Much of this material comes from this video module on trans fertility.
By Trystan Reese, Director of Family Formation
I’m sitting across from his cluttered desk as he stares at me blankly. I clear my throat and try again.
“Your ultrasound technician called me by the wrong pronoun. She was lovely the rest of the time, but I’m sure you know that it’s not acceptable for that to happen.”
The doctor shifts his weight and clears his throat as well. He takes a breath. “Yes, well… I’m sure she didn’t mean any harm.”
I nod my head in agreement. “Oh, I agree! Her intentions were clearly good. However, I’m expecting you to hold everyone to a high standard of care when it comes to my treatment. Can you make sure to give her the support she needs so this doesn’t happen again? Or maybe there’s another technician I can work with next time, if you don’t think she can get there?”
He sits up straighter. “Oh no, that won’t be necessary. I’ll see to it that it doesn’t happen again.”
I have been in this exact situation, and many similar ones, more times than I wish to remember. I can’t always pick the fight with the doctor (or nurse or doula or midwife or front desk person or therapist or whoever), because I just don’t always have the bandwidth. It’s hard to correct people over and over again, especially those in positions of power. For trans people, advocating for oneself within medical systems is hard. But there are tips and tricks to make the sometimes-awkward-mostly-painful situations when providers miss the mark a little easier.
To begin, medical discrimination against trans people happens often. I don’t mention this to stress you out, but to reassure you that if you’ve experienced bias, discrimination, harassment, or refusal of care, you are not alone. If you feel stressed out, anxious, scared, or frustrated when you have to see a provider, there’s a reason for that. Understanding and putting words to that reason can help you persevere through the fear you might be experiencing.
According to Lambda Legal’s study “When Health Care Isn’t Caring”, 26.7% of trans patients have experienced refusal of care. That’s when a provider straight-up refuses to see you, even if you’re in need of medical attention. When compared to other LGB community members, trans people are much more likely to have experienced harsh language, blame for medical conditions, and rough treatment at the hands of providers. So, if you’re scared to go to the doctor, you want to give birth at home, or you need a friend to come with you to the clinic… that might be why. Whether you’ve personally had a negative experience with a provider or you have just heard of others having negative experiences, primary or secondary trauma is real and present in your body. The good news? You can find healing, and you can hack those fears and still get what you need from the people giving you medical care.
Note: These suggestions take what is called a “harm reduction” approach to self-advocacy. Ideally, every provider should be thoroughly trained in trans health, use a trauma-informed approach when working with patients, and always use the exact right language. In a perfect world, a provider would listen to your feedback no matter how you presented it. But, we don’t live in a perfect world. We live in this world. While we at Family Equality are hustling hard to train as many fertility professionals as possible, the world needs to catch up, so we occasionally have to be strategic in how we approach issues of transphobia. The way we approach these issues can mean the difference between being respected and empowered during our fertility and family-building processes… or not. I wish the world weren’t this way, but it is. Take whichever of these tips proves useful, and leave the rest behind
Self-advocate in the moment.
If you’re working with a provider and they cross a line, you may want to say something right away. Whether they misgender you, use inaccurate language, or treat you in a way that doesn’t feel right, you’ll know in your gut that something is “off.” When that happens, take a deep breath. If someone says or does something that you find upsetting, one of the first things to go is your breath. You can even ask them to hold on for one moment while you gather yourself. Sometimes I will even drop something on the floor, so I can take a quick inhale/exhale while picking it up.
Next, if you can, let them finish whatever they were saying. You don’t want any distractions when you bring the issue up. Sometimes, others can get defensive when an issue like this is brought to their attention, and one of the ways to bypass that defensive mechanism is to try to frame it in a positive light. Make sure you’re not interrupting them, and begin the intervention by giving them an appreciation (“Thanks so much for taking the time to explain that to me. I really appreciate the information.” ). I actually find that this helps me hack my own fears around confrontation—it makes me feel like we’re just having a friendly conversation, rather than me calling them out.
Then, name the specific thing that occurred. It’s important not to veer into absolutes in this moment. Try not to say “you always…” or “you never…” That’s a trap that will give the provider a way to avoid accountability. Instead, tell them exactly what went wrong (“When you talked about pregnancy just now, you referred to ‘women’s bodies.’)”
At this point, explain WHY what they said was inaccurate, offensive, or inappropriate. (“As a transgender man, it is really important to me that you always use inclusive language when we work together. A lot of hurtful memories come up when you refer to my body as a ‘woman’s body,’ and it makes it harder for me to trust you and want to keep working with you.”)
