The Shortcomings In Knowledge of Healthcare Providers about Trans Issues and How to Fix Them

An Opening to my Argument-My Personal Experiences

In my time at Washington College I’ve had a few experiences that I think to be relevant. First, around Halloween I dressed up as what initially was “Generic WW2 Pilot”, but later became Tuskegee Airman due to my partially black heritage. In order for any of this to make sense, I need to go on a tangent about my parents and my upbringing. I’m biracial, with my dad being Jamaican and my mom being from the midwest. My mom is the middle of 3 sisters, with one being 3 years older and the other 5 years younger. They very much grew up as a unit. On the other hand, my father is the youngest of a number of siblings. I do not know the exact number because he’s the youngest of them and the next youngest is 10 years his senior. His experience growing up with his siblings was very detached with them seeming more like aunts and uncles instead of actual siblings. Additionally, by the time I was born, his mom was rather elderly and his dad had passed away. A further complicating factor is that his mother lives in Jamaica and the rest of his family lives scattered along the east coast, so it wasn’t exactly easy for us to be around them, given that at the time I was living in the Pacific Northwest. In comparison, my mom’s family lives in North Dakota and when I was growing up they were in their 60s and relatively speaking a lot easier to access. We had regular vacations to North Dakota. I have a lot of strong memories of playing with my cousins, fishing with my grandpa, jet skiing, tubing, and generally doing things with that side of the family. In comparison, I have almost nothing with my dad’s side, the black side. I grew up in a town where I only knew 3 other people who were also black. The most “diversity” I saw was one other black kid in my Kindergarten class that I never really knew and one of my friends was a redhead. My only exposure to other people who looked like me was brief mentions of black people in history class and that was just about it. Tangent over, now I can explain why dressing up as a Tuskegee Airman was important. It finally gave me a connection to a part of black history that was not mired up in negativity. I always suspected that there were some issues under the hood because I remember saying things like “When I grow up, I want to change my name to Jon” when I was younger. Furthermore, in the past I’ve always said that I don’t really care about being represented in media because it’d never happen anyways due to being queer, autistic, and biracial. With the Tuskegee Airman costume, I was finally able to have some connection to other black people that didn’t have any negative connotations. Just a history of pride and perseverance. Especially after all the recent attention to the BLM protests over the pandemic, I had felt like being partially black was a liability and I was finally able to see what had been hidden. The reason I share these personal experiences is that minority stress is almost inherently an intersectional experience, and by providing my own experiences, I aim to show the impact of those intersectional stressors (Reisner, 2014). The remainder of my argument will focus on the impacts of intersectional minority stress on healthcare experiences of trans patients.

My Argument

Based on my literature review, I identified several issues with transgender healthcare. One key issue is a lack of education on the part of the doctors which leads to worse outcomes for their patients. This is a big component of minority stress in healthcare for trans patients (Reisner, 2014). Due to doctors lacking knowledge, trans people oftentimes have to advocate extensively to get what they need related to transition services. This usually takes the form of having to push for doctors to adjust the dosage of HRT. Oftentimes they go so far as to obtain the medications they need on their own and do the whole thing without involving doctors, which some say is risky. It’s just a symptom of the problem. The real problem here is not trans people ordering and taking HRT themselves, it’s that HRT is so inaccessible that it is easier to DIY HRT than to get it from a doctor. This demonstrates the lack of education because trans people would rather risk their own health by managing the medication themselves than try to deal with their healthcare provider. This is a hard example of how minority stress (lack of education) directly causes harm to trans people.

From the Research

This is all supported by the research I found in my literature review. Some of the largest themes in the research are lack of education and intersectionality (Reisner, 2014). My argument is that doctors need to increase their understanding of trans issues and intersectionality, as well as understand their impact. When doctors understand more about their patients, the patients can get the desired care sooner and with better health outcomes. I will now demonstrate how the research supports this argument.

Lack of Education

Lacking education will often lead to microaggressions in a healthcare setting (Kcomt, 2019). This finding in the research is correlated from personal experiences that I have heard from other trans people. It is important to share these because research is abstract and when you put a story behind the research, it becomes personal. In my argument, I’ll be consistently linking it in with personal experiences for this reason.

