Category: Society

My experiences and observations about gendered aspects of society

3 Types of Trans Healthcare That Everybody Should Know About

When we hear about trans people and healthcare, we mostly hear about hormones and surgery. But trans people are way more than just hormones and surgery.

As part of my current research, I am learning about the different types of barriers that trans people experience when accessing healthcare. To my surprise, the majority of the barriers discussed were in relation to accessing transition related care – ie hormones and surgery (among other things). I had to dig significantly deeper to find anything on the barriers that trans people face in accessing regular, every day health care.

What I realized was that this was a reflection on society’s view that trans people are one-dimensional – trans. As it turns out, trans people are more than just trans. They are parents and kids and employees and students and immigrants and homeless and artists and athletes. They are just as multi-faceted as cis people – maybe more so!

This goes for their healthcare needs as well. Sure, they need access to things that are specific to medical transition, but they also need access to basic health care. They break bones, get in accidents, have chronic conditions, and get sick just like cis people.

Since this concept seems to be difficult for the medical and research communities to grasp, I thought I would break it down into three categories to make it a bit more straightforward. Here goes.

TRANS SPECIFIC CARE

This category of health care needs is specific to being transgender. These are health care protocols, medications, and surgeries that are only accessed by and applied to trans people. Some of these were created specifically for trans people. Most were designed for cis people but have been adapted in ways that are now seen as separate protocols when used for transition purposes.

  • Hormone replacement therapy (HRT) for the sake of gender transition
  • Chest masculinization surgery (top surgery)
  • Vaginoplasty
  • Orchidectomy
  • Phalloplasty
  • Metoidioplasty
  • Facial feminization surgery (a collection of many different procedures including trachial shaving)
  • Gender dysphoria diagnosis
  • Psychological assistance with gender/sex incongruity
  • Voice masculinization/feminization therapy

TRANS ASSOCIATED CARE

This category of health care needs refer to services that are used by trans people in the course of medical transition but are also used in the same form by cis people.

  • Puberty blockers
  • Electrolysis
  • Hysterectomy/Salpingo-Oophorectomy
  • Breast augmentation
  • Breast reduction
  • Liposuction/sculpting
  • Scar/Skin graft care post gender affirming surgery
  • Hair transplant
  • Hair growth treatments
  • Treatment for conditions related to bottom surgery
    • Pelvic pain
    • Incontinence
    • Urethral stricture
    • Urethral fistula
    • Post-op infection
    • Dilation

TRANS SENSITIVE CARE

This category refers to all healthcare needs that are not related to medical transition. These are basic healthcare needs that may or may not interact with an aspect of medical transition. For these aspects of healthcare, being trans is not the reason for or the focus of treatment but is still an important aspect of the whole person and their experiences.

  • Diagnosis and management of chronic conditions
  • Cancer screening, diagnosis, treatment, and follow-up
  • Mental health support and psychiatric care
  • Disability related care
  • Fertility, pregnancy, birthing, postpartum, and lactation
  • Emergency care
  • Geriatric and end of life care
  • Stroke and traumatic brain injury
  • Addiction management
  • Physical Therapy and other rehabilitation services
  • Preventative healthcare and health promotion
  • etc

If you are a cis person, think of anything you have ever needed the health care system for, or anything any of your cis family and friends have needed the health care system for. Guess what? Trans people need that care too.

It is the responsibility of the health care professional to know whether any aspect of care within their scope of practice will interact with an aspect of medical transition. For example, drug interaction with HRT medications. Even if the care is irrelevant to any aspect of medical transition or their experiences as a trans person, they still need to be treated with respect, dignitiy, and compassion in order to receive the care they need and have a positive outcome related to that care.

Check out my post about how to be a trans inclusive health care professional and find other recommendations about how to be trans affirming in the related posts below. In the coming years, I will be working on guidelines for medical researchers on how to include trans people in clinical research.

Because really, trans people may be unique in many ways but they are also people with regular, every day health care needs who deserve to have equal access to appropriate, respectful care.

Note: Trans people are by no means the only group marginalized by the health care system. People with disabilities are often reduced to their disability. People with chronic pain are often labelled as drug seekers. People who are fat/obese are reduced to a BMI category or number on a scale. None of these types of stigma are acceptable. If you are a health care professional, I challenge you to learn more about the experiences of all of these marginalized groups (and others). But if you’re overwhelmed and need a place to start, you may as well start here, with trans inclusivity.

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Gender Inclusivity in the Workplace: What it is and How it Feels

For the last five years I have worked in the same environment. During this time, my husband came out as trans and I discovered my identity as a nonbinary person. I recently cut back on my hours at this job and started a different job. These two jobs are wildly different environments, types of work, levels of inclusion, and effects on me as a nonbinary person.

For the last few years, I assumed that any workplace connected to my chosen profession would be the same in terms of it’s effect on me with mild variability in inclusivity. But since switching to the new job, I am realizing how much of the burnout I’ve been experiencing is from inclusion related factors, or the lack of inclusivity at my previous job.

A lot of these factors are within the control of my colleagues and management staff. But some of them are simply related to the nature of the job.

WHAT A NON-INCLUSIVE WORKPLACE FEELS LIKE

When going to work at my job that has minimal inclusion, recognition, or support for my identity as a nonbinary person, I have a nebulous feeling of resistance, anxiety, apprehension, disappointment, and risk. I carry this around with me to varying degrees throughout the whole work day. It is distracting and tiring. I feel like I am hiding, shrinking, holding myself in a small tight ball inside myself for the course of the day.

Every time I have a chance to show a part of this aspect of my identity I have to make a risk vs reward calculation. Every time I encounter something that directly relates to or impacts my gender identity, even if it isn’t directed at me, I have to decide if I’m going to hide or react which is again, a risk vs reward calculation.

This isn’t to say that everything about that work environment is bad and negative. There are lots of things I like about it or else I wouldn’t still be working there. But in order to engage with the things I like about that job, I have to bring the rest of this heaviness along with me.

I am not out to the majority of people in this workplace because it doesn’t feel safe or feasible (more on this below). When I am misgendered, it is primarily out of ignorance and assumption. But, because of many factors, I expect that the majority of people would continue to misgender me even if I did come out. This means that coming out is not worth the effort or risk.

