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“hi, how do you handle being intersex when you go to the doctor? my primary care doctor knows that I’m intersex, but I never know if I should talk about it if I have to go to the school nurse, the ER, or see a specialist. do I have to tell them? does it matter if I don’t? thx”

-Question submitted by Anonymous

Claudia Astorino Says:

Awww, booooo, Anonymous—having to go to the doctor’s is never fun, but having additional needs on top of your medical needs isn’t always intuitive to navigate. When I’ve chosen to disclose aspects of my body that aren’t normative for women—or even to say that I’m intersex—I’ve had results that range from really positive to really awful (like, eat the whole pint of Ben & Jerry’s awful #chubbyhubbyforevs). Based on these various experiences, I’ve created a few rules for myself that tend to end up making my visits a bit more pleasant.

1) I only disclose information about my body that is (I think is likely to be) medically necessary. So like, if I have a sore throat and go to the doctor’s, it’s probbbbbbably highly unlikely that my XY chromosomes are the reason I’m hacking up a lung. If the reason I’m getting medical care CLEARLY has nothing to do with my being intersex, I don’t mention it.

Now, I’ve put “I think is likely to be” in this rule as a reminder that if I think that my being intersex might be relevant to my medical care, then it may be worth bringing up to my doctor.  For instance, if my doctor may say something to the effect of, “Well, [health concern] is highly uncommon in women,” I may say, “Well, that may still be worth exploring since I’m not a biologically typical female. I’m an intersex person, and my form of intersex is complete androgen insensitivity. Is [health concern] likely to impact me?”

2) If doctors ask questions about my body that are medically relevant, I answer them (although I don’t have to give them all the details). I had an appendicitis scare, and the doctors performed an MRI of my lower abdomen to see if my appendix was inflamed. After doing this, one of the ER nurses said that she’d observed that I didn’t have a uterus, and asked me why.  I said, “I was born without a uterus.” In similar instances, I might follow up with, “I didn’t have a hysterectomy or other procedure you might want to be aware of.” These medical professionals are likely making sure that they’re ruling out any possible reasons why I may be having a set of symptoms, and answering these questions helps them to do that. However, I’m not obligated to provide further details. Read on, intrepid Anonymous!

3) If doctors ask questions about my body that are NOT medically relevant, I’m not obligated to answer. So. The thing is, doctors are people. And we people are living at a time in history where intersex people aren’t highly visible or well-understood. Many people don’t know what it means to be an intersex person, and sometimes these people wear white coats and stethoscopes and hold medical degrees. Sometimes, it is clear that medical professionals are asking questions about your body that aren’t medically relevant, and you might feel really uncomfortable with this. Well, Anonymous, I’m here to say it loud and clear: YOU DON’T HAVE TO ANSWER THOSE QUESTIONS, AT ALL, EVER

Let’s go back to that appendicitis scare I had. After I stated that I was born without a uterus the attending nurse asked me, “Um, why is that?” Hopefully, this nurse was trying to ask me if there was other medically relevant information she should know about. In response to situations like this, it’s perfectly acceptable to say, “That isn’t medically relevant in this case,” and state that I haven’t had a hysterectomy or other procedure they might want to know about, as suggested above. Another way to respond to questions like this is by asking another question: “Is that medically relevant?” or “Can you tell me how that’s medically relevant?” and wait for a response.

What doctors need to know is information that is medically relevant. That I’m intersex and my form of intersex is complete androgen insensitivity and I have XY chromosomes and I was born with testes and blah blah blurgh blah is usually not medically relevant information. Under those circumstances, I don’t need to report this info. If I feel comfortable providing this information, I can choose to do so, but I’m not required to.

Occasionally, you may have an encounter that makes it clear that doctors are asking questions about your body out of curiosity, and that’s not appropriate or okay. You are visiting them to stop hacking up your lungs or prevent appendageddon—not to teach them about intersex people.

