Medical Misgendering and Misdemeanours
A personal account from Kim Balfour – Transfolk of WA
As a non-binary transgender person, who uses they/she pronouns, the chance of being misgendered has proved to be inevitable. Transgender (trans) and gender diverse people are routinely misgendered and non-binary identities barely recognised, leading to high rates of poor mental health among these groups. Anxieties are especially heightened in health care environments, as I discovered during a GP visit about managing my hormone replacement therapy.
I was highly anxious about my appointment with a new GP and considered cancelling. The previous day a consultant and their manager from a well-known health insurer insisted that, as a trans person, I was mistaken in asking about electrolysis treatment, when what I really needed was “electroconvulsive therapy” (ECT). Nonetheless, I had been assured that my new GP had a long history in transgender care, and I had nothing to worry about.
Misgendering occurs when language is used to address someone in a way that does not match their gender identity, which is a common occurrence among administrative staff and clinicians alike. A trans person can be addressed using conflicting gender pronouns and honorifics by multiple clinical staff in a single visit, negatively impacting the delivery of effective healthcare. Trans people typically have firsthand experience with these issues, heightening fears of and discouraging future visits to health providers.
The medical centre’s receptionist said that they had no appointments under my name. I had booked the appointment under my new legal name, but the centre had defaulted to my birth name, my ‘deadname’. The waiting room was packed, a cacophony of coughing, sneezing and blaring television news. Palms sweaty and face flushed, I whispered my gendered deadname to the receptionist, who then gestured towards the waiting room.
As I filled out a new patient form, an elderly couple, in a loud whisper, idly mused whether I was a “lady or a man”. The patient form asked whether I was ‘male’ or ‘female’. I left it blank. Once inside the GPs room, I explained my situation and asked whether he could oversee my hormone treatment. I emphasised that I’d previously been prescribed topical estrogen due to my migraine with aura. I didn’t get far before the GP cut me off mid-sentence to lecture me on the nature of being trans.
The GP spoke in strict gender binary terms, noted my advancing years, and told me that “older people who transition to female just don’t look right”. He noted that I have a child, then launched into another lecture on how to be a capable trans parent. There is no right way to be trans, I wanted to say. I started to speak, but he told me to be quiet and listen. My lived experience and personal circumstances had no value.
I endured, as I needed someone to maintain continuity of my therapy. As the medical system continues to act as a gatekeeper to care required by trans and gender diverse individuals, trans people are often left with few affordable prescribing provider options. The GP prescribed me a fortnight’s worth of oral estrogen and told me to come back in a month. I mentioned my migraines with aura, but he said, “you should be fine”. I never used his prescription.
My GP experience highlights numerous problems in trans health care, especially misgendering, which can discourage trans people from seeking essential, sometimes urgent, medical assistance. The simple solution is to ask people for their names and pronouns and then coordinate this information across all levels of a medical provider. A visit to a health provider without the fear of being misgendered would reduce anxiety and remove at least one disincentive to seek out medical attention.
For those interested in accessing training on transgender health, North Western Melbourne PHN’s Trans GP Module is recommended while WA Primary Health Alliance works towards completing the WA specific module.
HealthPathways will soon be localising the Gender Diversity and Transgender HealthPathway this year. Click here to register your interest in taking part in the working group.
- Smith E JT, Ward R, Dixon J, Mitchell A, Hillier L. From Blues to Rainbows: Mental health and wellbeing of gender diverse and transgender young people in Australia. Melbourne, Australia: The Australian Research Centre in Sex, Health and Society; 2014.