WHAT AN INCLUSIVE WORKPLACE FEELS LIKE

At my new job, I am excited to get to work every day. I can focus and do my work efficiently. At the end of the day/week I am as tired as I would expect given the amount of work I did. I still have mild reluctance to engage with people who are not necessarily trans competent but I know that, should I need to correct them on my name or pronouns, I have the support to do that.

I entered this workplace using my preferred name, pronouns, and gender identity. Not everyone I interact with knows all of that information but I feel safe in providing it openly when I need to. I can share any parts of myself that are relevant without fear and with minimal risk vs reward calculation because the risks are much lower and the reward is more likely to occur.

Colleagues recognize the types of knowledge and expertise that my nonbinary identity affords me and come to me when they have things I can help with.

Overall it feels easy, affirming, and allows me to simply focus on my work.

WORKPLACE FACTORS THAT IMPACT GENDER INCLUSIVITY

Culture

This is the factor that we think about the most in regards to inclusivity and it is definitely the most complex one. You can think of cultural factors in three groups: policies and procedures, competence, and representation.

Policies and Procedures

Is there a policy in place that protects workers based on gender identity? Do their policy documents use gender neutral language? If they have a dress code, is it gender neutral? Do their application forms and other types of documentation such as ID and health insurance forms have inclusive fields (sex, gender, legal gender marker, legal name, preferred name, pronouns, neutral labels, etc)? Is the use of homophobic and transphobic language pervasive, ignored, discouraged, or penalized in the professional work spaces as well as the social spaces in the workplace? Is it commonplace to include pronouns in introductions and email signatures?

Competence

Is the management trained in equity, diversity, and inclusion to the degree they need to be in order to put the policies and procedures into practice? Do they know what to do if an employee or colleague comes out as trans or requests they use different language or pronouns for them? Is there positive, neutral, or negative regard for differences and diversity? Are there ‘safe space’ stickers on office doors? Is the messaging around safe spaces and being inclusive accurate to the level of competence of the staff?

See the end of this post for numerous other posts on this blog related to building basic trans competence.

Representation

Is pride month celebrated? Is diversity represented in the company/business promotional materials, staff support messaging, and among the workforce?

I’m sure there are more but these are the ones that come to mind from my experiences comparing these two work environments.

Physical Environment

This factor is a bit more straightforward but often overlooked by anyone who isn’t negatively affected by it. For gender related inclusivity, some of the questions that come to mind are:

Are there gender neutral/single use bathrooms and changing spaces (if applicable)? For places like gyms, yoga studios, and rehabilitation clinics, are there spaces that aren’t surrounded by mirrors? If asking clients about their personal or health related information, are these meeting spaces private (for both sight and sound)? Is the messaging that is visible at the entrance and throughout the space inclusive and representative of diversity?

Social Demands

This is a factor that is often overlooked and took me a while to recognize as important. My experience with it is more specific to gender identity (though I’m sure it applies to many other minority groups as well).

How many social interactions with strangers or acquaintance level co-workers are required throughout a day of work? This is important because, especially for nonbinary people, strangers, and anyone who we haven’t specifically come out to, will make incorrect assumptions about our gender identity and pronouns. No matter how inclusive the workplace is and how comfortable you are being ‘out’ in that environment, every interaction with a stranger requires coming out again.

Many of the components of the other factors make this significantly less onerous. For example if the company’s messaging is clearly trans inclusive, if employees have pronouns on their ID badges, and if the culture is supportive, affirming, and protective of trans people, I would feel much more comfortable introducing myself to a stranger using my pronouns (they/them). If the other factors are poor in terms of inclusivity, this one gets exponentially worse.

But, if the type of work requires very little interaction with strangers, it is significantly easier to get through the day in a workplace that has mediocre cultural and physical inclusivity.

  • What have your experiences been with gender inclusion in your workplace?
  • Have you ever quit a job due to it’s lack of gender inclusivity? What factors affected you the most?
  • How would you rate your current workplace on it’s gender inclusivity based on the factors above (or others that you’d like to add)?

Leave me a comment below or send me an email! I’d love to hear from you.

RELATED POSTS

Workplace and Coming Out

Surviving in a Non-Inclusive Workplace

Trans Competency

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When You Get It Wrong: How to Correct Yourself and Others When it Comes to Trans Identities

WHEN YOU MISGENDER SOMEONE

Even I, a nonbinary person with a trans husband, sometimes get people’s pronouns or preferred language wrong. Our brains are used to holding onto stereotypes and first impressions as shortcuts. It takes conscious effort to change how we perceive people and the language we are using for them. So, when someone you know comes out as trans or nonbinary, or simply asks you not to use certain language when referring to them, you will likely get it wrong at some point.

When you get it wrong, correct yourself and move on.

Do not apologize, especially not repeatedly or profusely. By apologizing, you are putting the focus on you and the mistake you made and forcing the trans person into the socially conventional role of either thanking you for the apology or excusing the original mistake, neither of which is acceptable.

The more you apologize, the more you are emphasizing the mistake in your brain. Repeating what you said with the correct pronouns, name, or other language is necessary to cement the correct version in your brain. The more you de-emphasize the mistake and emphasize the correct version, the faster your brain will adapt and stop making mistakes in the first place.

If someone else corrects you, say ‘thank you’ (not ‘sorry’), repeat it correctly, and move on.

Sometimes we are talking without hearing what we are actually saying and someone else hears the mistake for us. If the person you misgendered doesn’t correct you, it’s not because ‘it’s fine’ or they didn’t notice. Trust me, they did. It’s more likely that they don’t want to draw attention to the mistake, to themselves, or don’t have the energy to correct you and everyone else around them every time they are misgendered.

If the trans person or someone else catches your mistake and corrects you, that’s a good thing! That means that the culture of the place you are in or the relationship you have is one of support, openness, and inclusion. Respond to the mistake in a way that upholds this culture. Thank them for making the effort to bring your mistake to your attention, even though it meant going against social convention and interrupting the conversation. Correct yourself by repeating what you said with the correct language. And then move on by continuing with the conversation.

WHEN SOMEONE ELSE MISGENDERES SOMEONE

If people around you are making mistakes, make sure to correct them if you feel it is safe to do so. It is often easier to hear when other people make mistakes than when we do it ourselves. The more you correct someone else, the more you are emphasizing the correct version to yourself and others. You can correct others by interrupting them and stating the correct pronoun/name/language, by repeating what they said but using the correct pronoun/name/language, or by continuing on with the conversation, ensuring to use the correct pronoun/name/language with added emphasis.

