Copyright 1996
by Gianna E. Israel
Frequently transgender persons in the coming out process are uncertain how to discuss gender issues and their needs with physicians. This can include requesting hormones as well as discussing general medical concerns. Additionally, many people generally dislike visiting a doctor's office or feel uncomfortable talking about very private issues. When actually visiting a physician, some people fear that they may not adequately communicate their needs or that their suggestions will be overlooked. This article addresses effectively communicating with physicians.
In part, many of the fears and concerns people have about visiting a doctor's office stem from the fact that doctors are often busy. They also seem as if they speak their own language. I regularly hear complaints from clients who have experienced visiting a doctor who was constantly interrupted by nurses and phone calls. In part, these interruptions come with the territory. Extremely busy or successful physicians are quite likely to have a few emergency patients and many phone calls each day. If a doctor is continually interrupted to the point you are unable to communicate your needs during the course of a visit, state so.
In many respects there exists a wide variety of approaches that physicians use when interacting with patients. A single physician's office manners can vary greatly depending on location, type of medical clinic, and scheduling practices. For example, a physician who is employed by a community health clinic which treats low-income persons may be very overworked. In contrast to private practice physicians who offer more personalized service at higher rates, community clinic physicians frequently are required to see more patients in a lesser amount of time. Therefore, before you visit a physician be mindful of these circumstances. If you believe your visit may require more than 15 minutes of the doctor's time, state so when scheduling your appointment.
No matter what type of physician you have, the best way to insure a productive office visit is to be prepared. This can be done by writing down simple notes or "cue cards" of the items you wish to discuss. Make certain to place the most important items at the top of your list. During a general office visit if the physician is overbooked or contending with medical emergencies you may only have several minutes to discuss your needs. If time permits, you may then introduce off-subject questions or comments to the physician. If your appointment is cut short by an interruption, talk with the doctor's nurse or medical assistant. Frequently medical staff can be very helpful in addressing basic medical concerns or questions.
After your appointment, save your notes for future reference.
The most common gender-specialized concerns that transgender persons have when seeking medical care include requests for hormones, gender specialized resources, and post-surgical care. Generally, unless your physician specializes in treating transgender people, I suggest reserving these types of requests until you are face to face with a physician. This is particularly so when scheduling an appointment because most office staff are not familiar with gender-specialized medical needs. In other words when scheduling your appointment, when the receptionist asks what your visit involves, state that you can only discuss your concern with the physician. Otherwise, you risk being told that the physician does not provide gender specialized treatment.
Persons who are in the process of coming out often fear the prospect of asking for hormones, particularly since this disclosure is usually one of the first and most important that they will make. Some persons fear being turned down because a physician may be inflexible or has never heard of transgender persons. Other individuals may be uncertain as to whether their physician or insurance will approve hormone treatment because it appears to be specialized. While these concerns are realistic, in most circumstances they can be resolved when transgender persons place forethought into seeking hormones. For example where insurance coverage is concerned, at the present it is typically best not to inform insurance companies of your transgender status. Rather, when seeking a hormone prescription, request that the physician indicate only a hormone imbalance on charting and insurance forms, not transsexualism. Doing so will also help safeguard against an employer discovering your transgender status against your wishes.
Many physicians are not aware that providing hormone administration to transgender men and women is a general medical procedure. Many transgender persons in the coming out process are not aware that the vast majority of transgender people receive hormones from their regular physician. In providing nationwide telephone consultation to individuals and physicians, I have found this to be so because there are considerably more transgender persons than there are gender clinics. Finally, newcomers into the community, as well as their physicians, often are not aware that having a transgender identity or needs is not in and of itself mentally disordered, medically diseased, or pathological.
The letter you receive from your therapist which provides a recommendation for hormone treatment can be used to relay information found in the preceding paragraph. Furthermore, if you suspect your physician may not be familiar with hormone prescription levels and blood laboratory testing regimens, you may ask your therapist to include this information within the contents of his or her letter. Or, you may provide such information to the physician yourself. Make certain, however, that the information you pass on is written by a gender specializing care-provider or has been reviewed by one.
Transgender persons also frequently seek gender-specialized information and referrals from their physicians, particularly when their doctor is the first person they confide in when seeking support. Sadly, however, most physicians are not fully aware of gender-specialized resources or information. In many circumstances it may be likely you know more about gender issues than your physician. This in itself is OK, and so is sharing your experiences. At present, transgender persons, gender-specialized care-providers and organizations are responsible for passing on information to physicians. (It appears that this will be so until gender identity issues are included as part of medical school training.)
Lastly, because locating a physician who is sensitive to transgender persons can be difficult, I suggest that persons seeking genital reassignment locate and visit face-to-face with a prospective urologist or gynaecologist before undergoing surgery. Doing so insures that after surgery you will receive sensitive, prompt attention to your post-surgical follow-up care.