The Solution Is Part of the Problem

One of the many challenges for trans individuals is that presented by the very people they look to and rely on for help: medical and mental health providers. Both play key roles in the process of physical transition for individuals who choose to pursue it, yet an astoundingly large portion of providers are utterly unprepared to provide quality assistance towards such a goal. As a result, many trans people encounter frustration, confusion, disrespect, and sometimes even sabotage from the very people whom they are supposed to trust with their well-being.

Let’s start with medical care providers. Due to how the insurance industry has rallied around HMOs, it’s likely that a trans individual is going to be forced to work through their primary care physician to have even a slight chance of insurance covering part of their costs. Problem is, most general practitioners learned more about transsexualism from various movies than they did in medical school. There are a few diamonds in the rough here and there (and the trans community is quick to refer friends to doctors who are known to actually have experience with trans patients), but it’s quite common for trans individuals to be literally walking their doctors through the course of transition.

Imagine going to the doctor because you’re worried about a mole that has been acting like it might actually be a tumor from skin cancer. How would you feel if your doctor knew so little about skin cancer that you had to literally walk them through how to get it tested for malignancy? Chances are you wouldn’t feel like your doctor was being very helpful, and you almost certainly wouldn’t trust that doctor for medical advice. Unfortunately, that is precisely the kind of situation many trans individuals face on a frequent basis. Now, consider this: skin cancer (according to a 2007 study) has a prevalence of about 26 out of every 10,000 individuals. While the numbers for transsexualism aren’t as easy to measure accurately, one of the most recent studies on the subject (done in 2009 in the UK) states a figure of approximately 20 out of every 10,000 individuals. Given how similar these numbers are, why is the former something every GP would know the basic procedures and/or referrals for, but the latter never even heard of by some doctors until encountering their first trans patient?

Perhaps medical care providers consider transsexualism to be a mental health issue, and thus think it out of their of purview. While this is problematic in and of itself (due to the integral role they wind up playing in the physical transition process), the situation isn’t much better on the mental health provider side of things. On one hand, therapists and psychiatrists have a handy book to help them figure out the basics of transsexualism and provide them with the general procedures involved. On the other hand, that same book also happens to be the subject of enormous amounts of controversy because it takes an extremely pathological approach to transsexualism (which would require an entirely separate post to properly address). This is the same book that has in the past listed homosexuality as a disorder.

Aside from the problematic DSM, many psychiatrists and therapists have had no other education regarding trans individuals – even the most knowledgeable therapists often wound up simply learning over time through interactions with their patients. Unfortunately, many others are less open to learning as they go and prefer to just stick to the diagnoses they feel more comfortable with, leading them to blame transsexual feelings on other mental health conditions. While it’s certainly true that co-existing conditions can make it more difficult to determine the validity and cause of either diagnosis, there is a disturbing tendency among some providers to blindly dismiss transsexualism, focusing instead on the more “standard” mental health issues like bipolar disorder or depression, leading to massive amounts of frustration for legitimately transsexual individuals who also happen to have mental health conditions. Even worse, that frustration at the lack of assistance with trans issues can lead to such individuals becoming disillusioned with mental health providers and avoiding them entirely.

These are only brief descriptions of some of the issues that trans people face when trying to seek assistance from those certified to provide it, but they are enough to give a glimpse into the sad state of affairs that is healthcare for trans individuals. It doesn’t even touch on the more general education of society, nor the financial aspects of transition. It’s clear, however, that health care as a whole needs to improve its training for providers regarding trans clientele.