Let me tell you a story.  Several years ago, after I moved to NYC, I went to try and find a doctor to serve as my primary care physician. During my first appointment with a physician we shall refer to only as Dr. Doodoopoobutt, I was asked why I took a daily estrogen pill. Since Dr. DDPB was going to be my GP, I came out to them as intersex, and told them my form of intersex. Dr. DDPB responded by asking a series of inappropriate questions, including, “So, um, do you have a penis? Oh. *pause* So you have a vagina, then? Uh, what do you and don’t you have?” Later, when I was lying on the exam table, I was terrified that Dr. DDPB was going to try to insist I should pull down my pants so they could inspect my genitals.

Today, if this situation had happened, I would have the confidence to say, “Those questions aren’t medically relevant. Can we move on?” or perhaps to say, “Those questions are medically irrelevant and they’re insensitive. I’m going to leave now,” and walk out the door and buy a hot chocolate and sit on a bench in Central Park and watch the squirrels stealing soft pretzels right out of the garbage cans, because eff that noise you know? But at the time, I didn’t know these options were open to me. Dear Anonymous, know that if any medical professional acts in a manner that’s inappropriate or disrespectful, you don’t have to sit in that plastic patient’s chair and try to deal. You are fully within your right to let them know it’s not okay, to leave, to go get that hot chocolate.

4) If doctors ask questions about my body that are NOT medically relevant, I reserve the right to lie about it.

Yep, you read that correctly, Anonymous. Real talk:  I may choose not to be truthful in answering questions about my body related to my intersex if I know it’s not medically relevant—and especially if I don’t feel comfortable with a particular healthcare provider. I have mixed feelings about this—I want to be clear about the fact that, in general, I don’t advocate lying to health care providers, and that coming out to medical professionals can be a positive experience. That being said, you are not required to come out. It can be painful when clinicians are less-than-sensitive about my body after coming out to them as intersex. I’ve dealt with a lot of damaging words and procedures from various doctors at multiple medical facilities during my childhood and adolescence—I value myself and my emotional health too much to put myself in a similar position again as an adult.

In what situations might one lie? There are often standard questions you’re asked to fill out on medical forms or asked by clinicians that you can’t answer truthfully without coming out and having a conversation about it afterward. For example, I’ve never gotten my period, but I’ve never had a medical appointment where I didn’t have to report when my last period was.  Although I tell doctors now, “I don’t get my period,” or “I have amenorrhea,” and go from there, I used to simply lie about it when I was younger because I didn’t know that, “I don’t get my period,” was actually an acceptable answer. My go-to was, “The first of the month,” and then sit there white-knuckling it because I was nervous they knew somehow I wasn’t fessing up.

Finally, I am fortunate that I have never felt truly unsafe when visiting medical facilities as an LGBTQIA individual. However, this is not always the case for LGBTQIA patients. If I felt that my safety was at issue by disclosing my intersex, I would not hesitate to lie to protect myself, and leave the facility if I was able to. Remember, you can always find a new doctor. Keeping yourself safe—even if you have to lie—is okay. #safetyfirst #always

Well, Anonymous, I hope that this helps you out! Before appointments, I’d recommend spending a few minutes thinking about what information you’re comfortable disclosing and how much—it will make you feel more comfortable during the appointment and feel empowered that you’re taking control of the conversation about your body (which is not what most of us have experienced being medicalized as kids).

Fingers and toes crossed that your next appointment goes great! <3

***

Claudia Astorino is an intersex activist living in NYC.  Claudia serves as Associate Director of Organization Intersex International’s USA chapter (OII-USA), coordinates the Annual Intersex Awareness Day (IAD) events in NYC, and writes for Full-Frontal Activism: Intersex and Awesome (her personal blog) and Autostraddle. Help support our contributors here on Patreon!

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"I’m trans, and I’ve avoided going to any doctor for a long time. I have no idea how to find someone who will understand and make me feel safe. How do I find a trans inclusive doctor?? And what should I ask once I’m there to make sure they’re actually accepting?"

