Some Thoughts on Trans Health

A recent study revealed that trans men are twice as likely to have heart attacks as cis men, and trans women are twice as likely to have heart attackes than are cis women. That is a troubling statistic. But what makes it more troubling is how media reports frame the issue.

Bias makes us sick. For example, there is abundant evidence that facing racial discrimination damages people's health and shortens people's lifespans. This is exacerbated by the fact that people don't just face discrimination out on the streets--they face it in doctors' offices and hospitals.

Trans/nonbinary/gendernonconforming people face high rates of bias and harassment, making us sick. And trans people face high rates of mistreatment by healthcare providers. One in five have been flatly turned away when seeking medical care by transphobic providers, and almost a third have been harassed by a medical professional. As a result, a third have avoided medical care when seriously ill or injured, and many more avoid routine checkups.

If trans justice were centered, discussions of the fact that trans people have twice the heart attack risk of cis people would focus on the problem of transphobia, in society in general, and in the medical profession specifically. But instead, we see trans people being blamed. It's presumed (without evidence) that hormone replacement therapy must be the cause of our poorer health. We are told trans people and their doctors need to be "more vigilant" to ensure heart health. What's implied is that doctors should consider refusing to allow access to medical transition services, or withdraw HRT, for trans people's whose health is less than perfect. And given the poor health of marginalized people, that means a majority of trans people--especially those of us who are of color, disabled, poor, or otherwise multiply marginalized.

This attitude is pervasive in discussions of trans health. Sex and gender variant people are caught in a double bind. For example, we are warned that we are exercising too little (and thus doctors should consider withholding hormone therapy). Yet we are kept from exercising by the high rates of harassment that trans, nonbinary, intersex and gender-nonconforming people encounter in locker rooms, gyms and pools. Or we are literally caught in a bind, by healthcare professionals framing wearing a chest binder as an unhealthy and dangerous practice that transmasculine people engage in as a tactic for managing psychological dysphoria. In fact, many people bind to enhance their health and safety by reducing the levels of harassment and discrimination they face.

What is evident when looking at how doctors discuss trans health, and how media in turn report on that, is the phenomenon of concern trolling. Calling us unhealthy, blaming us for the effects of discrimination, and threatening to withhold access to hormones are all framed as "for our own good."

It's very disturbing how much this parallels the form taken by a lot of blatant, overt transphobia today.  Politicians opposing laws that would protect trans people don't say "I hate those sickos." They say, "These people are ill. Gender dysphoria is a mental illness that should be cured! By supporting trans people in their delusions that their gender identities are real, people harm them! And then they just get sicker--look at the statistics about the poor health people who identify as trans suffer. Allowing people to gender transition is clearly harmful."

People who are trans, nonbinary, gendertransgressive and/or intersex suffer poor health today because of how poorly we are treated. What will make us healthier is to give us access to competent care that respects our lived genders and our variant bodies, and to reduce the levels of social mistreatment we now endure.

We must push back at victim-blaming marginalized people--including sex and gender minorities--for the negative health impacts of facing social bias.

Dr. Cary Gabriel Costello
University of Wisconsin-Milwaukee