Carto's guide to doctors treating trans women

It can be summed up in two words: be careful, and please try to warn before you ask about really intimate stuff. Genitalia and trans, for example, being "really intimate stuff".

There's a background to this, obviously; I got a nice, yummy cystitis the other day (die e. coli, die) and had to see a doctor. My usual GP wasn't around (bless him, he needs his vacations, too), and so I took the first doctor I could get. Now, as I'm sure y'all know, cystitis means an infection is having a party in your urethra, you need to pee like mad and it stings and it's all very nasty, really. You need to see a doctor. DIY-ing is not an option, even though cranberry juice can help. You don't want any nasties in your urethra, and you definitely don't want them in your kidneys. And also, you having a trans background, it might be it's got something to do with surgeries - not very likely if it's been years and years, but it might; and the doctor sure as hell won't know, unless you 'fess up.

Trouble is, I hate explaining my background to people. It's a vile affair, and there's no way to make it comfortable to me. So. When the doctor asks me (he's very polite and affable and all) if I'm on any meds, I tell him I'm on HRT. I take a calculated emotional risk. He proceeds to ask the specific meds (I start getting uneasy at this point because I can tell where this is headed, right there, right then) - I tell, and start cursing silently to myself for telling. He then proceeds to ask me if this is because of trans. Which feels just about horrible, and I feel like I've been stripped naked against my will. I fumble on about it, get the prescription for an antibiotic (well duh, an UTI is an UTI, and my symptoms fit the description to a T).

Afterwards, I feel violated. Yes, I know, I'm sensitive, but blow me, I am. And I don't feel that's really to be faulted; I've had to explain this trans stuff against my will to a number of doctors in order to get the treatment I needed. It's one pact with the devil - yeah, you get the treatment you desperately need, but the price is that you need to play by their rules, and the rules for women brand you as trans: slightly off-the-rocker, pathetic/deceiving (take your pick, girl!) mental case. This seems to be considered as a permanent feature, even when you've gotten all the treatment you wanted and no longer fit the diagnostic criteria.

I took up this experience (it wasn't an experience from hell, but it was nasty - I'm not used to being identified as trans without my prior consent; the last time it's happened must've been, I dunno, like a decade ago. Yes, I'm one lucky, and healthy, bitch.) with him later that day, and sent him an e-mail describing my experience of the visit. He called back, explained stuff and, well, he's ok in my books now.

In retrospect, what I think he could've done differently is at least give me a warning he's going to ask me an extremely personal question. That might've given me some time and mental space to prepare myself. My rationale for this is that there's really no universal solution to asking about genital configuration; while I'm able to produce more-or-less precise information on mine, I'm pretty sure most people aren't. A question about genital configuration would simply be unintelligible to them, and asking, point blank, if you've got a penis, a vulva or something else is potentially just as invasive (or maybe even more) than asking someone about trans. I would prefer such questions, but I'm pretty sure many more people couldn't take it. And there's no way for the doctor to tell as far as I understand it.

Self-censorship

or, why it is so difficult to be an outspoken trans woman even within the feminist blogosphere

It's pretty obvious it is difficult to be thus, isn't it? It's not like there's hordes and hordes of us to start with, and even less who are willing to engage with the feminists (or anyone, for that matter) after our transitions are done and dealt with.

Firstly, there's the age-old issue of out/closeted, which is not the same wrt cis/trans axis as it is for people along homosexual/heterosexual -axis (which I consider to be a bit of a ruse, but I digress). Speaking from the position of a trans woman is fraught with difficulties: there's always the old transphobic tropes (for a list, see QT, under Trans 101), the endless derailing and decentring of trans concerns, but, and I think this is even more important, there's a real risk of humiliation, ostracism and violence, not only in the academia/blogosphere, but in the meatspace we live in. Woman's trans status can, and is often used to beat her into submission. "Outing" someone as trans puts the woman thus outed at risk. If you don't believe me, just dig a bit at your local newspaper archives and see for yourself how trans women are depicted. There are a number of common features: there's the degendering by the use of her old name; printing pictures of her forcibly masculinised* is pretty common, too. All that is simply crap one doesn't want to deal with, and while silence is quite a price to pay for avoiding that crap, it's pretty understandable.