If you know the person they misgendered personally, and especially if that person is often present when this misgendering occurs, consider asking them how they want you to respond in these situations. Depending on the relationships involved, they may prefer you don’t correct certain people in favour of preserving a tenuous connection. Or they may not feel comfortable correcting people themself but would really appreciate if you do it on their behalf. It may depend on who else is around or what context you’re in. Sometimes they don’t know yet and it takes some trial and error. You can always check back with them later to confirm or clarify their preferences.

WHAT IF THE PERSON THEY MISGENDERED WILL NEVER KNOW?

Let’s say you’re at a business meeting where a colleague is referring to a previous client who was trans. Or you’re a health care professional at a complex case discussion and someone brings up a case with a trans patient. Or you’re at a family gathering and your uncle refers to a celebrity who is trans. Now let’s say this colleague or family member uses transphobic or ignorant language when referring to the trans person.

What do you do?

You have three options:

  1. Correct them in the moment
  2. Correct them later, in private
  3. Don’t correct them at all

How you decide is important. If you would pick option 1 if there are trans people present who would be directly affected by their comments, and option 2 or 3 if there were no trans people present at the time, I take issue with this. You are assuming that you would know or be able to tell if there are trans people present. This means you are assuming that either trans people are recognizable by how they look (false), or that, because you are an ally, anyone who is trans or questioning would have told you (also false). It also means that you are assuming that if you don’t know of any trans people in the room, everyone must be cis. You are using cisgender as the baseline until proven otherwise rather than keeping an open mind.

I would prefer if you decide based on safety and energy. If you were to correct them in the moment, would it put you at risk, create a much bigger argument that would lead to significantly more transphobia rather than less, or use more energy than you personally have at this time? If any of these are true for you, then pick option 2 or 3, using the same questions to decide. If none of these are true for you, please choose option 1. You never know who in the room needs to hear the correction, either for themself, someone they love, or someone they will interact with in the near future.

Let’s look at each of these options in more detail.

Option 1: Correct them in the moment

This takes practice. The first few times someone says something transphobic in front of you it will be gone and the conversation will have moved on before your brain clicks in and says hey, that’s not right. If you are socially confident, you might be able to interrupt the conversation to make the correction. If not, it will take some planning and repetition.

Make note of phrases that you’ve encountered and what the correct phrase would be or what assumption needs to be corrected. Plan a one sentence correction that you could say. Also plan an interjection to use to get the attention of the people in the conversation first. There’s no point in making a correction if no one hears it. Something like “Excuse me, I heard you say something that I don’t think is right” works well.

The goal isn’t to create a debate around language use and trans issues. It’s to correct how they are referring to a person or using terminology in this context and continue the conversation. So keep your corrections relevant to the topic at hand, using examples specific to the current conversation.

This option takes significant confidence and energy, even if you aren’t a trans person. But it gets easier with practice. It also takes some quick calculations about what the social environment is, how the people in the room are likely to respond to your correction, and whether you have sufficient social capital to be heard. This is a small scale example of the types of calculations that trans people make all day long. It’s part of what it means to be an ally.

Option 2: Correct them later, in private

If, for whatever reason, option 1 isn’t going to be good for you or potential trans people in the room, or the moment passed and you didn’t recognize it or decide what to do about it until later, option 2 is the next best. You have time to think about what you want to say, gather some resources that might be helpful, and pick an appropriate time when they might be more receptive and/or you feel safer or more capable of making a good impact.

This can be a face to face conversation, a text, a phone call, or an email. Sometimes it’s best to have it in writing, sometimes not. You could also consider having backup included in the conversation if necessary – either someone else who was in the room, a supervisor, or an inclusion and diversity rep if one exists in your setting. You can make sure they go with you for the conversation or add them to the email, even privately if necessary.

The important part is that you take action. If the person who made the mistake is receptive, you will be supporting them in making a positive change and providing useful resources. If they aren’t receptive, you are safer and know that you’ll have to take it to the next level should this issue come up again.

The major drawbacks of this option are that the other people in the room didn’t hear the correction so a) they may not recognize that what was said was wrong, b) they may not know what should have been said instead even if they know it was wrong, and c) any trans, nonbinary, or questioning people in the room don’t know you are an ally. So, if you choose option 2, consider other things you can do to address these aspects as well.

Option 3: Don’t correct them at all

This is the least useful option but is also the safest. Only pick this option if you have no other choice. But, if you do have to pick this option, consider other ways you can get information out to the people around you about common errors or assumptions about trans people and corrections/accurate information. Because if you didn’t correct them, and no one else did, it’s not only the person that made the mistake that needs the information but everyone else who was present and didn’t say anything either.

I hope this helps you feel more prepared and more comfortable with correcting yourself and others instead of letting mistakes slide. Leave a comment below with your experiences of correcting yourself or others and any other tips or suggestions you have.

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How to be a Trans Inclusive Health Care Professional

THIS IS IMPORTANT AND YOU CAN HELP!

Trans people experience a wide range of barriers to health care including overt discrimination, uninformed health care professionals, systemic discrimination, and personal biases. As a result, trans people frequently have negative experiences in health care settings and often avoid accessing health care services even when it is necessary. Ultimately, this leads to significant health disparity. This is compounded by having intersectional identities and experiences that also experience health care bias (fatness, racial minorities, disabilities, neurodivergence, sex workers, previous incarceration, current or past drug use, etc.)

Trans people have a significantly higher risk of suicide, especially youth. The single biggest protective factor against this increased risk is having supportive people in their life that respect their name and pronouns. That’s all it takes (though the more support the better of course).

So as a health care professional, what can you do to help? Here are some suggestions.

DON’T ASSUME

Don’t assume you know someone’s gender. Not based on their legal gender marker, their presentation, their body shape, their voice, their experiences, or the clinical service they are accessing. Trans men can be pregnant, birth, and body feed their children. Trans women can have a low voice. Nonbinary people come in all shapes, sizes, and presentations. Not every trans person is able to or cares to change their gender marker.

Don’t assume someone’s pronouns or the language they prefer based on their gender (or any of the other above information). People can use any pronoun regardless of their global gender identity. Pronoun preference can shift day to day, depending on context, or depending on the people they’re with. Other gendered terms are separate from pronouns. People can prefer seemingly conflicting terms (such as preferring Mx., sir, guy, sister, and Mom) and this is perfectly fine.