-Question submitted by Anonymous

Riley Johnson Says:

Congrats on seeking care after some time away! I have had this tendency for avoidance a time or two myself. Accessing care and being consistently on top of one’s health can be a challenge for trans folks. In 2011, the National Transgender Discrimination Survey found that 28% of respondents postponed medical care due to discrimination and 48% postponed because they couldn’t afford it. So we are definitely not alone, unfortunately. There is definitely help on the horizon though.

RAD Remedy is a community-driven, nonprofit organization that created the first review and referral site for trans, gender non-conforming, intersex, and queer health. The Referral Aggregator Database (RAD) is live in open beta and has approximately 3,000 providers with more being added daily. RAD Remedy aims to make it possible for folks to find great doctors nationwide and know precisely what to expect when accessing care. Providers come to RAD in one of three ways – through an intensive questionnaire about their practice and expertise, through referrals from community organizations, and through the reviews of folks like us who have seen the provider. I would encourage you to check the database first, and if you have trouble finding what you need, drop RAD Remedy a line and we’ll work with you to find a good solution. [I can be reached at riley@radremedy.org.]

Next, I’d like to talk briefly about strategies for getting care safely and knowing the questions you can ask to find a welcoming and knowledgeable provider. I think it’s important to be real and say that we as trans folks need to meet providers where they’re at. Looking for a provider who is an expert and has many trans clients is great, but it can be unrealistic at times depending on your location. More often you will find a provider who is interested in serving trans clients but hasn’t done so yet. TransLine operates a medical consultation service to help those providers, and RAD Remedy works with providers to improve their practices, forms, and processes to make them more welcoming.

It’s also important to note that what I consider acceptable in a provider may not be what you might. Gather all of the information you can and make the best choice for your situation. Before you make your choice, I find it’s helpful to sit down with yourself and identify the following:

Must Haves: [an example from my list: providers must use my right name.]
It Would Be Nice: [an example from my list: I would prefer that a provider has experience with trans clients but I’m willing to work with one who hasn’t done so yet.]
Dealbreakers: [an example from my list: messing up my medications, being hostile or fatphobic, etc.]

Some key questions you can ask the provider (or ask the front desk person to ask the provider personally) to ascertain whether or not a provider is trans-affirming:

1. I am a transgender man (trans woman, nonbinary person, etc.) in need of primary care/gynecological care/etc. Will this be a problem?
2. Does the provider have experience with trans clients?
3. Have the provider and clinic staff been trained about trans issues?

Here are some best practices for providers serving trans clients (and ways patients like us can subtly see whether a provider is affirming):

*Do the intake forms have a spot for preferred name and/or pronoun?
*Does the office location have gender neutral or single stall restrooms?
*Does the office art reflect the clientele? If there are pictures, are the people in them diverse in age, race, etc?
*Does the office have magazine subscriptions for LGBTQ publications?
*Does the office have an efficient and transparent means of providing feedback or complaints if needed?

Here are some key general strategies for getting the most out of your time with your provider and feeling safe while you do it:

*Use the buddy system. Other than in some domestic violence screenings, you’re allowed to have a friend or loved one in with you for office visits and exams. You can insist that they come in with you to the exam room.
*Know the questions you’d like answered or the medical issues you’re having. Some folks find it helpful to jot down a short list so they’ve got a plan for the visit. Try to keep your list short and prioritized, since you often won’t have a lot of time with the provider.
* If you are concerned about information being listed “on the record”, discuss the issue with your provider. Providers will usually tell you the sort of information they feel compelled to record and what can be discussed “off the record”.
*Take notes when in with the provider (or have your buddy do it). It can be hard to remember what gets said in a visit – particularly if you’re nervous.

Lastly, know that you have the right to access health care without experiencing discrimination. Earlier this year, a federal court in Minnesota issued a preliminary ruling that discrimination against an individual because of his gender identity is prohibited under Section 1557 of the Affordable Care Act. For more information on how to file a complaint with the Department of Health and Human Services (usually after a provider-based complaint has failed or if things are particularly egregious), check out their website.

***

Click through to read more about Riley and our other contributors!

