Who Needs to Know?

Updated: Jul 6, 2018

Kyan Lynch, MD, MA

"In what circumstances is it ok not to disclose to medical practitioners?"

As this question implies, in today's health care system, the average patient is going to encounter tons of people that really don't need to know a patient's whole story. For example, the phlebotomist drawing your blood, the medical assistant showing you to your exam room, and the nurse taking your blood pressure don’t need to know your gender identity, unless you’d like them to.

The place where it gets more tricky is when you are actually encountering the medical provider who will be diagnosing the problem you are there to have fixed. Unless you have a good amount of medical knowledge, it can be hard to know when your gender identity is relevant and when it’s really not. Even more troubling, the data suggest that medical providers aren’t always good at knowing when your gender identity is relevant to the main problem you have (which would be called a “chief complaint” in medical lingo).

Here’s how I like to view it: generally speaking, a medical provider doesn’t always need to know how you identify on the gender spectrum, but they DO need to know which body parts you have and which you don’t.

Here are a few examples to illustrate that point:

Case example 1: A trans man comes in to the ER with lower right belly pain. In this scenario, if our patient “passes” as a cis man and doesn’t say anything, his medical providers would probably have appendicitis at the top of their list of concerns, and, depending on the story and physical exam (pressing on the belly in different ways), they might even jump to recommend surgery to remove the appendix.

This would be a big problem if our patient here still has his ovaries and/or uterus, because lower right belly pain could also mean that there is a cyst on his ovary, or that his ovary is twisted, or that he is pregnant and the fetus is growing outside of the uterus (remember: trans men can become pregnant even if on testosterone). In this case, our trans man would be much better off if he disclosed his transgender history to the medical provider he sees in the ER.

Case example 2: A trans woman comes in to the ER with shortness of breath. In this scenario, the medical providers in the ER are going to ask a bunch of questions in order to figure out what could be causing the patient to be short of breath. However, if the patient is on estrogen for hormone replacement therapy and doesn’t tell her medical providers, they might not realize that she is at greater than normal risk for blood clots, and they might not look for a blood clot in her lungs as the cause of her difficulty breathing.

Case example 3: a trans person visits their primary care provider for a yearly physical. The medical provider is trying to figure out what kind of preventive screenings to do to keep their patient healthy. Does the patient have a cervix that needs to be screened for cancer?

How about a prostate? What about some breast tissue, which could be left behind after top surgery? In this case, in order to keep the patient healthy, the medical provider really needs to know what body parts a patient has so that they can keep the patient healthy.

Case example 4: A trans man is getting an X-ray because he is having hip pain. In this situation, the radiology technician would benefit from knowing his gender status for a couple of reasons. First, if this trans man still has a uterus, the technician can do their best to protect the patient’s uterus in case he is pregnant. Second, a trans man’s hip anatomy will be different from a cisgender woman’s would be. Therefore, the technician will get the best image if they know what kind of picture they can expect.

Obviously, these are just a few examples of situations in which it is important for you to disclose your transgender history. In summary, I’d say here are a few general guidelines:

  1. Not everyone in the health care system needs to know your transgender history, but it is best if your medical provider understands what body parts you have, which you don’t, and what medication you are on so that they can make the right diagnosis and take care of you best.

  2. You don’t have to disclose your transgender history if you feel threatened or unsafe.

  3. If you know that you might need to disclose your transgender history to a new provider because of a situation like the ones above, it might be best to have an ally with you to provide support and advocacy.

  4. Know your rights. A hospital or provider cannot abandon you or give you sub-optimal care because of your gender status. This is illegal and unethical.

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