date of last menstrual period and if irregular:

many of us who are trans women live in a unique double-bind when it comes to basic medical care: this question on intake paperwork, which has a completely benign intent but ends up leading to the very bad decision: do you lie, or do you tell the truth and probably deal with problematic behavior?

i know why it has to be asked of womankind generally: it’s critical to know if someone is or isn’t pregnant before giving them medication for the condition they present with. it’s a bad idea to give a number of meds to a pregnant woman, or, god forbid, send her for x-rays. it’s not designed to block medical care for trans women, but the end result ends up being that it does, and there needs to be a better way to handle it because in many situations disclosure really isn’t necessary and  the danger to our health, person, and dignity is really unacceptable.

i’m sick of lying to appease people, especially people who should know better, and medical professionals, from the office staff to doctors, really ought to know better by now.  i know all the excuses, from Anne Lawrence to “we’re not familiar with…that, somebody else deals with that” to the reality that someone will either freak out and start yelling or alternately you get treated like a freak, asked improper questions, and probably misgendered by someone who would never have thought twice about you if you hadn’t said anything. it’s a bad scene because even if the doctor might be cool, a nurse or an office staffer might not; similarly, a nurse might be totally okay with it but the doctor themselves can’t discern you from Anne Lawrence and the results are expectedly horrible.

there is no special medical procedure involved in treating a trans person when they present with a sinus infection or a rash that would somehow differ from how you’d treat a cis person in the same situation. no matter how you try to throw in variables, there’s no magic difference between our bodies. yes, there can be a few minor differences, but estradiol does not somehow have a magic pull over the snot in your sinuses which causes your disease or disorder to be different.

i often end up getting much sicker because of this dichotomy. i live in a city where there are fairly few “trans-friendly” medical professionals (or at least there are fairly few who anyone will speak of publicly) and they generally focus on being dispensers of hormones and thus gatekeep your fitness for being seen by their practice that way, which is pretty much bullshit but such is life. for some reason, nobody has bothered to figure out the radical idea that a trans person (locally, specifically a trans woman, as there are a number of medical access options for trans guys that we don’t have) might need routine medical care, so it becomes a nasty waiting game: try to fake it without medical care, but have an established point where once you’re so sick, you go to the urgent care and forge your answers to this question (five days ago, haven’t had procreative sex since…you’re welcome), and then hate yourself for the next week and hope you don’t do anything stupid to yourself out of the self-loathing over lying, but at least the pneumonia won’t kill you, this time.

i’m not saying medicine shouldn’t ask this question…what i am saying is that you should probably have an option for “yes, i’m sure i’m not pregnant” while we’re at it. it would be helpful for cis women who don’t bleed, and most cis women don’t really want to talk about their menstrual cycle with some random doctor of the day who knows nothing about their body and cycle anyways, since, really, everyone’s so different and medicine really believes 28 days is normal, 28 days is absolute, and 28 days…well, guess what? it’s not, and it’s never been. it’s an average, a number which is designed to represent fictitious Average Fertile Cis Woman in her average stress-free life with her average (white) Toyota Camry who lives in Averageville, U.S.A. if you see a doctor for a while, they might get to figuring that out, but when it’s some random dude at the urgent care (and why are all the local urgent care doctors male, anyways?), it’s useless for a thousand reasons.

medicine, alas, is not a beast that is likely to embrace change. it’s stayed painfully white, cis, hetero, and male for a very long time, and this reality is much of what keeps it so hostile to trans people generally and trans women in specific.  i do not know how and why doctors form their opinion of trans women; i am quite aware that we’ve had our share of trans women who were doctors and behaved rather problematically in public, but it’s not like Joe Blow at the local urgent care knows any of these people, and besides, even if he did, one bad apple doesn’t mean we’re all like that, yet no matter what, medicine sticks rabidly to its fears and the worst-case scenario when it comes to trans people, especially when it comes to trans women.  somehow, at the end of the day, i think that’s my real problem: i can do all these things in life and yet i can’t manage to convince some random doctor that i am good enough to be treated like an actual human…i can’t convince them that i am any different from, well, Anne Lawrence.

…and you know what? that’s why this really sucks. we’re still considered freaks by medicine unless there’s some clear way to profit off of us, and then we’re good enough as long as we know our place, but don’t expect to be allowed luxuries like basic medical care or treatment for chronic conditions, because that’s just asking too much.

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15 Responses to “date of last menstrual period and if irregular:”

  1. I know I’ve probably said this before, but I don’t think it has anything to do with people thinking you’re Anne Lawrence. I think it’s almost the same reason most insurers get away with trans care: mostly inflated fears about higher costs (malpractice liability for doctors, literal costs for insurers) combined with the social acceptability of treating trans people as disposable. And the thing is, “persuading” them that “you aren’t like that” doesn’t address either. We can show with facts that the fears about costs aren’t justified; we can’t persuade them that you and I are people, we have to demand it.