Doctors often misattributed unrelated issues to being trans or transitioning, so much so that it has gotten a nickname in the trans community, “Trans Broken Arm Syndrome”. From the stories I’ve heard, someone’s rollerblading accident was blamed on them taking HRT and the fat redistribution throwing off their sense of balance and thus causing them to fall. This impacted the person because they felt dismissed. Like the problem wasn’t real or wouldn’t have happened if they just weren’t trans. This is an example of a microaggression due to lack of education. Microaggressions are minor moments of hurt caused by misunderstanding a minority identity (Kcomt, 2019). Back to this example, it was an exceptionally large reach because fat redistribution on HRT does not happen so fast as to potentially cause balance issues, yet the doctor didn’t take other factors that are more likely into account, such as it being a simple accident.

Microaggressions due to a lack of education may seem small, but they build up and can have a large and lasting impact (Kcomt, 2019). One of the impacts is hesitancy in going to the doctor (Reisner et al., 2014). This will chain into issues being caught later and thus worse health outcomes (Reisner et al., 2014). The research supports numerous health disparities in both physical and mental health (Valentine, 2018; Zeeman, 2019). For example, minority stress research has shown massively increased suicide attempt rates as well as increased rates of depression and anxiety (Valentine, 2018; Zeeman, 2019). This is because of a mix of the various microaggressions trans people experience, in addition to more obvious forms of discrimination (Valentine, 2018; Zeeman, 2019). For example, to connect it to personal examples, I’ve heard stories of trans people being massively mistreated my nurses when they’ve been involuntarily committed for attempting to commit suicide. This relates to both of the points I’ve made. They’re trying to get help just after a very dark time in their life, but are still getting mistreated by people in healthcare who are supposed to be helping them.

Once more, this is especially bad in healthcare because when you go to the doctor, you expect to get your problem fixed, not discriminated against for just trying to exist, and therefore experience worse outcomes. This is all in support of my argument that healthcare professionals need better education on trans people to prevent issues and get better health outcomes for them. Part of the education should be talking to trans people who’ve had these negative experiences like the ones I’ve just brought up. It’s one thing to hear about the stories in the abstract, it’s a completely different thing to hear someone talk about something that really happened to them.

Intersectionality

Another part of the education is that minority stress is intersectional. Multiple factors layer up and amplify one another, such as lower socio-economic status, being a POC, and others. In the research, it’s shown that trans POC are uncomfortable disclosing that they’re trans to doctors that are POC, but also fear racism when dealing with doctors that offer trans-specific care (Howard, 2019). I’m greatly aware of intersectionality, as I mentioned in the personal story that I opened this with. I feel less of a connection to the black side of my family, despite it being the more trans accepting side. Going back to healthcare, I’ve heard about another important part of intersectionality among trans people, socio-economic status. Multiple-minority stress can show up when people are both trans and of a lower SES due to the messed up nature of our healthcare industry. Many parts of critical transgender healthcare is not covered by insurance, which leaves trans people of a lower SES in an even worse situation.

This goes back to my argument because providers need to know about intersectionality so they can provide better care. If they are aware of challenges with insurance, they can better recommend solutions. For example, I have heard of trans people working at Starbucks because the insurance covers things such as hormone replacement therapy and various major gender-affirming surgeries. If healthcare providers know about this, they can then recommend it as a potential option. This all demonstrates the importance of understanding intersectionality with trans people in healthcare. Doctors need to understand all of this otherwise they will not be able to offer the best possible care they can.

Conclusion

Healthcare needs to change because the current rate of innovation is simply glacial. I have heard more about the effects of HRT from internet forums and blogs than from doctors. Doctors do not know enough to accurately prepare trans people for the effects. HRT is for all effective intents and purposes a second puberty. Imagine going through puberty without knowing half of what is going to happen. This is minority stress. This has a real impact. Furthermore, there is this background fear of insurance suddenly deciding to not cover HRT and then not being able to afford it at all. This is just a single intersecting factor. There are many more, as I’ve already discussed. It is very easy to understand why trans people would be struggling with this, given everything I’ve just shared. Doctors don’t seem to know, nor do many seem to care enough to educate themselves. This is the problem I aim to highlight. The research and personal stories I’ve shared also support this. After reading this argument, it should be clear why doctors should, and need to care more.

Sources

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Zeeman, Laetitia, et al. "A review of lesbian, gay, bisexual, trans and intersex (LGBTI) health and healthcare inequalities." European journal of public health 29.5 (2019): 974-980.

Valentine, Sarah E., and Jillian C. Shipherd. "A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States." Clinical psychology review 66 (2018): 24-38.