I’ve been saying, “I was born without a uterus”, which so far seems to answer honestly without directly outing myself as trans.
Any thoughts on how to best navigate this? Ideally without disclosing I’m trans 😅
To any cis people wandering in from c/All, please review the rules of this community and consider you may not have the same first hand experiences as trans people.
Cis people are welcome to participate here so long as they’re not disrupting the safety of our community. Spreading misinformation and maintaining ignorance is not acceptable here.
In an ideal world being transgender would be of literally no consequence. We do not live in such a world. Being trans is life or death across the vast majority of the world. The disclosure of transgender status is a massive vulnerability that is unwarranted in >90% of medical situations.
This thread was not created with this discussion in mind. If it continues to be derailed I will lock the thread.
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I may be wading into a minefield here
You are. And not only that, you’re in a community aimed at trans folk, offering advice to trans folk who are aware of the reality of the situation in a way you very likely are not. That’s not a good position to start from when it comes to offering advice. Doubly so, when your advice appears to be coming from a position of “in a perfect world” rather than from the practical realities that trans folk have to deal with in the world as it is.
I’ve learned it’s actually pretty important for doctors to know someone’s status as trans
As with all things, this depends on the context. Sometimes, it’s relevant. Mostly, it’s irrelevant. And sometimes, knowing causes doctors to make mistakes about our healthcare needs when they incorrectly assume our medical symptoms align with those of cis folk of our assigned genders (this is particularly likely if the doctor is not familiar with trans health care).
On top of that, there is a thing called “trans broken arm syndrome”, in which doctors tend to immediately aim for HRT or transition surgeries as the cause of whatever ailment the trans person has. Again, this is particularly true with doctors that don’t often treat trans patients, or worse, that hold anti trans opinions (even if they keep those opinions private).
Yet, even when it is relevant, telling the doctor can lead to all sorts of othering and exclusion. Sometimes, it’s outright transphobia and misgendering. Sometimes, it’s being isolated from other patients, because the medical staff don’t know how to deal with you. Sometimes, it’s just medical curiosity, where the doctor just wants to ask all sorts of irrelevant questions out of medical/personal curiosity, because they don’t often deal with trans patients.
I live in a very trans inclusive country, with protective laws. I’m openly trans, and wear a trans flag dog tag, and a trans flag arm band. Yet one of the few situations where I won’t openly out myself unless I have no other choice, is when dealing with medical staff who don’t recognise those flags. And I do that, because the folk who don’t recognise the flags are the folk more likely to other me, more likely to be confused by me, and more likely to ensure that my interaction with them is as uncomfortable as possible. And that’s in a safe, accepting country. Imagine what it’s like for folk who live in places where transphobia is not only common, but sometimes legally mandated…
Which is to say, each and every trans person navigating healthcare has to decide for themselves how to walk this tightrope. And general advice of “you should tell them” suggests you’re not familiar with the lived realities of trans folk, despite working in a hospital
The moment I told my psychiatrist I am trans I was denied further care. Your advice is wrong and dangerous. See Ada’s comment for more detail on why.
Edit: For more context I live in Norway where this is highly illegal. I’ve complained to both the hospital and to higher authorities, but to no ones surprise there’s no response yet :)
What are some examples of the biological implications and risk factors? As far as I can tell the only one I can think of (and the only one my doctors told me to disclose) is that I have a prostate, but risks of prostate cancer are very low when estrogen dominant.
Either way, assigned sex is often arbitrary and a can be a poor indicator of the medical situation, e.g. 20% of intersex individuals are trans and may or may not have typical anatomy of their assigned sex. So communicating you’re a trans woman gets misunderstood as “I’m male”, which is not the correct conclusion.
I should also state I obviously disclose my trans status to doctors who are providing care like HRT, or who need to know for other reasons (e.g. a gyno who would perform a prostate exam through the vaginal canal).
But my question is for contexts where it’s not appropriate or necessary to disclose trans status, such as walk-in clinics or ER visits.
I assume you are cis from your comment, but you should know it’s not just the prejudice and mistreatment that motivates not disclosing trans status (whether overt bigotry, or other forms of discrimination like “trans broken arm syndrome”). When you tell someone you are trans, it immediately undoes your gender in their eyes. It can feel dehumanizing, and it also comes with a lot of bad assumptions (e.g. that biologically I’m not different from other men, but also that I must be like a man in other ways, too).
