Physician knowledge of trans Identities | 1 | “I’m always educating. So it’s, like, I get that you didn’t freak out—I love that, because 10 years ago that would have been different, but the questions ... it’s like, read a textbook, right? I’m always very polite and I answer the questions because they’re curious and at least they’re curious—they aren’t hateful. It’s just exhausting emotionally to, like, constantly always be teaching. Like, I’ve taught so many nurses and doctors so many things” (P3) |
2 | Interviewer: “Do you think your current family physician would have been able to support you on your journey?” Participant: “Not at all ... I don’t think. No, she knows nothing” (P3) |
3 | Interviewer: “And so how did you feel about that? That your doctor ... wasn’t particularly knowledgeable but was willing to learn?” P7: “I said that ‘If you are willing to learn, I will be willing to teach you’” |
Patient self-advocacy | 4 | “I’m just exhausted with having to navigate these things and be so proactive. It’s not a bad thing. I think it’s awesome for patients to be proactive ... but there’s a line where I think the physician should take up the slack” (P3) |
5 | “It was, like, really frustrating to be a 20-year-old kid teaching your doctor how to do something” (P11) |
6 | “We literally had a support group in [city]. And, like, one of the main focuses was, like ‘Here’s the script you go to your doctor with.’ And, like, [they] would run you through interviews. Like, fake interviews so you knew exactly what to say to get [hormones]” (P11) |
7 | Interviewer: “Have you ever had to educate your family doctor or nurse practitioner about your gender identity and-or trans health–specific needs?” P10: “I believe I, like, tried to do that with my doctor in [town] a little bit. Like, I did try to have these conversations with him but ‘in one ear, out the other’” [laughs] |
Positive spaces | 8 | “If they had something, like, queer positive ... you know, one of those positive-space stickers, that would be amazing! But they don’t. And that’s just life ... even a small tiny sticker means the world to me ... and it doesn’t necessarily mean everyone in that clinic is positive, but it means that ... somebody’s thinking about this and they care enough to put that there and they care enough to at least create a space that’s a little bit safer. To let everybody, clients, everybody know that this is what is expected here. You’re going to treat everybody well. We don’t accept homophobia or anything like that” (P3) |
9 | “It would be nice if they had some kind of posters or something in the waiting room to help educate the cis people about trans people and gay people in general about the LGBT community” (P6) |
10 | “The receptionist is great—she is a big-time ally. She is a doll …. She refers to me by my name and she was, like, ‘OK, what do you need?’” (P7) |
Discrimination | 11 | “I changed my name 3 years ago. I changed my ID, etc, for the right gender marker, etc. Up until 6 months ago his secretary was still calling me by my old name. Still calling me ‘him’ ... and I go to correct her and she’s ‘I’ll try to remember eventually,’ which, every other place I deal with they get it right, so ….” (P1) |
12 | “[The psychiatrist] was supposed to be, like, counseling me for my gender issues. And he knew that I identified as male and I used male pronouns but he never used them” (P4) |
13 | “Lack of education, lack of interest in learning more about it. Which considering ... he’s getting more and more patients that are coming out as trans” (P1) |
14 | “But, like, I—most trans people are really uncomfortable going in the emergency [department] because that’s when you’re—if you’re going to get clocked by the medical profession—that’s the place it’s going to happen. That’s where they’re going to do you in, right there. And there are horror stories that are just awful. So you know … you don’t ever want to go into emergency if you can avoid it” (P6) |
15 | “So we all have kind of these issues of, like, running into doctors discriminating against us, especially for mental illness. And I feel like that’s where a lot of doctors put transgender in. And, I mean, I guess that kind of makes sense because transgender was seen for a long time [as] a mental illness” (P10) |
16 | “[I] feel very, like, trapped by my doctor into presenting a certain way and if I even deviate from that a little bit then I won’t have my options. And I’ve heard that over and over from nonbinary people, binary people .... Like, if I don’t do this the right way my doctor’s going to take away what I need, which is not a very nice way to have to interact with your doctor” (P10) |
17 | “I said ‘I’m a female-to-male transsexual and ... I do have an appointment here’ and she ... like, everything in her just went silent. And she said ‘Just wait over there,’ there’s a clock and she said ‘Go wait over there,’ and so I stood under the clock. Literally she just had to sit there for like 2 whole minutes. I think it was 1 to 2 minutes and she was just collecting herself. It was even kind of funny back then. But these things kind of add up and they’re a bit humiliating” (P3) |
Expectations of ideal care | 18 | “I would love it if everyone would have the expertise to deal with it. I would love it. The realist in me says ‘Let’s start small.’ Starting with just the desire and the understanding to want to learn and to know where to go to get the answers. And be willing to take that journey. That would be the willingness. Let’s start with the willingness to not be afraid of taking a new patient when they say ‘Oh, by the way, I’m transgendered.’ You don’t want to hear click, zzzzzz. It’s not a big deal—say ‘Yeah, oh, sure’—whatever. Right. That’s—we need health care. We need basic-human-right health care. That’s all we’re asking. That’s it” (P9) |
19 | “In an ideal world it would be really nice if your family doctor could do it directly because you know, like, it’s really hard getting [hormones]. So it’s nice to have it with somebody you have an actual relationship with all the time” (P10) |
20 | “Well, I’d want [residents] to, like, talk to an actual trans woman and actual trans man who are going through hormonal transition … and kind of hear their take on it. And hear their experiences with it” (P10) |
21 | “I think like the ABCs of trans ... like, you show those few definitions. I think if people had the slightest ... just knowing the definitions and the different possibilities and knowing what FTM is or MTF. Just that sort of basic knowledge so that when they meet a trans person—like, I know it’s not a usual occurrence and there might be a little bit of a, like, a human hiccup, ‘Oh, interesting,’ right? But just the basic knowledge so that they are not starting from absolutely nothing” (P3) |
22 | “I’d like them to have at least a basic knowledge and have some reading and kind of be able to troubleshoot some things” (P10) |