I’m Canadian, so I always think about being extremely firm and extremely polite. I am not letting them off the hook in any way, shape, or form. They will know exactly what they’ve done wrong and exactly what I expect them to do differently. But I also want them to actually WANT to fix what’s gone wrong, not because I’ve bullied or shamed them, but because the intervention is more effective if I have recruited them to my side.
Then I tell them what I expect from them moving forward. (“When I come in for my next appointment, my hope is that you’ll be able to use inclusive language the whole time. Is that possible?” )
The provider will likely apologize. They may defend their actions, offering various excuses and rebuttals. Stand your ground! Accept their apologies and/or excuses, but be extremely firm. They can be sorry and they can make a mistake and they can be “working on it” and they can be new to trans issues… and you are still going to ask them to be better for you, because you deserve to be treated with dignity throughout this process.
If they truly seem to need help, you can always offer to help them find a consultant they can hire to train their staff so they don’t have these problems anymore. (I’ve never had a provider take me up on this offer, but hey—it’s worth a shot!) Remember that it is not your job to train them, and it is certainly not your job to train them for free.
Finally, I always thank them profusely. Sometimes, for whatever reason, being super humble and showing appreciation for their work seems to help move folks forward. I want it to feel like we’re a team. When I was pregnant, it was especially important to stay on good terms with my providers because many of them were going to be supporting me during labor—and I wanted them to respect my decision-making authority when it came time to deliver my baby. If I had created an oppositional relationship with them early on, I worried that it might make the process more difficult later.
Not everyone can afford a doula during their pregnancy, but everyone can take the concept of a doula (a non-judgemental support person) and create their own doula-like systems. Think of the people who care about you—friends, family, partner(s)—and put them to work! Ask someone to come with you to visits and share your fears with them ahead of time. Let them know what you’d like them to do. Do you want them to hold your hand? Correct providers who use the wrong language? Give you space? Talk to you afterward? Be clear about what you need, and you’ll find that having a buddy can really help.
Look for the supportive people in whatever system you’re in. Is it the nurse who checked you into the appointment? The department therapist? That one midwife? When you find someone who is an ally at your hospital or clinic or center, don’t be afraid to call on them. I’ve asked allies to educate labor class teachers, ultrasound technicians, midwives, doctors, lactation consultants, and more! Most allies desperately want to know how to help, and they can’t always see transphobia as clearly as you do. Let them know what you need, and don’t be afraid to ask.
Seek opportunities for healing.
I think one of the reasons I’ve been able to be a good advocate for myself is because I’ve had access to healing. I’ve been able to process some of my own emotional wounds, which allows me to advocate from a place of empowerment instead of pain. You can absolutely do great advocacy from a place of pain, but it often comes at great emotional cost. If you’re able to get support and heal from your traumas, the advocacy will be easier on you.
There are many ways to heal from trauma. Here are a few:
- Go to support groups, where you are able to talk through your experiences and be heard (and believed). Simply being able to share can be incredibly healing, depending on the level of trauma experienced.
- Talk with a professional, such as a therapist or counselor. Remember that if any provider, including a therapist, isn’t the right fit for you, you can get a new one. That’s not always possible, of course, but try to find someone who can really support you and help you move forward. If you have experienced particularly intense or complex trauma, you may need to see someone who specializes in that field specifically. It might take you some time to find the right person. Don’t be afraid to ask for help with this as well. You may be able to find a friend or ally to help you call through your insurance’s list of in-network providers so you don’t have to do the work alone.
- Write. There are several trans-specific guides on healing that might work for you. I found one for trans survivors of sexual assault, and I regularly use The Queer and Transgender Resiliency Workbook when coaching transgender people who are incarcerated. Even through writing, finding new ways to tell old stories can help you heal.
- Give yourself time and space. If you’ve just had a traumatic experience, you’re unlikely to be able to engage in interventions with providers right away. Everything is just too fresh. Make sure to recruit a friend to come with you to appointments, and let them know what you need ahead of time.
Envision the future.
Sometimes, I find it’s hard to just advocate for myself. Asking for what I need can feel impossible. But imagining the next trans person who will come to this provider is a major motivation. If I don’t say something to this doctor/nurse/midwife/doula, they will continue to exhibit this problematic behavior for the next trans person, and it will likely be harmful. Speaking up today makes for a brighter tomorrow.