We're Sick and Tired of Being Sick and Disrespected

Please excuse my mess! I'm currently working on renovating my website so I can put it to good use. While I do that, here's a filler post– I apologize for not posting more often. This is a piece I wrote on medical discrimination for my English class, slightly edited to fit the passage of time and the new audience.

For 13 years of my life, I wondered why I hated myself. I hated my name, I hated my hair, I hated my face. I hated the way I treated others, and I hated the way others treated me. I hated being a daughter, a sister, a niece, a girlfriend.

And then one day, I pictured myself as a man. I pictured myself as somebody’s son, somebody’s brother, somebody’s nephew, somebody’s boyfriend. Suddenly it felt like my skin fit around my bones, and I knew who I was. Convincing everyone else was the hard part.

Being transgender in the modern day isn’t easy; according to the Human Rights Campaign, 2021 was the deadliest year on record for trans people. With at least 46 transgender homicides in the United States alone, mostly people of color, it’s clear that being visibly trans can be a death sentence*. So for trans people, “passing,” or being perceived as cisgender rather than as one’s sex assigned at birth, is often a necessity for safety. To achieve this necessity, medical intervention is often necessary.

The problem is, due to discrimination, medical intervention isn’t always accessible. As trans people face their deadliest year on record, they also face medical oppression. According to the American Academy of Family Physicians, in a survey of 27,000 trans people, more than ⅓ reported being harassed or denied care in 2015.

Think back on that number from the Human Rights Campaign. 46 homicides, as of November, were committed against transgender people in 2021. 29 of those transgender people were Black. There’s a lot of reasons for this, but there’s one that’s very important. Medical discrimination doesn’t only happen on the basis of gender identity: Black transgender people also have less access to medically transitioning than their white counterparts.

So how does medical discrimination affect people? Where do we see it taking shape? One issue is the financial aspect. In the same survey cited by the AAFP of 27,000 trans people, over ¼ had reported experiencing insurance issues related to being trans in 2015. According to the U.S. Census Bureau, 27.9% of Black households hold medical debt compared to 17.2% of white, non-hispanic households. Without being able to pay for medical services, many people avoid seeking any kind of care.

Doctors aren’t the only ones blocking the path to medical care. In some states, including Ohio, laws are being considered that would prevent transgender minors from receiving any kind of affirming medical care. Ron Hood is one of the Ohio representatives introducing a bill that would punish doctors for prescribing affirming treatments. He said that his “number one concern, by far and away, is the irreversible nature of these procedures."

There’s a big hole in this argument: the most common affirming treatment given to children is puberty blockers. Almost entirely reversible, puberty blockers give kids time to decide whether they want to medically transition or not by stopping puberty entirely. Puberty blockers are much more reversible than going through puberty.

One of the biggest problems in the medical field is the lack of education. In a 2016 study cited by Medical News Today, 73% of white medical students were found to have held at least one false belief about biological differences between races. Most commonly, believing that Black people have thicker skin, less sensitive nerve endings, or stronger immune systems. These beliefs were often fabricated by 19th century doctors in an attempt to justify inhumane treatment of slaves.

These false beliefs are also likely the reason that Black patients, especially women, often struggle to be taken seriously by white doctors when expressing their medical needs. This leads to inadequate pain treatment and often misdiagnosis.

Education in the medical field also impacts transgender patients on a huge scale. In a survey of 140 primary care physicians, 85.7% were willing to provide routine care to transgender patients, but only 69% reported feeling adequately prepared to do so. Patients notice this. Many PCPs will send their trans patients jumping through hoops to receive affirming care.

For example, my former general practitioner would often answer my requests to look into hormone replacement therapy by sending me on a wild goose chase to a variety of mental health specialists. She would often claim they were the ones I could look to with my intent of medically transitioning. These professionals didn’t know what to do either.

In reality, receiving hormone replacement therapy can be as simple as receiving a letter of recommendation from a therapist and a prescription from your general practitioner. (I would know– this is how I was finally able to start testosterone in December of 2021.)

While there’s a million things in the way of marginalized communities receiving healthcare, uneducated doctors cause a large chunk of those problems. No one in the medical field should be holding entirely false beliefs that could cause their patients serious pain or worse. Everyone in the medical field should be able to provide their patients with the care they need or know what to do when they don’t feel prepared to do so.

Contact your state’s congress people or the Department of Health and Human Services. Tell them more needs to be done to ensure that doctors are being educated on marginalized groups. No medical school should be allowing students who can’t care for any patient they might have in the future to pass with flying colors.

Nobody deserves to be disbelieved about their own medical needs, and everybody deserves the things they need to live their lives as who they are.

*While this number may appear small, note that 1. transgender people only make up about 1% of the population 2. data collection is often incomplete as victims may not always be identified as trans or gender non-conforming and 3. the number is climbing every year; with 46 homicides, 2021 became known as the deadliest year on record for the trans community, but the previous holder of this title was 2020.