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“I’m trans and pansexual, and I’ve wanted to be a therapist for a long time. However, last year I outted a loved one to my therapist–just because it was a big part of my life and what brought me and that person closer–and my therapist told my parents. I know that he didn’t have to and that he was breaking rules, because I came out to the therapist I had before him and she was fine. Now, my view on therapy has changed, and I’m afraid to go back, but I know I need it. What do I do?”

- Question submitted by Anonymous

To answer this question, we reached out to our friend Kati Morton, who is an awesome mental health YouTuber, as well as a Licensed Marriage & Family therapist, to say a few words before you get your standard Everyone Is Gay advisement from the lovely Dannielle.

Kati Morton Says:

This is obviously a case of someone not being good at their job, and that definitely sucks, but know that this is the exception not the rule. That is why it is so important to know that you can always switch therapists! If you don’t click with one, or you don’t feel that they “get” you in one way or another, it is perfectly fine to find someone else. In fact it takes most people a few different therapists to find the “right” one. So please get back out there. Don’t let this one bad therapist take away your chance at an invaluable resource.

Dannielle Says:

Unfortunately for all of us, there are really wonderful people and really terrible people in nearly every field. There are straight up MONSTERS that run non-profit companies. There are doctors that mis-diagnose patients with cancer on purpose, so they can make money. There are lawyers that make up stories and evidence to get their undeniably-guilty-clients off the hook. There are cops that use their position of power to commit disgusting acts of racism. There are therapists that out their clients and prescribe sending them off to pray-the-gay-away camps.

Fortunately for all of us, those aren’t the only people in the world. There are people who work tirelessly to make the world a better place. There are doctors who put everything they have into making sure their offices don’t experience even a hint of malpractice. There are lawyers who fight the lawyers who fuck it up for everyone. There are cops who truly do believe in protecting all people and are disgusted by men-in-uniform whom do not comply. There are therapists that would never, in one million years, under any circumstance, share your confidential information.

I think you should find one of those therapists, and if you’re still considering it, I think you should be one of those therapists.

If you have the opportunity to be one of the great people in your field, please do it. Please be the good among the bad. Give people a reason to feel safe. If there is one thing this world needs a lot more of, it’s safe spaces. Safe spaces for all types of people, for all types of reasons. We need good therapists, we need good doctors, we need good cops. We are raised to believe these people are looking out for us. We are brought up to believe these people have our backs. We spend our entire lives seeking out these specific types of people because they have the power to do something we can’t, they are supposed to be on our side. Sometimes they’re not. Sometimes they’re so far from being ‘on our side’ that it’s sickening. Please, please, do not give up your dream – and do not give up therapy – because some people are pieces of shit. Believe that the world is better because you are in it and you will make it better.

And. Trust your intuition. Another thing we’re taught from a young age is that we are wrong. We’re taught this over and over and over, until one day you’re sitting in a room with a therapist and they say to you, “being gay isn’t actually a real feeling, a study was done to prove that it’s because of your abuse as a child, if you don’t remember the abuse, it’s because there is a block on it.” Immediately your guts go “whoa whoa whoa, this doesn’t feel right,” but because we’ve been taught to stop believing in ourselves so early on, you stop that thought process. You stop it and say, “well, my therapist is a professional, they must know what they’re talking about,” and you find yourself in a much worse position because you didn’t trust your own intuition. Your intuition is powerful as fuck. Trust yourself, and do what feels right.

***
Hi! Our advice is always free for all to read & watch. Help us keep this gay ship chuggin’ by donating as little as $1/month over here on Patreon. xo

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"I’m a young (20) transman who is still mostly not out. I haven’t transitioned, etc. Well it’s about time I go to the girly doctor, because biologically I’m a girl. But the thought of going gives me incredible amounts of anxiety. I freak out just thinking about it. I don’t think I can go. Also, if I did go, I don’t think I can be honest with the doctor about being trans. Any advice would be great."

- Question submitted by Anonymous and answered by Liam Lowery as part of Everyone Is Gay: Second Opinions.

Liam Says:

First of all, props on planning to go to the doctor. Going to the doctor is so so so SO important! And it is so easy to let that get away from you because of everyday things like work or school or watching Netflix, let alone when going to the doctor means considering coming out (or not) to a healthcare professional and steeling yourself for all the negatives that can come of out that interaction. So good job, you health-nut! You are doing something very hard and important, but it is worth it.

