#Transhealthfail Exposes the Need for Transgender-Specific Training in Healthcare

When you experience discrimination, it’s easy to feel like you’re alone. The very nature of discrimination is isolating: the minority is singled out for insults, ridicule, or poor treatment from the majority, and for transgender people, the numerical difference between majority and minority is huge. A 2011 study put the U.S. transgender population at an estimated 0.3 percent. Although a definitive count has never been performed, that estimate gives a sense of scale to trans people’s experiences as they fight for recognition and respect.

One of the most daunting and pervasive forums for anti-trans discrimination is the health care system. The landmark 2011 transgender discrimination study Injustice at Every Turn reported that 19% of trans people studied had been refused care due to their gender identity, 28% had postponed care due to discrimination, and a staggering 50% wound up educating their own doctors about trans issues. Yet it’s easy for individual trans patients to feel like they’re the only ones being treated this way.

Enter social media. The hashtag #transhealthfail was started by @MyTransHealth, an upcoming website that is building a database of transgender-friendly health professionals. (Their Kickstarter is here – and Philadelphia coverage is among their stretch goals!) The first tweets invited trans folks to share their negative experiences with healthcare providers, and the hashtag quickly exploded.

These posts reveal a daunting, often hostile environment for transgender patients. Some were misgendered, outed, or ridiculed in public:

Others were questioned or dismissed by doctors with narrow-minded or uneducated views of trans people:  

And still others highlighted the serious failings of insurance coverage for transgender people in the U.S.:  

The tweets go on – and to date, they show no sign of stopping. Although it’s terrible to see so many horror stories, the attention #transhealthfail is getting is encouraging. It is my hope that all of these tweets, shares, articles, and replies will spark support not only for political action – the passage of laws that ban discrimination and ensure health care access for all trans and non-binary people – but for transgender-specific training for health providers.

I got involved in healthcare training in 2013, just two years after I started my medical transition. I had previously spoken to college students and activists about transgender identities, but had never thought about addressing the medical community until I was asked to give a workshop at Good Shepherd Penn Partners, a physical rehab center in Philadelphia. They had recently served a transgender patient and were looking for ways to improve future care. I agreed, but the night before the presentation, I was getting nervous. Medical professionals go through years of school and training, I told myself. What could I tell these doctors and nurses that they didn’t already know?

It turned out that I had a lot to offer. The professionals I spoke with were all at the top of their field, yet many of them had never been trained in transgender issues. Every one of these doctors and nurses wanted to do their best for patients of all genders – they just didn’t have a lot of experience with the terminology, the range of identities, and the personal stories of trans people.

After the session, the organizer walked me to my car, and it was clear that the workshop had made a difference for her. “We just never talked about this back in medical school,” she explained to me. “I mean, for a lot of us, our training was ten or twenty years ago. They weren’t discussing these types of issues back then. Just having a vocabulary reference, knowing what to say and what not to – that’s huge!”

As I continued speaking at hospitals and clinics, I quickly realized the difference that a training session could make for both providers and patients. While there are certainly doctors who discriminate against trans patients out of bigotry and fear, I believe there are many more who want to be allies to the LGBTQ community – but they need the tools to do so.

We must champion comprehensive training and professional development for medical professionals – training that prepares them to treat transgender patients with compassion and respect. Of course, this training must start in medical school, but it must also extend beyond the classroom so that we can reach professionals who are already working in the field, and so that providers can keep up to date with best practices.

The best way to avoid a #transhealthfail is to teach our doctors, social workers, receptionists, nurses, security personnel, therapists, and everyone involved in patient care about transgender identities. This is not the job of the patient. It is the responsibility of the institution to seek out knowledge and to better serve the trans community.

Healthcare providers: Please step up and ensure that your staff have the knowledge they need to provide transgender patients with the highest standard of care. Let’s put the #transhealthfail hashtag out of commission for good.

socks on the floor

Packing as Code-Switching: What’s In My Pants, and When, and Why

A guy walked in on me today in the bathroom at work. It was entirely my own fault; I was sleepy, and I had forgotten to click the lock on the single-stall men’s room. He retreated at once, but I had to wonder what he saw.

At a glance, I’m sure I looked no different from any cisgender guy using a toilet. There’s nothing unusual (as I often remind myself) about a man sitting down in the loo — we all have to do it sometimes, right? I could have been any man at that moment, my shirttails rumpled from being tucked into my slacks, my boxers down around my knees, and my tie dangling as I hunched over my phone. My coworker surely didn’t look long enough to register any details. Yet in the sheepish aftermath, I kept wondering: Did he notice the sock?