Don’t assume a trans person’s transition trajectory. Don’t assume every trans person wants to transition in any way, what components they will want to include in their transition, or what order or length of time they will take to access and engage with the options available to them. There are not only two pathways for transitioning. There is no set end point to transitioning. It is a highly variable and individual process that spans many many years if not the rest of their life.

So if you’re not supposed to assume any of these things, how do you find them out so you can interact respectfully and provide the appropriate care? You use neutral language for everyone (not just the people you suspect of being trans) until they specify or until you confirm by asking specific questions. Knowing what questions to ask and how to ask them in a specific and respectful way comes with practice. It is your choice whether you want to practice on your own time (via accessing formal training opportunities or informally interacting with trans people on a personal level) or over the course of your professional career.

RESPECT NAMES, PRONOUNS, AND GENDER IDENTITIES

You don’t have to understand every gender identity in order to respect them.

When you get someone’s name or pronouns wrong (which you will, we all slip up sometimes), correct yourself and move on. Do not apologize, especially not repeatedly or profusely. By apologizing, you are putting the focus on you and the mistake you made and forcing the trans person into the socially conventional role of either thanking you for the apology or excusing the original mistake, neither of which is acceptable.

Repeating what you said with the correct pronouns, name, or other language is necessary to cement the correct version in your brain. The more you de-emphasize the mistake and emphasize the correct version, the faster your brain will adapt and stop making mistakes in the first place.

If someone else corrects you, say ‘thank you’ (not ‘sorry’), repeat it correctly, and move on.

If people around you are making mistakes, make sure to correct them if you feel it is safe to do so. It is often easier to hear when other people make mistakes than when we do it ourselves. The more you correct someone else, the more you are emphasizing the correct version to yourself and others. You can correct others by interrupting them and stating the correct pronoun/name/language, by repeating what they said but using the correct pronoun/name/language, or by continuing on with the conversation, ensuring to use the correct pronoun/name/language with added emphasis.

This goes for documentation and patient records as well. Find a way to include preferred names, pronouns, and other important language in your patient demographics tracking system. Document using the patient’s preferred name and pronouns. If these don’t match their legal information, start with a note that states that you will be referring to [legal name] as [preferred name] and using [preferred pronouns] for the remainder of the patient’s chart. If you have to do this at the beginning of every chart note, then do it. It’s important.

IT IS YOUR JOB AS A PROFESSIONAL TO BE OR BECOME INFORMED

It is not your patient’s job to educate you on the basics of trans identities, trans health care, trans bodies, or how to respectfully interact with them.

It is your job to know what aspects of trans experiences and medical care relate to your scope of practice. If you are a medical doctor and do not understand that trans men do not need prostate exams and trans women do not need pap smears, you have a significant amount of learning to do to be considered a competent medical professional (for anyone, not just trans people).

‘I was never taught that in school’ is never a good reason not to know something. All regulated medical professions have an expectation of continued learning and keeping up with medical advances and new research. Would you prescribe someone the same medication now that you did twenty years ago even if it was no longer recommended and newer medications that are cheaper, more effective, and with fewer side effects had since been developed? No? Then don’t treat a trans person according to twenty year old ‘best practice’ guidelines. Those are no longer best practice. The world of trans care is changing rapidly. It is your job as a professional to stay up to date.

YOU DON’T NEED TO KNOW EVERYTHING TO BE A GOOD HEALTH CARE PROFESSIONAL

Even if you are doing your best to stay informed, there will be times when you’re not sure whether you’re missing something or whether their experiences as a trans person simply aren’t relevant. You don’t need to know everything. But…

You need to be willing to admit when you don’t know something.

You need to do the work to learn what you need to know when you identify a gap in your understanding or knowledge.

And you need to be able to find the information you need and assess whether the source is reputable, scientifically based, and whether it holds bias (hint: there is always some bias if it is a scientific source so it’s important to be aware of it).

TRUST THE PATIENT

Trans people’s experiences are incredibly nuanced, intersectional, and often very internal. You cannot judge what a trans person (or anyone, really) is struggling with internally by looking at them. Therefore, you cannot judge what care would be best without first understanding and accepting what they are telling you about their experiences, struggles, joys, and desires.

It is your patient’s job to be as honest with you as they think is safe and necessary in order access the care they need. Sometimes this involves misrepresenting their identity or hiding parts of their medical history. The more informed you are and the more respectful you are, the more likely your patient will trust you, the more honest they are likely to be with you, and the better the care you can provide.

Don’t question their lived experience because it is outside your area of experience or expectation. Trans people are not exaggerating when they describe the systemic barriers they face such as long wait times, repetitive updates and submissions of forms, lack of appropriate processes for changing legal documentation, etc. You can be shocked and disgusted that that is the way the system is but unless you have your own lived experience of navigating these barriers with a trans person and have found a way around or through them, you have no right to argue against them, suggest that they are doing something wrong, or simply haven’t tried hard enough.

TRANS PATIENTS ARE STILL PATIENTS

At the end of the day, trans patients are still patients. If you’re not sure how to proceed, draw on your clinical knowledge and treat the patient in front of you, not the trans patient you are assuming they are.

Don’t know whether the testosterone that a trans patient is taking may be relevant to the reason you are seeing them? Go back to the basics. What affects does testosterone have on a human body? What body systems might it affect? Are these relevant to your patient’s current concerns? You can follow a similar thought process for any component of trans experience or medical care.

If you think something might be relevant, explain your reasoning to the patient in terms they would understand and ask some clarifying questions. If you’re still not sure, make a note of it and move on to the next part of your assessment. Then, before you see the patient for their next visit, learn more about it.

As with any patient, consider the whole health of the patient, mental health included. If there is a component of their trans identity or trans specific medical care that you are worried is causing concern for other aspects of their health, consider ALL the consequences of interrupting that behaviour or medical care before making a recommendation.

Often, trans people have to compromise their physical health and wellbeing in order to protect or maintain their mental health and wellbeing enough to function in society. If you then suggest that they change their behaviour in order to protect or improve their physical health, that change could cause significant damage to their mental and emotional health (which is much harder to get help with and recover from). So, before making any recommendations, ensure that you understand the patient’s reasons for engaging in that behaviour or pursuing that avenue of medical care. You may not be seeing the big picture, or your version of the big picture might be different from your patient’s.

