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Aoife Martin: 'There are few people as expert in their own healthcare as trans people are - we have to be'

Our new columnist writes about the importance of listening to trans people when it comes to healthcare, sparked by a recent visit to the doctor’s.

Aoife Martin

Ppl I HAD OCCASION to visit my GP just before Christmas, something I had avoided doing in these COVID-19 times, not wanting to burden my doctor unnecessarily.

I had been suffering for a number of months with an intermittent pain in my lower left abdomen. Doctor Google had diagnosed me as having diverticulitis, a kidney stone and with not sitting correctly at my desk.

My own doctor, being the scientific person she is, took a urine sample, found blood in it and declared it to be a kidney stone. Doctor Google was 33% correct.

Happy Christmas, Aoife, from 2020, the year that keeps on giving.

I was put on a course of antibiotics, given a prescription for painkillers and told to drink lots of water. If the pain became unbearable, I was to go to A&E and hand them a letter that my doctor gave me.

The letter described my symptoms and my medical history, part of which was a declaration that I had Gender Identity Disorder. It’s always strange to see it written like that. Gender Identity Disorder.

Now, let’s be clear, this is not my GP’s fault. This is the diagnosis I received after I was referred to a psychiatrist by the National Gender Service (NGS). Gender Identity Disorder was the term used up until 2013 with the release of DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), after which the condition was renamed to Gender Dysphoria to remove the stigma associated with the term disorder.

Oh, did I mention that my diagnosis was in 2017? (I should also point out that as of 2019 the World Health Organisation (you might have heard of them, they’ve been in the news a bit lately) no longer classifies being transgender as a mental disorder.)

When we think of trans healthcare we tend to think of it in two ways: hormones and surgery. The truth of the matter is that it’s much more complex and varied than that.

The level of healthcare a patient needs varies from person to person and is often contingent on the level of that person’s dysphoria. In my years of dealing with the health service in terms of my gender identity one thing that stands clear is that you have to advocate for yourself. This means not only knowing what is best for you but having the knowledge to back it up.

There are very few people as expert in their own healthcare as trans people are. This is because we have to be. We learn, for example, about the various methods available for delivering hormones into our bodies; we learn how to self-inject; we learn what our surgical options are and where the best places are to go for that surgery (we have to travel abroad); we learn about surgical aftercare; we learn about all the ancillary treatments that we might need. We do this because we don’t have a choice. There is a lack of education out there among medical practitioners when it comes to trans-related healthcare.

When I first told my GP that I was trans I was lucky that she (a) accepted it at face value and (b) knew where to refer me. There are GPs up and down the country who don’t have that knowledge. I have heard anecdotal evidence of GPs telling patients that it’s just a phase or that maybe they should just try crossdressing in private.

Often a trans person’s first point of contact will be their GP. This will be their first entry into the system and it’s important that this is handled sensitively and knowledgably. As already noted some of the terminology used is outdated and should no longer be in use. I’ve seen the term transsexual, an outmoded term, used on official HSE literature, for example.

But it also has to be said that there is a willingness and a hunger to learn from many in the health service. Training courses delivered by TENI (Transgender Equality Network Ireland) are often booked out. But these changes are slow and take time to filter through the system.

Trans healthcare is not just surgery and hormones. There are numerous other procedures that some patients need and much of it needs to be self-financed. Some of it, if you’re lucky to have private health insurance, will be covered there but most of it isn’t.

Take, for example, laser and electrolysis treatment. This is expensive, time-consuming and painful. There’s nothing quite like getting what feels like hundreds of needles jabbed in your face to make you consider whether this is all worth it, especially now that we’re all wearing masks anyway. Okay, I’m joking.

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For me it was absolutely worth it but I’m also lucky that I have been able to afford it. At €60 per session, requiring multiple sessions over many months, it is costly, yes, but it has made a huge difference to my life. The NHS in the UK covers laser treatment for transgender patients but unfortunately that is not the case with the HSE here yet. This, like a lot of other trans-related healthcare, is deemed cosmetic.

Other trans-related treatments include Tracheal Shaving (to reduce the size of your Adam’s Apple), FFS (Facial Feminisation Surgery), breast augmentation and voice training (something the NGS in Loughlinstown does provide) – and these are just for trans women. I haven’t touched upon the treatments required by trans men.

What I’m trying to get across here is just how complex and diverse trans healthcare is and also how multi-disciplinary its requirements are. More often than not trans people have to navigate these pathways alone or with the help of other trans people who’ve been through the system and know what to expect. There’s no one size fits all when it comes to trans healthcare and scaremongering articles like we’ve seen in the media recently certainly don’t help.

Trans people are the best advocates for their own healthcare. We know the complexities, we know our own needs and we know our own bodies. We also know the risks – all medical intervention comes with risk. We understand the difficulties all too well.

Listen to us.

Aoife Martin is a trans woman and activist. In her spare time she likes reading, going to the cinema and practicing card tricks.

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