This piece wouldn’t be complete without the hard work that Natalie Reed has done, both from a research standpoint and from graciously sharing her experience and wisdom in navigating the medical system herself. I’ve taken a lot of what she said and woven throughout my original piece. However, any mistakes or shortcomings are my own, so feel free to lay into me! If you have comments about this, or would like to share your own personal experience, I would love to hear it in either the comments below or at [email protected]. And now for this week’s collaborative column.
There are many reasons why queer individuals may have problems getting their medical needs met, but two of the largest are a lack of education within medical training, and unexamined provider biases. As we’ve discussed previously, LGBT issues get minimal amounts of time within medical school curricula, when it is discussed at all. When these issues are addressed, some populations receive more time and attention due to an imbalance in incidental comfort levels and available research. And while the concept of values clarification exists to help future healthcare providers to explore their approach to dealing with topics such as abortion, birth control, or vaccines – due to the lack of curriculum touching upon LGBT and kink communities, there may not be as many opportunities for students of medicine to grapple with their own personal biases regarding kink, queer, and transgender individuals and the care they may need.
None of this information excuses the lack of access to healthcare, especially for the more vulnerable sets of populations (underage queer minors at the mercy of parental good will, transgender individuals who may be subjected to extreme forms of gatekeeping, non-monogamous individuals who are pathologised and slut-shamed). And things are improving, both from a knowledge base and from an acceptance amongst healthcare professionals as to an obligation to provide care to individuals of all spectrums. But there are some things that may help in creating a good working relationship with a healthcare professional so that your needs are met and you feel safe seeking medical assistance and preventative care. This is absolutely more work than most people who fit a heteronormative standard have to do, but on the plus side some of these steps will make you a better engaged and informed patient which good doctors will find helpful!
Educate yourself about the clinical standards and practices that pertain to your situation. Transgender individuals may find it extremely helpful to be aware of the standards of care with regards to seeking and achieving transition and be aware that there is a ridiculous amount of gatekeeping that occurs. Doctors may feel it is acceptable to disregard the WPATH standards of care and require unreasonable “proof” that your condition is legitimate and you are “worthy” of treatment. Individuals practicing any form non-monogamy should be up-to-date on sexually transmitted infections and be aware of how their partner pool may affect their risk level for certain pathogens.
Know your legal rights within a medical setting, especially when it comes to individuals practicing some form of BDSM play, transgender individuals, and non-monogamous individuals. There are some states in which doctors are legally obligated to report what looks like domestic violence/intimate partner violence – know if this is true in the area you live and how you will manage that risk. For any non-conforming individual, it may be helpful to bring an extra set of eyes and ears along to assist in recording the medical experience and ensure that your needs are legally getting met.
It’s also helpful to know what “normal” is for you and your body. Individuals going through transition may find their interactions with healthcare providers greatly improved if they feel confident in their knowledge of where they are reaching to be and where they should be at now. It isn’t uncommon to have to teach your doctor how to treat you. Some specific items of interest could include drug interactions, the actual mechanisms of the medications you take, where your hormone levels should be, what effects (and side-effects) can and can not be reasonably expected to result from HRT (such as that estrogen will not effect voice but testosterone will, that anti-androgens may diminish body hair but likely not have any effect on facial hair, that testosterone will cause muscle development but fat redistribution takes considerable time, etc.), what possible complications or problems can emerge from whatever treatments you are undergoing or have undergone, what potential complications, symptoms or problems are unlikely (or almost impossible) to be related to your transition or medications, and what the standard doses are for most people of your age, height, weight and intended results.
Find a doctor that is professedly queer (and hopefully trans) friendly. If there isn’t someone on these lists that you can access, either because of location or insurance issues, then ask around within your social group. There’s a reason you are friends with those people, and there’s probably a reason they keep going back to the same health care provider.
Don’t be afraid to interview your prospective healthcare professional like you would if you were hiring a plumber or someone fixing your car. You wouldn’t take your car to a mechanic who vehemently informed you that your brakes didn’t need fixing, but your whole damn car does because it’s a Honda, so why would you put up with that from a healthcare provider. (Obviously, those Smart Cars are just wrong…) Your provider should work for and with you, not against you. It may be helpful to pick three points that you would like clarification on and go into the initial interview with those written down. Let your doctor know ahead of time that you have questions you’d like to discuss (I usually do this at the scheduling of the interview, which allows the medical assistant to make sure that everyone has enough time), and then have at it!
If something a health care provider is telling you seems off, get a second opinion. And maybe a third. It’s also acceptable to look at different regions for guidelines – Iowa country doctors may have very different experiences and comfort levels with non-monogamous relationships and their implications than New York doctors or Vancouver doctors.
Look critically at both the credentials and what information the healthcare professional is offering. They should be coming from a nationally accredited school, have passed some sort professional testing, and be promoting the current standard of care. Steer clear of sources of information that claim to be “non-allopathic” or “all natural” (and yes, just because an individual has MD behind their name does NOT make them someone who practices science-based medicine). Transition through herbs and tonics ain’t gonna happen, and neither will you be able to “pray away the gay”
This is a lot of work, and can absolutely feel overwhelming when you’re first seeking healthcare as an out-of-the-closet queer. It’s perfectly fine to tackle things in baby steps and to tweak your healthcare until it is meeting your needs. It is okay to take time to learn how to talk to healthcare providers so you can get what you need and they can better help you with preventative, urgent, and emergent care.
What isn’t okay is for the disparity between LGBT populations and heterosexual populations to continue. The gaps between transgender populations, LGB populations and heterosexual populations are symptomatic of the discrimination that exists within our society and government, and there are groups working within and without the medical profession to address this. However, preventative care rarely waits for policy change, so I strongly encourage you to think about how to get better access within the circumstances you currently have, and also support those around you that may be (understandably) reluctant to seek medical care in light of bad experiences.