WHERE TO GO FROM HERE

I hope this has helped clarify a few things and point you in the right direction. Simply by reading this, you are already showing you are a better health professional to trans people than the majority. That is how low the bar is. Please help raise it.

Below you will find recommended resources. These are a place to start, not a sum total of what you need to know. If these links are outdated or broken, please let me know. I will try to keep it up to date. But again, if you are a health professional, you have the skills to find these resources on your own.

Beyond these links, how are you supposed to learn more about trans people (or other minority groups that differ from your experience)? Here are a few options:

  • Talk to a trusted friend or family member who is trans (or other minority) outside of a professional-patient relationship
  • Read descriptions of trans experiences written by trans people (such as this blog)
  • Attend a lecture or other learning opportunity presented by a trans person
  • Pay a trans person to provide education to you and your staff or assess your clinic/practice on the basis of trans inclusion

Reach out if you are struggling to find specific resources. If you are a trans person and would like to add suggestions to this post for how health professionals can be trans inclusive, please leave a comment!! The more experiences and voices the better.

REFERENCES AND RECOMMENDED RESOURCES

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Welcome! Who Are You and What Do You Need?

I have now been writing this blog for three years! I recently discovered that with all those posts, my blog was not very searchable (sorry about that!) I have fixed this somewhat but also wanted to provide a snapshot of what you might find here.

Depending on your situation, identity, or what brought you here, you will be looking for different things. Scroll through the section titles in this post to find one that seems like it fits. Check out the posts in that section (and maybe some of the related posts linked at the bottom of those) to get started.

You can also use the links in the menu on the left to find a list of posts under each category and an excerpt for each. One of the links in that menu is for Let’s Talk Gender – our podcast about our experiences with gender and transitioning and my experiences with and thoughts about nonbinary identity so if audio is more your thing, definitely check that out. The archive or timeline of when posts were written is on the left as well. You can quickly look through that menu to see if any titles jump out at you. Lastly, you can click on a tag or key word from the list on the left that relates to something you’re looking for to find the latest posts related to that topic.

Are you…

QUESTIONING YOUR GENDER OR DECIDING WHETHER TO COME OUT?

LOOKING FOR FTM TRANSITIONING EXPERIENCES?

LOOKING FOR NONBINARY EXPERIENCES?

LOOKING FOR TRANS PREGNANCY EXPERIENCES?

A QUEER OR TRANS PARENT?

LOOKING FOR MENTAL HEALTH SUPPORT?

A PARTNER OF A TRANS PERSON?

A FAMILY MEMBER OR FRIEND OF A TRANS PERSON?

A MEDICAL PROFESSIONAL, TEACHER, OR BUSINESS PERSON WHO WANTS TO BETTER SERVE TRANS PEOPLE?

TRYING TO UNDERSTAND NONBINARY IDENTITIES?

LOOKING FOR BIG IDEAS ABOUT GENDER?

I hope this list helps you navigate this blog more easily and find what you’re looking for. Let me know if you are looking for more information on a particular topic. I will point you in a helpful direction and/or create new content on that topic!

If you have different gender based experiences than I do and you are interested in contributing to this blog, please get in touch! I’d love to have more diverse stories and experiences represented.

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Baby Clothes and Gender

Baby clothes are predominantly marketed as being for girls or boys. Even though the babies that wear them are too young to have any concept of gender. Even though clothing isn’t inherently gendered. The only reason for this is so that families that have a second child of a different sex than the first have to buy a whole new set of clothes.

Society has bought into this idea so strongly that a baby’s clothing is often used to indicate their ‘gender’.

This is not something I agree with. I don’t think clothing is inherently gendered. I don’t think we should restrict a child’s clothing based on their sex assigned at birth. And I don’t think clothing is an appropriate way to indicate gender. My goal as a parent is to provide my child with a wide range of clothes, toys, and experiences from all areas of the socially defined gender categories.

We got most of our clothing second hand in one big batch from one family. At the time, they were getting rid of 0-6 month old clothes that were predominantly pink and styled as ‘girl’s clothes’ and 6-12 month old clothes that were predominantly blue and styled as ‘boy’s clothes’. We were given a bunch of neutral and boy style newborn sized clothes so that expanded the range of clothing for the first little while. But since they outgrew the first sizes, we have been predominantly dressing them in ‘boys’ clothes (because that’s what we have).

This has gone against my gender-free/gender-full parenting wishes so I intentionally went shopping for clothes that would fit my baby that were pink and purple, or had flowers and butterflies, or were otherwise more on the ‘girl’ side of the clothing spectrum. I love seeing a variety of clothing in the drawer to choose from.

When I dress my baby to go out for a walk or visit with family, I am conscious of what clothing I put them in and what assumptions people will make or associations people will have as a result. Despite the fact that I don’t feel that clothing has a gender and I don’t think clothing should indicate gender, I’m also aware that the majority of people do hold these beliefs. This forces me to consider the ‘gender’ associated with the clothing I am choosing for my child. And then I find myself thinking of pink as girly and a blue football motif as boyish.

I’m constantly playing this tug of war with myself. I don’t want to think of clothing as gendered. I put my baby in whatever clothes I want the majority of the time. I mix and match and alternate but this gendered thinking still creeps in. I have to constantly remind myself to think of clothing as different styles, colours, and patterns, not different genders.

I also think about what clothes my baby was wearing the last time they visited with a particular person and try to pick something contrasting the next time. Again, I have to remind myself, not something of a different gender, something with a different colour, pattern, or style.

Because, ultimately, baby clothes are not only for the baby, but also for the adults they are interacting with. And by influencing the adults around my baby in subtle ways, I can hopefully maintain a more gender creative and inclusive environment with fewer overt and potentially confrontational conversations.

The internal struggle against gendered thinking is constant. But when I feel the binary veil lift and I can see my baby for who they are as a giggling, food-loving, good-sleeping, commando-crawling 8 month old, I feel more connected and at ease in my role as a parent.

