Eyeballs Have No Gender

Trans-affirming medical care is good for your health

My genderless eyeballs (and brows).

While waiting for a bus on an ordinary night a few weeks back, a large dark smudge and a field of dust-like specks suddenly appeared in front of my left eye. I took off my glasses and wiped them on my shirt, but after replacing them the obstruction— which was near the top of my field of vision, partially but not completely obscuring my sight —remained; a dirty lens was not the culprit. I rubbed my eye and peered out, sans glasses; the smudge still did not go away.

Upon returning home I did some web searching, beginning to panic that I had a torn or detached retina. I made an appointment for the following morning with the first physician available at my medical clinic, where I was already planning to drop in for my biweekly testosterone injection. My optometrist was closed that day, and I figured I would need a referral to an ophthalmologist in any case.

My poor artist’s rendition of the smudge.

At my appointment the next morning, I described the incident, showing the physician a rough sketch that I’d done in brown marker to illustrate what I was seeing. After some questions and a brief exam, he called up an eye specialist to try to get me a same-day appointment. I overheard him on the phone state “The patient prefers they/them pronouns.” He paused and then repeated this information.

While he was on hold, I asked if the eye doctor actually asked what pronouns I preferred, as I wasn’t used to most doctors’ offices being as trans-aware as mine. The online profile for patients at my provider offers pronoun options of she/her, he/him, and they/them, an optional space to enter preferred name (which for trans people often differs from our legal identification), and an optional space to fill in gender identity (which for trans people often differs from what is on file with our insurance providers). I’ve redacted the name of the clinic in the screenshot below as I don’t wish to advertise for anyone, but am happy to provide it via private message to anyone seeking a trans-supportive doctor.

Screenshot of gender and sex portion of patient profile. Under Sex, the explanatory text reads: “We require this field because one of the many ways we use this information is in communicating with your insurance provider. Please make sure the sex you provide here is the same as what your insurance provider has on file (usually the same as what your HR has on file). If you would like to tell us more about your gender identity, please click on the ‘Add gender Information’ link; that information will not be shared outside [clinic]. Our entire team is committed to making sure every member feels safe, welcome, and respected.”

The physician replied that the eye clinic had asked if the patient was male or female. We both agreed that my sex or gender should not matter in this case; though there might some eye conditions where “genetic” sex is a factor, such as color blindness, my sex was unlikely to be relevant to my condition. However, I told him that if they couldn’t process my non-binary pronouns, then referring to me as “he” or male was acceptable. He relayed this information.

Fortunately, I was able to get an appointment at the eye clinic that very afternoon. Unfortunately, their staff did not acknowledge my agender identity, referring to me as “Mister” and “Sir”. As I was in no state to educate about non-binary gender, and had said that I would accept being addressed as male, I did not complain.

But even though being addressed with terms typically used for men is far preferable to me to being misgendered as female, it is still not ideal, and causes me some discomfort. When I’m already in distress due to a physical ailment, the additional psychological burden of gender dysphoria does not help the healing process. At my main doctor’s office I’m on a first-name basis, so titles and salutations don’t come into play; I wish everyone would simply address me as “Pax”, but I can’t expect strangers or employees trained to use formal address to know or honor this preference.

While reviewing my medical history with the ophthalmologist, I mentioned that I was taking testosterone because I was transgender. He was silent for a moment, and that hesitation worried me, as I wondered if his opinion of me —or medical treatment of me — would change as a result of this disclosure. He did not outwardly display any negative judgment, but his manner of speaking to me changed subtly, addressing me as “Hey man” and such, perhaps overly eager to display affirmation of my presumed gender.

I’ve seen this shift in behavior in others before, including some who knew me before my transition. While it is most likely well-intentioned, it is neither necessary nor appreciated in my case, as I prefer to be addressed as a neutral human being. Of course, in mainstream US culture, “neutral” is typically synonymous with “male”. But what I’m getting at is that despite choosing to transition to male for legal and medical purposes, I am agender, and not particularly masculine or a “bro”, so I don’t wish to be addressed as such.

After running various tests, the eye doctor concluded that I had retinal vein occlusion; basically, a blood clot. There was no treatment, but it should eventually heal on its own. By the time of my first follow-up appointment two weeks later, the smudge had indeed cleared up quite a bit, and there did not appear to be any permanent damage to my retina, which was a relief.

While waiting in the hallway at that appointment, I was distracted and did not hear a staff member calling me. “Mister Gethen? Mister Gethen?” After rousing and following him into the exam room, I let him know that it was fine to just call me “Pax” in the future. He gave me a thumbs-up.

This week, I returned to my regular doctor’s office for a necessary but unpleasant procedure that I need to undergo every five years: A Pap smear. I was reminded how fortunate and grateful I am to be a member of a trans-affirming clinic, as my doctor was very respectful and well-aware of my discomfort in that area. She even asked if it was OK for her to refer to body parts such as the clitoris with their conventional anatomical names.

When it comes to genitals and reproductive systems in a clinical context, I accept that knowing a person’s assigned sex can be useful information. But assigned sex is independent of gender, and sex is irrelevant to many medical conditions. Regardless of what part of the body is ailing, gendering a patient correctly and respectfully fosters a healthy body-mind connection and aids healing.