us are living with HIV and eating disorders, some of us struggle to find work and housing. Many of us have mental health challenges unrelated to our genders. We are survivors of domestic violence and sexual assault and we are less likely to call the police when bad things happen to us. And some of us, myself included, are insulated from the worst of the harms because of our whiteness, our citizenship statuses, our access to education, our supportive families. We are the lucky ones - nay, the privileged ones.

I am a white settler on these stolen lands, an assigned female at birth non-binary trans person who navigates the health system with relative ease.[viii] I'm nearly finished a PhD, I teach Trans Studies, and I conduct research and deliver talks on the topic of gender- and trans-inclusive health care with everybody from abortion providers to nurses-in-training. I hope that from my platform of privilege you will hear me.

My community is sick and dying. Assigned male at birth non-binary people and trans women of colour are especially vulnerable. And I am angry and terrified. We are resilient in the face of injustice. Trans and non-binary people are strong. We protect each other, create information-sharing networks[ix], fund each others' health-care expenses, and help each other navigate a health-care establishment not built for us. No amount of resilience, strength or community building will make the most marginalized among us healthy and well – we need you, the health-care providers, to help us with that.

I write 'we,' but I do not speak on behalf of trans and non-binary people. No one elected me spokesperson. The barriers I face are nothing compared to those faced by my assigned male at birth, of colour, disabled, undocumented, rurally living or otherwise more marginalized peers. But, I can tell you what the literature says about our lives, and hope that speaking from a place of 'we' will allow you see that this is not reducible to an exaggerated, reactionary personal statement of need, but a call to action informed by the evidence and shared on behalf of my trans and non-binary siblings who do not have the same privileges as I do.

So, what can you do? You can educate yourself – there are so many great online tools to learn from - and prepare for our inevitable arrival (because we are already your patients).

Imagine a trans or non-binary patient trying to navigate your space: from finding your website, to booking an appointment, to sitting in your waiting room, to filling out an intake form, to providing you with a medical history, to receiving a physical exam, to being given an information pamphlet about a possible treatment, to receiving referrals to other services. Then ask yourself - what barriers a trans or non-binary person would encounter in these spaces and interactions? Can you attend to those places that would present obstacles for us, make changes big and small?

Be gentle with yourself – don't let the fear of getting it wrong stop you from trying. We need you to try. A recent study showed that health-care providers' willingness to learn is a huge factor in whether trans and non-binary people will consider you a trusted provider – much more important than you getting it right all the time[x]. Please be gentle with yourself, while also holding yourself accountable to do better. We are sick, we are dying and we need you.

[i] Scheim, A. I., Zong, X., Giblon, R. & Bauer, G. R. (2017). Disparities in access to family physicians among transgender people in Ontario, Canada. International Journal of Transgenderism, 18(3), 343-352.

[ii] Clark, B. A., Veale, J. F., Townsend, M., Frohard-Dourlent, H. & Saewyc, E. (2018). Non-binary youth: Access to gender-affirming primary health care. International Journal of Transgenderism, 19(2), 158-169.

[iii] Seelman, K. L., Colon-Diaz, M. J. P., LeCroix, R. H., Xavier-Brier, M. & Kattari, L. (2017). Transgender noninclusive healthcare and delaying care because of fear: Connections to general health and mental health among transgender adults. Transgender Health, 2(1), 17-28.

[iv] Bell, J. & Purkey, E. (2019). Trans individuals' experiences in primary care. Canadian Family Physician, 65, e147-e154.

[v] Clark, B. A., Veale, J. F., Greyson, D. & Saewyc, E. (2018). Primary care access and foregone care: A survey of transgender adolescents and young adults. Family Practice, 35(3), 302-306.

[vi] Vermeir, E., Jackson, L. A. & Marshall, E. G. (2018). Barriers to primary and emergency healthcare for trans adults. Culture, Health & Sexuality, 20(2), 232-246.

[vii] Blodgett, N., Coughlan, R. & Khullar, H. (2018). Overcoming the barriers in transgender healthcare in rural Ontario: Discourses of personal agency, resilience, and empowerment. International Social Science Journal, 67(225-226), 83-95.

[viii] Lowik, A. (2020). Betwitx, between, besides: Reflections on moving beyond the binary in reproductive health care. Creative Nursing, 26(2), 105-108.

[ix] Ross, K. A. E., Law, M. P. & Bell, A. (2016). Exploring healthcare experiences of transgender individuals. Transgender Health, 1(1), 238-249.

[x] Frohard-Dourlent, H., Strayed, N. & Saewyc, E. (2017). “The agency to choose what's right for their body": Experiences with gender-affirming surgery in British Columbia. Vancouver, BC: Stigma and Resilience among Vulnerable Youth Centre, School of Nursing.