Health Care LGBTQIA+ Love

Doctors must do better by trans and nonbinary patients

The right to healthcare remains hotly debated in the United States. And for some people, our current healthcare systems are not set up to set up or support our needs. If you’re nonbinary, the healthcare industry barely knows you exist, and professionals might only acknowledge your identity to deny its validity.

The state of transgender healthcare in general leaves a lot to be desired. Trans individuals who don’t fit a specific narrative often have their experiences and healthcare needs questioned or denied. Nonbinary people in particular throw a wrench in trans healthcare: their desires and needs for healthcare often clearly follow the storyline we’re used to for trans people.

Some doctors refuse to treat trans people because of their identity. 36 percent of nonbinary people responding to this survey chose not to seek healthcare they needed because they were so worried about discrimination. The National Transgender Discrimination Survey (NTDS) conducted by the National Center for Transgender Equality in the U.S. found that 50 percent of their respondents had to educate their healthcare providers about trans identity and healthcare needs.

If you’ve been to the doctor lately and filled out an intake form, you probably had to check either male or female as your gender. Things like that, and many medical providers’ ignorance about nonbinary identities in general, can make nonbinary individuals feel unwelcome and uncomfortable in medical settings. Many respondents in the above study mentioned that they worried about their care providers thinking their identity was a sign of mental illness or hormonal imbalance that needed to be cured, rather than accepting it as a legitimate identity. And even in cases where their doctors were understanding, some faced problems with other medical support and administrative staff.

Although medical understanding of transgender identities is progressing, it is still often rigid in its adherence to the gender binary (the idea that there are only two genders) and to very limited understandings of what it means to be trans. For instance, trans people with same-gender attractions are still sometimes denied medical help transitioning, as are trans people who don’t conform strongly to gender stereotypes. And doctors are still often resistant to the idea that nonbinary people might want some sort of medical transition, whether surgery or hormone replacement therapy, without identifying with a binary gender. New standards of care released by the World Professional Association for Transgender Health (WPATH) have addressed some of these issues, but it takes time for that new knowledge to diffuse, and there are still many healthcare providers who don’t know about those standards, or don’t want to follow them.

One of the most important changes in WPATH’s new standards of care is a change made to their ethical guidelines, stating unequivocally that therapy attempting to cure people of being trans, or make them identify as their assigned gender at birth, are unethical. That’s a big deal: many professional health associations, including the American Medical Association, have stated that conversion therapy doesn’t work. In fact, people who undergo conversion therapy are almost 9 times as likely to experience suicidal ideation, and 6 times as likely to experience depression.

Despite this, conversion therapy is still legal in 41 American states. That reflects a deep misunderstanding of and prejudice against LGBTQ identities. Most studies focus on the effect of conversion therapy on queer and binary trans individuals, meaning we still don’t know how many nonbinary people are affected by this issue. But the fact that nonbinary identities are still widely misunderstood doesn’t bode well for us.

While people often still view nonbinary identity as a fringe identity, between 30 and 40 percent of the transgender population in the U.S. may identify that way (exact numbers are hard to nail down, especially given the discrimination trans and nonbinary people face). And given the problem of nonbinary invisibility, they often face even less understanding from their healthcare providers than binary trans individuals. Beyond that, all of the health disparities faced by trans and nonbinary individuals are even worse for people of color. They face higher rates of HIV infection, and were more likely to postpone medical care either because of discrimination or an inability to afford it. In a country where people count on their jobs for access to healthcare, the respondents to the NTDS were twice as likely to be unemployed as the general U.S. population, and people of color were unemployed at four times the national unemployment rate. They also face higher levels of abuse and were more likely to be denied care.

Our healthcare system can and must do better by the entire LGBTQ community, and start actually paying attention to the struggles nonbinary people in particular face. Your identity shouldn’t be a hazard to your health.

By Laura Muth

Laura Muth is a writer and researcher with a BA in political science from Johns Hopkins and an MA in international affairs from Boston University. They write at the intersection of security and human rights issues, with a special interest in gender, nationalism, racism, and religious identity. Laura loves connecting specific current events with larger trends in global politics.