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Trans Wisdom: Consumer Categories are Irrelevant (Part 2)

This is a continuation of Trans Wisdom: Consumer Categories are Irrelevant (Part 1)

INTERESTS AND CAREERS ARE FOR EVERYONE

I think you’re getting the picture by now. This categorization of clothing, jewelry, makeup, toys, and just about every consumer item also gets applied to activities and careers. Many cis people fight against this with varying levels of difficulty. But many people are unaware that they have been guided towards some interests and away from others.

Many trans people transition while in the work force and either start out as the odd one out or become the odd one out in their field. Only after transitioning do they realize how hard it was to swim against the current or how much harder it is now that they have to.

The extra effort it takes to do something we love, either for fun or for work, when it is not something that our gender category should be good at or interested in is unnecessary but very real. Sometimes it is subtle – confused or disparaging looks from friends and family when you talk about it or messaging that is always aimed at the other binary gender category. Sometimes it is overt – harassment, withdrawal of family support, lack of promotion, less pay, difficulty getting hired. These pressures are like the banks of a river, trying to keep us in line. But sometimes rivers chart a new course or spill over the bank.

Don’t let societal pressure stop you from doing something you love. Find the support of people who believe in you and other people in the same situation as you. Form your own group and keep going. (Caveat: if fighting this type of fight against the current is taking too much of a toll on you, don’t be afraid to step back. Find a different way to do what you love, even if it wasn’t plan A. Your mental health matters more than changing the system from the inside.)

MASCULINITY AND FEMININITY ARE FOR EVERYONE

What is masculinity? Write a list of what masculinity means to you. Now, beside each trait, write the name of a person who identifies as a woman who exemplifies that trait.

What is femininity? Write a list of what femininity means to you. Now, beside each trait, write the name of a person who identifies as a man who exemplifies that trait.

Masculinity and femininity do not equal male and female or man and woman. Anyone can embody traits that are deemed by society to be masculine or feminine and often we all do. If we question society’s categorization of these traits, we start to realize that the terms ‘masculinity’ and ‘femininity’ lose their meaning. That is because they are arbitrary. Everyone’s definition of these terms is going to be different depending on their experiences.

Some traits that are deemed masculine are referred to with words that have a positive connotation when referring to a man with that trait and a negative connotation when referring to a woman with that trait. Managerial vs bossy for example. The same goes for feminine traits. A sensitive woman vs an emotional man. Be aware of how people are described and see if you notice this use of connotation to indicate a positive or negative value of their level of masculinity or femininity. Try describing the person using a word with a positive connotation and see how people respond.

List your own traits – personality, presentation, interests, etc. How many of them can you easily label as masculine and feminine? Did you write any using negative words? What category do those fall under? Can you find a word that means the same thing but with a positive connotation? (Think of applying that word to friend – how would you flip it?)

Masculinity and femininity are not specific to sex, gender, name, pronoun, race, social standing, or any other category. They are for everyone.

YOUR PRESENTATION IS YOURS TO PLAY WITH

If clothing, jewelry, makeup, toys, interests, careers, and any other masculine or feminine (or androgynous) trait is available to everyone, that means you get to decide what you include in your presentation, regardless of consumer category. You can pick and choose whatever parts feel best for you on a given day.

Presenting in ways that defy consumer categories will attract more attention, often negative attention. Trans people are painfully aware of this. Before transitioning, they sometimes hide who they are and work hard to fit in with a presentation that is expected of them. Then, during their transition, they fight to present how they are most comfortable despite all the negative attention. After socially transitioning, they sometimes present in a way that matches a binary consumer category in order to avoid that same negative attention. It takes a lot of support, self-confidence, courage, and often privilege to be able to consistently defy consumer categories and present how you prefer.

If your preferred presentation matches pretty closely to one of the two consumer categories, you are lucky. But don’t let that stop you from finding the subtle ways that you butt up against the edge of your typical category or even cross the boundary into the other one. These are the aspects of yourself that tell you that you are being authentic, an individual, not a slave to binary gendered consumerism.

Go and be free! Consumer categories are irrelevant! Be who you are, present how you want to, defy expectations!

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Trans Wisdom: Consumer Categories are Irrelevant (Part 1)

CLOTHING IS FOR EVERYONE

Have you ever been shopping for clothes in the part of the store that is labeled with your gender and felt like nothing fits you or feels like the right style? Have you ever shopped for yourself in the other section of the store?

Because our society sees masculinity as the standard and femininity as a deviation that is only acceptable for specific people, I would guess that people who identify as or are assumed to be women are more likely to shop across consumer boundaries. It is less likely, and potentially dangerous, for people who are assumed to be men to shop in the section labeled ‘women’.

Trans people have to find ways around this in order to find clothes that feel good. They find a friend who is assumed to be the gender of the category they want to shop in who is the same size as they are and go shopping together. They pretend to be shopping for a partner or friend ‘who is the same size’. Or they go in a group so they are less likely to be harassed or have support from each other if they are harassed.

Clothes from different sections are shaped differently. Sometimes our bodies don’t match the shape that the consumer category says we should have. Sometimes our bodies are closer to the shape of the opposite consumer category. Or we prefer the style of the clothes from the other category but they don’t match the shape of our bodies. Many trans people learn how to alter their own clothes or find a friend from the community who will do it for them. Or pay to have alterations done.

Nonbinary people especially have free reign. There is no ‘nonbinary’ section of clothing stores. What would even go in that section? A little bit of everything? Next time you go clothes shopping, pretend you’re nonbinary if that helps you ignore the gendered categories on the signs.

You don’t have to compromise on clothes that are the right style just because the manufacturer decided that they were for a different body type than yours or a different gender. Find the clothes that feel good for you, alter them if you have to, and ignore the label above that section of the store.

ACCESSORIES AND MAKEUP ARE FOR EVERYONE

As with clothing, play around with accessories and makeup if you have never done it before. ‘Dainty’ jewelry isn’t only for ‘women’ and heavy, thick jewelry isn’t only for ‘men’. I have had to alter every watch band I’ve gotten in the last few years because the watch face I want only comes on a band that is too big for my wrist. As if no man could possibly have such a narrow wrist. Or no one with such a narrow wrist would choose to wear a large faced watch that doesn’t have sparkles on it.

If you like bright colours, try wearing nail polish if you never have before. Start with a clear coat that is nearly invisible to see how you feel about it. If the idea of makeup interests you, ignore what the consumer categories say about who it’s for and try a bit of eye shadow or lipstick. If you have a child who was assigned male at birth and you are raising as a boy, let him play with makeup and jewelry without shaming him.

