Taking transgender healthcare seriously
*I am speaking from my personal experience, rather than on behalf of the whole transgender community. I acknowledge and respect that everyone has had different experiences within the healthcare system. I use the term ‘transgender’ here to encompass anyone who does not fully identify with the gender they were assigned at birth.
The healthcare system in Aotearoa is failing some of its most vulnerable people. Despite the transgender community being overrepresented in homelessness and suicide statistics, our country’s lawmakers continue to dismiss an issue that desperately needs to be addressed: the need for safe and accessible healthcare for people of all genders. Transitioning should not have to feel like finding your way through a maze in the dark, but due to the current lack of understanding, funding and resources in our country, it does. Creating a safe and accessible healthcare system for people of gender minorities is imperative to prevent the needless loss of transgender lives.
New Zealand is seriously underfunded when it comes to transgender healthcare. Public funding for gender reassignment surgery barely exists, and the waiting lists are endless. These surgeries take place overseas because there are no surgeons in Aotearoa who perform gender reassignment surgery under public funding. Each district health board currently follows different regulations as New Zealand does not have official standardised guidelines for transgender healthcare. This means most health professionals are working off the American standards of care, which poses a myriad of problems due to differences in cultural values and beliefs. We should not have to navigate a system riddled with paradoxes and misinformation on our own, but there is scarcely any information readily available to the public regarding medically transitioning. It is crucial that mental, sexual, general and trans-related healthcare is made available to all trans people in order to tackle the unnecessary adversity some of us face.
It is worth mentioning that every person experiences Gender Dysphoria differently. Some suffer from very little, while others’ bodies are so foreign to them that they struggle to get out of bed each day. Some might feel dysphoric about certain parts of their body and may therefore want to seek medical help to alleviate these feelings. Currently, New Zealand’s healthcare system encourages a forced way of being by assuming that everyone experiences Dysphoria in the same way. When wanting to acquire hormones or surgery, we are coerced into framing our stories in a particular way that will satisfy health professionals. On one hand, we want to be deemed ‘transgender enough’ (however that may be interpreted) to earn the doctor’s tick of approval, but on the other, we don’t want our gender identity to be shrugged off as just some by-product of a mental health condition. Gender is fluid, and health professionals should recognise that not all trans people want to leap from one end of the gender spectrum to the other.
The current healthcare system demands that transgender individuals undergo certain procedures before starting to medically transition. Some endocrinologists, for example, ask that we receive a psychological assessment before prescribing us hormones, despite this not being a mandatory requirement. These loopholes are based off binary ideas of what it means to achieve femininity or masculinity. In reality, these standards are impossible. There is no one right way, nor one way at all, to be any gender. The beauty of the trans community is that, through the exploration of our gender identities, we are liberated from binary boxes and systems. Gender is self-determined. It is completely okay that some people do not want to alter parts of their bodies in any way. Putting pressure on individuals to live up to expectations of what it means to be a certain gender, or sex, is unhelpful and often harmful. We are not replicants of each other, and all wish to transition in different ways and at different paces. Health professionals must start acknowledging that our identities are no more or less valid depending on how we want to transition.
Throughout transitioning, we are likely to encounter a number of professionals with various skills and knowledge, including endocrinologists, GPs, nurses, psychiatrists, psychologists and surgeons. Often, we are the first, or among the first, transgender clients they have seen, so even the fact that transgender people exist may be news to them. Unfortunately, this puts our safety at risk and leaves us having to explain what it means to be transgender. The roles get reversed, and more time is spent educating the doctor than helping the patient. Personally, I have encountered healthcare professionals displaying varying degrees of awareness of transgender issues. I have been to counsellors who did not know what the acronym LGBTQIA stood for, and, after explaining in great detail how much it hurt when people used the wrong pronoun or name, continued to misgender me. Medical centres have written made-up names on my official records, and outed me in front of busy waiting rooms. I am fortunate that this is as bad as it has gotten for me; others’ experiences are far worse, and are sadly part of a recurring narrative. Far too many young people feel as though they do not have access to adequate healthcare simply out of the fear that they will not be recognised for who they are. There are many services around the country, however, that prove that it is possible to embrace gender diversity. If some healthcare professionals can do it, so can the rest. It should be mandatory for healthcare professionals across the country to be sufficiently educated on gender diversity in order to create safe and accessible healthcare for people of all genders.
Having access to transgender-friendly healthcare can drastically improve individuals’ mental health, because transitioning allows our minds and bodies to align. Living in a world where gender expectations are based off sex characteristics, transgender people are often left feeling vulnerable when forced to live in a foreign body. Some people perceive gender ambiguity as a threat, resulting in stigmatisation against our community, and in some cases, physical and mental abuse. Seeking medical help is often not a choice for us, but the only means to enable us to live authentically. Approaching a medical professional requires contemplation and courage. The last thing we need, then, is for a doctor to tell us they would like more proof of our identity before they can unlock the gate. For us to be told that we need to overcome more obstacles than necessary harms people whose mental health might already be fragile due to prejudice faced in society. Bureaucratic barriers like age restrictions, legality around gender markers and requiring psychological assessments should be replaced with a system based on trust and integrity. We are as sure of our identities as cisgender people. Doctors should therefore not impede, but rather work alongside us to get to where we want to be in our bodies and minds.
To our allies, friends and advocates in the healthcare system: please embrace our identities. Let us know you are willing to help us live in our real bodies. Do not make us feel like we must pass a test in order to start transitioning. Instead, get to know us. It is better that you ask what pronoun we prefer than to assume our gender based on our external appearance. Please do not question our identity. Recognise that it might not be possible to fully understand what it’s like to experience Gender Dysphoria, but stand by us and trust that who we know ourselves to be is true. We don’t expect you to have all the answers to our questions, but please be open to learning and advocating with us. The maze is ours to navigate, but you can help us by providing the light for us to see in the dark. Being transgender is far from a phase or an attention-seeking device; it is a legitimate way of being. Our bodies are exactly that; ours to live in and celebrate.