Tag: Ally

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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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 Ally

ALLYSHIP 101

Being an ally for any minority takes more than being accepting of a friend or acquaintance from that identity. Not being a biggot is not the same thing as being an ally. Being an ally isn’t a perspective, a state of mind, or even a level of understanding. It requires ongoing action that at first can be a challenge but eventually becomes automatic.

As someone who is part of a majority group, it is not for you to say that you are an ally. If you take actions that show to members of the minority group that you are safe to be around, understanding, supportive, affirming, and uplifting, they will label you as an ally.

Being an ally takes work, requires an open mind, and most of all, a willingness to feel uncomfortable. At some point, someone from a minority group will tell you that what you’re doing isn’t helping or may actually be causing more harm than good. Being an ally means listening to this perspective, asking questions to understand it further and what you can do differently, then acting on what you’ve learned.

Being an ally for one minority does not mean you are an ally for all minorities or even all the identities encompassed by that minority. Being an ally at one time does not guarantee you are an ally forever or in all circumstances.

But don’t let this discourage you! We need more allies!! Below are a number of ideas for what it means to be an ally to trans people. Please leave a comment below or get in touch with me if you have questions or other things to add to this list!

PRONOUNS

Put your pronouns in your email signature, your social media profiles, your video chat name, and on name tags. As a cis person, you likely have never had your pronouns questioned, never felt uncomfortable with the pronoun people assume you use, and never had to justify your use of that pronoun. Trans people have to do this every day or deal with the discomfort of being misgendered. So please, normalize the expression of pronouns by including yours.

Along the same lines, when you are introducing yourself to someone (anyone, not just someone you guess or know to be trans), introduce yourself with your pronouns. “Hi, my name is _____ and I use ______ pronouns.” You may get some funny looks or confusion from cis people who are not trans aware and you may feel awkward the first few times but just like anything else, it gets easier with practice. If you give up the first time it is uncomfortable, you really aren’t understanding how uncomfortable, scary, and often painful it is for trans people to be in a similar situation. And they don’t have the choice to just walk away, pretend it doesn’t exist, or avoid the discomfort.

Learn how to use a variety of pronouns. No, she/her and he/him are not the only singular pronouns out there. They/them is fairly common. There are also neopronouns such as per, xir or zir, and aer. Learn how these pronouns sound, how to use them in a sentence, how to switch between different pronouns, how to use pronouns that seem counter to your perception of someone’s gender, and how to avoid using pronouns altogether. Often, in English anyway, it is easy enough to rearrange a sentence to remove pronouns or substitute the person’s name.

KNOWLEDGE

Understand what it means to be trans. Understand the difference between sex, gender, sexual orientation, and gender presentation. Learn about some of the various identities that fall under the trans umbrella. Learn about the different steps someone might take to transition. You don’t need to know all the ins and outs of all the medical procedures or medication options (unless you are a healthcare worker and this is relevant to your field) but a general understanding is required.

Understand some of the challenges faced by the trans community in your area. This may be systemic barriers such as access to medications and medical procedures, cost of changing ID, wait times for medical procedures and documentation changes, lack of inclusive forms at medical clinics, banks, and workplaces, and difficulty accessing employment and housing. Or it could be interpersonal barriers due to transphobia that increase the risk of physical and emotional harm. Or personal challenges such as dysphoria, lack of social support, or struggles with mental health or addictions.

Some of this knowledge can be gained through online resources (such as this blog) but you will also have to engage with your local trans support networks and advocacy organizations. You may be tempted to simply ask your trans friend a slew of questions to learn about all these things. DO NOT do this. Trans people have to educate almost everyone they come in contact with. As an ally, you do not want to be another one of those people. If you have looked up everything you can online and joined the mail lists of your local organizations to learn more and still have some specific or personal questions to clarify a couple things, ask your friend if it’s okay with them if you ask them and when a good time would be. They are not obligated to answer. If you see this refusal as a lack of their friendship you really don’t understand what it means to be trans.

CHECK YOUR ASSUMPTIONS

Avoid making assumptions about someone’s gender based on their sex, presentation, physical characteristics, or mannerisms. Keep your language neutral by referring to everyone using they/them pronouns and neutral language until they have disclosed their gender to you. Yes, everyone. Not just people who fall outside the ‘norm’ of gender presentation or someone you think might be trans. You can’t tell someone’s gender from the outside. Being an ally means creating a safe place for trans people that you haven’t met yet. The only way to do that is to consider that anyone could be trans and act accordingly.

Once you learn someone’s gender, don’t make an assumption about what pronouns they use, what steps they have taken or plan to take in terms of transitioning, or what their experiences are with dysphoria. Every trans person’s identity, journey, and experience is different. You don’t have to understand all the different possible experiences to be an ally but you do have to keep an open mind and understand that there is no one way to be trans.

KNOW HOW TO ASK QUESTIONS

You may not be able to learn everything you want to without asking a trans person some questions. And if you’re not supposed to make assumptions about anyone’s gender, you may have to ask someone questions to learn more about their experiences. Knowing what questions to ask, how to ask them, and when/where it is appropriate to ask them is part of being an ally. This, too, takes practice.

The knowledge you have gained about terminology will help you with appropriate wording. Knowing what challenges trans people face will help you be aware of the context and choose an appropriate time and place. Beyond that, honesty is the best policy. If you’re not sure if the question is appropriate, or you’re not sure how to word it, make sure you’re in a safe and private environment before asking and then be honest about your lack of knowledge. Ask for feedback and be open to it when it’s given, solicited or not.

Keep in mind that just because one trans person was comfortable answering a particular question does not mean every trans person will be. Some people are open, some people are private. This is true for trans people as well.

ADVOCATE AND AUGMENT!

As an ally, your main roles are to set a good example for other cis people and to create a safe environment for trans people. This means correcting yourself when you make a mistake with pronouns or other gender references and correcting those around you if they misgender someone (regardless of whether the person is present or not). If you’re not sure whether the trans person wants you to correct other people on their behalf, ask them!

If someone asks you to speak about trans experiences and issues or asks you to review a policy or resource to ensure it is trans inclusive, defer to a trans person, especially if it is a paying opportunity. It is not your job to speak for trans people but to give trans people the support, space, and opportunity they need to speak for themselves. You can also share social media posts from trans accounts and spread news stories that talk about trans people in positive ways.

On a smaller scale, you can offer to be a buddy for a trans person in your life, especially if they have limited social supports. Whether it’s going to the public washroom with them for safety, going with them to medical appointments or registry offices for document changes, or being a caregiver after surgery, there are lots of ways you can help support a trans friend when other people who aren’t allies wouldn’t realize they would need extra support or when the trans person wouldn’t feel comfortable asking for support from non-allies.

I hope this helps give you some ideas of how to be a trans ally. If you are a trans person, feel free to share this with people in your life. We need more allies! Please leave a comment below if you have any questions or if you have suggestions for other ways to be a good ally.

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