Dear Dr. **********,
It is my duty to preface by saying that the services you provide trans* patients are indispensable. I am deeply aware of this. I see you as an advocate on our behalf, and it is precisely because I value you in this capacity that I must discuss the manner in which these services are provided.
To be completely honest, I walked away from my most recent appointment with you deeply upset. When you said that you knew a good therapist who could completely eliminate my female speech patterns, tears automatically sprung to my eyes, not because I felt emasculated (since I transitioned to become closer to myself and not closer to the emulation of male stereotypes), but because I felt so pressured by the expectations of a cisgendered person.
You said that you felt you were only doing your job, but it is not your place to establish how someone should express their gender, nor to suggest that some element of their gender expression should be "corrected."
I identify as male but my gender expression is fluid. One day I want to dress like a British school boy; the next, I wear my old girl jeans and belly shirts. I adore makeup and love wearing eyeliner. I'm in a queer fraternity whose members venerate drag artists and collect heels.
Throughout my transition, I have had to censor from several doctors the elements of my gender identity that society does not categorize as male out of fear that they would rescind their necessary support. The medical community is not kind to people whose gender experiences do not fit into binary concepts. Unfortunately, we are forced to assimilate in order to access the care that we so desperately need. For example, I made sure I saw one of the best endocrinologists in Manhattan not because I needed an approval letter from him, but solely because I didn't want to start taking testosterone until I knew that I was completely healthy, and I wanted a second opinion. All I wanted was for him to do things like check my thyroid, and he proceeded to asking me really intrusive and unnecessary questions about things like my sex life/sexual preferences and what role I adopted or saw myself assuming in bed.
So please understand that the current paradigm of transgender health oppresses trans* people. When medical and mental health practitioners police our gender expression, our bodies cease to belong to us. When my (stereotypically) male business casual attire elicited your approval or when you told my friend that his haircut was "appropriate" and insinuated that his clothing choice satisfied the supposed requirements of his gender, I felt as though we were being appraised rather than complimented. Understand that on a daily basis, we are subjected not only to these institutionalized methods of observation, but also to the scrutiny of society. For example, I am used to hearing from a lot of people that I am "convincing" or being asked if I had "the surgery." The constant barrage of intrusive questions and unsolicited praise creates a cultural context in which a trans* person feels as though his or her body constitutes public domain.
At the end of the day, what makes a person who is assigned female at birth male or a person who is assigned male at birth female is our word. Our interests are secondary. Our behaviors are secondary. The way we dress or style our hair is secondary. I do not agree that these things are important or even worth addressing. I think that the medical community needs to accommodate our core sense of self, rather than the other way around. After all, cisgendered women don't have to justify to their doctors why they want a breast augmentation. We are the only group of people whose medical autonomy has little instrumental value on its own.
Also, I am empathetic to the fact that pronouns can be difficult to master, especially when you are juggling many trans* people in your head at once. Even I have slipped when addressing fellow trans* friends. All the same, I have to inform you that the way in which you handled the situation in my friend's case should not be repeated. In the future, if you use the wrong pronoun, an apology will suffice. When you turned to me and said that I am easier to work with because of where I am visually, your use of words implied that my friend looks less biologically male, which is the opposite of what he would want to hear. It is not acceptable to justify your instance of misgendering by using my friend's appearance as a scapegoat.
Finally, over the course of my transition, you have consistently reminded me of how bad my acne is and how greatly the testosterone had exacerbated it, even though I have been very clear about not wanting to focus on my face. On several occasions, I have firmly rejected the offer for acne medication and made my aversion to the topic clear. There is a reason why I insist on keeping the conversations medically relevant and less focused on my appearance. The eating disorder that flared up this summer was certainly not the first one I have struggled with. When you told me that my skin looked a lot better, in spite of there still being a little bit of acne on the right side of my face...which you pointed out...it made me feel uglier when I looked in the mirror. Eating disorder histories, as well as patient requests to abstain from topics surrounding body image, should be appreciated and taken into account when dispensing advice. Because honestly, every time you fixate on what is wrong with me, or even on my appearance in general, I don't want to eat. I never want to talk about my acne again.
There is something that is uniquely scathing about being subjected to the judgments and values of people in positions of authority; please recognize that because you are the one who decides upon the provision of hormonal treatment and who gives the diagnosis, someone else is at your mercy. I know that you are try so hard to be helpful, and that effort is greatly, truly, appreciated. We need advocates like you and we do not take that for granted. But please be aware at every moment that the practices and protocols under which you operate are the product of a system that was assembled for trans* people, and not by trans* people.
Sincerely,
Jordan Pollak
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