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For Trans People on Hormones, Doctors Can Be the Worst Part of the Treatment

New research shows that younger endocrinologists are more comfortable treating trans patients, but for many people, transition has been rife with prejudice. We spoke with one woman who has encountered stigma and ignorance changing her gender in the...
Photo by Sean Locke via Stocksy

People who seek to change their sex have long been at the mercy of endocrinologists. Gender transition classically includes cross-sex hormone replacement therapy (HRT), and it is these hormone specialists that are responsible for testing hormonal blood levels and prescribing the appropriate medication for trans patients. New research shows that younger endocrinologists are more comfortable working with transgender people, which is promising for the future of trans health care—but it's also a painful reminder that it is all too common for the health care of transgender people to be mismanaged by prejudiced physicians.

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The science of transitioning is rapidly developing, with youth at the forefront of these advancements. Trans children are reclaiming the liberty they've long been denied. Their identities are becoming culturally recognizable, families are increasingly embracing their gender different kids, and the field of trans medicine is being studied, funded, and expanded. Medicaid programs in some states are beginning to cover transition-related services, even the military is stepping up, and trans people are able to transition younger than ever before. But what of the people who have not escaped the prejudice of transphobic, medical conservatism?

Read More: To Stop Trans Kids from Killing Themselves, Shocking Study Says 'Accept Them'

Julia first learned about HRT in the late nineties. Living in rural North Carolina, she sought out an endocrinologist that might be sympathetic to transgender patients via online message boards. But she didn't begin treatment until 2012. "The research eventually sent me to seeing a gender specialist, who performed the referral to one of those endocrinologists I found years prior," Julia said in an interview with Broadly.

She describes her first experience with an endocrinologist as "humiliating," relaying a disturbing interrogating relationship with her provider that speaks to the way that prejudice can coalesce with power in the medical field to marginalize transgender patients and deter them from seeking care. "The endocrinologist demanded to know every detail of every interaction regarding my history of gender issues in order to 'prove' that I was indeed transgender," Julia said, adding that she was patronized and "berated" because she had been self-medicating with hormones during the extensive five-month waiting period to get an appointment.

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"I had to fight a great deal of gatekeeping and had to continually prove that I was indeed transgender, and actually happier, healthier than I was before," she said. "It became a very adversarial relationship, where I had to fight out dated beliefs of treatment, and basically continually bring up-to-date information to the conversation." Even under treatment, Julia describes a certain hesitancy from her endocrinologist to fully provide care: he kept her estrogen levels intentionally low. "It has been quite an adversarial relationship and a struggle to even keep my dosage maintained," she said.

I have never felt like I've received appropriate care from my endocrinologist.

I've heard worse experiences from trans people over the years, from being turned away by providers who don't treat "those people," to becoming subject to transphobic slander, but Julia's experience is perhaps more common, and an example of the insidiousness of ignorance and transphobia in the medical establishment. From subtle yet concrete obstacles like phone calls going unreturned for weeks, to delayed appointment times, Julia says that every interaction she had with her endocrinologist was a challenge in some way. "It didn't deter me. I knew where to obtain what I needed otherwise, and have been very blunt with my endocrinologist to that fact in order to actually make any progress forward," she said. Because Julia had prior experience with self-medicating HRT, she knew she could return to that practice if her doctor prescribed treatment were to become intolerable. Meanwhile, she had to actively combat her provider's misinformation: "Nothing like having to get labs pulled by other providers to prove your endocrinologist wrong."

Watch More: Dressing the Part: Meet the Consultant Teaching Trans Women How to Be 'Feminine'

There was a marked shift in Julia's treatment after she underwent gender reassignment surgery. "I have never felt like I've received appropriate care from my endocrinologist and have always felt that they were not truly invested until after I had surgery." This experience correlates to a similar, oppressive cultural obsession with the genitalia of transgender people, from healthcare to dating and daytime talk shows. Julia has considered seeing another endocrinologist in her area, but it isn't clear if that decision would be ultimately helpful or hurtful. "To quote my fiancée," she said, "the other endocrinologist option was even more of a disaster."