“So how did your family and friends react? Are they supportive?”
It’s not that I don’t understand why others want to ask questions like this, but that doesn’t make it less frustrating to experience, and it doesn’t make it a sensitive question to ask someone who isn’t a close friend.
Recently, I’ve been on a few dates with a queer woman of color. I don’t ask about her family. Full stop.
She’ll tell me anything that’s relevant when she’s comfortable telling me. And when it’s relevant. I don’t need to know about family, chosen or otherwise. I need to know what’s important to her. How do I find out? By asking.
I updated the templates I created to help trans people come out to family, friends, or coworkers, and to help trans people write claims, complaints, appeals, or grievances to their health insurers, health care providers, or others intermediaries between trans people and medical care. Please use, modify, and share freely. If you’d like, you may attribute this website ( https://transilhouette.wordpress.com ) or my pseudonym, Sarah Frank.
As always, if you have any suggestions or recommendations, please let me know!
I want cis people to understand some of the struggles and frustrations that trans people face with medical care.
Even in the states where trans exclusions are illegal, many trans people don’t realize that insurance “should” cover most of their medical needs in transition—largely because health plan contracts still contain explicit, illegal transgender exclusions. Health plans reply to concerns about these exclusions with “well, we just haven’t rewritten the contract”…18 months later!?
There’s zero net cost (i.e., reduced costs are comparable to expenses), and there’s significant evidence that appropriate medical treatment reduces attempted suicide rates from over 41% to under 2% (more than 95% reduction in attempted suicide!). Administrative arguments from health plans against covering requested treatments boil down to “but trans people are gross and icky” and “We’re Really Trying To Help“. The California state agency licensed with protecting our rights (DMHC: Department of Managed Health Care) spent nine years since their 2005 Insurance Gender Nondiscrimination Act knowingly contracted with a transphobic organization to provide “objective” medical reviews of insurance claims—all of which could have been resolved by enforcing the one and only Standard of Care (WPATH), but they continue to say “well, trans exclusions are illegal, but we’re Really Just Not Sure which procedures should be covered” (see also: “hey, do you remember that Standard of Care discussing applicable treatments?”).
It’s unbelievably, nauseatingly frustrating that these problems could be fixed on any one of six different levels of hierarchy devoted to “objectively” evaluating medical needs, and they spend more time and money dodging or pointing fingers than providing medical care…
Yes: cis people also struggle with insurance providers to get their medical needs covered. That doesn’t make it comparable. Some of the major differences:
- several decades of worldwide professional medical standards of care have established successful treatment plans
- trans medical care has a fair amount of research indicating that these treatments increase QoL and reduce suicide rates in spite of abysmal funding
- said research is held to far stricter standards than are typically expected of medical procedures (again in spite of abysmal funding)
- trans people face significant financial barriers to accessing medical care (e.g., buying insurance, losing jobs)
- trans people face significant social and psychological barriers to accessing medical care (e.g., untrained and disrespectful medical staff, ID mismatches, harassment from medical staff, and internal struggles with avoiding dysphoria triggers in medical offices)
I spent eighteen months trying to get hair removal and facial surgery covered, and now that I’m on the verge of success, I’m losing coverage and I have to change plans. I might have to start over again. Not from scratch, but it’ll still be probably several more months before I can get back to this point. Who has the time, energy, education, intelligence, and persistence to go through all of this!? The system is designed to frustrate people into paying for services out of pocket. For unemployed trans people, that’s a recipe for suicide.
- Avoid using “trans women” or “trans men” without a space.
We use trans as an adjective. We speak of trans women (trans men, trans people) just as we speak of short women, gay women, or Chinese men. We don’t say “chinaman”: we say Chinese man.
- Transgender is an adjective—not a noun, and not a verb. Avoid speaking of “a transgender“, or “transgendered“.
We also use transgender as an adjective to speak somewhat more specifically of transgender people (though it’s somewhat more clunky than trans). Misgender is a verb (using the wrong gender to describe a person), and the participle formed by adding the suffix -ed makes misgendered an adjective. Transgendered is a nonsensical word, because transgender is not a verb! You cannot “transgender” someone.
- If you must refer to transition or the time before transition, then refer to transition and the time before transition, never “when you were…”.
If anything, you might say, “When I thought you were a man“. I may have presented myself differently, but the only person confused about gender was you.
- Trans women are female. Trans men are male. People who are not trans are cis people.
Again and again: if you must refer to the fact that someone is not trans, then describe them as cis: cis women, cis men, cis people.
- Non-binary people are a minority among both the cis and trans population. (NB people, or enbies)
I identify within the gender binary. Most trans people identify within the binary (either as men or as women). Non-binary people (enbies) are part of the wider Trans* umbrella, but they are often cissexual, rather than transsexual: their physical (primary and secondary) sexual characteristics have not changed, though they may have been through a social transition. Since I am not an enby, I can’t speak for them, but trans people and enbies often have similar social experiences, and some enbies are also trans people with similar physical/medical struggles. Some enbies take HRT, and some seek various surgeries as applicable to their needs.
Point of clarification: Neither sex nor gender changes during any surgery.
“Sex change” or “gender reassignment” are just synonyms—you don’t improve phrases like “the blacks” by inserting synonyms for black (…”negro”, anyone? BAD plan). When you say “sex change” to refer to genital reconstruction, you imply that genitals define sex.
We don’t need to police bodies for sex and gender. Additionally: as someone who runs a trans* support group, I’m comfortable declaring that it is *very* rarely useful to distinguish sex and gender, and only in a medical context. Human bodies that bathe in estrogen react differently to chemicals and substances than bodies that bathe in testosterone. In this sense, it’s useful for doctors to calibrate doses based on physical “sex” separately from gender identity. It’s not based on the presence of testicles so much as the presence of testosterone. (E.g., my alcohol tolerance dropped like a rock when I started taking estrogen and blocking testosterone. GRS didn’t change that.)
The thing cis people don’t get is that I have a really good body image. My body fails to fit that image.
I don’t say that in jest.
My body literally fails to fit the image I have in my head, and every few minutes that image is shattered, and I have to reassemble those shards of glass into my body image with my bare fingers.
Chloe Sevigny spoke about wearing a prosthetic on the show “Hit and Miss” in her role as a trans woman who hasn’t had GRS: “It was horrifying,” says Sevigny. “I cried every time they put it on me. I’ve always been very comfortable being a girl, so it was hard to wrap my head around the fact that someone could feel so uncomfortable in their own skin.”
I’ve ignored and repressed and avoided dealing with it for so long that the process of pursuing GRS uncovered all of the nasty questions and answers I’ve been hiding from to leave the underlying dysphoria raw and bleeding. “Is GRS really necessary?” “Are you sure?” “Do you worry that you might regret it?” “Tell me about why you want GRS.”
Each day I see another magic trick that helped protect me from dysphoria. The worst part of revealing a magic trick is that you’ll never see the magic again.
Today, I lost some magic.