Written by: Milo Misseri (they/them).
Edited by: Miles Llewellyn (they/them).
DISCLAIMER: Sex[M]ed would like to recognize and acknowledge the lack of racial diversity. Unfortunately due to folks’ availability this article predominantly reflects the experiences of white individuals. Sex[M]ed is always looking for more writers and more content, priority is given to BIPOC individuals.
Transgender Day of Visibility. Today is more than just a day of acknowledgment. It is a day of liberation, celebration, awareness, history and so much more! So, what does it mean to be transgender? Transgender, often shortened to trans, means an individual identifies with a different gender or genders than they were assigned at birth. Whether their new gender identity(ies) are binary or non-binary, that individual can still choose to identify as trans! It’s an umbrella term!
What a lot of people may not consider is how vastly different trans folks’ experiences may be, both in and out of the healthcare system. There are so many factors that play into an individual’s experience that it’s unlikely any two experiences would be the same, even if they identified in many of the same ways. The best way to learn about trans folks’ experiences (both good and bad), is ALWAYS to ask them, never assume. I was fortunate enough to interview four individuals who have agreed to share their experiences within the healthcare system.
Let’s dive in!
Tell us about yourself. Share whatever you feel comfortable about who you are and how you identify.
GARRY DART (he/they/she): As a queer, genderfluid, Newfoundlander I bring my experience in sexuality research, sex education and access to healthcare for queer folk. I have worked and volunteered for many 2SLGBTQIA+ organizations in St. John’s, Halifax and Ottawa, on community, provincial and national levels including prideHealth – Nova Scotia Health Authority, ACNS, MAX Ottawa, and PFLAG Canada for many years.
I have two honours degrees in Psychology and Ecology and Conservation Biology with a minor in French and am the only Canadian with a graduate certificate in Advanced Training in Affirmative Therapy for Transgender Communities from Widener University, PA.
I have run over 60 events in the past two years, ran a National 2SLGBTQIA+ Summit for 150+ folks and given countless workshops and guest lectures. Most notably, I managed a $550,000 National HIV Anti-Stigma ‘POZitivity’ Campaign including the ‘Slay Stigma Canadian Tour’ with Trinity K. Bone’t from RuPaul’s Drag Race in 2019, have been guest lecturer at the University of Toronto and Dalhousie University, and provided workshops for the international UFCW OUTreach team in Vancouver.
You will most likely find me sipping tea, cooking, reading a book, or meditating in nature.
ANDY DONOVAN (they): Hey I’m Andy, 38 years old, I am intersex and agender, I use they/them pronouns.
ANONYMOUS (he/they): I am a white, queer, multi gender young disabled person. I have a connective tissue condition and use a power wheelchair as well as various assistive devices in my daily life.
CELINE MACRAE-HAMDY (she/they): Hi! I’m a thirtysomething trans woman living in Vancouver, and I identify as bisexually demisexual, in that I’m attracted to both, people with the same gender as I, and people with different genders than I, and even when I’m attracted to folks, I usually don’t have desire to have intercourse with them– I’d rather engage in other romantic activities. I’m currently in an asymmetric polyamourous relationship (there’s a diagram!) with two cis men, one cis woman, and one trans non-binary lover.
(Just as an aside, I understand the term transgender to inlude all non-binary people (assuming they also choose to identify as trans) because being trans is a state of identifying with a gender identity that differs from the sex-assigned at birth and/or the gender one is socialized as, and why would I want to be a bootlicker for the binary?)
All this can be a bit of a mouthful, so for short, I usually just tell people I’m a Rainbow (aka LGBT+) woman, my pronouns are she/her/they, and leave it at that!
What comes to mind when you hear about trans sexual health education?
GARRY: Usually, the lack thereof! I work within Nova Scotia Health to try and educate and train healthcare providers to be more affirmative and competent in their care for all 2SLGBTQIA+ folks, with a priority on trans, two spirit and gender diverse folks. This needs to be implemented on a structural level within the education systems of ALL healthcare professionals.
