Dear Feminist Women’s Health Center:
Once upon a time not long ago, I was struck by a car. Paramedics brought me to trauma care in critical condition. I was alert throughout. One of the questions an urgent care doctor asked was what medications I was taking. I mentioned to her an antidepressant and oestradiol.
One more question was asked a few hours later: another physician in the recovery ward double-checked my medications. He asked why I was on oestradiol. I replied truthfully: my body does not produce it on its own. I forgot what he wrote on the patient file. I think he jotted down that I had completed a hysterectomy at some indeterminate time in the past.
A couple of weeks later, just before I left, I carefully went through the 300-plus-page binder that had accumulated all the tests, the blood work, the scans, the vitals, and other remarks. There was nothing unusual about it, and its ordinariness is what taught me something profound.
Even after invasive surgical procedures and several days of recovery before discharge, there was nothing extraordinary (at least not to these physicians at a highly respected university research hospital) about my being prescribed oestradiol for life.
My endocrine system is exogenously assisted with the same 17β oestradiol molecule that the ovaries produce. I’m also a woman with a transsexual body. That means I was not born with ovaries.
That’s why the routine of this hospital convalescence felt so unprecedented, startling, and instructive. It’s because the already scary experience could have gone a lot worse through absolutely no fault of my own, but through the fault of a socially-embedded cissexism maintained by so many people with cissexual bodies.
I’ve been transitioned for more than half of my life. This is my entire adulthood. Experiential hindsight informs that, no — to the trauma specialists, doctors, and nurses who helped me when I was pretty badly banged up — I certainly would not have received as respectful, as dignified, or even as comparable a calibre of care had it been disclosed to them that my body was transsexual. Instead, I might have died.
Welcome to my reality. This is the unvarnished fear of every trans woman (and trans man) who seeks medical care from cis — that is, non-trans — healthcare providers. This barrier of dignity and access persists because the cisnormative clinicians who should be there for us instead reduce our health needs to a morphological history — treating us as conditional and elective women.
[side note: there is a PDF of that last link you can download without buying a subscription; I recommend that your staff earnestly read it].
As women with transsexual bodies, we are not conditional, and we are not elective. I want to remind you of this again of this inequity a little bit later.
Had I disclosed to any of those hospital physicians a summary of my body’s morphological history, it’s clear why the fear I have of saying anything about my being trans has not been borne in some vacuum.
I fear being reduced to another statistical Tyra Hunter — a trans woman of colour whose life-threatening injuries from being hit by a car killed her only because cis paramedics laughed at her body’s morphology while she succumbed to shock and haemorrhaging.
When you’re a trans person — and especially when you’re a trans woman — you fear the doubt, incredulity, and even horror lurking just under the surface which cis people around you are well known to express when they come into possession of privileged knowledge about your body. This is the kind of privileged knowledge whose discretion should be valued, respected and, most of all, understood no differently than with the privileged knowledge a cis body contains.
But it isn’t. That’s why so many medical facilities — hospitals, clinics, offices — bar trans women with the thinnest of equivocations. “We’re not equipped to treat your kind.” “We lack the knowledge.” “We don’t understand your bodies.” “Go see a gender clinic.” “We’re sure there’s another clinic for you.” “You lack ovaries and a uterus.”
All of these say the same thing:
“We would rather you die than for us to treat you. We really do know enough — we earned our medical licences somehow — but we’d like to tell you that we’re just not qualified to treat your kind of body or face your kind of person. We’re not being truthful, but we hold the power. Go away.”
This onus and responsibility of extending respect, expected without hesitation, must fall not to the person with the trans body, but to the cis people whom that vulnerable trans person must engage as a precondition for receiving equitable, routine, and ongoing medical treatment.
As a trans person, you don’t want cis people — the very caregivers whom you want to entrust with a basic ethics entwined with the Hippocratic oath — to be the key agents behind why you got sicker or why you succumbed prematurely. You want an advocate who takes the lead on assuring equitable care each and every time it is needed.
Primum non nocere. Do no harm.
So why this open letter?
Your treatment policy and core values at the Feminist Women’s Health Center were recently brought to light online before several feminist communities — including fourth-wave trans feminists like me — on how your clinic adequately treats cis women and trans men.
Your clinic, in contradiction to its name, the Feminist Women’s Health Center, categorically treats men (trans men are still men), while it categorically refuses to treat women — that is, any woman who discloses that she has a transsexual body. Your core values categorically begin with this statement: “We provide quality healthcare and community education regardless of race, ethnicity, sexual orientation, gender identity, socio-economic or immigration status.”
