Patients & Providers: Expect Excellence

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 excellence

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! 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.


13 thoughts on “Patients & Providers: Expect Excellence

  1. Asking what pronouns to use not just at the initial appointment but every follow-up thereafter. Pronouns change from time to time and what we stated at the beginning may be different later on. Excellence in healthcare = make no assumptions.

  2. Thank you so much for being YOU. Thank you for your understanding and kindness. If only more CIA people think like you. I am a transgender man and I appreciate what you are doing

  3. It’s perhaps not appropriate to make suggestions for a different country’s healthcare system. I’m not out to my own doctor in the UK because I don’t have confidence in him even knowing what non binary means, let alone listening to my experience of gender, noting my pronouns and having those respected in a wider system of healthcare. However, what would help a great deal is knowing which general practitioners are open to gender discussion. This could be subtle and non-verbal, like maybe having a some visible, visually inclusive, symbol sticker or desk ornament flag that let patients know that they would be understanding and open to gender and/or sexuality questions or safe space talking?

    1. That’s a great suggestion, addilight. There are some clinicians who post “safe zone” stickers or signs, but this doesn’t necessarily mean they have any training and/or competence in discussing issues about gender identity or sexual orientation (or even sex and sexuality more broadly). Safe zone stickers are a good first step, though, if they denote the persons displaying them have received some sort of training. We have much work to be done, both in the US and U.K., to make healthcare fully inclusive. Thanks again for your comment!

  4. I’m not asked for a pregnancy test, asked if I’m pregnant, or otherwise have my ability to get pregnant alluded to.

    ~Tumblr commenter

    1. Thanks for your comment, Micah. Because I don’t know how you identify in terms of gender, I’m not sure whether you’re happy that healthcare providers “read” you as a man and don’t ask about pregnancy, or whether you’re unhappy that healthcare providers “read” you as a woman and don’t ask about pregnancy. Can you say a bit more so that I understand your comment more fully?

  5. I’m a non-op trans woman. I went to a new doctor a few years ago for a routine physical exam, and was surprised when the doctor lifted the towel off of the instruments left by her nurse (I actually had been wondering why there was a tray brought in at all, as I’d never had a doctor use any instruments for a routine exam – as the doctor’s fingers and hands are sufficient for examining a male). The revealed speculum led to a pretty good laugh for both the doctor and myself! Still, the nurse’s assumption was rather affirming for me. I always make it clear that I have a prostate, and usually even before being asked. I’m more concerned with getting proper health care than proper pronouns!

  6. Currently, there’s silence and shame on both sides of the Dr’s table. I’d like it to not be an issue, not so difficult. I’m disabled my primary impairment is invisible but I use a wheelchair, so its assumed I have no gender or sexuality.
    Good healthcare providers read my notes and then ask relevant questions rather than asking me to explain my whole history (traumatising). l’d like there to be no difference in how my tonsils and my gender identity are discussed, theyre just tonsils.

    1. Thanks for your comment, jenx. I’m sorry about your experiences with healthcare professionals who’ve failed to recognize that persons with disabilities are sexual beings who may identify as female, male, non-binary, genderfluid, genderqueer, or any of a myriad of other identities. You deserve better!

  7. Excellent care to me affirms my trans identity, but also recognizes that there’s more to me than this identity when addressing my care. Because providers so often mainly focus on this facet of my health over whatever I am seeing them for once I disclose, I don’t always reveal that I take testosterone or that I am trans. I decide this based off of why I am going to the doctor (for a basic vaccine vs. for something that may require blood work analysis). It’s a problem that I don’t always feel comfortable disclosing my trans-ness, but it’s something that has built up over time based off of past experiences.

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