Things left out of trans awareness training

I was interacting with people who need not know my medical history. Something banal for me. But I was there with a friend who’s known me since prior to transition. She followed my lead, didn’t disclose me, but her facial expression conveyed how she’d never conceived of me not disclosing in the situations that came up. (E.g. accessing health care not related to hormones, dating, parenting related stuff)

It got me reflecting on how much isn’t covered in typical trans awareness presentations.

Photo by Jonathan Allison on Unsplash
[photo by Jonathan Allison from Unsplash. Description: black and white aerial view of a major round about intersection.]

A. Trans people continue to exist years and decades into transition.

Their main concerns related to transition are unlikely to start or end with their chosen name and correct pronouns, if those are still concerns at all. Other stuff comes up, which might include emerging or evolving relationship to hormone therapy, autoimmune conditions, the evolving impact of strained or estranged relationships with our families of origin, grief from those we lost to suicide, murder, things we put on hold, sacrificed or lost to transition, transphobic health professionals, post-op depression, attending funerals, which will be attended by transphobic or senile relatives, so on, so forth.

Photo by Ben White on Unsplash
[Photo by Ben White from Unsplash. Description: young child holding a book open and looking shocked.]

B. Trans people believe what we tell you: trans men are men, trans women are women, non-binary people are fabulous.

When someone says a variation of “what sort of guy doesn’t like/know/do X” to me (whether or not they know my medical history), I don’t skip a beat in answering “I assure you, I’m not the only one.” The answer is seldom to never “oh, well, since/because I’m trans…” Often time, when I don’t know an expression, or didn’t experience a right of passage type of thing, it’s because I didn’t grow up an anglophone or in a christian household. Gender is inherently cultural, so those of us not from the dominant local culture, whether we’re cis, trans or non-binary, often can’t relate or have “gaps” in knowledge or experience, because we have our own; that’s the richness of diversity.

Photo by Annie Spratt on Unsplash
[Photo by Annie Pratt from Unsplash. Description: graffiti on a brick wall reads: Everything has beauty But not everyone can see it.]

C. Self-awareness moments, and the ongoing management of dysphoria triggers not resolved by medical and/or legal and/or social transition.

Transition is often framed as a finite process and/or about everyone else’s relationship to the trans person. Hormone therapy is often done for the remainder of the person’s life, scars on our torso impact our ability to be organ donors, our zombie names crop up at the least opportune time and place, and the most important relationship in all of this is our own to ourselves.

Photo by Nik Shuliahin on Unsplash
[Photo by Nik Shuliahin from Unsplash. Description: a man sitting on a coach in a dark room, one hand over his face. Part of another person appears in the foreground, obscuring the view.]

D. Safety isn’t the only reason to not disclose.

Sometimes it’s about sparring ourselves conversations that are old and tired to us. Long ago, I saturated in hearing “I never would have known you were trans!” “what was your name before?” “have you had the surgery?” and “how did you become a parent?” I will go some length to spare myself these redundancies. These aren’t potentially meaningful education moments; they don’t even have that merit. I know how to respond to these but they zap my patience, and can leave me in a sour mood. No thanks.

Photo by Erica Nilsson on Unsplash
[Photo by Erica Nilsson from Unsplash. Description: a sign post on a rail in front of a body of water that reads “DANGER thin ice keep off”]

E. The struggle to find a doctor willing to pick up the prescribing for our hormone therapy. Maybe our doctor retired, or relocated. Maybe we relocated. It’s especially difficulty if we emigrate.

Photo by Lena Bell on Unsplash
[Photo by Lena Bell on Unsplash. Description: several old Eurocentric globes showing incorrect maps of the world.]

F. Break-ups can include bitter exes that disclose us, and/or bitter custody battles mediated by transphobic law officials. This is often, eventually, followed by dating for the first time since transition or in a long time, and navigating if, when, and how to disclose to dates/new partners, given the power it gives the other person over us, especially in the advent of a break up.

A special note that in the United Kingdom and Israel, a bitter ex can turn around and claim to have not known their partner was trans while they dated, and get them charged with “sex by deception”. Thus far this has predominantly affected trans men in relationships with cis women.

[Personal photo of a water buffalo crossing a road in Timor Leste.]

G. Social isolation from fellow trans people.

Most trans spaces, whether IRL or virtual, focus on providing information to those struggling with the early steps of transition. That’s much needed, but it provides no reason for those who are well beyond that to stick around. Sometimes, we’re searching to connect with other trans older people. Even our capacity to share for the benefit of others is only of value for a limited time. Policies, language, providers and agencies change, making our lived experience outdated for those starting out today.

Also those in the earlier stages are seldom interested in the things of relevance to those further along. Getting little to no response to one’s posts, except for the odd person willing to derail your post to answer their own queries while contributing nothing towards yours doesn’t inspire to continue to contribute. Add to this watching the dozens if not hundreds of response to “check out my voice cracking/scars healing/my parents are transphobic/today I was discriminated yet again” posts, and you quickly know when you’re being ignored, and where you’re not valued.

To say nothing of those who wonder why you’re still discussing trans at all if you’re further along. They’re drowning in internalised transphobia and/or they don’t understand struggles they haven’t faced yet. But if you live in the all too similarly cisnormative/transphobic world as those newer to transition and/or trans communities, you don’t have many alternatives, if any.

Sometimes, we’d like to share funny moments or how our sex lives improved as a result of medical transition with people who can relate and chuckle along.

Photo by Samuel Zeller on Unsplash
[Photo by Samuel Zeller on Unsplash. Description: black and white photo of people sitting along a table at the end of a hallway.]