ANDY: Validating gender identity through pronouns, hormone therapy and gender affirming surgery. Also, being recognized for who you are and how you feel, and having it reflected back at you by healthcare providers who understand your needs.
ANONYMOUS: Trans health topics related to body changes from transitioning are what come to mind because it tends to be more of a focus in society. The psychological impact of navigating and engaging with one’s own body (or others’) while concurrently managing gender dysphoria is another topic at the forefront of my mind. Within trans sexual health specifically, campaigns to promote testing for people with certain body arrangements (e.g. encouraging people with cervixes to get paps). Part of this is about finding ways to make these services less gendered, more supportive, and affirming for trans people.
CELINE: Honestly, probably an episode of Discovery Channel’s “Sex Files” that aired back in the early 2000s, and addressed the existence and some experiences of trans people. But other than that, I can’t think of anything in my sex education (of the comprehensive variety), that specifically focused on trans sexual heath education.
What is important that people should know when it comes to trans sexual health?
GARRY: They need to know that everyone has a different journey and that care should be individualized. We need to broaden how we ask questions surrounding partners, body parts, and continually push to de-stigmatize sex/sexuality/PrEP use/HIV/STBBI’s.
ANDY: People are the experts of their own bodies! Also, that listening to challenges and experiences of trans folks is the first step in helping them get what they need.
ANONYMOUS: I think it is incredibly important to talk about the unique context of sexual health for trans people with disabilities. There is limited awareness within the healthcare system, specifically within continuing care, community nursing, and personal support work, about the unique sexual health needs for trans folks.
I need assistance with bathing and toileting, but also need assistance surrounding sexual health maintenance, sexual activity set up and cleanup, and grooming. For example, due to atrophy internally from testosterone, I have estrogen tablets inserted twice a week. This does well to treat the dryness and reduce pain when I’m sexually active. But because my hand function is limited, I need help inserting the tablets. I don’t have someone who I live with or who could assist regularly (and going to the sexual health centre that frequently isn’t feasible, especially for someone who requires accessible transportation). Instead, strangers (public VON nurses) come to my home to do this. For a long time, for each session there was a different worker. Only recently, for unrelated reasons, have I been able to get a team of less than ten consistent workers. This should be a consideration from the beginning for trans folx receiving a service like this.
There needs to be education for these nurses around working with people who are trans (and/or people who may not identify as trans but have non-traditionally gendered bodies) . In general, there appears to be an assumption that trans people don’t exist within the populations that typically receive community nursing services. When I raised issues with how I was being treated (e.g. workers avoiding looking at my genitals while placing a catheter resulting in physical injury, and workers using incorrect language when referring to body parts and incorrect pronoun usage), I was told everyone was already “trans friendly” and they wouldn’t be providing any training for staff.
I get assistance from personal support workers with washing my whole body and shaving, including my genitals. It is important that the people assisting me use language and interact with my genitals in ways that are affirming. I’ve had workers who refused to wash my body properly, saying that that’s not how they were taught to wash ____ type of body. Workers need to understand that everyone is different, so as long as it’s not dangerous to wash or groom in a particular way, they should do it in a way that works for the client. This is basic consent when touching an individual’s body – doing it only in an agreed upon way. If I’m not washed properly, I’m very prone to infection and can end up in severe pain. This means that I’ve had ongoing infections while receiving care from staff who weren’t respecting my bodily rights.
For homecare staff, such as VON, I raised these issues and was similarly told that all staff were trans friendly. This time, though, they also said that homecare simply wasn’t set up for people with “my needs”/ people who wanted more independence and choice in their care. Eventually I moved to hire workers independently because I was experiencing so much trauma from the way in which they were interacting with me. Now, I choose who I hire and select based on their approach. However, it shouldn’t be the case that individuals with marginalized identities can’t access competent care within the system and are subsequently forced to find and educate workers themselves. Everyone has a right to competent care that treats them like a whole person – it’s not about personal choice or wanting independence.
