Better Sexual Health Care for Trans Men
Accessing competent, culturally-sensitive, non-judgmental sexual health care isn’t always a given—for anyone. But for transgender men in particular, questions about gender and sexual identity at a clinic can interrupt, even interfere with, the primary issue at hand—our health. When medical professionals fail to affirm our gender and sexual identities without judgment, they lose the opportunity to engage us in effective HIV prevention and treatment.
Gay and bisexual trans men—which are estimated to be about half of trans men—report substantially more prevalent high-risk sexual behavior than any other demographic group. Although research data on transgender MSM and HIV prevalence are few and far between, one small study found that over 40% of their sample reported having condomless vaginal sex with cisgender men of unknown HIV status within the past year. Another larger study with 123 transgender men found that over half reported having condomless vaginal sex with a cisgender male partner, and over a quarter reported having condomless receptive anal sex with a cisgender male partner.
Yet transgender people oftentimes have difficulty getting the right sexual health services—if we get any sexual health services at all. In my case, I’ve been denied full-panel STD testing because I was categorized as female at a clinic I attended. I’m legally male—am listed so on my passport and driver’s license—and have sex with cisgender gay men. Because of this, it makes sense for me to get regularly tested for STDs and HIV—every 3 to 6 months as typically recommended for men who have sex with men. But as a gay trans man, I’ve had to fight tooth and nail for this basic sexual health care far more often than not. I’m not alone in this. One survey of over 6,000 transgender and gender non-conforming people called the U.S. National Transgender Discrimination Survey (NTDS) found that 19% of respondents had been denied service altogether in a doctor’s office or hospital because of their gender. And over a quarter (28%) reported being verbally harassed in a medical setting. My experiences speak to these statistics.
At one point, the health care provider told me outright that I was not eligible to receive the full panel of STD tests because they were only available for “real men” who have sex with men—and that I wasn’t “high risk” enough to justify spending testing funds on.
These types of experiences—when the wrong gender pronoun is used, when a medical file is mislabeled with the wrong gender marker, when a health professional belittles a patient or denies their identity—have a discernable effect on the willingness of transgender people, who are disproportionately affected by HIV, to seek testing, prevention and medical treatment. And out of all the challenges that transgender people face, discrimination in health care settings is linked with an especially high rate of reported suicide attempts. Among respondents to the NTDS who have been denied medical care due to their gender identity, 60% have attempted suicide.
The conclusion is unambiguous: Transgender people are many times mistreated—even unintentionally—by the health care system meant to take care of us, and this leads to significant negative impacts on our personal sexual health and wellbeing as well as overall public health. We are the population most affected by HIV in the U.S and least likely to seek medical care.
How can health professionals do better to affirm our identities and bring us culturally competent care?
Empathy is a good place to start. How clinicians respond when transgender patients state their gender has a direct impact on the care they receive during that visit, their likelihood of coming back for future visits and regular checkups, and their psychological health and stability after they’ve left the office. In order to end the transmission of highly preventable sexually transmitted infections, every patient needs to be treated as a whole, competent human being who legitimately knows their own lived experience better than anyone else.
Clinicians must ask questions without presuming to know the answer. This demonstrates respect for the diversity of people’s lived experiences. “What genitals were you born with?” is a question I’ve been asked by competent nurses in their quest to determine what form to fill out without invalidating or diminishing my identity in the process. I appreciate this, because it does not impose assumptions about my body, my sex organ history, my gender, my sexual orientation, or my sexual practices.
Everyone should be aware that gender and sexual orientation are not the same. I am no less of a man because I am gay. Yet, because I am transgender, I’ve had health care providers mistakenly think (and tell me) that I’m just a confused straight woman. Emasculating gay men for being transgender, or emasculating transgender men for being gay, does nothing to improve our health. A healthcare worker’s job is not to judge sexuality; it is to provide us with the tools we need to be safe, responsible, and capable of making informed decisions about our health.
Healthcare providers should realize that the stigma that once existed between cisgender and transgender gay men has decreased substantially in the past decade. Transgender men have been increasingly integrating into gay sexual spaces without inhibition. Cisgender gay men have sex with transgender men. So when there’s a public health alert for syphilis issued in my county and I tell the nurse I’ve had sex in a bath house recently, the only appropriate response is to test me—without argument, without judgment, and without expressing abject bewilderment when I talk about the sex I’m having with other gay men.
This should go without saying: Clinic personnel should be kind and respectful to everyone who walks through the door. Transgender people are real human beings. We have the same real feelings, the same real desires, and the same need real for supportive, competent healthcare as anyone else.
We’re really not that different at all.
Brandyn Gallagher, Executive Director of Outshine NW, is a Seattle-based activist and community servant who has devoted his life to redistributing happiness by raising awareness about HIV, stigma, social justice, and the struggles of queer and trans people in pursuit of equitable healthcare access.