When I was growing up, RuPaul was all I knew of transgender anything. She was tall, flamboyant, charming, and I would look at her and try to see the man underneath the drag. I didn’t know the definitions of drag and trans, gender identity and intersex, ambiguous genitalia and gonadal dysgenesis.
Now that I’m a physician, I see transgendered patients on a regular basis — unfortunately, it’s usually in the setting of a positive HIV test. I can see the difficulty they have in filling out medical forms that ask only “male or female.” Our electronic medical record system, for example, will list the biologic sex and their legal name. Thus, my female transgender patient runs the risk of being called, “Mr. Smith” when she waits for her lab draw in the hospital lobby. These are things that cisgender people, like myself, don’t worry about or even think about. We are usually just hoping our names are pronounced correctly.
A 2010 report showed that 50 percent of transgendered people have had to educate their physicians on transgender care. That’s embarrassing to me as a physician. It’s one of the reasons that 28 percent of transgendered people surveyed had delayed seeking medical care. In this same survey, 41 percent of respondents reported attempting suicide. This is not just thinking about or suffering from depression. This is an actual suicide attempt.
One of the most disheartening things from this report was that if the physician knew that the patient was transgendered, the rates of discrimination increased. 22 percent of male-to-female patients reported being refused medical care outright. This is in the medical community, where we are called to care for all people, where we are taught about ambiguous genitalia and gender identity. Within the broader medical community, the American Psychological Association issued guidelines a few years ago on how psychologists can help in the care of transgendered patients. Their first guideline is that gender is not a binary construct (male or female). They cite the Institute of Medicine’s 2011 publication that, “Gender identity is defined as a person’s deeply felt, inherent sense of being a girl, woman, or female; a boy, a man, or male; a blend of male or female; or an alternative gender.” It seems the medical community at large is waking up to our role in this important arena. The New England Journal of Medicine recently published a piece on how denying a transgendered person the right to use the bathroom of their choice can lead to important medical problems, such as dehydration and renal insufficiency, urinary tract infections, and stool impaction.
With these so-called “bathroom bills” taking center stage in our country, I thought of my young, female transgender patients. I thought of what that would look like, a beautiful young woman walking into the men’s room at a high school or government building. I thought about how embarrassing that would be for the men using the restroom, for her walking to a stall to urinate, for people outside the restroom seeing her walk through the “wrong” door. Imagine Laverne Cox going into the men’s restroom. It’s a ridiculous picture. It’s much more natural for her to go into the women’s restroom, freshen up her lipstick with the other girls, and go on her way.
Transgendered youth are especially vulnerable. This is their time of transition. This is when they come out to parents, peers, teachers and coaches. It’s when adults — who used to have the answers for everything — are suddenly uncomfortable and unaware of how to move forward. It’s a time when they need support and recognition. Recognition of their value as an individual, and recognition of their gender identity. Bathroom bills fail to do this. They relegate these youths to unisex bathrooms at best and force them to use cis bathrooms at worst. It sets them up for bullying and violence.
Missouri, my home state, is looking at a bathroom bill, along with Texas. The Trump administration has rolled back the Obama administration’s guidance for schools on how to best meet the needs of transgendered students in this regard. Thus the Supreme Court, which was set to hear a case around this very issue, they have pushed it back to the lower courts. These decisions, which are now in the hands of individual states, will have lasting implications on the lives of our patients. I believe it’s on us, as a society, to provide a safe place for people to do the most basic of human necessities. I, for one, thought we had put the issue of bathroom rights to rest after the Civil Rights’ movement. It’s extremely disheartening to see history repeating itself.
Erica Kaufman West is an infectious disease physician.
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