Medical Drama

g-InsuranceDenied.widecThose who follow the Facebook page for my blog likely saw me make a post yesterday regarding the shooting and denial of medical care of a trans activist in Pakistan recently. Along with that link, I mentioned that I’ve been dealing with a lot of medical drama the past month or so, which I will discuss somewhat today. While I will be explaining why I’ve not made a post in close to a month, I’ll also go into how this is an issue for the community at large as well as some basic educational stuff. Now that the basic “introduction paragraph” that all your professors harp on you about is out of the way, let’s get on with the details!

So, about a week after my last post (the Thursday night after, if I remember correctly), I was doing my monthly self examination for lumps, and I found one. However, this was not in one of my breasts, but actually on one of my testicles (yes, I’m pre-op, if that wasn’t clear before). Being the educated and mostly responsible person that I am (because who’s honestly responsible 100% of the time?), I went to get it looked at with the VA the next day. My primary physician was out that day so I got someone else, who referred me over to the radiology department for an ultrasound to confirm what it was. That appointment ended up being scheduled for almost a week later, on Christmas Eve. The results came back the following Monday, revealing that whatever the cause was, the lump was one of multiple cysts down there. However, by this point, the lump had doubled in size and was becoming more sensitive/painful, so I was told to go to the ER.

At the ER last Monday, the doctor who saw me didn’t even bother to really look at it, never even feeling the lump, and just wrote it off as a bacterial infection. He gave me some antibiotics and told me that if nothing improved after a week (or if it actually got worse), to go back in. A week passed, and so I contacted my clinic again to determine if my physician wanted to see me himself this time, or wanted me to go back to the ER. At first, I was scheduled to go see him on Wednesday morning, but then at about half an hour before closing time on Tuesday, I got a call telling me that he was cancelling the appointment and wanted me to go see the endocrine (hormones) clinic. That appointment is scheduled for next Tuesday, all while the cysts continue to grow and become more painful (the pain likely being because at least one cyst is on the inside as it grows).

So that (along with the holidays) is why I’ve been absent for the past several weeks. However, I want to go more in depth on this first. If, after reading that, you got the impression that the doctors were basically doing whatever they can to not deal with me in order to make themselves feel less uncomfortable, then you’ve hit on what I’m addressing next. Now, denial of medical service to gender non-conforming people is nothing new. Just look at the article I linked before to see that it’s still happening in the world. And much of it happens here in the US as well. Tyra Hunter is one of many such cases, but probably the most well known. Heck, I made a blog post on this very issue back at the beginning of this blog, so lemme just link that here. That said, denial of services isn’t always as overt as in some of those examples. Sometimes, it’s as simple as saying “your symptoms mean nothing, go away” or “your symptoms have nothing to do with the incident that most likely caused them” as I discussed when I got my concussion.

Now, let me be clear, I’m not saying that every misdiagnosis or shunting of a trans person to another clinic is because of transphobia. Fact of the matter is this: there are so many things with similar but not exactly the same symptoms that most doctors can only make guesses. While the ER doc in this case failed to do his job by failing to even exam the lump (the source of the pain and other issues), his response was basically what best he could likely do at that time: guess at the cause with the limited information he had and try to treat it. There were errors in his logic (not just regarding it being a bacterial infection, but about other parts that I will get to shortly), which I called him out on, but the fact of the matter is that he did do what he could. However, it is also clear that he was uncomfortable in that situation, and the fact that my primary physician won’t even see me regarding this issue hints at his own discomfort with it as well.

That said, while it isn’t our fault as trans people that we get treated this way, the fact of the matter is that the only way we can be guaranteed to get relatively decent healthcare is by knowing all about the medical issues we may encounter. I’m really trying hard not to make this come off as victim blaming, which is something I also think of when it comes to teaching self-defense, but I honestly think that knowledge is power and that everyone, trans or cis, could benefit from more knowledge regarding their own medical issues. That said, I understand if anyone wants to make comparisons to rape culture and victim blaming here, because I’m seeing those same comparisons. However, in this case, I’m going to justify it because a.) this is your health here, and b.) even the medical professionals who should know better don’t.

Case in point, one of the primary things transsexual people are told throughout their physical transition is to always look out for signs of sex-specific medical concerns. The one I’ve always heard has been that I’ll need to get my prostate checked regularly as I get older for signs of prostate cancer. On the one hand, yes, this is largely good and true advice, there remains the issue of the other hand, specifically this example. Telling a trans woman she needs to have her prostate checked is redundant. The preferred method for treating prostate cancer is doses of estrogen in order to shrink the prostate. As such, a trans woman (who is often on a higher dosage of estrogen in her system than even cis women have) is at such a minute risk of prostate cancer as to have other examples be better for the argument, like testicular cancer (at least until she has an orchiectomy, assuming she wants one). That said, knowing this fact also enabled me to call out the ER doc when he made the assumption that the cyst on my testicle could be caused by “chronic inflammation of the prostate.” He countered that it was unlikely, but that a.) they don’t know what causes the inflammation in those cases so it’s still possible, and b.) greatly reduced risk doesn’t mean no risk.

That last point holds true here as well. While on the topic of cancers, let’s look at the trans masculine side of things. Even trans men who have had top surgery run the risk of having breast cancer. Yes, their chances are greatly reduced, but even cis men can get breast cancer, so it’s still a worry. Likewise, until they’ve had a hysterectomy, they also run the risk of ovarian cancer.

This is why I’ve said that in some ways, transsexuals are a sort of “artificial intersex” after they’ve physically transitioned long enough. Yes, I know that sort of lumps in those who actually are intersex and were born that way with the artificial batch, and I know it’s a flawed analogy, but it’s the best I have right now. Anyways, the point is, there is no surgery that can 100% change the sex of someone (one reason many argue against the term transsexual). Simply put, we become a mix of both, with medical concerns of both becoming something we need to deal with. The mere fact that we face an increased risk of denial of medical service just heightens how bad our situations are.

Yeah, sorry, I’m still in pain, and this was a relevant topic. I’ll try to be more upbeat next time. That said, I encourage you to share your own experiences if you feel comfortable doing so, or maybe just ask me some questions. We haven’t had an “Ask Caitlin” post in a long while, so if there’s something you want me to talk about next week, then ask away!

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