Having workers who are affirming has done wonders for my sexual health. I’m currently preparing for surgery in Montreal and so the other day I had to get one of my workers to take personal photographs for my phone consultation. I felt comfortable with them being a part of this because of how they treat me. I’ve had them assist with setting up sex toys, cleaning up, as well as brainstorming options. While I can’t physically do these particular activities on my own, they are just as important as cooking or eating so that I can take care of my basic needs.
I’ve heard some trans people talk publicly about VON and personal support work, but only in the context of short-term surgery recovery. In general, people are anxious to be done with the personal support work, and there is a lack of acknowledgement that some trans people need this type of support all the time. It seems like there’s the perception that as soon as you need this support, you no longer have a sexuality.
CELINE: In my experience, comprehensive sex ed covers most of the “mechanics” and best practices of safer sex, and those practices and many of the mechanics still apply to trans folks. What I think people should know about sexual health for trans folks, is that your transition (social, medical, surgical, etc.) should include revisiting comprehensive sex ed resources again, because some practices that didn’t apply in the past, may be important now. Beyond that, I’d want people to know transitioning can cause a lot of changes to the dynamic of a relationship, so as with cis folks, trans folks should understand their sexual health as inclusive of their mental health, and relationship health, even extending to the risk of domestic violence. This isn’t to scare folks, just that it needs to be considered and prepared for, either before transitioning, or at the very least, during one’s transition.
If you could say anything to a group of healthcare providers and students, what would it be?
GARRY: It is your duty and responsibility to provide competent, affirmative services and healthcare to ALL people, regardless of their race, gender, sex, expression, sexual orientation etc. If you do not want to provide service to any particular group of marginalized people, no matter what the reason, be it religious, personal stigma, racism, or a phobia, you should not be a healthcare professional. We need to change the oppressive structures in which we exist, work and live so that they empower every single person to feel able to access competent affirmative healthcare; do your part and amplify the voices of those with less power and privilege than you.
ANDY: Listen to your patients, respect the language they use to describe themselves and their bodies, educate yourselves on issues that impact trans people and find the best path forward to assist your patient.
ANONYMOUS: One reality for trans disabled folx is never having a choice to disclose one’s trans status or not. Having a disability often necessitates interacting with the healthcare system, which constantly asks for personal information. This means that those of us with disabilities don’t have the privilege of nondisclosure of our trans status.
Trans disabled people want to have sexuality. I went through a period of sexual freedom when I discovered my gender and took steps to better align my body to my identity. When I became disabled, I lost that access to sexual health and sexuality — I no longer had the same physical access to my own body and my sexuality was no longer affirmed or recognized by society in the ways it was as a trans person. People have a right to access their own bodies and if it’s within your power to assist, do it.
CELINE: One of the biggest positive impacts you can have on a trans person’s healthcare experience and outcome, is by affirming their gender, through the way you talk to them, the way you treat them and their concerns, and by helping them access affirming medical care through medical transition, if that’s what they desire.
If you haven’t received formal training on providing transition care, or respecting trans patients, seek it out! There are numerous education programs in BC (and I’d hope in other provinces too) for you to receive professional education. Aside from that, simply asking someone for their personal pronouns (they aren’t “preferred”!) and chosen name goes a long way towards building respect and demonstrating to a trans patient that you care and don’t want to be an antagonist. If you can’t access formal training, reach out to a local 2SLGBTIA+ organization, and they’ll probably be happy to help you learn or provide resources you can offer to trans patients. If you’re assisting someone in their transition, ask them what they want and how you can help them. If you’re providing care for a trans patient beyond transition care, don’t make assumptions about their anatomy, try to degender your language, and even consider using passive verbs when referring to their bodies. For instance, instead of saying “many women notice [Symptom X] on their period”, you could try “many patients notice [Symptom X] while menstruating”.
What has been your experience with the healthcare system? (good or bad)
GARRY: I have had ok access to healthcare but I also have white privilege and people assume that I am a cis male. I am also able to advocate for myself and feel safe to do so. I often see how marginalized folks are not listened to, even when brought to the table, have fewer resources, are systematically oppressed and are constantly under pressure to do emotional labour and education that is not part of their job.
