Medical Abuse

Trans Specific Dynamics

Medical abuse can come in many forms. The areas below are commonly experienced by trans-specific dynamics that may be a part of a trans/nonbinary person’s experience with medical abuse.

Neglect or being denied care

Medical neglect is language frequently used to describe when parents/guardians fail to provide adequate healthcare for their children. This section instead looks at neglect committed by healthcare professionals. Medical neglect may include refusal to provide needed care, dismissing patient concerns, denying tests or treatment, or failing to provide appropriate information and follow-up.

Sometimes, trans and nonbinary people are denied care for simply being transgender. They may also experience neglect that is targeted at a disability, their race, or another identity.

Trans/nonbinary patients have shared that they have received sub par treatment , been made to wait for care while others are treated and have been sent away with minimal treatment for their health concerns.

A provider might defend their right to deny care by stating their religious beliefs, claiming they “don’t know enough” about trans people, or they may not explain why they are refusing care. Many trans and nonbinary patients are told that they should go somewhere else for care. This might be well-intentioned–a provider suggesting another provider or clinic where they might be able to get more trans-specific care–or might simply be a provider avoiding treating a patient because they feel uncomfortable. During listening sessions with trans/nonbinary community members, one survivor shared a story of being denied care:

“There has been a lot of, ‘Well, you’re a complex case, and we don’t know how to work with you, so you really need to find someone who specializes in working with your population…’ I’ve been straight up told in the emergency room that I should just up and move to New York City because no one’s gonna take me seriously here, and I should just leave to my face…”[i]

This behavior is never okay. Even if a provider hasn’t worked with a trans patient before, they still have a responsibility to provide the same level of care they do for cisgender patients. The vast majority of medical care sought at emergency rooms has nothing to do with trans-specific types of care.

Trans and nonbinary people often face hurdles to accessing gender-affirming care, depending on their state’s legislation. Anti-trans healthcare legislation has become quite prevalent throughout the country, resulting in many providers being fearful of providing gender-affirming care.[ii]

This is yet another way that state-sanctioned hate allows trans and nonbinary patients to suffer institutional neglect. When restrictions are put in place to prevent access to gender-affirming care, trans and nonbinary people experience the negative mental and physical health consequences from being denied care.

These barriers to care are rarely considered neglect by the legal system but cause extensive harm to trans/nonbinary people nonetheless.

Privacy violations, outing

Healthcare providers have access to trans and nonbinary patients’ personal information, including medical history and often name/legal status information. While most providers guard this information and keep it confidential, some providers intentionally out [ link to 101 section on outing] a trans patient’s identity to other staff, a partner, or a family member, putting them at risk of additional harm. It can be especially dangerous for trans and nonbinary youth who may still depend on unsupportive parents for financial support or housing, which might be withheld if a parent/guardian finds out they are trans or are seeking transition-related healthcare.

Verbal harassment

In addition to misgendering and neglect, some trans/nonbinary people also experience verbal harassment from providers. Harassment might include derogatory comments directed toward trans people, inappropriate comments or jokes, and more.

Conversion therapy

Conversion therapy involves harmful attempts to “change someone’s sexual orientation, gender identity, or gender expression” to fit with dominant cultural norms. While conversion therapy is widely recognized as ineffective and abusive, it is still legal in 19 states for minors, and all states for adults. Even in states where conversion therapy is banned for minors, “these laws apply only to licensed therapists, and not to clergy or unlicensed counselors (like life coaches), leaving open the possibility that minors in these states could still be subjected to forms of conversion therapy.”

Conversion therapy is most commonly recognized in mental healthcare settings, but can also occur in physical health settings. As one participant in the 2015 US Trans Survey shared:

“[An] OB/GYN forced me onto birth control pills to ‘fix’ me into thinking I was a woman again. I ended up in the psychiatric ward of my local hospital on suicide watch after three days on birth control.”

Physicians may use their positions of power to coerce trans and nonbinary people into medical treatments in an attempt to “change” their gender identity or sexual orientation. This may happen without the patient’s knowledge (non-consensually providing “treatments,” like birth control pills), or by convincing the patient to receive “corrective” medical interventions.

Sexual violence

Some trans/nonbinary people experience sexual assault by healthcare providers. This can take many forms – including using the pretext of required examinations conducted in order to assault a person.

During listening sessions with service providers, a healthcare provider talked about changes to policy around physical exams to prevent medical abuse:

“The level of mistrust is very real, and it’s based in providers’—excuse my language—fuckery… There was a provider who was giving inappropriate physical exams. I’m not gonna go into too much detail, but his exams were inappropriate. He was fired, but that also meant changing the workflows around physical exams.

“So now all physical exams that involve genitals or anything below the waist include a medical assistant who’s just in the room, letting the patient know they’re there if they need to stop this at any time. Who’s there kind of like watching the provider who’s doing the exam. We realized that was just necessary to build trust again with patients after this provider’s history of neglect and their mistakes.”[iii]

Trans/nonbinary survivors have reported that providers sometimes require invasive or unnecessary exams, such as requiring a patient to undergo a pelvic exam in order to start gender-affirming hormones. Healthcare providers have the power to gatekeep medical care, especially in situations where gender-affirming care is difficult to access. Guidelines for access to gender-affirming care are often changing, so a trans/nonbinary patient may not know what is or isn’t required. These unnecessary exams are always a violation of trust and bodily autonomy.

In addition to medical assistants and/or chaperones, trans/nonbinary patients may choose to have a loved one or partner in the room with them for physical exams.

Physical assault

A small number of trans and nonbinary people also experience physical assault in healthcare settings. While this is less common than other forms of institutional violence, like verbal harassment or being denied care, any amount of physical violence not acceptable. Physical assault or violence might look like a provider being unnecessarily rough with a patient, causing pain during medical procedures or exams, restraining a patient, or more overt forms of violence like hitting or slapping. Providers might also use threats of violence or harm to intimidate trans patients.

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