Second, I take it from your questions that by “girly parts” you mean your internal reproductive organs—such as a uterus, ovaries, fallopian tubes, etc., as opposed to external reproductive organs like testes and penises. I also have those internal organs, but I don’t consider them girly parts. And my care provider isn’t a “girly doctor,” she’s just a garden-variety gynecologist. Here, this great piece by Dean Spade about gendering body parts is helpful. Because honestly (and this is a bit of a mind-f’er, the first time you hear it) there is nothing about any organ that is inherently girly or dudeish. Those categories (along with the idea that, somehow, reproductive organs “make” you one gender or another) is cissexist, and has been put in place without transfolks and intersex people in mind. Now, if we all operated using Dean Spade’s preferred language, there would still be room to say things like “Most women are cisgender, therefore most women have internal reproductive organs” but it would leave that all-important room to acknowledge that there are men walking around with uteruses, women with testes, and many people with a combination thereof, and that our gender identities are in no way determined by or determinative of our reproductive organs. Basically your junk and/or reproductive organs do not make you “biologically” anything.

Next, you need to find a healthcare provider. Remember, please, that finding a healthcare provider is a process, not a quick fix. When you go to your first appointment, treat it like an interview—is the office clean? Do you like the staff? This is a place you will likely come at least once a year, so you want to be comfortable and feel like you are getting your needs taken care of.

As to your relationship with your care provider, it is not my business whether/when you come out to anyone, but I would advocate for coming out to your healthcare provider (as long as you feel safe doing so) as early in the relationship as possible to derive the benefits being out can give you. I know this can be awkward and nerve-wracking, but it is worth it. For instance, since I am trans and have internal reproductive organs, I need to get those suckers checked out. I am on testosterone, so I need certain tests other people may not need. Moreover, a healthcare provider needs all the relevant information they can get to provide you with good care, and you need to feel safe and comfortable asking questions. I remember asking my pediatrician, who often called me “little lady” though I have never been either of those things, if it would be safe for my “friend” to procure injectable testosterone. She was like “Uhhhh no… that would not be a good idea.” I never brought anything up again, I just stopped going to the doctor for two years until I decided I wanted to get on testosterone and pretty much HAD to see a doctor, which I always thought would be a nightmare.

My point is this: to be comfortable and receive holistic care from a doctor, AND to make sure it’s not a terrible, harmful mis-gendering experience for you (that will make you not want to go again) it makes sense to be out to your healthcare provider. And now that I am out with all my healthcare providers (including my dentist, who is super gender-affirming) I love going to see them!

Full disclosure here: I live in New York, and there are heaps of LGBTQ friendly healthcare providers here, especially when compared to other areas of the country I’ve lived in. I can take a train half an hour and get a physical at a trans* clinic, and I know I’m spoiled. But regardless of where you live, I’d recommend asking other LGBTQ folks if they like their healthcare providers, and searching online using the GLMA “Find a Provider” search tool.

Now, I know what you might be thinking: That’s all great Mr. City Slicker, but I don’t live in a city and there’s no trans* clinic near me. But I still need a doctor. What am I supposed to do, tell my doctor what language to use for my junk? They’re the doctor, I’m just some schmuck! Well, my friend, print this column and that Dean Spade article out, and bring them to your appointment! Remember, there’s no Gender Identity 101 in med school—often doctors learn from their patients. So as long as you feel safe, come out to your healthcare provider, and see how it goes.

WARNING: sometimes it will go badly—they won’t get it, or they won’t care. But often, doctors care about their patients enough to at least try and respect their patients’ culture and identities.

If the healthcare provider is a jerk, just peace out. Seriously. Just stand up, say “I don’t really appreciate your disrespectful bedside manner, you are not the doctor for me,” and leave.

Make sure to treat yourself to a can of ginger ale in the waiting room, and try a new doctor next week until you find one who works for you. Keep trying new clinics and offices until you find one that works for you, you’re worth it. Remember: all it takes is one good provider to give you the care you need, the way you need it.