For that reason I find it’s actually better to just disclose necessary information without framing it as being transgender - I disclosed that I was born without a uterus, and I disclosed the hormones I take and in what amounts, etc. which is what they need to know.
EDIT: I should mention, I’ve responded to a similar comment in the past, I’ll throw that inline here for convenience:
click here to expand my prior response
No worries!! It’s true that sometimes there are medically relevant differences, though I don’t think anything was relevant in this instance. Also, my trans status is was in their medical file, and they saw I was on estrogen and could have read that I have gender dysphoria and have medically transitioned. I just think the ER staff didn’t read my file closely, and operated on the assumption I was cis. If I thought being trans could be relevant, I would certainly disclose that, though.
Separately, you should know trans women tend to have brains that function more like cis women’s brains (and become even more like cis women’s brains once on estrogen), so the way drugs interact with my brain would probably be more like a woman’s brain would react than a cis man’s brain, for example.
It’s a similar story with my body - assuming I’m 100% biologically male is the wrong take-away, my body is hormonally female for example. A lot of sex differences are mediated through sex hormone levels (and resultant body composition differences) - but in both of those cases I’m more like cis women than cis men. And this matches my experiences, drugs absolutely absorb, metabolize, and feel different since I have medically transitioned.
Also, my body was different from a cis man’s from birth in other ways, for example I did not go through typical male puberty and I couldn’t grow a beard until my mid 20s. My guess is that I might have mild androgen insensitivity syndrome, which is a common genetic condition in trans women.
Obvious other differences between the sexes with regards to drugs is more about concerns about possibly impacting a fetus in women (hence the unnecessary pregnancy questions in my case), and differences in weight / stature and thus dose. But they were able to get relevant information to make the right decisions (they didn’t give me anything but a single dose of toradol).
Disclosing I am trans in medical contexts is mostly relevant for screening prostate cancer (which is at a much lower risk in trans women on estrogen, not only is estrogen actually a treatment for prostate cancer but male levels of testosterone, one of the reasons prostate cancers develop, are absent), and there is not much else relevant to providers. (That’s actually the only time my doctors indicated I need to disclose that I’m trans, to ensure I get prostate screenings.)
All that said, if you have some information about other instances where those differences matter or situations you think it would be really important to disclose that I am trans, I’m all ears!
EDIT2: another way trans status might impact health is for directing them for certain kinds of care that impact the community, such as testing for HIV, connecting with drug abuse resources, etc. - but that’s rather generic and less of the kind of “biological implications” you mentioned, but it’s an angle I hadn’t thought of before (if we were thinking about policy choices this would be something to consider, but in terms of what I as a trans woman should do, it feels less relevant).
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Do you understand this is a global problem?
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https://piefed.blahaj.zone/post/236212#comment_1057480
Edit: Besides, it’s nuanced. Disclose if necessary. Don’t disclose otherwise. It can cause us a lot of harm as others have gone into detail on to always disclose that we are trans. You don’t know what you are talking about.
Edit: What I have to do in one of those countries you blindly assume is a-okay with trans people is I have to specifically look for doctors and medical professionals that are known for not mistreating queer or trans people. This is stuff we talk about and share with each other all the time. I’m not an isolated case.
absolutely, I have to find everything through the trans community - what dentist to see, my hairdresser, etc. Doctors are some of the most important to be vetted by the trans community first.
how is it vital medical information? what difference does it make?
Just another cis guy speaking confidently over minorities
sure, but the real sin is being confidently wrong, lol
there seems to be real confusion, the main misunderstanding being that trans people really are their assigned sex, it betrays a kind of persistent essentialist thinking
it’s a complicated topic, so I prefer to just invite that nuance - what are the differences? If they’re right and I’m wrong, I’m sure that can be demonstrated - the worst case for me is that I learn something and grow.
These conversations are especially absurd given the fact that women weren’t even included in clinical trials until the 90s, and for the most part medicine still doesn’t even differentiate cis women, let alone intersex and trans people.
What it feels like is like a line is being crossed with cis people when I am a woman in a medical context. They were maybe willing to tolerate I am a woman socially, but the idea that I’m a woman “biologically” is like a third rail somehow, it’s dangerous and against truth, etc.
Consistently I’m told it’s important to disclose being trans for medical reasons, but I have yet to hear why, I never get an explaination that makes sense.
My doctors aren’t even telling me this. Instead I think it’s a kind of acceptable and anxious expression of latent transphobia, a desire to maintain a boundary between the social gender which has been expanded and made open to trans possibilities, and the “biological reality” which must remain fixed.
