The “T” in LGBT is unique as it is a variation of gender identity (who you are), as opposed to sexual orientation (who you are attracted to).
In addition to being the most visible, transgender people are (typically) also the ones most dependent on health care.
March 31 marks the Transgender Day of Visibility (TDOV), a day created to offset the more sombre Transgender Day of Remembrance on November 20. Whereas the latter is to mourn the trans lives lost, the former is meant to acknowledge those trans people who are still alive and kicking.
Transition
“The only choice I ever made was the choice to be myself.”
Transitioning is the conscious decision a transgender person makes to present in a way that is compatible with their gender identity.
Contrary to the widely held but ultimately misinformed and toxic belief, transitioning has nothing to do with choosing a gender identity. The choice lies in either accepting or denying who you are.
Social Transition
Social transition relates to the outward expression of a transgender person’s gender identity. This step can be quite arduous, and society’s typically negative responses usually result in significant mental health issues.
Another misinformed belief is that being transgender itself is a mental health issue. It’s not. It’s the discrimination, self-loathing (internalised transphobia), and lack of support that makes transgender people more prone to depression, anxiety, substance abuse, high-risk activities and suicide.
This is where mental health professionals – counsellors, psychologists, and psychiatrists – have a chance to play a significant role.
While I believe that a large number of mental health professionals are sympathetic, only a small number have the expertise in handling transgender clients.
I’m heartened that initiatives like the BlueBird project are available to help transgender people connect to the appropriate resources, but waiting times can be unbearably long due to limited supply.
On the other end of the spectrum are those “professionals” who willfully ignore the evidence-based science of their craft, and prescribe harmful treatments like conversion therapy (an almost-universally banned practice of trying to get a person to “stop being transgender”).
Medical Transition
Medical transition is the process of taking medication and/ or undergoing surgical procedures to help align a transgender person’s physical appearance to their gender identity.
Not all transgender people undergo medical transition, and those who do may not undergo every possible procedure; either due to choice, lack of physical fitness, or lack of availability.
Whereas lack of physical fitness (things like hypertension, obesity, diabetes, heart disease) is something health professionals can typically handle – vanishingly, few health professionals in Malaysia are competent enough (or have any interest) to manage medical transition.
The vast majority of doctors will regard medical transition as a “lifestyle choice” — simply another part of a patient’s history that further complicates management of whatever other problem the patient has.
Oftentimes, the easiest solution would be to tell the patient to stop their medical transition instead of attempting to work out a more comprehensive treatment plan.
But honestly, who can blame the doctors? The current socio-political situation makes it impossible to include transgender healthcare into medical school syllabus, and the professionally-prepared Guidelines For Trans-Specific Primary Health Care In Malaysia (yes, there is such a thing!) will never ever receive the blessing of the Ministry of Health.
The entire issue is compounded by the fact that a lot of the recommended medication are not available in Malaysia, resulting in transgender people having no choice but to buy unlicensed medication off the internet.
The process of bringing in new medicines is complicated and tedious, as most people have realised from the copious use of “provisional” during procurement of Covid-19 vaccines. Without the effort and the will of health care entities who care, transgender people in Malaysia will continue to play Russian roulette with their health.
Avoidance of Health Care
“Health is a human right.”
Navigating the health care system as a transgender person is a demeaning process through and through.
So much so that most transgender people would avoid going to anybody other than their own trans-friendly GP (yes, these exist too, thankfully; and have been the forefront [read: back-alley] of Malaysian transgender health care for decades!).
Most transgender people would let their health conditions fester and bring them to the brink of death before they let themselves be stretchered into the corner of an overcrowded Emergency Department.
Among the things that people take for granted but that transgender people face in the health care system are:
- For those who have socially transitioned, having to face the front counter and watch the repulsed look of the clerk when you hand them your IC. Then, having the counter yell out the name on your IC into the crowded waiting area so every other person there knows as well.
- Being automatically assumed to carry some infectious disease, and being tested for HIV every single time without your explicit consent.
- For those who have medically transitioned, being placed in the ward that corresponds to what’s written on your IC and dealing with the fact that your anatomy is different from the other occupants.
- Facing snickering, insults, and blatant misgendering (first-hand experience from my days working in the wards), in addition to helpful, unsolicited “advice” about how being transgender is wrong.
On the flip side, there are anecdotes where individual Malaysian health care staff have treated transgender patients with respect, although these are few and far between.
In the absence of awareness, education and specific anti-discriminatory guidelines, the average health care provider will see nothing wrong with perpetuating (intended, or otherwise) a hostile environment for transgender patients.
Conclusion
“I see you.”
This TDOV, I would argue that visibility for transgender people is not only about being acknowledged and given a chance to be understood.
Visibility is also a plea for society, health care providers particularly, to look at a transgender person and see a human being instead of just a label. Built a little differently, but no less deserving of this fundamental human right we call health care.
Dr Git Kim Ann is a radiologist who naively believes that she can make a difference in people’s lives by typing alone in a dark room; be it MRI reports, computer code, or letters like this.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