Good luck, and take good care!

***

Click through to read more about Liam and our other Second Opinions panelists!

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“I finally got up the courage to tell my parents I want to start seeing a therapist, and they’ve been fully supportive. The problem is, I want to tell my best friend because she knows I’ve been feeling down for a long time (though I don’t think she knows that it’s this serious), but I don’t know how to go about it. I probably won’t see her in person for about a month, so should I wait until then or tell her over chat? And what do I SAY so it’s not too awkward?”

- Question submitted by Anonymous

Dannielle Says:

First of all, going to a therapist is RIDICULOUSLY COMMON. 95% of the people i know in real life go to therapy and prolly a whole bunch of people i dont know also go to therapy.

I think telling her over chat is totally fine and i think you don’t have to take it too seriously. I recommend calling your therapist CAPITAN POTATO so you can chat her and be like ‘hey sorry i’m late i had another meeting with CAPITAN POTATO and i got caught up talking about my dumb ole mom leaving the refrigerator open all the time, i dunno why it bothers me so much, but IT JUST DOES’ and then she’ll be like ‘who’s capitan potato??’ and you’ll be like ‘LOL cappy p is my therapist, i gave her a fun name bc dannielle from everyoneisgay.com told me to’ and then she’ll be like ‘omg i love everyoneisgay.com’ and you’ll be like ‘ME TOO WEBCAST MARATHON???’ and then you guys will have the best day ever.

I understand that the things that you’re going through in life may be difficult and that’s why you are in therapy and really THAT’S what you wanna talk about, but the fact that you’re seeing someone and talking to someone to make these things easier IS NOT A BIG DEAL. Don’t let that weigh you down at all because that is the tiniest of things. Talk to your friend the way you would talk to her about getting a new pair of shoes, therapy is not a big deal, save the serious talks for the serious issues, you know? AND MAYBE you can use the news of your therapy sesh to talk about serious things! and you can be like ‘yea actually capitan potato has been helping me with THIS which is actually awesome’ and make your BFF aware that things are headed in the right direction, if you’re feeling awesome she will feel awesome and you can talk about being awesome together.

Kristin Says:

Usually I make up additional names to supplement the ones Dannielle creates, but there is no way in hell I am going to top CAPITAN POTATO, so that is officially your new therapist’s name. I really, really, REALLY hope that somehow that comes up in your next session because I REALLY want CAPITAN POTATO to know that is their new name…

Aaaaanyway. Yes! Absolutely tell her over chat and you can say it in any way you like, because the best part about life is that even if the initial moment is awkward, you have a whole bunch of moments that follow that where you can work it out and make it not-so-awkward. My initial coming out process with sooooooo many of my friends was sooooooo awkward (and I know this isn’t ‘coming out’ but it still fits the same IDEAS), and now so many of those stories are our absolute favorite ones to relive. Once I came out over chat (at the time it was AOL Instant Messenger #old) by saying, “I am dating someone. HER name is Randi,” to which my friend immediately chatted me back, “Ohhhhh so you swing both ways like a rusty door?” There I was thinking she’d be horrified and instead she made a joke and that was that.

Dannielle is right, you going to therapy is not something that should make anyone feel weird, because I am very convinced that nearly the whole world goes to therapy (I went for about 8 years!). That said, it may be a big deal to YOU and that makes total sense because it is a new thing, and an important one. So, if you don’t feel up to making a TOTAL joke about it, just say, “Hey. I know that I’ve told you about how I have been feeling down and stuff, and so I finally asked my parents if I could see someone about it and they said I could. So, I am now your friend who goes to a therapist. Everyone needs at least one.” That way you address the serious, you address that it’s an important thing to you, and you still get a tiny giggle. Approach it like that, and remember that even if you feel awkward… that’s totally okay. BFFs are BFFs are BFFs you guys. You will work it out, and she will love you just the same and be supportive of you.

Please, though, no matter what you do, do not do this without using CAPITAN POTATO.

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