But you categorically don’t.
As with my situation in triage, there are trans women who do not disclose their bodies as transsexual. Some have the affordance of not having to do so because their morphological transparency gets them placed as cis by other cis people. Because of this, these women also sometimes escape being denied treatment under structural systems like your clinic’s own.
That a woman must withhold useful knowledge to assure the best quality of care is a vetting of the days when women had to reach out to find Jane.
That’s where we, an entire populace of women — trans women and cis women (who advocate for trans women) alike — find ourselves at stark odds with your policy of declining women as patients whose bodies were not equipped at birth with ovaries or a uterus.
And yet, the endocrine needs of women with transsexual bodies are no different than cis women of their age: a healthy endocrine system not only facilitates proper bone density, but it also makes the difference between life and death. It is a holistic concern.
Let me repeat that: the endocrine needs of trans women are no different than cis women. The end objective is that women, for a great deal of our lives, require baselines for oestrogen in the body; progesterone for the regulation of much more than just menstrual cycling; and an assurance that free testosterone is kept to a nominal level.
Try this exercise:
Subject a cis woman to regular testosterone injections and wait to see how long it takes for her neurochemistry to shut down — that is, for her to slip into depression and even suicidal ideations. That’s because her neurological sex is incompatible with that exogenous endocrine intervention, or EEI for short. That’s what trans people face. Every day. (And no, you wouldn’t in your ethical mind subject a woman with a cissexual body to that kind of, well, torture).
The policy at Feminist Women’s Health Center fails not at the argument that your staff are not yet “qualified” or “equipped” to accept as patients those women whose bodies are transsexual. No. If that is the rationale for rejection of treatment your clinic is electing to advance, then that means your policy failed at pre-med and med school — namely, on those days when the endocrine system was reviewed.
When the Feminist Women’s Health Center uses the suspect language of “biological women”, it undermines everything taught in med school with a shifty language. This language’s entire raison d’être is to produce a separate-and-not-really-equal equivocation for which women are proper enough and which fall below this threshold. It is a cattle guard. It is a velvet rope. It is a moveable goalpost.
“Biological women/female/vagina”, as biologists will readily share, are the province not of the clinical sciences, but of the social sciences. In other words, “biological” as a qualifier is quite political and lacks both scientific and therapeutic basis. “Biological women/female/vagina” is spoken in one spirit: a harmful one. “Biological women/female/vagina” serves as a subjective device for the thinly-veiled exclusion of women and, as your clinic realized in the not-very-distant past, for men — that is, trans women and trans men, respectively. Where your clinic rose to the challenge of trans men at the expense of trans women is baffling and broken.
The same harmful spirit applies to “genetic” or “chromosomal” qualifiers as weapons of social-institutional exclusion, as we are well aware that probably 90 per cent of every person’s dimorphic morphology is dictated and shaped by what its endocrine receptors are tasked to do: the presence of sufficient oestrogen produces one dimorphic morphology, while the presence of sufficient testosterone produces another dimorphic morphology. And that morphology is quite malleable, especially if EEI begins early enough.
You see, much of what makes gynaecological care what it is is that healthy endocrine function informs quite directly the state of one’s entire body — holistically so. Yes, some of gynaecology addresses PCOS, pregnancy, birth control, and cervical exams (incidentally, sexually active trans women who have vaginas also require pap tests, and the procedure is pretty much the same — speculum, scrape, and all).
But as the Feminist Women’s Health Center clinical staff are I’m sure quite aware, a woman’s health is only partly informed by the activity of a reproductive-age uterus, ovaries, or cervix. There is so much more to what a woman faces which a clinic like your own is charged to address. A women’s clinic is a source point of education for women to make healthy choices for their lives — including keeping themselves safe from social relationships which could otherwise harm them.
There’s an essay I want each of your staff at the Feminist Women’s Health Center to read. It’s pretty short — much shorter than this letter is. Astrid Lydia Johannsen’s essay marks the inextricable relationship between reproductive medicine and trans medicine since their inceptions. They are two halves of the same endocrinological whole. They are both medicines birthed in the 20th century. One cannot be wrested from the other.
Once you’ve read that, then come back. We’ve more to talk about.
Clinics by and for women share their historic urgency in the poor, obstructed, and even nonexistent quality of care which women have long been forced to confront time and time again.
