Humiliation or Secrecy: The Hard Choices Faced By Transgender Patients
Transgender people like Afton Bradley are routinely embarassed and objectified by doctors and staff — if they aren’t denied health care completely.
By Gillian Branstetter
It’s not unusual to find 29-year-old Afton Bradley at the hospital. After the Richmond, Virginia resident survived a car accident, they needed a series of surgeries to repair an ankle injury.
The surgeries are routine, but each follow-up visit at a nearby teaching hospital brings its own surprises.
“Anytime they do an X-ray, they always give me the lead apron that folks are intended to have if they have a penis, which I do not. I always say I need the other because I have ovaries,” says Afton.
Once they make that clarification, the questions from nurses and staff pour in.
“They ask me questions about my transition, and ask, ‘How did your family handle that? How many surgeries have you had? Why haven’t you had this or that surgery done?’” says Afton. The questions rarely have anything to do with their reason for visiting the hospital.
“One asked me if, as a child, I had ever been hurt or abused, making a connection between that and being transgender,” said Afton. “I spent less than three minutes talking about my ankle and the rest of the time answering questions that are traumatic for me and for others to even have to answer.”
“He kept saying how well my chest looked, kept complimenting me and touching me more than he needed to.”
Like transgender people across the country, Afton routinely faces humiliation or even denial of service when visiting hospitals, doctors, and specialists. As Afton told NCTE, they’re regularly turned down by nurses or gynecologists who don’t understand why a non-binary transgender person would need routine health checkups like pap smears.
They recall one particular visit to a gynecologist. ”They asked, ‘Where’s your wife? Where’s your girlfriend?’” After Afton explained to the staff that they, in fact, were the patient, the nurse left and returned with another member of the staff who said they couldn’t be treated there.
Afton found another provider who would treat them, but had more probing and unnecessary questions when Afton revealed they had undergone a double mastectomy — commonly referred to as “top surgery.” The doctor immediately began objectifying Afton and their surgery.
“He kept saying how well my chest looked, kept complimenting me and touching me more than he needed to,” said Afton. “They refused to respect my body.”
Afton’s experiences may be disturbing, but they are far from alone. “The objectifying experience is not unique. People have shared similar stories with me,” said Afton.
Afton is associate director of Transgender Health Programs at the Virginia League for Planned Parenthood. They regularly interact with transgender people seeking primary treatment and care, including treatments related to their gender transition.
“I get to, unfortunately, hear a lot of the negative experiences people have had getting access to health care,” said Afton. “Not being able to find providers, being turned away by providers. One patient disclosed the first provider started questioning them about god and faith and how it was immoral for them to be their authentic self.”
“One person said a nurse lifted up her gown, saw a penis, and ran out of the room screaming,” said Afton.
The mistreatment faced by Afton and many of the transgender people they interact with is illegal under the Affordable Care Act. The Health Care Rights Law — a provision within the ACA — strictly prohibits discrimination by a provider on the basis of sex. As federal courts have overwhelmingly ruled, that includes discrimination against transgender people.
Despite this, confusion and misinformation about the rights of transgender patients is widespread in the medical community. In 2016, the Department of Health and Human Services published new guidance for doctors clarifying how they should — and should not — interact with transgender patients in order to comply with the law.
Now, the Trump administration is set to roll back that guidance, encouraging doctors and hospitals to refuse treatment to transgender people — effectively letting them pick and choose who they will and will not treat.
Afton takes seriously their own role as a healthcare provider to patients who often have few other options for fair treatment.
“I think we should be a sanctuary space, and all health care should be like that,” said Afton. “Whether it’s the front staff, the nurse, the doctor — once you act maliciously, you’ve taken away that sense of safety.”
According to the 2015 US Transgender Survey — which polled the experiences of nearly 28,000 transgender people — one in three have faced mistreatment from a doctor, nurse, or other health care provider. This can range from getting asked invasive questions to being verbally harassed to being denied treatment altogether.
The most common negative experiences stem from ignorance among providers. Over half of USTS respondents said they — the patients — needed to educate their doctors about their health care.
For these reasons and others, transgender people — particularly those who live in rural areas — are often forced to travel great distances just to see their doctor. As Afton noted, their doctor in Richmond frequently sees patients from West Virginia and Pennsylvania.
“When patients are willing to travel six hours to us because we are their best resource,” said Afton, “it leaves many folks living in rural spaces without necessary care.”
It’s difficult for transgender people to bring change to hospitals and big medical companies, especially when many of those companies refuse to recognize their own legal obligations to treat transgender patients the same as every other patient.
It’s why the Trump administration stands to do so much damage. By taking away the guidance that makes the legal rights of transgender patients clear to doctors, they’ll spread even more misinformation and deny more transgender people access to life-saving health care.
For Afton, it could mean answering more invasive questions and having fewer options for basic medical care. But as Afton notes, their experience as a provider helps them past some of these issues.
“I know the right pathways and the people I need to call to get past these barriers,” said Afton, “so I can only imagine when someone doesn’t have the health literacy that I do.”
