Barriers to Equal Health Care for Transgender & Disabled Individuals
Get the proper training — You know, the one that includes caring for all bodies.
People tend to listen to doctors, since they have their MD and we assume they know what they’re doing. Or, that they’re properly trained to treat all bodies. We may be sorely mistaken.
“A lot of medical professionals and people in general don’t know how to appropriately interact with transgender individuals. Instead they let bias and misconceptions rule their thoughts and actions. They walk away unscathed, but it’s us who suffer and leave with more scars than we started with.”
Julian Gavino is a trans-masculine man who came out as transgender at 13–14 years old. Gavino has also shared his diagnosis of EDS (ehlers-danlos syndrome), an incurable connective tissue disorder that disproportionately affects women.
Being transgender and disabled has posed limitations for Gavino when it comes to proper healthcare and equal treatment. The medical field has imposed barriers when it comes to accessing hormones, proper medical treatment, and surgical transitioning for transgender people under the age of 18. There is also a lack of medical research for trans people in healthcare and this impacts the quality of care trans people receive. Gavino’s medical concerns have been dismissed as Trans Broken Arm Syndrome, an extremely invalidating way to look at a patient who is both transgender and disabled. It is described as a method by which medical professionals blame all of a patient’s medical issues on being transgender. A provider may blame a medical issue on the use of hormones, or dismiss it as a side effect. For example, Gavino was accused of his pain being all in his head. It is no wonder that someone might be hesitant to disclose their disability status, as Moya Bailey mentions, because there are negative stigmas and stereotypes associated with being transgender and disabled — or either of these identities individually.
While all individuals deserve the same quality of healthcare from their physicians, it is rarely the case that everyone receives the same quality of healthcare. With limited support from his family, and being under the age of 18, surgically transitioning, and gaining access to hormones and the tools Julian needed to transition, were a struggle. Since coming out, Gavino has experienced the disparities in the health care system, and in terms of treatment by health care professionals towards transgender and disabled individuals. His intersecting identities as both transgender and disabled, which are heavily marginalized, have provided Gavino with first hand exposure to physicians’ naiveté and lack of bedside manner. Gavino has been transparent about his top surgery scars, which led to an incredibly troubling experience with one physician, who, in response to seeing the scars, asked “what parts do you have?” As any person would take offense to such an obscure and inappropriate question, Gavino refused to answer and insisted the doctor look at his medical records, and this is when the doctors sexually assaulted and touched Gavino without his consent.
Being transgender challenges what society thinks a person can be. Someone who is trans may not physically present as being on either side of the male/female binary, and this introduces a situation where medical professionals need to reevaluate their own ideas of how they treat a trans patient. Creating a more accessible and inclusive healthcare system includes proper medical training and education surrounding various intersecting identities, as well as weeding out physicians who refuse to adhere to equal treatment for all patients, regardless of their identities. Physicians should be asking for a patient’s pronouns, respecting the use of mobility aids or devices, speaking directly to the patient and not other people in the room, and avoiding unnecessary and judgmental questions or assumptions about the patients sexuality or gender, and disability. Sometimes, it is necessary for a physician to ask a patient if they get their period, or if there is a possibility they could be pregnant, despite how the patient physically presents. These changes need to be made at a policy level, and need to be included in an updated version of physician training.
Moya Bailey focuses on Black Disability Framework, which allows for the consideration of disability in Black studies and race in Gender Studies. Bailey states, “stigma further complicates acknowledging disability, as it places an already precarious self at further risk of marginalization and vulnerability to state and medical violence, incarceration, and economic exploitation.” While Bailey is referencing the Black experience and Black women with disabilities, I think this quote does a great job of representing how experiencing two marginalized and oppressed identities takes a toll on an individual and impacts their psyche. Or, how identifying with one already oppressed identity, such as transgender, can hinder someone from also identifying as disabled. Being both Black and disabled, or being transgender and disabled, are both forms of taking on or identifiying as two heavily marginalized identities.
Again, while Bailey is applying these concepts mainly to race, the base understanding of this theory works very well to explain the ways in which intersectionality often excludes disability framework. Disabled people are also often infantilized, and looked down upon or talked down to due to their disability. The infantilization of disabled folks creates issues for a “misinterpretation” of disabled patients’ consent, or lack thereof, as detailed earlier on by Gavino’s experience with a physician in the emergency room.
In order to address questions of creating a more inclusive healthcare system, individuals need to engage in an intersectional disability framework, and look past the heteronormative binaries that Crenshaw and Bailey are working to countercheck. Even if a physician doesn’t think that a question might apply to an individual based on their apparent physical presentation, one’s reproductive organs are not automatically matched with how one physically presents. The way Julian has openly shared his experiences, highlights that the levels and quality of medical treatment and care that an individual receives will vary based on their intersecting identities of gender and disability status.
Gavino has experienced these differences first hand, and he identified a significant difference in the quality of his care once he transitioned and passed as male, and legally changed his name. Indeed, once Gavino passed as male, and fit into the heteronormative binary that most people are comfortable with, the stereotypes associated with the gender divide seemed to settle. Gavino states “Never once was anxiety/mental health brought up, and my care was sped up dramatically. I was treated with a different professionalism. Even spoken to differently. It took me a while to even realize what was happening and that this was a form of privilege due to gender.”
Returning to Julian’s experiences, he has been extremely open about the encounters he has faced as a trans individual who also identifies as disabled. Gavino openly shows his top surgery scars on his instagram account @thedisabledhippie and uses medical devices such as AFOs, his wheelchair, feeding tube, and his service dog. It seems as though his pain and experiences are further invalidated by being a trans, disabled man. As Bailey references, societal responses have the ability to impact whether or not an individual wants to reveal their disability status. Being transgender and disabled seems to serve as an either/or scenario. The healthcare system claims to operate to help people who are sick or disabled, however it’s never implied that they will adequately treat a disabled person with another oppressed identity. The quality and standard of care drastically changes when it comes to members of the LGBTQ community.
Kimberlé Crenshaw is well known for the term “intersectionality,” which is used to describe how race, class, and gender, as well as other identities — such as disability status — and characteristics interact and overlap with one another, creating identities that are not politically recognized. Crenshaw breaks down the concept of intersectionality into three categories: Political, Representational, and Structural intersectionality. For the purposes of looking through a disability lens, representational intersectionality is the most efficient means of looking at the quality of transgender and disabled healthcare. Gavino’s experiences have also been based purely on his intersecting identities of being a transgender male, who is also disabled.
Crenshaw states, “an intersectional analysis offers both an intellectual and political response to this dilemma,” meaning that you have to look at both the subordination and intersectional analysis of pairing disabled and transgender identities. I see this as showing how each of these identities has an impact on the interpretation of its counterpart, and an intersectional lens allows us to see how various identities go hand-in-hand in creating societal responses to overlapping identities. Bailey argues that disability framework “highlights how and why Disability Studies must adopt a comprehensively intersectional approach to disability and non-normative bodies and minds” and her work expands off of Crenshaw’s notion of intersectionality. Disability is often obliterated when people first think of intersectionality. Frequently, people think of race, class, and gender as the sole intersecting vectors, and are the main focus of intersectionality.
I am by no means excusing the behaviors of medical professionals, as I, myself, am a disabled member of the LGBTQ community. I do strongly believe that people in our healthcare system are not equipped or well trained to deal with the LGBTQ community when it comes to healthcare. While these experiences are not new for transgender folks, as medical professionals are ill prepared to treat transgender patients, they are also not new for transgender, disabled people; these experiences are more often invalidated and underrepresented in our healthcare system.