Yes, there was a sock between my legs.

Let me explain. When I go to work or to certain more formal events, I wear a packer, which is basically a silicone penis. Some packers are functional and may be used as an STP (Stand To Pee) device, or sometimes for sex. My packer is entirely cosmetic. Its sole purpose is to provide a realistic bulge in my slacks.

(Here’s a bit of irony: after going to the trouble of finding and purchasing a realistic packer, one that even matches my skin tone, I wear my packer inside of a sock. This is for purely practical reasons. It’s a lot easier to throw a sock through the wash than it is to scrub silicone, and while I only own one packer, I have plenty of socks to switch out while one is being washed.)

My decision about whether or not to pack for a particular day is usually a question of wardrobe. Wearing a tie and khakis? Put on the packer. T-shirt and jeans? Packer stays home. This means that in general, I am packing 100% of the time at work, and close to nil in my personal life.

When I first started packing, it was because I had just started work as a college professor. I was in the early stages of my medical transition, and though my voice had dropped and my binder kept my chest reasonably flat, I couldn’t yet grow a beard or even male-signifying stubble. I was nervous about standing in front of a class as my not-quite-complete self. My job is to be watched; I have to capture and hold the attention of a group of late teens and early twenty-somethings, and when they’re seated at desks while I stand by the board, their eyes are naturally at crotch height. I didn’t want to risk questions — or worse, whispers — about what was not in my pants.

Yet in my everyday life, I never think about packing. Even when wearing relatively tight jeans, I never consider what people might think of my decidedly not-bulging anatomy. I know that some trans* men use packers to counteract dysphoria, that simply feeling the weight of it helps to ease the profound distress that many transgender people feel when they’re stuck in a body that doesn’t align with their gender identity. That’s not the case for me. I don’t feel any more or less like myself just by wearing a packer; I would never, for example, bother to wear it when I’m at home alone. So why do I feel the need to do it in public, and specifically on the job?

As I transition, my masculine gender expression is challenged much less frequently, and then I start to question the steps I take to reinforce my presentation as male. Some things, like wearing a beard or a tie, I do because I like them. I like the way that facial hair and men’s clothing make me look and feel, and the fact that they are such strong signifiers of masculine identity certainly doesn’t hurt. Other things, though, like wearing a packer and a chest binder, have no intrinsic value to me. These extra bits of wardrobe are uncomfortable and inconvenient; I wear them not because I want to, but because I feel like I have to.

As I thought more about my trans* wardrobe this year, I realized that switching back and forth — wearing a packer to work, then taking it off when I go home and go out with friends — represents a kind of physical code-switching. I alter the dialect of my gender expression depending on the “listeners” around me and how comfortable I feel with them. This is especially evident with my chest binder. I wear it whenever I leave the house for any significant period of time, no matter who I’m with, but if friends come over to visit, they’ll know we’re close if I excuse myself to go change out of my binder and into a baggy shirt.

When I realized how much I was allowing other people’s perceptions to dictate what I wore and how comfortable I was, I felt immediately rebellious. After all, I told myself, what does it matter what students think of my crotch? They probably don’t notice anything. And aren’t there plenty of cisgender men with bigger chests than mine who walk around every day, unchallenged and unperturbed?

I made up my mind: I was going to stop wearing a packer to work. It was silly, I told myself, and was evidence of nothing but my own insecurities. I wasn’t yet ready to give up on the chest binder, but the packer seemed like a good place to start.

On the same day that I steeled my resolve, I met up with a friend and colleague, a fellow transgender male college professor. We were discussing “teaching while trans,” and he told me the story of a time when he had disclosed his identity to a group of students. Most of the students had been respectful, he explained, but one was visibly shocked, so much that she fell out of her chair. She looked up at him and burst out,

“So that’s why there’s nothing in your pants!”

The story had a positive ending — the student kept taking courses with my colleague, and eventually told him how that disclosure had inspired her — but it also shattered my newly-formed resolution. How could I put aside my packer when I was now absolutely convinced that everyone was staring at my crotch?

That’s how it came to pass that this morning, at work, I was sitting on the can with a silicone penis, wrapped in a sock, dangling from an elastic strap around my waist.

The guy who walked in on me probably never saw the sock, and even if he had, it’s unlikely that he would connect the dots and realize that I am transgender. Yet the very fact that I was wearing a packer made me feel much less self-conscious about that embarrassing restroom moment.

I continue to wear a packer in my professional life because it acts as my armor of expectations. When I’m at home or with friends, I can feel very comfortable subverting expectations, especially gendered ones — but at work, I tend to save my fighting spirit for other things. I’d rather challenge students’ ideas about the materials they’re reading than upend their mental graphs correlating “manhood” with “observed penis.”