This is the same anxiety that lead universities to stop karyotype testing as an exercise for students, because so many find out they are intersex who perviously thought they were “normal”. There is incredible anxiety around sex and gender and a desire to see things a certain way, and trans and intersex people complicate that way of seeing.
Telling trans people that disclosing their trans status in medical contexts on the surface seems defensible, but it seems to me that it may be more motivated by a desire to reduce trans people to their assigned sex in medical contexts, which in the end is less about good medicine and more about cis-sexist norms.
A few things.
Firstly, OP specifically said “Ideally without disclosing I’m trans”. Your whole comment was unnecessary first off from the outset.
Secondly, you have grossly overstated medical necessity here. Hormonally trans women who have been on HRT are functionally much closer to cis women than cis men. Trans status is rarely relevant to any medical treatment that isn’t specifically about reproductive organs.
Thirdly, trans status is a matter of life or death in the vast majority of the world. Medical necessity, even if it were as significant as you’ve tried to portray it as, means nothing if you get arrested or killed.
Assuming you’re not a trans woman, nobody asked you. Maybe don’t go blundering into minefields.
This is a vibrant thread that sparked informative discussion about trans people’s interactions with healthcare. None of this would have happened without someone blundering in here and saying something uninformed.
Anyone is welcome to participate in this community, including cis people.
yeah, but I wasn’t asking for cis perspectives on this, and it feels more like the thread has been hijacked and taken a direction I wasn’t intending. It’s making me think having a community where cis voices are not allowed might be a good idea … To be honest, this isn’t the first time this has happened either.
For an ongoing relationship with a primary care doctor or a specialist for a new health problem that my GP has referred me out for, sure. For something like the dentist or an urgent care doctor because I have an ear infection? Absolutely not, I’m not trying to deal with trans broken arm syndrome.
If I have concerns about medication interactions I’ll ask the pharmacist at my local LGBT health center. The odds of there being a medication only cis men can take (for reasons other than fetal health) or that the dosage is going to be drastically different because of my sex rather than my hormonal profile, medications, and weight is vanishingly small.
If I have concerns about medication interactions I’ll ask the pharmacist at my local LGBT health center. The odds of there being a medication only cis men can take (for reasons other than fetal health) or that the dosage is going to be drastically different because of my sex rather than my hormonal profile, medications, and weight is vanishingly small.
I assume by “cis men” you mean “biologically male” (roughly including trans women?), and while this is an idea that hasn’t been revised much in the hospitals, that idea is a bit broken and scientists have moved on from the idea of “biologically male/female”, either way - what I was wondering is what even is an example of such a medication? I don’t know of any medication that would be so different for men vs. women that a trans woman would need to be treated differently than cis women.
Generally the drugs that metabolize differently (or are dosed differently) between sexes (broadly speaking) are going to be the same whether you are a cis or trans woman (assuming the trans woman is on estrogen), because estrogen seems to mediate a lot of those differences.
Can you think of an example? I don’t know of any!
I wrote cis men because I’m a trans man and was talking more about a hypothetical medication that would harm me if the doctor thought I was a cis man and didn’t out myself. But yeah, I’ve never been able to get an answer from anyone on how urgent care is going to kill me if I don’t tell the doctor I’m trans before I get antibiotics 🤷♂️
🤦♀️ sorry about that mixup, I hate it when I make bad assumptions like that 😬 also, glad you’re here!
and yeah, I have no clue either … I’m open to being wrong, but my doctors aren’t telling me I need to disclose I am trans. To the contrary they seem to indicate I shouldn’t, and were clear the one exception was to get prostate exams past a certain age, a concern that is suspicious, and may be a bit misinformed, considering it is based on the assumption of risks from male levels of androgens. I have a relative with prostate cancer currently taking medication to block androgens to treat the cancer, for example …
Though I am in the U.S. so my doctors might be more concerned about my disclosure given the context. I was also at the time getting care in one of the worst anti-trans states.
