Featured Voices is a series on NN where transgender authors and allies share their stories. This summer’s theme, Trans Health: Patients & Providers, is co-curated with transgender health advocate Charlie Blotner. We’ll feature an assortment of international medical professionals whose varying perspectives will push the limits of transgender best practices and standards of care.
This series is meant to be a conversation between provider and patient. So we ask: What does your ideal visit to a health provider look like?
by Kimberly D. Acquaviva
I’m lucky. And by “lucky,” I mean exactly that: the white, cisgender body I inhabit is mine because of luck, not because I did something to deserve it. I’m a lesbian and that comes with its challenges, but let’s be honest: as a cisgender white person, I enjoy a shit-ton of privilege. The fact that I have a PhD and I’m a tenured professor piles even more privilege on top of the privilege I was born with. I’ve chosen to use that privilege to advocate for more inclusive health care for lesbian, gay, bisexual, transgender, gender non-conforming, queer and/or questioning (LGBTQ) people.
Yet no matter how much I read or how many people I talk to or how many articles I write, I can never really know what it’s like to be assigned a sex at birth that doesn’t align with my gender identity. I’m an outsider – well intentioned, educated, and committed to the cause – but an outsider nonetheless.
There are moments when I experience a flicker of deep understanding, when:
- I’m misgendered by a waiter in a restaurant.
- I approach the airport security scanners with a sense of dread that my unreconstructed prophylactic bilateral mastectomy* will trigger yet another awkward pat-down.
- I put on my Assistant Scoutmaster uniform and realize my flat chest and short hair make me look more like a Boy Scout than a mom of an Eagle Scout.
[*Because I have a strong family history of breast cancer and had several breast biopsies and a lumpectomy before I was 40, I chose to have a prophylactic bilateral mastectomy even though I never received a diagnosis of cancer. When a lumpectomy of a questionable (and ultimately benign) lump near my chest wall was unable to get clear margins, I was fortunate that my insurance company understood the medical necessity of this procedure. Fun fact: If you have a BRCA (gene) mutation, your insurance company may cover both a mastectomy and oopherectomy (removal of the ovaries). Who knew?]
But then I remind myself that these experiences aren’t anywhere close to those of transgender and gender non-conforming persons, because I’m buffered from any real discomfort – by my privilege. I could choose to grow out my hair and wear prosthetic breasts and wear lipstick more often and I’d never be misgendered again. The fact that I can choose is evidence of my privilege.
So why am I telling you all of this? Because I want you to know that there are cisgender health care professionals out there like me who genuinely care about making health care more inclusive for transgender and gender non-conforming people, even though we can’t truly understand your lived experiences.
We’re outsiders, and with that comes occasional mistakes and misunderstandings. That’s why the onus is on cisgender health care professionals to educate themselves, so they can minimize those mistakes and misunderstandings, to ensure that their transgender and gender non-conforming patients receive the best care possible.
No patient should bear the burden of being a “teachable moment.”
Patients seek health care for a variety of reasons, but I’m pretty sure “paying a doctor/nurse practitioner/physician assistant to teach them about trans health care” isn’t one of them.
Even when a health care professional has taken the time to educate themselves about caring for transgender and gender non-conforming patients, they’re going to make mistakes. When a health care professional you just met stumbles over their words when you ask a question about your prostate, instead of concluding they must be transphobic or ignorant, consider that maybe you’re looking so summertime fabulous in your sundress and espadrilles that it literally never occurred to them you might have a prostate. Give them a second for their brain to process things, restate your question, and see whether they’re able to answer your question in a way that meets your needs. If they’re not, find another health care provider who can.
Bottom line: There’s no reason in the world why a health care professional shouldn’t be able to skillfully answer questions about menstruation from someone rocking a bowtie, wingtips, and a chest binder. Or why a health care provider shouldn’t be able to understand your request that they use a term like “front hole” instead of “vagina” when talking with you. It really isn’t that complicated. Health care professionals took classes in really complicated stuff like pathophysiology and pharmacology – so for goodness sake, they can master using your correct pronouns.
Expect from your health care professionals. You deserve nothing less. Your health care professionals are downright lucky to have the privilege of caring for you.
So, dear readers, now is your chance to tell us in the comments:
What does excellence in health care look like to you?
About Dr. Acquaviva
Kimberly D. Acquaviva, PhD, MSW, CSE is a Professor at The George Washington University School of Nursing. When she isn’t working, she’s busy doing stereotypically lesbian things like camping, hiking, and playing with her three dogs. She recently wrote a book on LGBTQ-inclusive Hospice and Palliative Care, and hosts the em-dash podcast that explores patients’ lived experiences in health care.
Tweet your questions to @kimacquaviva
Are you new here? Welcome! GQ.me is a platform of resources and personal stories for & by the transgender community, focusing on nonbinary gender identities, run by the amazingly cute Micah. If you like what you read, support this community through a small monthly donation.