Secondly, because of our rather unprivileged pasts with regards to feminism, women's studies, gender studies, queer studies and what have you (no, in case you were wondering, those fields did (and maybe do) not welcome trans girls into the fold of feminism and queer: trans girls are more often than not gendered as boys, or men, and are hardly given the same space to explore their sexes and gender the way female-assigned-at-birth -people are. Cissexism does not stop at the door to academia.

So, when I look at the queer studies I do recognise the stuff there is pretty vital to my thinking, but I also feel I'm not welcome. I feel the thinking I do is rather far from the atmosphere they're breathing, and while I do think there's value in my perspective, I find my perspective hard to communicate and possibly triggering hostile responses. I'm not always up to that hostility.

I'll write another piece on my perspectives - at least I can give them a home here.

In short, I don't believe the binary system at all. There is gender, but there's a lot more of them than two. I think lesbian woman is a different gender (and maybe sex, too) from heterosexual woman. I think femme is a different gender from butch, or from heterosexual woman. When I use words like "woman", "man", or "heterosexual", my mind has to make these somersaults to translate what I'm thinking into cis-ese. I think of sexualities in terms of attractions: what do you like? If you like snogging bearded men, you're "snogs-bearded-men-sexual" for all I know. If you're a bearded man yourself, more power to you, but it doesn't mean squat as far as your attractions are considered.

The violent game which cises play with genders makes me sick. I don't want to play, but fucking up the system totally has such a high price I cannot pay it on my own, and not playing is not an option. I play, but not willingly. I play 'cos cis men might smash my face in for not playing, for telling it like it is - that cis boys and men brutalise trans girls and women and force them (and yours truly in the past) to pretend to be boys and men. I play 'cos cis women might simply dump me for not playing. I play 'cos it seems to be the price of admission into the society of humans, and I cannot survive on my own.

But in my heart, I want to smash the cisarchy.

[ETA 21:36 EEST: * forcibly masculinised: this what the cises might call "when she was a man" Trans girls and women do not choose to be assigned and raised as boys and men - it is forced. It's not voluntary, and very often, violence is used to enforce compliance.]

Out and closeted

This was the second thing cis lgb individuals had a hard time understanding. Being out as trans is different to being out as a lesbian, say. Both can be dangerous, true, but they're not even remotely the same if you happen to be binarily gendered, like I am.

It's 'cos I don't feel particularly trans, and I'm not probably even remotely genderqueer in any way. My sexuality's queer, thank you very much, but my gender is woman, and my sex is female. There isn't anything special there. And being out about the history of my body is, frankly, a completely ridiculous thought. The only people who really need to know are the people I have sex with, if the said sex would involve something a trans body is not capable of, and a cis body is capable of, or if my personal history is really relevant to the things I'd be doing with my lover. It might, but it's my call - after all, I'm responsible for my life, health and all such, not anyone else.

And as to being queerly sexual? Well, it's not much good being out about that, either, 'cos I'm monogamous, and partnered with a woman, which means I'm effectively read as a lesbian, and it's not too wrong - I really do love women and all that lesbian stuff, and again - why should my queer sexuality concern other people so much 'cos I'm not gonna be doing it with them anyway? And if I am - let me tell you, I can open my mouth and say what I like.

But being out as a lesbian? I think I do that as a matter of course. The sex/gender of my partner's no secret, and the fact that we have a, erm, carnal relationship can't really be missed by anyone who's seen us together for more than a few hours. It's no big deal being out with that, 'cos it's something anyone can see - I don't have to go out of my way to explain it to anyone (ok, there are those odd people who just don't get it that two women kissing each other on the mouth is, like, homosexual, but they're beyond my help anyway) - they can just see all of it in action and that's that.