Yeah. The best way to lower risk of prostate cancer is to lower testosterone levels. And the best way to stop it growing if you do develop it, is to lower testosterone levels, and add estrogen. And they rarely, if ever choose surgical intervention when it comes to prostate cancer. So, despite being at the age where a cis man would have to start thinking about this, it’s not something I plan on investigating, given that I’ve got a reduced risk profile, and I’m already on the same medication they use as treatment…
right!? I find it so strange they are treating my prostate like it’s in a cis man’s body … one guess is maybe the time before transition adds risk because there was exposure to male levels of androgens? But then … I’m already on the treatment for prostate cancer … something just doesn’t make sense here and it feels like blind policy being implemented on the assumption that I’m “male”, exactly the kind of mistaken view I don’t want to perpetuate by disclosing I’m trans.
No worries, this is literally the transfem community!
And yeah, I get all the relevant exams that my GP (who I’m out to) thinks I should get, I disclose what medications I’m on, beyond that it’s my discretion because it’s not their business.
hypothetical medication that would harm me if the doctor thought I was a cis man and didn’t out myself
Not that I’m accusing you of anything, but this is a hypothetical that I hear a lot from transphobes (ie, "would you take the medication only for “biological” men / women despite being a trans woman / man? If so, ha ha! You admit to being your AGAB really. If not, ha ha! You die).
Other than questions of what anatomy is physically present, I’ve never heard of (and sincerely doubt the existence of) any case where birth sex is relevant.
Yeah, I say hypothetical medication because as far as I can tell it remains that. Medicine is complicated enough that I’m not willing to rule it out as inherently impossible, but if such a thing exists I doubt we even know about it, given the sorry state of medication trials with regards to treating cis men as the default human.
Finding new doctor is the worse experience every.
Here in public health your town gets a few of them, and you can only change between those.
The procedure takes days, more days to take new appointments and then to suffer the issues again.
That is really shit. You get no spoons to even start again.
I don’t pass so “never lol” usually works for me.
lol, if you don’t pass they don’t ask you the question, silly 😝
You’d be shocked, but it does happen sometimes (nurses, through force of habit).
Usually just say something like I wasn’t born with them because of genetics. I mean technically true. Although not sure if it would work in states that are really anti trans. But using the nurse just usually continues like it’s nothing. But fyi my medical practice isn’t really transphobic so just fyi.
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aw, I didn’t get to see what you wrote :-(
Woops, sorry! I got immediately multiply downvoted 100%, I haven’t posted in this community before so not familiar with the culture, and even though I thought my response was relevant, it didn’t look like the community was interested in such an opinion, so I withdrew my post. I said something like that unless I am literally there do get tested for a suspected pregnancy, I would tell them it’s none of their business, or more politely, “given the current political climate, I do not answer questions like these”. Thanks for checking up on me!
This community is hosted on blahaj, an instance that disables downvotes. None of us locals have the option to downvote, nor can we see downvotes. Apparently other instances can downvote and those do federate to instances that enable it. So if you’re being downvoted, its because people from other instances disagree with your statements. Downvotes are not a indication of this community’s opinions. We can only disagree through replies.
I appreciate you restating your comment. We’re happy to hear from you!
this is helpful context, thanks for raising awareness 😊
oh, huh - yeah, it is pretty scary that women are asked about their periods - esp. the way that information can be used in an increasingly political campaign to criminalize women and surveil pregnancies. Only makes it worse that it’s a question that might out me.
Still, I get that the doctor needs to know if I am pregnant or could be pregnant and not know it.
Agreed! That’s why I much prefer the “Is there any possible way you could be pregnant right now?” phrasing. Which is straight to the point of “we are about to operate on your abdominal section that could cause fetal loss if we are not aware of it, assuming you care about that sort of thing.” But if you are getting the period question, then it’s just a nurse checking off a box on an insurance checklist when you are there for an ear infection, and 100% of the time it is not relevant then.
it’s interesting because in the ER I was asked “is it possible you could be pregnant” and I simply said no, and that was easier than trying to explain why I don’t have periods. I even had to correct a nurse who assumed I had a hysterectomy, I had to re-iterate that I was born without a uterus.
Should note that transfem people can and do get periods too, if they vary with their E levels a bit. It’s just not the bloody kind, but you do get the muscle cramps ('cause those in cis people are also around the uterus as well) – and the symptoms with it.
period cramps in cis women are due to prostaglandins causing uterine tissue to contract, which obviously isn’t possible in trans women.
However, trans women on estrogen can experience cyclical PMS symptoms, so it’s not totally unfair to say there is some overlap with periods that way.
I also suspect there can be bowel discomforts during the PMS that get conflated with period cramps, so that makes sense too.
Obviously trans women don’t experience period cramps in the way cis women do, and don’t have menstruation.
