Transgressive health care

Even though I’m a kind and joy-filled person, I’m always prepared to deal with inappropriate comments or behavior from the government-employed health care services workers. I’m always ready to ask why a medical doctor, nurse or technician’s bigotry is getting in the way of treating a veteran with respect to their service. Yet, I’ve never had even one treat me with anything but the purest of professionalism at the Veterans Health Care Administration (VHA) or at the Navy Medical Center, and I’ve never had to challenge anyone on their bigoted speech or behavior. Here in San Diego, I just haven’t experienced that kind of inappropriate behavior.

That I’ve never had difficulties with those who provide health care services to veterans, that I’ve never had anything but positive experiences with those health care professionals, actually makes me a bit proud of those VHA and of those Navy Medical Center, San Diego employees. Here in our city, these folk have all served me as a retired and disabled servicemember with honor, respect and professionalism.

It was no different when I received a mammogram recently at the VHA facility in La Jolla. There was nothing but professionalism shown by all the staff and all the medical providers I encountered, even the ones who knew I was trans.

And, of course, even if a transsexual person’s life is nearly totally “stealth” – where almost no one knows a transsexual person’s personal or medical history – among those who should know are medical providers that provide sex and gender specific health care. This is because the medical histories of transsexual persons can impact the delivery of that transsexual person’s health care.

Such as my history with my breasts. At 54, my breasts are only 10-years old, so in one sense I’ve the breasts of a woman in her early twenties instead of the breasts of someone in their mid-fifties. Also, my breasts developed through hormone therapy, and because transdermal estradiol hormone patches are how estrogen is delivered to my body my breasts are particularly dense. These are things that the doctor who reads mammogram images for me needs to be aware of to accurately interpret my mammogram images.

Well, any woman who’s filled out an intake form for a mammogram has filled out a form that asks some pretty standard questions: How many children do you have? When was your last period?

And these forms don’t usually provide an N/A checkbox for when one’s last period was for those women who’ve never had periods for whatever reason. Add to that that these forms make the heteronormative assumption that all of a woman’s children were children she gave birth to.

So, what these forms don’t ask is significant as well. A woman may be trans or intersex, but there’s no checkbox on the intake form to quickly communicate this to those who’ll be taking and evaluating the mammogram images.

If an x-ray technician looked uncomfortable having a discussion with you about your sexual orientation in relationship to the children in your family, or looked uncomfortable when you told him or her that you are a woman of transsexual medical history, would you feel comfortable going back for another mammogram the following year? I would, but many I know wouldn’t.

I’m not afraid to have uncomfortable conversations with my medical providers – well, uncomfortable conversations for them but not uncomfortable for me. But knowing that all of my trans sisters aren’t comfortable with those kinds of conversations, when I recently had my annual mammogram I practiced what I call transgressive health care and made specific suggestions for improvement to the technician who created their local mammogram intake form. I suggested that an N/A checkbox be added to the answers to the question of when was one’s last period; suggested that the question about children be rephrased to ask how many pregnancies a woman has had; and I suggested that the question of “Are you intersex or transgender?” be added to the intake questions.

The intake form at the San Diego VA Medical Center is going to be updated with my suggestions. That’s what I call transgressive health care – changing things for the better for my trans community siblings who access health care at the VA facility I do.