It started in September 2018. I had just moved to North Carolina from New York City, and I decided to find a new doctor so I could receive the last of the three HPV vaccines. When I first arrived, the nurse practitioner asked me generally about my health, and then she said, “They told me you asked for the HPV vaccine?” I nodded. She said “Good girl.”
I put my head down and accepted the offhanded, gendered comment. I didn’t know how the nurse would react if I told her that I’m actually nonbinary and use they/them pronouns. I live in a rural area in North Carolina, which passed a law in 2016 that banned trans people from using the bathroom that matched their gender identity. (The law was partially repealed in 2017.) The Trump administration has also condoned doctors who refuse to treat trans patients.
I didn’t know if the nurse would deny me treatment entirely or ask if I needed to be referred to a psychologist. Even if she didn’t do that, even if she just looked confused and said, “Huh, OK,” like some people have said to me before, I would have been overwhelmed with shame. I would have hated myself for days after, repeating in my head, “Why did you have to tell her?”
So instead, I stayed silent. I just wanted to get the shot and leave.
Since then, I still haven’t told any health care provider here in North Carolina about my gender identity — and none of them have asked. They immediately use she/her pronouns for me. Most of them have also assumed I’m straight.
I have tried seeking health care from providers I thought would be affirming. One time I drove an hour and a half to Chapel Hill, North Carolina, which is home to a university and considered a more progressive area. I went to a community health center and almost cried when the form asked for “preferred pronouns.”
But then it also asked for “gender,” and the only options were man or woman. Then it asked for “gender identity,” with a few options that included nonbinary. The form reduced who I am to a preference, as if it wasn’t really true and staff were just playing along with my delusion.
Still, I wrote down my pronouns and defiantly crossed out “gender” and wrote “sex” above it. For the entirety of my visit, the staff — including the social worker — continued to refer to me as “she” and “her” to each other. I sat in the car afterward and cried until I felt ready to drive home.
I decided that it is more painful to advocate for myself to health care professionals and be let down than it is to not try at all. At least when I don’t tell them about my gender, I won’t potentially be denied care like so many trans people are. A 2016 study of more than 3,000 trans people nationwide found that about 1 in 4 were denied equal treatment in health care settings.
Hiding who I am keeps me safer, and it also saves me the pain of having my request to be affirmed as who I am completely ignored.
But lying to health care providers is a double-edged sword. I also have depression and anxiety, which are in part due to various traumas in my life, but also due to my coming out and living as a nonbinary person in the rural South. If I talk to a doctor about my depression, I often only mention my mother’s death in 2012 and not the daily struggle of finding people here who accept me.
My mental health is also made worse by these repeated omissions and lies, which I feel guilty for. They allow me to skirt discrimination when so many trans people cannot. Though I often present as androgynous or slightly more masculine, I pass as a cisgender person. I am also white. Both afford me a lot of protection that others don’t have. Black trans people often face both racism and transphobia from providers.
A 2017 study also found that 1 in 5 trans adults are also uninsured, so I’m lucky that I can at least afford some care.
When I lie to health care providers, I feel like I’m slowly chipping away at who I am. I feel like I don’t have a right to claim my identity. I feel like a poor advocate for those in my trans community who aren’t able to hide. I feel less like myself and more like the person I was before I came out: a person who was playing an assigned role that I could never fit into.
But I also know that I lie to help protect myself. I recently realized that the shame I feel from not advocating for myself is built on an assumption that it’s always my responsibility to educate everyone about trans identities. I do it in my life outside of health care. I write about trans people. I answer questions about my identity. I volunteer with a local LGBTQ+ nonprofit to help change my community.
But health care is different. Advocating for myself in this case could mean being denied care entirely. Until more affirming providers start practicing in rural areas, I will continue to accept the misgendering and the assumptions.
I should be able to walk into a doctor’s office, be affirmed and respected for who I am, receive whatever care I need, and walk out — just like anyone else would. I shouldn’t have to hide, but I will until others work to make doctors’ offices a safer place for people like me.
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