In this, the era of cross referenced computers where doctors and specialists alike can access your medical records from the same database in order to assure they are fully informed of your various diagnosis, treatment, allergies and even test results, they’ve given access to you, the patient.
Nowadays, you can see what that Doctor was scribbling on his medical pad as you revealed your most personal health concerns. You can log in to see your medical history, track your cholesterol, even make appointments via this patient portal program which is used to make sure all of your physicians have the same information regarding your medical history.
I always considered myself pretty educated when it came to my own health. I never bothered logging into the Patient Portal given the fact that I knew I was a mess. Years long battles with depression, crippling anxiety, panic attacks, social phobias and MTFHR; A genetic disorder inherited from both of my parents rendering me incapable of breaking down certain amino acids- that would all be there. So would the occasional health blip- a sprained shoulder; Colonoscopy and Cystoscopy results. Certainly, there would be no surprises. Right?
I’ve had the same doctor for 20 years and he’s a splendid man. Although he’s what we might call a typical “Band-Aid” doctor who doesn’t bother with things like examinations- in fact I can’t recall the last time he’s physically touched me. I’ve come to expect this as my normal. Although he usually misdiagnosis’s me, I’ve grown diligent enough do my own research or seek out specialists in the afterglow of an unsatisfactory appointment. Usually, it proved justified. His diagnosis of a sprained shoulder turned out to be a torn rotatory cuff. His diagnosis of a urinary tract infection turned out to be a urethral stricture.
Often, I have to be my own doctor, or, alternatively, aggressively pursue a diagnosis for an ongoing condition via a specialist- or multiple specialists because it’s a bit like Russian roulette. My experience with medical Professionals have been largely the same. They come in expecting to see a man, due to my government name. Instead they see me. Immediately they are confused and uncomfortable. They stand in the corner of the room, nodding rapidly but not listening as I try to explain my reason for being there. They prescribe me something and send me home. There is no friendly banter, no polite handshake, no physical interaction. Regardless of my complaint, they don’t want to touch me. They want to get out of the room as fast as possible. I knew it was because of my gender nonconformity. I respected, perhaps to my own detriment, that they had no idea how to interface with me. I was an anomaly to them. An alien.
In December of last year, I posted about this on facebook prior to a procedure.
Only recently did I decide to take a peek at my Patient Portal records after receiving an email alerting me that new test results had been added. I’d had bloodwork to retest my chronically elevated homocysteine levels that leave me predisposed to blood clots, heart attack and strokes.
I peeked around at my various conditions listed in a neatly organized table, and one of them startled me.
To provide some background, in 2005 I visited this Doctor to disclose my gender dysphoria. After years of research, education and advisement from close friends in the Trans community, I felt it was time to consult with my physician. I was terrified on the day of my appointment. The fear of being judged, rejected, thrown out of the office for being, what I had come to acknowledge many people believed was a derelict. It didn’t happen that way. Instead, I spoke while he sat silently and listened and then he wrote me a prescription for high-dose estrogen and spironolactone, a testosterone blocker. This is a common tonic for Transwomen who begin transition in order to feminize themselves over a period of time.
I took my medications home, put them in a closet and didn’t take them immediately. This was a huge life decision that was irreversible. I needed to research the side effects of the medication and make certain that I had the fullest confidence in proceeding. I learned that Spironolactone increased risks of blood clots (DVT) heart attack and strokes. High dose estrogen (Premarin) presents some of the same potential risks. As I am already predisposed to these conditions given my genetic defect, I opted out. I decided not to medically transition. The risks were too great, for me in particular. I would have to learn to love myself as I was, but still be authentic in how I present.
I made it clear to my doctor I was Transgender. I was given medications to reinforce that he agreed with the diagnosis. Despite this, in my medical chart, which would be seen by every single specialist and doctor afterward would take note of his erroneous entry: Transvestic Fetishism.
Now, for the sake of full clarity, this is how Transvestic Fetishism is defined:
A. Over a period of at least 6 months, in a heterosexual male, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing.
B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if: 
With Fetishism (Sexually Aroused by Fabrics, Materials, or Garments)
With Autogynephilia (Sexually Aroused by Thought or Image of Self as Female)
According to this diagnosis, which refers exclusively to Heterosexual men and women, of which I am not, I dress in female clothing for sexual kicks. According to the Wikipedia definition, it indicates that I “…have an excessive sexual or erotic interest in cross dressing; this interest is often expressed in autoerotic behavior.”
While I don’t think that anyone should ever have to be in a position where they must justify their sexual activity, nor do I believe someone who is more active than another should by any means be embarrassed or ashamed, I, specifically have had two monogamous, long term relationships. One was 11 years and the other was 5 years. I have never been promiscuous, and most certainly did NOT require female clothing to manifest arousal. In fact, I’ve always been envious of people who had the confidence to be more sexually liberated. If I did not experience the self induced paranoia of warts, herpes, gonorrhea, crabs, or any other tonic of sexually transmitted diseases, as well as my own body image issues, I’d happily engage in a much healthier, active sex life. Instead I have 7 cats and sit at home on weekends.
