In some cases, the issues are baked right into the heart of our medical systems.
Consider this: if you were to look through every single medical record in the UK – all 55 million – you won’t find a single record labelled as belonging to a transgender person. This is also true for those assembled by many providers in the US.
“You can register as male or female, but you can still only choose between these two options – you can’t say if you are transgender or non-binary,” explains Kamilla Kamaruddin, a doctor who works for the National Health Service (NHS) and transgender woman. “So that’s quite difficult.”
Instead doctors must rely on their patient to tell them.
“Sometimes this can be okay,” says Dina Greene, a clinical chemist and expert in transgender health at the University of Washington, Seattle. In many cases, if someone is going to see a medical expert where gender seems irrelevant, patients might not want their doctor to know they are transgender, she says. “It’s stigmatised.”
But this rigid male-female dichotomy also has some bizarre, and much less desirable, implications. “There are lots of simple things, like our medical record systems often cancel pregnancy tests if they’re ordered on men,” says Greene. (Some transgender men can get pregnant, depending on the treatment they have had. And though very few countries track this aspect of their health, 250 gave birth in Australia in the decade leading up to 2019).
The gender you’re registered as also dictates which screening tests you are invited to, meaning that thousands of transgender men could be missing out on potentially life-saving cervical (Pap) smears and breast exams, while transgender women could be missing out on abdominal aortic aneurism check-ups (or prostate cancer screenings, if they live in the US).
When Charlie Manzano, a transgender man from Martinez, California, informed his healthcare provider that he would like to register as male, he was told that he would lose his gynaecologist – though he still retained his female reproductive organs. “Most of my doctors have no idea about trans patients,” he says.
Similarly, your gender shapes a number of other medical decisions, such as the dose of drugs you’re prescribed. For those whose gender and sex are the same, this makes sense, because male and female biology is fundamentally different – the former have more water in the body, a higher surface area, and a higher body mass. All of these factors can influence the way pharmaceuticals behave. Females also have more sites for certain drugs to bind to, and are therefore more sensitive to them. They tend to clear them more slowly, so they are more susceptible to overdoses.