Again, this sort of exploration is going to be more difficult for anyone assumed to be male or assigned male at birth who wants to explore things that are labeled ‘feminine’. They especially need lots of support, protection, and community. But that doesn’t mean that it is wrong. Just that society tries to convince us it’s wrong. Trans people know better.

TOYS ARE FOR EVERYONE

A lot of trans people remember wanting to play with specific toys as kids and being told no or even punished for it. The stupid thing is that toys are inert. They don’t have preferences. So why can’t any child play with any toy?

If you go into a toy store or the toy sections of a superstore you will see a pink aisle with dolls and ponies and unicorns and maybe some pink blocks and you will see another aisle with bold colours like blue, red, and black filled with all kinds of vehicles, tools, blocks, building sets, and first responders. This is completely unnecessary and is designed to get parents to buy more toys by making them feel like the toys for one child are not transferrable to a child of a different gender.

As adults, you see the same thing. Bikes are built differently with the assumption that women will be wearing skirts or dresses and will need to cross their leg over the bar instead of behind the seat. Anything that is labeled ‘masculine’ will only appeal to women if it is pastel coloured or sparkly. Anything labeled ‘feminine’ has to be rebranded entirely and labeled ‘masculine’ before it will appeal to men. No, the gendering of inanimate objects doesn’t end with kid’s toys.

Next time you go shopping for something fun for yourself, your partner, a friend, or your kids, ignore the categories. What is their favourite colour? What would they enjoy having? Think of them as an individual rather than a member of a gender category. If they are a man that has dry hands and enjoys gardening, get them a cream that has a scent that reminds you of their garden.

Stay tuned for Part 2 next week.

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Trans Wisdom: Language Is Important

PRONOUNS ARE FOR EVERYONE

Since trans people have become more visible, pronouns have been discussed a lot more openly. The funny thing is, we were all using pronouns the whole time. We were simply assuming the gender of the people around us based on their presentation and then assigning the pronoun that related to that gender.

What trans people are trying to show the general public is that not only can you not assume someone’s gender based on appearance but you also can’t guess what pronouns someone is most comfortable with. This means we have to ask people what pronouns they use. Not only if someone looks ambiguous or doesn’t fit our cis-based expectations. Everyone.

This means cis people should also get asked what pronouns they use. Even better, cis people should be initiating the conversation about pronouns with each other. Specify your pronouns and then ask a new acquaintance for their pronouns. Keep doing this until it no longer feels awkward.

Have you ever thought about what pronouns you are comfortable with? Have you ever tried referring to yourself with a set of pronouns you don’t typically use? Try it. See how it feels. If it’s extremely uncomfortable, you will have a better understanding of what trans people experience. Maybe you’ll discover that a different set of pronouns actually does feel better than what you’ve been using. If pronouns do not equal gender, your gender can align with what you were assigned at birth (you can be cisgender) even if you are more comfortable with a different set of pronouns.

KNOW WHAT LANGUAGE FEELS GOOD TO YOU

There is a lot of gendered language out there other than pronouns. Depending on your history with various terms, some of it will be comfortable for you and some won’t. You can think critically about the language that people use to refer to you on a daily basis and decide what you’re okay with and what you’re not. And then you can ask those around you to use the language that you’re comfortable with.

This practice is part of the trans experience but is not exclusive to being trans. When someone comes out as trans, most of what gets talked about is respecting their name and pronouns (very important). But another component is using appropriately gendered language. Saying ‘hey girl’ in greeting to a trans man is likely to be extremely uncomfortable for them while saying it to a trans woman might be very affirming.

More to the point, there might be cis men that like being greeted with ‘hey girl’ and cis women who hate it. You are allowed to specify what language people use to refer to you. But in order to do that you have to know what language bothers you and what language you would prefer them to use instead.

ANYONE CAN CHANGE THEIR NAME

Lots of people change their last names when they get married. Trans people often change their first names. If trans people can do it, so can cis people. You do not have to change your gender marker when you change your name. Those are two completely separate processes. You can change your name to anything you want. You can do this legally without asking people to call you by the new name, you can ask people to call you a different name but not bother to change it legally, or you can do both. It is a challenging, irritating process but it does not require you to provide proof of being trans.

If you or someone you know might be interested in changing their name and is wondering where to start, ask a trans person who lives in your area! If they haven’t gone through the process yet, they can likely find out how from someone they know.

LANGUAGE CAN BE DANGEROUS OR PROTECTIVE

It is extremely important to be aware of the context in which you are using language. It can be irresponsible and possibly damaging to your relationship if you refer to a mutual friend’s recent cancer diagnosis when you were the only person they had told. Or if you treat someone differently after they tell you they’re pregnant and thus alert others to that fact before they were ready.

Outing someone as trans in a situation where they are vulnerable (to their employer, to a group of people who are potentially transphobic, to their family that they live with) can be extremely dangerous. This could happen a couple different ways: if they are assumed to be their correct gender by those around them (stealth) and you make reference to their trans status or misgender them, or if they are assumed to be their gender assigned at birth and you refer to them with their correct name or pronouns.

However, constantly misgendering someone in situations where they want to be identified for who they are also has a chronic negative effect on their mental health. For this reason, making sure to gender them correctly has a protective effect. It also sets a good example for the people around them.

So if gendering them correctly and gendering them according to their sex assigned at birth could be both dangerous and protective depending on the situation, how are you supposed to know what language to use?

You ask them privately, or better yet, in advance.

It is important to find out who knows what type of information and who it is safe to mention it to. This is the same strategy that you should use for other types of sensitive information such as a cancer diagnosis or pregnancy. Find out who else knows and how that should inform the language you use around them.

INCLUSIVE LANGUAGE REQUIRES SPECIFICITY

Lots of people or organizations want to be inclusive. They filter out any words from their messaging that label a specific group of people assuming that the more generic their message, the more inclusive it is. For a general statement of address such as changing ‘ladies and gentlemen’ to ‘honoured guests’ this is fine. But for anything more specific than that, in my experience, generic does not equal inclusive.

If language doesn’t specify a group of people or a specific experience, the assumption is that it is designed to meet the needs of the majority, not designed to be inclusive.