ANDY: In relation to gender it has not been great, it gets muddier being intersex. I have been invalidated for my gender and my intersex variation based on my appearance and how I’m perceived. I have felt that medical providers have only ever felt the need to “fix” my intersex variation based on my perceived gender. I’ve had difficulty trying to talk to specialists and doctors because of these experiences.
Due to most information about XXY (Klinefelter syndrome) being outdated, my most recent incident was last year when I was in recovery from meningitis and had two young doctors (students, I think) come in and ask me if I knew about Klinefelter’s and that I have a shortened lifespan if I don’t go on testosterone therapy (the shortened lifespan has been disproven; most people with Klinefelter’s live full lives).
ANONYMOUS: Overall, my experience with the system has been traumatic. A few highlights…
When I was taken to the hospital for passing out in class in the early 2000s, I was nearly put in a psychiatric hold simply because I insisted on being addressed with my correct pronouns. Thankfully, a friend who is a social worker rescued me.
Between 2013-15, doctors were still blaming sinus infections on my hormones and asking questions about my genitals when I was there for unrelated reasons, such as acid reflux.
My experience with the system in the last ten years have also involved fighting to get a diagnosis for my physical health condition and for accessing the assistive devices and mobility aids I need, with many barriers along the way. For some of these, doctors have tried to say that my chronic pain was associated with being trans and mental health issues because of that. So my trans status has complicated my other medical care. Specialists with no experience in trans health have also impacted my trans healthcare access. For example, making statements in reports about whether they think I am a good candidate for trans related surgery (as a rheumatologist), based on personal opinions and fear has led to delays and added years of advocating for access to what I know will improve my health, including sexual health.
I’m much less likely to be seen and heard by doctors because I am multi gender / non cis. People often associate trans identities with mental illness. When physicians document biased information in your medical file such as the perception of your gender identity as an illness, it remains there for future physicians to read, which can result in them having a skewed perception of you. The last time I was at the hospital, I nearly died because the doctors would not listen to the unique needs of my body.
Because of these things, I avoid accessing healthcare when possible.
I now have a small VON team of familiar nurses who do my regular care and this has been a small positive. For the most part, it hasn’t been harmful.
CELINE: Ok, so let me just say that starting hormone replacement therapy (HRT) has been one of the best things to ever happen to me. I feel better about my body and myself, and really feel affirmed as a result of taking action on something I’d dreamed about for decades. Overall, my experience in the healthcare system has been mostly positive but I’m privileged that I have medical professionals in my family, so I don’t feel intimidated by medical practitioners. Beyond that, I still feel I had a positive experience once I decided I wanted to pursue medical transition, and was able to find a physician specializing in transition healthcare, who was incredibly supportive and knowledgeable. But even acknowledging that I’m super fortunate to live in Vancouver (and all the “progressive” attitudes that entails), navigating the medical system was not easy. The waiting times at every stage made me realize how much harder this would be for trans folks who might get discouraged or frustrated at an early stage when it’s not clear that they’re making progress.
How do you self-advocate in the healthcare system?
GARRY: I regularly use my voice to point out when I am mis-gendered, or assumptions are made about me. I also correct folks when they ask very binary questions, in particular when it comes to my sexual health and my identity.
ANDY: Lately I don’t. I used to talk about gender and intersex issues a lot when I had the energy to, but recently I’ve been burnt out.
ANONYMOUS: Constantly! I bring people with me, take notes, follow up, ask for copies of everything and more. I wish I didn’t need the level of self advocacy I do. I often need another person present because they do not listen to me (or sometimes even talk to me).
CELINE: Honestly, I don’t feel like I self-advocate! Like I said before, I’ve got doctors in my family, which has made me trusting of any medical practitioner, which is not only a naive attitude, but also is completely atypical, as many people have struggled to trust any medical practitioner because of abuse, harassment, neglect, or otherwise poor experiences/outcomes in the healthcare system.
