When you think about trans healthcare, you might (rightly) think of long waiting lists to access Gender Identity Clinics (GICs), the challenging hoops trans patients are often required to jump through to ‘prove’ their identity, or the recent legal case around prescribing puberty blockers to under 16s. But that’s not all trans and non-binary people are subjected to.
We already know that there’s a gender health gap when it comes to the healthcare that cis women receive. We’re less likely than men to be believed or taken seriously when we’re in pain and, in my work on these issues as a health journalist, I regularly hear from women who have been dismissed or disbelieved by their doctors and other healthcare professionals.
But you might not be aware that trans people face a similar phenomenon, even when accessing healthcare that has nothing to do with their transition. It’s known as Trans Broken Arm Syndrome – a term coined by Naith Payton in a 2015 article for Pink News. Trans Broken Arm Syndrome refers to a tendency among healthcare professionals to dismiss any health issue a trans patient may present with as being caused by their trans status and/or hormone treatment.
For cis women, trans and non-binary patients, being believed in healthcare settings can never be counted on. Neither can being trusted to know our own bodies and minds, or to make informed choices about our care.
In my reporting, I’ve found that in the same way a cis woman might be told her agonising period pains or crippling low mood are just part and parcel of ‘being a woman’, without any further investigations into the underlying cause, so too might a trans patient’s concerns be automatically dismissed as a result of their transition. This, as Naith explains, can apply to any health issue, “from mental health problems to, yes, broken arms.”
Trans Broken Arm Syndrome stems from a failure by health professionals to recognise that trans patients can have the same general health needs as any of the rest of us.
Thirty-three-year-old Cassie, a trans woman from Belfast, has had issues with her skin since a young age, beginning with fairly typical childhood eczema and progressing to more chronic dermatitis in her 20s. Despite this history, when Cassie saw a new doctor about a particularly bad eczema and dermatitis flare-up in 2018, they immediately suggested it was caused by her HRT – the hormone replacement therapy she’d been on since late 2015 as part of her transition.
“It’s maddening, and subsequent doctors at a different practice have said the same thing. I was firm with them that HRT was not the issue, and pointed to my medical history as proof,” she says. “I really feel that doctors do not treat me in the same way since transitioning. My concerns are disregarded and I feel like they look at me as a nuisance, regardless of if I’m trying to speak with them about something non-transition-related.”
Fortunately, Cassie’s GP was at least persuaded to prescribe steroid creams to deal with her flares in the immediate term but the broader issue of waiting times to see an NHS specialist meant she ended up paying to attend a private dermatology clinic. “I’ve received slightly better treatment there, however again they tried to blame my HRT,” she says. “I’ve almost completely lost faith in doctors and the medical establishment. Thankfully I don’t have any other health issues that are a concern, aside from the ongoing skin problems. However, unless something changes, I will always be mistrustful of doctors.”
Trans Broken Arm Syndrome typically stems from a failure by health professionals to recognise that trans patients have the same general health needs as any of the rest of us; that their health is not purely defined by their trans status. As Dr Ruth Pearce explains in her book Understanding Trans Health: “In understanding ‘trans health’ in terms of transition, practitioners may fail to take trans patients’ other health concerns seriously.”
This, she says, “appears to be most common among mental health service providers, many of whom appear to regard trans people’s mental health as relevant only in terms of or in relation to transition… However, the flawed logic of Trans Broken Arm Syndrome can be applied to almost any health issue.” As a result, it can be difficult for trans patients to access support for health issues that are unrelated to their transition. Common experiences, as documented under the hashtag #TransDocFail, include trans people being referred back to their Gender Identity Clinic or denied treatment altogether on the basis that their healthcare professional ‘doesn’t know how to treat trans patients’.
Trans woman Alice from Northumberland had this experience after asking for her hormone levels to be checked as part of a routine blood test at her local GP surgery. At the time, Alice was self-medicating while waiting to start HRT and her GIC had written to the GP, recommending that he check certain hormone levels in her blood. “I was due a full health check-up anyway, which included a blood test, so I suggested including the hormone check as part of it. My GP refused and told me he was not comfortable treating transgender patients,” she explains. “I’m quite resilient and thought I could win them round, but the following year I needed a repeat prescription for my daughter’s eczema creams and they even refused to prescribe that. It was very apparent then that they just wanted rid of me.”
In understanding ‘trans health’ in terms of transition, practitioners may fail to take trans patients’ other health concerns seriously.
Dr Ruth Pearce
When Alice phoned around other surgeries in the local area, she had mixed responses. One surgery was only willing to take her on as a private patient and a doctor at another surgery said he was “not against transgender people, he just didn’t know how to treat us.” When, on her fourth attempt, Alice eventually found a surgery – two villages away from where she lives – willing to treat her, the health check-up and blood tests couldn’t have been more straightforward. “It was just a normal, routine blood test, and then they took an extra tube of blood to send off for the hormone check. When the results came back from the lab, I sent them to the GIC. There’ve been no problems with these doctors at all,” she says.
In stark contrast to the disillusionment that Cassie now feels, Alice’s experience illustrates just how different trans patients’ experiences could be, given a little more open-mindedness and understanding on the part of healthcare professionals. While transition-related healthcare can be left to the gender specialists, it’s important for all doctors to be aware of how anatomy-specific issues may or may not apply to their trans and non-binary patients. Some trans men and non-binary patients still have a cervix and require cervical screening, for example, while trans women and people assigned male at birth could still develop prostate cancer. For the vast majority of other health concerns and procedures though, trans patients can and should be treated the same as anyone else.
There’s no doubt that there are significant overlaps here between what trans people are facing and feminist issues about bodily autonomy and reproductive rights like abortion. There should be solidarity and coalition between us all but fear, bias and ignorance too often get in the way, creating a dangerous barrier to the healthcare that trans people need.
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