Trans Health Crisis

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I'm sitting in a cardiologist's waiting room filling out my intake forms. The tip of my pen hovers above the ubiquitous binary boxes. Female or male? I was born female-bodied and I identify as female--as a lesbian butch. However, some people see me as a feminine male. And whether they guess male or female, I am always perceived as "queer" because my gender expression is very fluid and complex. I am transgender. Which box do I check to get the medical attention I need so badly right now?

I sit here recalling recent studies showing that females my age are more likely than males to die from heart attacks. The symptoms of females are not necessarily the same as those of men. Distorted through the lens of sexism, these symptoms are often not recognized or taken seriously enough. I consider all this and decide to check the "F" box, hoping the doctor will take my birth sex into account in listening to my cardiac symptoms.

One of the 2 women at the front desk takes the clipboard and flashes me a generous smile. "Have a seat. sir." Minutes later she calls out, "Miss Feinberg, do you have insurance?" I stand up; she looks bewildered. To her credit, she recovers quickly. She goes out of her way to be warm to me.

I sit back down and leaf through a magazine. The other woman at the front desk explodes in derisive laughter. She comments out loud about a patient's records: "Do you know what's on this man's chart? This man had a breast biopsy!" She snorts and snickers in a mean-spirited way. Everyone in the waiting room can hear her.

You may be appalled at that breach of patient confidentiality. But as a transgender patient, I have another take on it. I hear her backwardness about sex and gender variance, and I hear her intolerance. I feel more fearful about this appointment today. My reluctance isn't just because of how I might be treated by the front office staff. I dread seeing a physician because of a lifetime of experiences.

Five years ago, while battling an undiagnosed case of bacterial endocarditis, I was refused care at a Jersey City emergency room. After the physician who examined me discovered that I am female-bodied, he ordered me out of the emergency room despite the fact that my temperature was above 104oF (40oC). He said I had a fever "because you are a very troubled person."

Weeks later I was hospitalized with the same illness in New York City in a Catholic hospital where management insists patients be put in wards on the basis of birth sex. They place transsexual women who have completed sex-reassignment surgery in male wards. Putting me in a female ward created a furor. I awoke in the night to find staff standing around my bed ridiculing my body and referring to me as a "Martian." The next day the staff refused to work unless "it" was removed from the floor. These and other expressions of hatred forced me to leave.

Had I died from this illness, the real pathogen would have been bigotry.

I could recount many terrible incidents that illustrate the various ways hostility to trans patients is conveyed. This is not my individual problem; it is a widespread social crisis. You may have heard of Billy Tipton, a well-known white jazz musician who died of a bleeding ulcer in 1989 rather than see a doctor. After his death, lurid headlines revealed that he had been born female-bodied.(FN1)

In 1995, African American hairdresser Tyra Hunter was in a car accident in Washington, DC. Eyewitnesses reported that rescue medics suspended treatment and made ridiculing remarks after they cut open her pants to treat her and discovered she had male genitals. Onlookers shouted at the medics until they took her to the emergency room, where she died. Hunter's mother won a wrongful-death lawsuit against the District, in which the jury also ruled against the emergency room physician for failing to diagnose Tyra's injuries and for not following nationally accepted standards of care.(FN2)

Everyone who is living in a sex other than the one assigned to them by a stranger at birth, or who is born on the anatomical spectrum between female and male, or who cross-dresses, or who is perceived as a feminine male or masculine female, or who is gender-ambiguous or gender-contradictory, can most likely recount similar horror stories. As a result, many of us fear contact with health professionals.

Too many of us have already died unnecessarily, have been turned away from a doctor's office or a hospital, or have delayed pursuing preventive or emergency care because of previous mistreatment. And many individuals who are socially identifiable as transsexual or gender-variant are so marginalized by oppression--specifically, in the workforce--that we lack health insurance and a primary care physician. Those who do have insurance often cannot afford health care plans that allow us to choose our own doctors. Then, trans patients hesitate to go to HMOs and start over each time with a new physician who might be hostile.

There are also many people in this society who may not identify as trans but who have been humiliated because of some perceived difference in their secondary sexual characteristics or because their mode of self-expression is not considered "man" enough or "woman" enough. All of this shaming drives people underground. As a result, there is no way of knowing how large a segment of the population avoids seeking health care because they have been wounded by sex and gender oppression.

BEYOND PINK OR BLUE

How the term "trans" is defined, and by whom, will shape the approach of public health to our population. Many communities--representing a spectrum of sexualities and a wide range of individual identities--march under the banner of trans liberation. And transsexual, transgender, and intersexual people can be found in every economic class, nationality, ethnicity, and region.(FN3)

Broad generalizations about gender and sex will oversimplify this manifold segment of the population. A female who is considered feminine in her rural community may find herself harassed on urban streets for being too masculine. A Latina drag queen who has lived homeless on the streets of Manhattan since she was 10 years old does not experience the world in the same way as does a white heterosexual male who owns a corporation and cross-dresses several times a year at private parties.

I would recommend that public