Privilege and healthcare

Image description: rows of orange pills in blister packs
Image description: rows of orange pills in blister packs

They kind of look like knock-off Minion toys. Or is that just me?

Here’s a picture of cis privilege.

I once went to a GP and asked for a prescription for an anticonvulsant. I didn’t have any documents from my neurologist with me. The only thing that could indicate that I might need an anticonvulsant was my wheelchair. Despite that, I was given a three-month prescription of the drug. There was the request to send documents from my neurologist “at some point.” I did — but I could’ve just as easily ignored that request.

The medication gives excellent results in the management of neuropathic pain, seizures and spasticity. However, it has side effects which can be difficult to manage. But I know them: it is my healthcare and I give informed consent to the effects of the medication.

I’m not criticising the GP for prescribing me the anticonvulsant. I really appreciated the convenience. Most people I know have had similar experiences with requesting medication from their GP, including HRT. Primary healthcare workers are able to prescribe a whole range of medication, even ones with psychiatric effects, based on informed consent.

Now compare that to the experience of trans, nonbinary and gender nonconforming people.

Every trans person who I know has a story of primary healthcare providers who treated them as “impossible patients,” giving reasons why they could not offer any help beyond a referral to a specialist. They refer to out-dated rules that contradict international standards of care for trans people; they say they wouldn’t know anything about prescribing blockers or hormones even though they’ll prescribe them to cis patients with other medical needs; they claim to not be able to give bridging prescriptions; they say informed consent doesn’t apply.

The reality is that even in Ireland and the U.K., primary healthcare providers have the power to do more than they say or realise. Some know and some are willing to learn or help. Some trans people have gotten what they deserve from their GP. However, the majority say no and refer you on.

If this is your first encounter with trans healthcare, you might think that they’re not refusing to help because they are giving a referral to a specialist. However, many countries, including the U.K. and Ireland, have too few specialists providing services to trans people. The time from referral to the first appointment can be two to four years. That’s longer than the waiting time for almost any other medical intervention. What’s more, many systems pathologize transition: in Ireland, the first step is a psychiatric diagnosis of gender dysphoria.

Imagine knowing that any doctor could prescribe what you need and monitor your blood work, but being told you have to wait for three years. Imagine knowing that information is freely available to any doctor who wants to learn, but that most don’t want to change the status quo of sending people to a few gatekeeping specialists. Imagine knowing that informed consent is a thing, but not for you. Imagine having to prove that you are trans enough to receive treatment.

This is why some trans people start their transition by using private medical companies or self-medicating. Of course this is only a solution if they have financial privilege. It’s also not right that someone should have to pay for healthcare that should be freely and readily available. Note also that there are government agencies and journalists who have taken it on themselves to interfere with the services of private medical companies, as has just happened in the U.K.

Without the means to pay out of pocket for hormones, many are stuck waiting for the slow national systems, which seem to be full of gatekeepers.

Trans people know all this. I’m writing this for cis allies. I’m asking you to learn about trans healthcare in your state or country. If it isn’t good enough, you can help.

Ask what your GP’s policy is regarding trans healthcare. If it doesn’t conform to the international standards of care for trans people, ask why. Offer to send them the document or buy them a copy of Transgender Health: A Practitioner’s Guide to Binary and Nonbinary Trans Patient Care by Dr. Ben Vincent. If they don’t offer bridging prescriptions, ask why. Push them to change their policy.

Do the same if you have a friend who works in primary healthcare.

Check if there any charities that support trans people who are on waiting lists. Donate to them. You could be helping someone get the care they need two to four years sooner than if they waited.

Find your national or local trans rights organisation that is working to improve the situation. Donate to them. Ask if there are any political actions you can support, whether it’s writing to a minister to demand change or joining a protest. Irish organisations include TENI and ITSA.

Think about trans healthcare and other trans rights when you vote.

It is not fair that I can walk into a GP’s office and get a life-changing medication with informed consent but a trans person cannot. Let’s make this post obsolete.

Beyond the scope of this post is the white privilege I have in the healthcare system. Take the time to look into how differently requests from white people are treated. That’s another area where change needs to happen.

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