‘Are you a man or a woman?’

As part of our focus on gender identity issues, here we’re looking the some of the experiences of trans men and women when accessing primary care; while some spoke of good relationships, many had serious concerns about their encounters with healthcare professionals

This is an edited version of an article which appeared in The Guardian.

Being outed by healthcare professionals

Francis, a 23-year-old trans man, was outed to other medics by his GP. “I needed a referral to a neurologist and ended up having a brain scan. The referral to the neurologist mentioned that I was trans,” he says. “I admit there are times when you might have to mention it – otherwise it’ll be confusing – but I don’t think a brain scan is one of those times.”

Win Wyatt, an 18-year-old trans man, was told he needed to come out as trans to his parents before receiving any further help. Getting hold of prescriptions, he said, could be difficult; one situation at a pharmacy involved having to disclose he was trans in front of a queue of people.

“It was the pill,” he said. “I was stood at the counter for an hour and a half because they were very confused as to why they were giving me this medication because my biological gender marker, or whatever, was not marked on my prescription and my name was ‘Winston Wyatt’. And they were like, ‘This is not for you,’ and I was like, ‘It is, it is for me, actually’.”

Hostility and a lack of education on gender issues

Ali Brumfitt, 45, who identifies as gender queer, went to the doctor to talk about difficulties relating to the menopause. But the GP insisted that Ali explain whether they were ‘a man or a woman now’. “I was like, ‘Well, I was assigned female at birth and I am not taking hormones…and I do have a womb’,” said Ali.

But that was not enough for the doctor. “‘Look, I am just trying to get my head around it,’ is what he said to me. ‘Are you a man or a woman? And were you born a man or a woman, and what are you now?’,” Ali recalls. “He just was really angry with me; he was very patronising. And I was in tears, and shaking by this point.”

Problems with referrals to gender identity clinics (GICs)

Kimberley, a 31-year-old trans woman, was initially, and wrongly, sent to mental health services after talking to her GP in 2016. Six months later she was referred to a GIC – but has yet to have an appointment. She said the lack of contact after the initial acknowledgement left her feeling very alone. “Unless you keep pushing you don’t hear anything. I have received nothing from the clinics themselves since I was referred,” she said.

The idea of surgery was a distant thought, given that that was only considered by doctors after an individual had been seen at a GIC, and had been on hormones for a certain time, Kimberley said.

“It doesn’t feel like it is ever going to happen because it is just this constant thing of waiting and, because I have not heard anything, because nobody gets in contact, if I am having any problems, I am here on my own,” she said. “I have nobody who understands that can talk through it with me.”

Feeling like trust in the doctor has been eroded

“I do feel nervous about going [to the GP], particularly anything where I am going to have to mention anything about gender and/or surgery, because I feel they then go off on a complete tangent,” said Ali. “A bit like, if you are obese, they just think everything that is wrong with you is because you are fat.”

Eric, a 36-year-old trans man, expressed similar concerns. “I have never been a massive fan of going to the doctor for every little thing anyway, but I will avoid it probably longer than I should,” he said. “I know I should be going to see the GP for something completely unrelated to gender identity, hormones or anything else and I have been putting it off for quite some time.”

The presence of gender dysphoria, and contact with mental health professionals on Eric’s records, meant such topics were invariably raised, regardless of why he was visiting the GP.

Problems with GP records

Annabelle, 38, a trans woman, tried to find out what updating the gender marker on her records to female would mean for her medical care after her practice manager asked if she would like it to be changed.

“I was like, I don’t know, actually, because what are the implications for managing my health provision moving forward?” Annabelle said – adding that, for example, in the case of an accident it would be important for doctors to know she would not be expected to be pregnant. The upshot was a ‘phone call that lasted around two hours. “I was trying to ask them what the medical implications were of them changing my gender marker on my notes and they were trying to do the politically correct thing of saying, ‘Well, it is about what you want; it is not about what we want.”

In the end, Annabelle had her gender marker updated. A week later she received a letter inviting her for cervical screening – despite not having such anatomy.

Some names have been changed.

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