The closest I come to “self-advocating” is that I try to ask a lot of questions, specifically which options are available to me. If someone gives me three potential courses of action, I want to ask them what the pros and cons of each option are, and in what situation or scenario they’d recommend each of the three options. I make sure to write this all down, so that if they say something contradictory later, I can check my notes and ask them about the conflicting advice. Other than that, I try to think of my medical providers as partners in my transition and my health, but always with the attitude that while they might have pure intentions, they very well could be “pure fools” when it comes to trans patients. We’re partners in my treatment, so that means sometimes I lead, sometimes they lead!
What are some sexual health inequities & general health inequities that you believe trans folks experience?
GARRY: There really are too many to list. I think the use of language is incredibly important and impactful. Often healthcare providers do not even know the right language to use, the right questions to ask and often just don’t ask questions because they are afraid to say the wrong thing. This leads to major issues as many things just go undiscussed leading to health inequities. Fear of saying the wrong thing should not trump providing competent healthcare. It is an excuse.
Healthcare providers need to be more trauma informed and understand that the majority of trans and GNC (gender non-conforming) folks have had negative healthcare experiences and will bring that bias into your clinic/space if you don’t address it from the get go. Talk about pronouns, names, language, body parts with all patients/clients. Educate yourselves!!!! It is up to you to provide care and not rely on your trans clients to educate you.
ANDY:
- Not having access to resources that cis people do.
- Having access to jobs and shelter would improve the health and wellbeing of trans folks.
- A workplace that affirms their gender would make it better for both their physical and mental health.
- Although there is more information on sexual health these days, some of the resources are still styled in a way that is very binary and uses outdated terminology.
As an aside, since this is for Trans Day of Visibility I would like to remind people that intersex and trans are not one in the same. Intersex people face unique challenges in the medical system; whereas trans people are fighting for the right for their gender to be affirmed (socially, medically, and/or surgically), intersex people are fighting to stop non-consensual cosmetic surgeries and/or forced hormone therapy on intersex folks without fully informed consent. As this interview is more about Trans Day of Visibility, I don’t want to take up to much space on intersex activism so I’ll leave it at that.
ANONYMOUS:
- Access to information.
- Access to physical devices, toys that work for our bodies (compounded for disabled trans folx).
- Not being listened to as cis people are in the same scenarios.
- Lack of accessible queer and trans spaces – for dating, discussions on sexual health. Trans folx with disabilities are missing out, including things like housing and public spaces.
- Lack of knowledge of nursing and continuing care staff related to trans issues.
CELINE: It’s hard for me to think of a health inequity felt by trans people, that isn’t at it’s root, a symptom of broader social inequities felt by trans people, that have health impacts. Being transgender is much much more than suffering from cisgender-heteronormative oppression, but it is one oppression that many people experience. For many trans folks, that axis of oppression intersects with other oppressions they’re burdened with (racism, misogyny, ableism, ageism, etc) as can best be understood through Dr. Kimberlé Crenshaw’s framework of Intersectionality (consult your local library!).
That being said, I believe that the greatest inequity trans people can face is isolation, lack of community or support network. It can be easier to navigate the sexual health and medical systems as a trans person if you know other trans folks. That way y’all can learn from trans elders and understand better where you fit in in trans history and the 2SLGBTIA+ community, you can share experiences and benefit from the knowledge that has been gained by trans folks at different stages of their journies or with different perspectives.
So, I don’t know if there is a sexual health inequity or general health inequity experienced by trans folks that wouldn’t be ameliorated, to one degree or another, by community-building and space-making that makes trans folks feel valid, supported, and loved!
Trans people exist 24/7, 365 days of the year, 366 if it’s a leap year. While it is important to celebrate Transgender Day of Visibility it is equally as important to acknowledge and celebrate trans people the rest of the year too. We want to hear from you! Please reach out and share your stories. Share the good, the bad, your triumphs and your frustrations. We want to hear it all.
Finally, the hugest of thank yous to Garry, Andy, Celine and Anonymous, your vulnerability throughout this was commendable. We hear you, we recognize you and we thank you for being exactly who you are.