Whereas my trans past/trans body needs a whole encyclopedia of explaining that almost no-one really needs to know, and can't figure out on their own because it doesn't change things for them in any practical way unless they're having the transphobic cooties.

So. I think when well-meaning (or not) cis homosexual people want someone trans to be out about their cis/trans status, they're really wanting that trans person to be a miner's canary for transphobia. Of which the cis people themselves don't have to suffer any consequences. So it's kinda unfair, and I'm not playing along.

It's also about establishing and maintaining practical power differentials: it's about keeping us uppity trans women in our place: Lord forbid what'd happen if we were just taken to be regular people with control of our lives. If cis people aren't constantly reminded of my past they tend to slip into the realisation that I actually am a woman, which is kind of a tacit acknowledgement that all that sexing-at-birth went titsup anyway, and doesn't really work. Which destabilises cis sexes and genders quite a bit, because if sexing went wrong with me, what's stopping it from going wrong for everyone? It also puts the cis on equal footing with the trans, which might be a bit unsettling for the cis, too - no "other" to define yourself against.

Oh yeah, and if you're cis and don't like being called cis - tough titties. I didn't choose to be labelled as trans, either.

The stress of not being cis

It's not stressful because of the oddities in my biochemistry. It's not because of surgery. It's not, even, because of the disturbing memories. It's because cises won't let it lie.

It's because they keep on picking the scab and the new skin that's forming underneath, because they reopen the wounds I've been trying to close all my life. It feels like cises are deliberately trying to bleed me to death and stop me from trying to stop the bleeding.

The logic goes like this. I hurt because my biochemistry and some bits of my body and some legal details are simply all wrong for a girl. I have them fixed, am happy as a clam. But cis people won't let it lie there. They want to talk about it. They want, specifically, talk about the mistake they made in misgendering me as a boy, and keep on talking about it, and probably feel cuddly'n'everything about having given me the chance to transition, but they won't admit they've made a mistake in gendering me as a boy. It doesn't matter if all the evidence points in that direction, it doesn't matter that the sex hierarchy doesn't work in many other cases, either, it's like if the facts don't agree with the sex hierarchy, so much worse for the facts.

In short, I feel like I'm treated as a deluded loonie who's given what she insists on having because she'd be way too much trouble otherwise.

The cises don't want to forget. It's all so fascinating from their point of view. And many, too many of them really do think the problem is me, and my mind, and not my body and their minds, even though it's precisely my body, and their minds, that've been fixed. Except they actively resist the fixing, 'cause they can't see anything much wrong in assuming that gendering and sexing is as simple as A, B, C. I, and many other people, are, of course, living proof of that not being the case.

I can't help being the living proof. And I don't find it acceptable that I'd have to accommodate to cis majoritys' prejudices and phobias, I don't want to play along. Playing along has too high a price. Playing along would mean I'd have to give an account of myself to any passers-by who feels like questioning. Playing along means accepting people having my personal life and intimate details of my body as coffee-table talk. It seems rather, um, unfair to me that I'd be required to give in to that whereas none of the cises has to. They have a right to privacy. I should, too.

Lack of privacy is the main stressor for me. My past feels like a huge millstone that I can put away whenever cises don't know I'm not cis. But some cises who do know seem to need to tell other cises, as sort of a warning that I'm not cis. And I can tell it, from the looks of the cises who scrutinise my looks, my voice, my mannerisms - it's like being on display for the cises. It makes me even more self-conscious than I already am. Cises run around and find the damn stone and hoist it around my neck again and again. I'm not asked, of course.

It's not like I have a solution. I don't. But somehow I'm gonna get this stress out of my system, and I won't take just accepting it as an answer - cises don't have a right to treat me like this. They don't treat other cises this way, either.