Another way people try to use language to be inclusive is by naming a specific group and tailoring their services to that group. This becomes a concern when their services are actually related to an experience, not a group. They make the assumption that everyone in that group shares that experience and everyone with that experience belongs to that group. For example, labeling everything related to pregnancy as a woman’s experience. Instead, it is more inclusive to name the experience instead of a group. For example, ‘people who menstruate’ instead of ‘women’.

In order to use language in inclusive ways you also have to know how the meaning of words has changed over time and how different groups of people use words differently. The same messaging could mean very different things to people of different generations, different races, or different classes.

It’s hard to be completely inclusive but using language that is as specific to what you really are talking about makes it more clear who you are referring to.

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Trans Wisdom: The Power of Community

COMMUNITY HAS EXPERIENCIAL KNOWLEDGE

Many things in life, including transitioning, are difficult, complex, and not well understood by the general public. Navigating these experiences is difficult in part because there is so little information available about what to expect, what to avoid, and what resources are available and helpful.

Communities are full of people who have gone there before you. They have way more knowledge and information that is tried, tested, and true than any professional or google search can provide. The bigger the community, the wider the range of experiences and suggestions you will find and the more likely you will find something that works for you.

Without the local trans community, we would not have known that ‘the proper referral process’ that our family doctor was following was outdated and incorrect. We would not have found a doctor willing to follow the current referral process to prescribe my husband Testosterone. We would not have had personal recommendations for where to go for surgery. We would not have had scripts to use when encountering resistance at various governmental and private institutions when trying to change his name and gender marker on documentation. We would not have had scripts to use when acquaintances, friends, and family asked inappropriate, invasive, or poorly worded questions. We would not have been prepared for how long the waitlist was for specialist referrals needed to complete paperwork.

So much of what we learned about how to navigate my husband’s transition came from our community. Without the community, we would have struggled significantly more, waited for specialists that were not required, and felt incredibly alone.

COMMUNITY PROVIDES SUPPORT

We need support from a variety of sources when we are going through something difficult and big. Support from a broader community is one of those sources. Being part of a community of people that are all experiencing something similar normalizes the experience and provides validation.

Often, when our experiences are rarely or poorly represented in mainstream media, we are left feeling like we are the only ones going through this. This can lead to questioning whether your experience is legitimate, whether your reactions to this experience are valid, whether you should be dealing with it differently or better, or whether you’re doing the right thing. We can feel lost, isolated, confused, self-conscious, fearful, anxious, and angry. We can internalize the judgements and negative responses from those around us, including what is represented in mainstream media.

While having a community won’t automatically make the experience an easy, positive one, it will show us that there are others out there struggling and thriving in similar circumstances to our own. Seeing someone else describe their own experience in the same way we would, navigating the same barriers and systems, struggling with similar emotions, tells us that our experience is shared, normal, and valid. We find voices other than our own to counteract the negativity and judgement that we have internalized.

Normalization and validation of our experiences doesn’t take away the difficult aspects, but it helps fortify us against the toll that those parts of our experience can take on us. It helps us weather them. Community gives us someone to talk to who will respond with positivity, understanding, and support without us having to first explain our experience to them from the beginning.

COMMUNITY MEMBERS HAVE IMPLICIT UNDERSTANDING

People who share our experiences will automatically understand our struggles, milestones, and achievements. This is huge. If you need support, even just an ‘aw that sucks’ or ‘I hear you’, and you share your point of struggle with someone outside your community, instead of support you might get a blank stare, a confused look, a platitude, or an inappropriate question. In order to get the response you’re looking for you would have to explain your situation from the beginning, often sharing a lot of personal information in order to bring them up to speed, and may not ever get them to the point of understanding enough to provide the support you need.

I repeated this process many, many times over the course of my husband’s transition. I spent more energy in the explanation than I received in whatever support I got back. The more marginalized your experience is, the less likely it will be that you will automatically get the response you’re looking for. I found a huge difference between the support I got when I had a miscarriage vs the support I got when my husband was transitioning (and we were struggling against systemic barriers).

It was always such a relief when we could tell a group of trans people about something that had happened and immediately get the response we were hoping for, be it support, commiseration, information, or celebration, without having to provide any explanation or background. I learned through trial and error when it was worth explaining my situation to non-community members and when to keep my struggles and triumphs to myself until I had community to share it with.

COMMUNITY HELPS US CELEBRATE

I didn’t realize how important this function of community was until I had something to celebrate and got a response from non-community members that was sympathetic or blank instead of excited. It really takes away from the positive experience when someone assumes it’s negative and you have to explain the whole backstory before they conceptually get it. Even then, they don’t really feel excited for you.

But members of your community do. They have celebrated the same things or are looking forward to the moment when they can. They understand how hard it was to get there. They understand why that milestone is worth celebrating. Without community, the milestone passes you by with a small blip of excitement, self-satisfaction, accomplishment, pride, relief, and perhaps some apprehension about what comes next. But when you get to celebrate with community, your milestone is celebrated by so many others that it is magnified. It becomes a bright moment in a timeline of struggle that you can look back on to give you strength when you need it.

Being able to celebrate the high moments with people that understand can shift our perspective of the entire experience. It can shift the focus from the struggle and loss to the achievement, hope, and success. The story of our experience, when we look back on it, is now characterized by the moments we celebrated with the community. They shine so brightly that they overpower the dark parts between them. They don’t erase the struggle but when the experience if viewed from farther away, they stand out as the most important parts. They make the rest of the experience worth it.

COMMUNITIES HAVE LOUDER VOICES

The voice of the many is often louder than the voice of the few. The more marginalized your experience is, the more powerful the effect of the community. These are also the experiences that get the least attention from media, politicians, health care, and research. Community is necessary to amplify our voices to share our experiences and gain access to the resources and services we need.

The members of a community often have a wide range of outside expertise, connections, and influence. So not only do they have a louder voice, but they can often find a way to get their message heard by the right people with a lot less effort than a single person might.

Communities can form organizations, develop a funding base, and develop their own resources. They can hold fundraisers that are coordinated across an entire country. They can pool their resources from multiple sites and put them towards something that no one person from the community would be able to change.

Feeling like your voice is being heard and that you helped to change the system so that the next person to go through a similar experience will have a slightly easier time of it than you did is huge.

What experience have you had where being a member of a community made a big impact on you or the wider world? What other ways did being a member of a community impact you? Leave a comment below or send me an email!

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