Beyond the Binary: Let’s Go To the Doctor!

A note about terminology in this post: Unfortunately, we’re forced to rely on the language of the kyriarchy when it comes to talking about gender identity and gender issues. The kyriarchy is pretty firmly convinced that people like me don’t exist, and if we did, we shouldn’t, which means that there’s not a lot of nonjudgmental language we can use to talk about gender issues. In this particular piece, I’m going to be using “assigned sex” to refer to the identity assigned to me at birth on the basis of certain physical characteristics and “gender” to refer to my gender identity. I am not happy with these terms, and they can be very exclusionary for a lot of trans* folks, but I’m not really sure what else to use here. I apologize in advance, and welcome alternate suggestions in the comments[1. Comments suggesting binarist, transphobic, or transmisogynistic alternatives will, needless to say, not be published.].

The doctor’s office is an area in which gender variance can become a particularly fraught issue. For the most part, a doctor can provide treatment to a patient without needing to know that patient’s assigned sex. When I go to the doctor for a chest cold, my assigned sex is not relevant; my gender is, because it’s important for the doctor to know which  pronouns to use when referring to me. Assuming that my doctor is a respectful person who likes to treat other human beings with politeness, at any rate.

However, there are situations in which a conflict between assigned sex and gender can actually be relevant and potentially be critically important. For example, a trans man can develop vaginal cancer. A trans woman can have a prostate disorder. And someone who is nonbinary or agender can have disorders which are more commonly associated with one assigned sex than another and these disorders may be missed due to binarist or transphobic assumptions. Not to mention the sexism inherent in some aspects of medical treatment, like the fact that women rarely receive timely treatment for cardiovascular problems, and the racism which allows doctors to disregard symptoms presented by some patients because “people like you don’t get X.”

This is life or death. There have been cases in which trans* people have been denied needed medical treatment out of bigotry or ignorance and they have died or become very sick. Nonbinaries and agender folks who have highly ambiguous gender presentations may experience missed diagnoses because of conflations between assigned sex and gender made by a doctor or care provider.

So, when do you disclose, and to whom, and how? Herein lies the rollercoaster ride of the doctor’s office.

You probably don’t want to do it on the forms you fill out in the waiting room. You want to mark your gender identity there so that staff know how to refer to you. And while forms are kept confidential, there’s a high chance for being outed. If you note that you are a trans woman, for example, a staffer may blab to another staffer, someone may use the wrong pronouns (out of malice or confusion), or you could be subject to abuse. That abuse could range from finding that there is never an appointment available when you call to see a doctor to being raped while you are under anesthesia. And yes, both of those things happen.

One might think that a good time to do it would be when the doctor enters the room; say “I am a woman [or whatever your gender is], but I want you to know that I am trans* because it may be relevant to my medical care, and I am asking that it not be entered in my chart for safety reasons.” But how do you know that your doctor is friendly to trans* folks when you’ve just met? What if the doctor enters with a medical student or nurse? Worse, what if you tell the doctor and the doctor invites a medical student in to gawk at the freak?

Once you have a relationship with your doctor and you feel safe around ou, you might bring it up then. “Hey, just so you know…” But that’s going to be awkward too. You run the risk of being treated like you were withholding information. You run the risk of realizing that your doc actually is not friendly. You potentially put yourself in danger. Especially when you have a situation like, say, a man politely asking to be screened for cervical cancer. Suddenly you’re a deceiver because your body isn’t “right” and who else knows what you might have been lying about.

I’m actually pretty fortunate in this regard. I have a body which is usually read as being in alignment with my assigned sex, even though it conflicts with my gender, and as a result, I receive medical care which is appropriate to my body; I am screened, for example, for breast and cervical cancer[1. Of course, consequently people use the wrong pronouns to refer to me.]. But this is not the case for all trans* people, and requesting care which is appropriate to your body can be extremely dangerous.

This is the direct consequence of living in a society which is centered on a cis binary. If we lived in a society in which gender was recognized as a spectrum, people could feel comfortable making disclosures about their bodies when they were seeking medical care. They could be assured that they will get the care they need and be treated with respect in the process.

Boys don’t necessarily have penises. Girls don’t necessarily have vaginas. People aren’t necessarily girls or boys.

In the doctor’s office, this can be deadly.

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