H. Friends and relatives who know your medical history will be in the same space as friends and relatives who do not.

They may not have any experience and/or comfort in discussing you/your relationships in ways that don’t disclose your medical history. They may not understand why you haven’t disclosed to everyone, especially if they get the impression the other friends and relatives would affirm your trans medical history. This can be especially difficult for cis queer people who equate coming out with disclosure.

Photo by Ethan Hu on Unsplash
[Photo by Ethan Hu from Unsplash. Description: 2 parents and a child enjoying a meal on a wooden table in chilly weather.]

I. A significant portion of trans people are parents.

Some had children prior to transition, others become parents following transition. Some contribute genetic material and/or carry their children, some become parents via other routes. According to one study, more than 1 in 4 trans people are parents.

[Personal photo of a firetruck on a hill, with stabilising pillars out at varying heights so the wheels are no longer on the ground, enabling the vehicle to remain leveled.]

J. Most disabilities add a whole layer of barriers to transition.

Learning disabilities, mood disorders, and other mental health stuff can render parents, legal and health professionals weary of someone’s ability to provide informed consent. Episodic or chronic STBBI and other illnesses can complicate access to surgeries, especially lower surgeries. Autoimmune conditions are impacted by hormones.

Deaf and HoH people often find health care professionals are unwilling to arrange for sign interpreters, that insurance doesn’t cover interpretation while accessing care out of network/outside of our public health insurance region/out of country, even when hospital and surgical fees are covered, and/or for other reason find themselves relying on significant others, family or friends to provide amateur interpretation.

People who depend on Personal Support Workers on an ongoing basis for essentials may rely on someone else’s cooperation to dress and present as they wish. They may have effectively no safe space even at home and/or have to come out/disclose to new PSW regularly (it’s a profession with a high turn over rate.)

People who have autoimmune conditions may have a complex relationship to hormone therapy for a number of reasons.

Photo by Varshesh Joshi on Unsplash
[Photo by Varshesh Joshi on Unsplash. Description: 3 monkeys of varying age.]

K. Elderly care is complex for trans and non-binary people.

The emphasis for most trans and non-binary advocacy is on youth, training in schools, and helping young people coming out for the first time. Few are the retirement and nursing homes with care givers knowledgeable on LGBTQ+ matters. Many people desexualise the elderly generally. Some prioritise the comfort of cishet seniors over that of LGBTQ+ people. As dementia sets in, some carers assume people will “forget” or not realise if they’ve been dressed according to their sex assigned at birth rather than their chosen/authentic gender/sex. Carers may become hostile while providing help to bath and get dressed. As with people with disabilities, facilities for the elderly have high turn over rates. Seniors are potentially having to come out/disclose in their home on an ongoing basis, pending the care they require, their surgical status, etc.

Photo by Johannes Plenio on Unsplash
[photo by Johannes Plenio from Unsplash. Description: the silhouette of a single person standing amidst trees in a dark forest, looking unto the sun in the background.]

L. End of life matters, when we die, or when our loved ones do

Pending legalities and circumstances, trans and non-binary people may struggle to have their final wishes respected when it comes to presentation and name used at their funeral service. Some, for whom spirituality is important, may struggle with after life concerns, especially if they belong(ed) to a religious institution that abandoned them upon their transition.

Or transphobic relatives may exclude trans people from attending funerals, and/or run interference in their access to inheritance. Parents with dementia may gradually forget they transitioned.

Photo by Jamison McAndie on Unsplash
[Photo by Jamison McAndie on Unsplash. Description: light swirl in successive circles along the shore of a beach at dawn or dusk.]

M. Ghost Moments

They’re a particular kind of self-awareness moment, for those of us who didn’t move away from where we used to live, or who go back to visit. You run into people who used to know you, you see them, but they don’t see the person they used to know. Some times they leave a smile on our face, sometimes they cause some melancholy. Seldom is disclosure a practical solution or an improvement.

gabriel-grayscale man fading over train tracks-unsplash
[Picture by Gabriel on Unsplash. Description: grayscale of man fading while standing over train tracks.]

N. Older relatives with dementia

Those of retain a relationship with their family of origin or who reconnect after a period of estrangement may find themselves before aging relatives whose dementia makes them forget the coming out and transition.

jr-korpa-couple holding hands fading-unsplash
[Photo by JR Korpa on Unsplash. Description: couple holding hands appearing more clearly as they mvoe away from the camera.]

O. Medical discrimination can be harder or impossible to avoid post-transition. Whether it’s a need to access an abortion clinic years into hormone therapy, paramedics cutting off a binder while we’re unconscious, or lab technicians being asked to perform cancer screening associated with women to a guy with a M on his medical record, there are times and places we won’t be able to withhold knowledge of our transition from health professionals. And we won’t always be able or successful to convince them to begin or continue to provide care, no matter what legislation, their regulatory body or Hippocratic Oath says. In fact, many will argue that doing nothing was them doing no harm, despite the subsequent worse outcome as a result of the delay in care.

Photo by meredith hunter on Unsplash bored bulldog laying down

This list is by no means exhaustive. And as I noted under G, it isn’t all doom and gloom, some times it’s about little victories, hilarious circumstances and the positive ways transition may enrich our lives.

I don’t judge my friend for not having foreseen how I would navigate the various conversations the way I did. You can attend a dozen trans awareness trainings, have trans friends for years, and not have acquired much depth in knowledge.

What would you add to this list? Is there anything you’d like me to cover that was left out?

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