Sometimes I think that this makes me a coward. In a perfect world, maybe I would toss out my packer, and my chest binder too, and champion a fluid kind of masculinity. But then, in a perfect world, I’d be able to continue my medical transition to my preferred endpoint and render both packer and binder obsolete.

I often think of being transgender as living a compromise. My body doesn’t align with my gender identity; that’s a fact I have to live with. My transition is about making choices that let me express who I am, even imperfectly, and to do that I often switch the language of my gender expression according to who I’m with and what I’m trying to communicate. So for now, I’ll keep packing — it’s just another part of my gender code.

Feminist Sticker

Reclaiming My Feminism

When I finally realized my gender identity around my junior year of college, one of the first things I did was attend a meeting of the women’s group on campus. It did not go as planned.

It was not my first encounter with feminism. I had been taught about women’s liberation all my life. I was raised by a strongly feminist mother who told me horror stories of being required to wear skirts as a child, and who encouraged me to become whatever I wanted, regardless of gender stereotypes. In the house where I grew up, Barbies were unwelcome, and Our Bodies, Ourselves was prominently featured on the bookshelf. Yet in spite — or perhaps because — of these early lessons, I never really identified myself as a feminist. To my younger self, my mother’s feminism seemed historical; I had never been prevented from doing or saying something because of my X chromosomes, so I assumed that the need for action had passed.

As I grew into young adulthood and became more aware of the world around me, those assumptions vanished. I learned about women’s struggles abroad, and also those closer to home — and the more I learned, the more I realized that I was also struggling. I began to recognize and interrogate the gender roles I’d been brought up with, not because my parents had fed them to me, but because I had absorbed them from the larger culture. From fairy tales and movies, textbooks and TV shows, toy aisles and playgrounds, I had picked up the stereotypes to which I had earnestly striven to conform. In those first years of college I realized, with the sudden shock of a cold-water wake-up call, that I didn’t want to wear skirts and make-up and date boys. I had only assumed that I did.

It took more of a push for me to recognize my transgender identity (which is a story for another time) but when I came back to college in the fall of my junior year, I felt electrified by my new knowledge. Ironically, it was the realization that I am not a woman that made feminism and gender studies feel relevant and personal to me. It was in the midst of this giddy excitement that I went along to that women’s group meeting on campus, but I was about to get a shock of a different kind.

I can’t remember the name of the club, nor the discussion topic for that day. I do remember that most of the other group members were also residents of the Womyn’s House on campus, an all-female dorm for students who were devoted to feminist causes. The discussion, from what I recall, was avid and fruitful. It was towards the end of the meeting that I had the opportunity to introduce myself, and it was one of the first places where I shared my transgender identity with others — and the first where I shared it with strangers.

I don’t know what I expected — support, solidarity, encouragement? — but it wasn’t what I got. It could have been worse; I could have been yelled at or ridiculed, or even subjected to violence, as so many transgender people have been. Instead, what I encountered was a sudden distance, with a hint of betrayal.

The women at the club that night didn’t see me as a fellow feminist warrior. They saw a tool of the patriarchy. Why do you want to be a man? they asked me, as if I had just announced to a group of socialists my intention to become a hedge fund manager. Why aren’t you happy being a woman? What’s wrong with women? Why do you want to switch sides? Not everyone said these things, but the ones who did are the ones I remember. To them, I wasn’t a gender pioneer. I was a traitor.

I never went back to the women’s issues club. I still believed in all of the things they wanted to achieve — equal rights, equal pay, respect for women and their bodies — but I didn’t feel comfortable in that group. For a long time after that encounter, I even stopped calling myself a “feminist,” advocating for words like “humanist” or “equalist” instead.

I still consider myself a humanist, but now, more than ten years after that club meeting, I am beginning to reclaim my feminism. For a long time I thought that “feminism” had an image problem, that the word was too scary or too exclusive or too damaged by its enemies to remain relevant. Now I know better, thanks to another word with an image problem: “queer.”

My understanding of the word “queer” has always been a positive one, associated with things like queer studies, queer theory, genderqueer, and the LGBTQ community. But when I was researching the etymology of the word for a presentation earlier this year, I realized how profoundly its meaning and usage have changed in just my own lifetime. If a former slur can become the name of a movement, then surely we can’t give up on the name of the movement that came before it.

The feminist movement laid the groundwork for the gay rights movement, and both still have work to do. So I’ve put the past behind me to say:

I am a feminist.

And so can you.