    And apologies in advance if this is splainy, and it certainly doesn’t address the greater issue, but what’s wrong with writing “I am completely certain I cannot become pregnant and I do not want to discuss this further as it is not pertinent to my condition”?

    • the latter solution doesn’t work because they just keep asking. idk what it is, be it “you’re not intelligent enough to know” or “now i have this awful curiosity” but it leads to more questions, often in the waiting room, which is not really an okay place to do that. it’s kind of that sort of thing which only renders the matter more tantalizing to the person asking the questions. there’s no really useful way around it other than lying or outing yourself because nobody ever really believes me when i point out that i’ve not had sex with a man in the recent past.

      the problem is that fear of malpractice liability is pretty much as bullshit as thinking i’m Anne Lawrence; they both go to bullshit stereotypes of trans women which have nothing to do with me. if you’re scared i’m gonna sue…what does that say about what the doctor thinks of trans women?

      i don’t have a lot of power to demand in a doctor-patient situation, since “demanding” tends to end up with me getting socked with a $200 bill when they never performed any services. unfortunately, the way the system works right now, they can say they won’t treat you for pretty much any reason, and then it’s back to square one, where it’s more important you not get pneumonia than it is to be truthful with intake paperwork. and, well, your ability to lie should not determine whether or not you’re getting antibiotics…

  2. When I had a period mine was never regular even when I took the pill and forced my body to bleed at certain times. My body still would bleed whenever it felt like it. I agree, seeing a random doctor for sinus infection should never require the knowledge that they ask for. I don’t know the solution, but I hope there is one that’s fair to everyone.

    • yeah, i know women on the 17/35 system (17ish days one month, 35ish the next, happens to some ladies on triphasic BC) and they seem to be treated like three-headed jungle cats by doctors when asked the same question. the funny thing about the pill is that it regulates the timespan of a menstrual cycle into something fairly regular but it doesn’t magically make it 28 days, and doctors don’t always get this.

  3. Yeah…. It’s always “fun”explaining why I’ve never had a menstrual period when I’m feeling like shit. Though I suppose I could take it as a compliment that “oh you’re biologically male” didn’t cross their mind……… But the whole being sick thing kinda uses up the patients needed to process the interactions like that…. why are we talking about my genitals when my sinus are swollen and flooding my throat with snot?

    Though I don’t think they asked anything about periods at the urgent care I went to recently. Though I think I basically answered some of the questions with basically, “fuck you”. And was grumpy as hell…. Having your eye swollen shut from shingles apparently makes me hostile towards bureaucracy and paper work. Also I’m sure white privilege helps me get away with the grumpy patient thing.

    • i don’t really take it as a compliment or not that it didn’t cross their mind that i’m trans. i mean, passing is part of basic survival for someone like me, so i don’t get room to do anything else. at the same time, however, i know their idea of what a “trans woman” is not including me is kind of offensive because it narrows what a trans woman can be down to a certain set of stereotypes which i don’t meet.

      and, well, that’s superbad, since that’s the same kind of test that in-community gatekeeping uses to decide someone like me isn’t good enough to be allowed in a support group (and thus the exclusive venue for where safe medical provider information is discussed locally), or that some non-gender-related thing like disability makes me “not trans enough.”

      i’ve literally never run across a provider who didn’t have some amount of questioning about fertility for people they assume to be female…hell, even the doctor i see for my hormones had an extremely confused receptionist when i noted “infertile, not having procreative sex anyways” but fortunately it was early so the waiting room was half empty, i was far from home, and we both spoke Spanish so it was pretty simple to explain without it being embarrassing or worse.

      and yeah, i don’t blame you in the slightest for answering “fuck you” to half that stuff with an eye swollen shut. that is one of the worst feelings ever, imho.

  4. I believe that it doesn’t have to be that way, that their are very simple steps they can do into this. But… I have to get outed to everyone in the room everytime I go to the doctor. And we are talking about rooms full of people who have everything from PTSD to missing eyes and limbs. I dread going to the doctor for anything because it upsets me to deal with that. My PCM is good, but any other clinic in there and I get the “weird looks” and “uncomfortable posturing”. I’d like to have my name change done already, but it’s either that or groceries for a disabled veteran in my situation. It is a situation that the VA is supposed to have “Fixed” but my VA hospital’s the general staff as no fucking clue what to do in those situations or at previously being asked they don’t.