I celebrate diversity and consider myself an activist for the LGBT community, including people who don’t conform to gender norms. That includes people who self identify as Transvestites, or leather daddies or sex workers. No one should be ashamed of who they are in public or what they do behind closed doors with another consensual adult.
The problem is, this diagnosis is not me. Every doctor who has ever cross referenced my medical records has seen this in my file, and I believe that it has contributed to the highly uncomfortable interactions I’ve had with those in the medical field for years. It has created a narrative that I am a straight CISgender male who dresses in women’s clothes to sexually satisfy myself.
The reality: I don’t need to dress in women’s clothing to be viewed as a woman. I look like a woman. Even in sweatpants and a T-Shirt, I look like a woman. Every day, despite my attire, I’m referred to as She, Miss, Her and Ma’am. Indeed, my appearance contradicts my name, which has caused medical practitioners to be at once both confused and embarrassed. Last year, as I was escorted to get an X-Ray while wearing one of those chic hospital gowns, I’d had multiple staff think I was the wrong patient because of my male name contradicting my female face. It had happened so frequently that I took a video waiting for it to happen again, and it did:
Sure, it’s a little demoralizing when you have to disclose to a doctor or nurse that your body design presents as Male, but I’ve always found its far more embarrassing for them than it is for me. I’ve grown a thick skin and learned to navigate these circumstances with kindness while maintaining my dignity. However, I don’t have to correct, say, the cashier at Costco, or a a waitress at Applebees because they’re simply acknowledging who I am and how I present. I am a woman. Those in the medial field, unfortunately, need a little more information about you in order to pursue an accurate diagnosis. I can’t tell you how many times I’ve been asked by a doctor or nurse if I could be pregnant before having to say, “I don’t have a womb. I’m Transgender.”
I find it problematic that my general practitioner gave me a psychiatric diagnosis- an inaccurate one at that. That it potentially subjected me to the prejudices and ignorance of other Medical professionals who viewed my patient profile feels very unfair. A lot of interactions over the years where I was left feeling rejected, dehumanized, even humiliated by a physician makes more sense. Like the time I went to the emergency room for urinary problems and the doctor insisted- didn’t suggest- insisted that I had an STD. He made this assessment without conducting any diagnostic tests or examination. He asked me no questions about my medical history. I argued that I wasn’t sexually active; That I lived with cats and watched netflix for years. He wasn’t listening. Instead, he threatened me, saying if I didn’t take his antibiotic injections to treat gonorrhea despite no evidence, he would give me a urethral swab that he promised “Has made grown men serving in the military cry.”
I left the hospital the minute he walked out the door after feeling coerced into accepting antibiotic injections for a condition that was impossible for me to have. It turned out to be non-bacterial prostatitis, likely due to lack of sex!
Why am I telling you this story? This amplifies a greater problem in the medical community. Doctors do not know how to engage with- or treat Transgender or gender diverse individuals. While Transvestite fetishism is a real thing, it is wholly inappropriate and negligent to use this to define a Transgender woman. Being Transgender has absolutely nothing to do with sexuality or sexual preference., although my diagnosis implies otherwise.
This year, President Donald Trump, in his ongoing attack against LGBT Americans, in his overhaul of the Health and Human Services Civil Rights Office, has legalized discrimination against Transgender identifying men and women. Doctors can now refuse to accept us as patients or treat us for medical conditions citing religious or moral objections. This comes on the heels of Mr. Trump banning the word “Transgender” from any dialog or research from the CDC to the White house. Already, there is a huge chasm between Transgender patients and medical professionals who lack training and experience when interfacing with us, as my case demonstrates.
Now, they don’t have to treat us at all. And although this may sound controversial, I don’t mind.
As a Transwoman who has experienced intolerance from someone intended to help me, I’d rather be turned away at the door rather than be (mis)treated by a physician who discreetly resents he has to. Similarly to the emergency room doctor who wanted to hurt me, specifically to have the privilege of doing so after accusing me of having a sexually transmitted disease, many doctors and nurses treat us Transgender people with the same personal moral outrage or sheer disgust by our bodies due to their own internalized phobias. They associate us with sexual deviation. With respect to my own safety and health, I’d prefer a Doctor decline to see me and give me the opportunity to find one who is open to, or experienced with, treating a Transperson. I’d prefer not to have my insurance pay a bigot who refuses to touch me, accurately diagnose me or who is not interested in my physical wellbeing. So, if God is telling them I’m an abomination and they’re secretly cringing and praying for forgiveness, calling on the spirits as they feel forced to sit in the same room with me, I’d prefer to spare myself the dehumanizing consequences of tempered bigotry.
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