    Then, this response really gets my goat when asking someone what I need to do to fix that. I usually have to essentially out myself, and the only thing they have to say to is this, “Oh, you’re pretty, I’d have never known”. At least the VA is working to fix the issue at the top, but none of their staff seems to have a clue how to put these policies into use. Hell, I asked them about mammograms and even my own doctor was clueless. I am lucky to live in a place with more awareness of these issues, but I’d have to say that it still upsets me that no matter how many “notes” they put on my records I still have to dread that moment they call me back. Will they get it right, or will the fuck it up again. Will someone catch on and follow me home tonight with less than honorable intentions, who knows…

    I have enough anxiety without having to deal with as a result of my own service at the one place I shouldn’t have to. But medical care with trans people is always like this… It’s either a legal hurtle, or some uncomfortable question about who or “what” one is. It’s a matter of medical privacy, and it isn’t respected as much as it should be, especially for women (trans and cis). It’s not like they have to change my legal name in their system, but if they are really going to make it “easier” for trans people seeking medical care they are going to have to do a better job for it to be truly equal. The problem with medical care isn’t just that there is latent transphobia within those fields (while it is present), but that there is latent paternalism and sexism in it. It’s only women in general who get probed like that and in a sense medicine has always had a tendency to do that to women, and trans women really add a whole new level to that very issue.

  5. Hiya, doctor here. Unfortunately some people (through ignorance, or denial, or lack of insight, or other reasons) are absolutely certain that they’re not pregnant and it turns out that they ARE, so having a tick-box for “I’m sure I’m not pregnant” is not something that I’d be happy to do, especially if I were sending someone for x-rays. Usually in that circumstance though we’d do a urine test just to be sure, which makes the invasive questions unnecessary.

    I know that talking about menstrual/fertility stuff is uncomfortable/upsetting/triggering for a lot of women and so I don’t know what to suggest instead but if someone told me that (for example) that they don’t want to talk about why/how they are sure they aren’t pregnant, I would leave it at that and if it was absolutely necessary to know, do a urine test. I’d hope that most doctors would understand that fertility related stuff is a very emotive topic.

    • yes, i get the especially vexing issue of x-rays (or certain antibiotics, i’m always amazed what ends up being pregnancy category X aside from the obvious stuff) and i’ve gotten sent for a urine test before in the urgent care setting, which is kind of ironic but i get that one’s butt must be covered. (there is also that i’ve never had consensual sex with a man, but for some reason this universally fails to register.)

      however, none of this really goes to the problem at hand: it’s almost impossible to get safe medical care without lying if you’re in my shoes, and i’d really rather not be lying. the end result of a lot of how medical offices structure this is that you have to lie or you don’t get medical care. i mean, i’d really like to go see my aunt’s amazing dermatologist, but disclosure isn’t a safe option with most doctors, and given that information about who is and isn’t safe is so closely guarded and not given to outsiders, there’s a major disconnect at work when it means not getting necessary medical care.

      getting sick is doubly terrifying for me, and there’s a lot of stuff i end up having to let fester which really shouldn’t because it’s not bad enough to be worth how shitty lying makes me feel, and because “i’m infertile” just doesn’t seem to work as a parry, these questions with the best of intent end up having the worst of results: screwing trans women over. i shouldn’t be put in a bad position because medicine is too bigoted (as a field, generally) to allow my existence, dammit.

    • But uh, isn’t this putting embryos’ needs ahead of people’s needs? (Or, maybe more cynically, putting legal liability ahead of serving *everybody*, because as I think Erica showed, asking a cisnormative question excludes some people from receiving medical care more than it does others.) Like, how many trans women’s lives are equivalent to the value of one embryo? (Or, if the more cynical interpretation holds, the value of a dollar?)

      • That is a very good point. It had never occurred to me that this very statement had that connotation, rather than an issue of “female” medical needs. There is a very paternalistic aspect to this sort of “intrusive battery” that the doctor somehow has the “right to now” you are pregnant so that he may make sure you don’t hurt your fetus? No, there is no sexism there… Right? Ha. That question smacks of heterosexism, cissexism (by proxy), and of coarse of plain old sexism. But this wouldn’t be the first time that the medical establishment had something that was overtly paternalistic in nature. That question plain and simple doesn’t need to be on uptake paperwork, or be optional for the woman unless there is a need for the doctor to warn you that “X is bad for fetuses, would you like to check first?”. In the end, it’s about (to some degree) a woman’s rights to her body, and to not have it unnecessarily intruded upon by others.

      • I agree, I think it’s paternalistic and would be paternalistic even if everyone was cis. Cis women have the right to prioritize something other than their role as a flowerpot, too.

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