When the Feminist Women’s Health Center denies health care for an entire class of women, it wilfully betrays the integrity of clinic’s name. When it then proceeds to treat men while continuing to deny care for those women, it flatly contradicts any kind of feminist mandate. When women are denied care, it is inherently misogynistic and deeply counter-feminist.
And yet, the very systems of obstruction — which women-oriented and reproductive care clinics were organized to put a halt to such barriers — are the same systems of obstruction which your clinic is now actively facilitating when you reject known trans women from your care. The master’s tools are still the master’s tools regardless of who holds them.
What your present mandate is actually doing is treating only those people who have (or had) a uterus. You are no longer just treating some women. In short, your clinic is only open to people coercively assigned female at birth. This is CAFAB. You’re going to have to get used to hearing this and the complementing CAMAB (coercively assigned male at birth) and CASAB (coercively assigned sex at birth).
The Feminist Women’s Health Center must understand that by excluding all non-CAFAB women, it is validating and perpetuating a specific, complicit violence towards these women — these CAMAB women — which has been branded onto their bodies for their entire lives. Women’s health, in its holism, is to advocate the stoppage of abuse, to stop the systemic social and institutional harm.
This is not what the Feminist Women’s Health Center is doing.
Other women-oriented clinics have begun to realize the faults of this obstruction on which your clinic is now being challenged by both feminists and women — in both Atlanta and far, far afield. In the last couple of years, Planned Parenthood updated their care policy to provide at a national level to open their clinics to all women — irrespective whether they were CAFAB or CAMAB, and irrespective whether their bodies are cissexual, transsexual, or intersexed.
This isn’t progressive medicine. This is a best practice. This is an affirmation that womanhood is not reducible to a handful of reproductive organs on a checklist — the same checklist which men in medicine used to bar women so systemically that an entire generation of women-oriented clinics were chartered by necessity.
Planned Parenthood, as with an increasing number of women’s clinics, are now recognizing with less and less difficulty the inextricable, sinister relationship between a history of back-alley and coat-hanger abortions, and a living history of black-market hormones of questionable provenance; back-alley silicone injections; and the many complications arising from a clinical depression brought on by a neurochemically incompatible endocrine system.
Planned Parenthood and others affirm that women’s blood is continuing to pour. They recognize that women’s bodies are continuing to appear on cold metal slabs as a direct function of the systemic barriers which women face when they cannot access woman-positive health care.
When your clinic, the Feminist Women’s Health Center, then goes out of its way to provide endocrine care for men — for men who, yes, started their life with a uterus — but not for a class of women you refuse to receive as clients, it begs the question: how do you reconcile your feminist mandate?
Why are you called the “Feminist Women’s Health Center”, when your clinic does not prescribe or administer oestradiol, which is not a controlled substance, to neurologically female women with transsexual bodies?
Why are you even called the “Feminist Women’s Health Center”, when your clinic readily prescribes and administers testosterone, a Schedule III controlled substance, to your neurologically male clients?
How is it that you purport that your clinicians are “less qualified” to treat trans women? The only way they could be less qualified is if some of them bombed med school because of that day they skipped out on endocrinology 201, 301, and 401.
Your differential treatment of men with transsexual bodies against the rejection of women with transsexual bodies is a double contrariety: by denying some women and admitting some men, you not only contradict the “Women’s” component of your name. You also advocate for and perpetuate a misogyny which contradicts the “Feminist” component as much as men who pine for a return of women to the kitchens of Atlanta, America, and the world.
Yes. This kind of misogyny is transmisogyny. Cis women are no less susceptible to being misogynistic than men are. The key difference is that with women — cis or trans — that misogyny is deeply internalized, and it still hurts other women.
In the end, that misogyny hurts all women — both cis and trans.
The Feminist Women’s Health Center exists to be there for women. It’s in your name. But you’re not actually there for women, and this is a fundamental problem.
Should the Feminist Women’s Health Center maintain that it is there for women, then trans women should be no exclusion to your mandate. Should the Feminist Women’s Health Center continue to categorically exclude known trans women under whatever reasoning you please, then you are operating in poor faith — even deception — under your clinic’s present name. In this case, call a spade a spade, then: you are simply a Uterine Health Center — nothing more.
I don’t have a specific investment in turning to the Feminist Women’s Health Center for holistic health care, because Atlanta is nowhere near where I live. But I would be remiss to ignore how other women — my sisters in struggle — are continuing to needlessly struggle in what amounts to an abusive policy of exclusion.
I’ll end this open letter as it began: on my medical narrative.
A dozen years prior to my accident, I sought out health care services at a women’s clinic in upstate New York. It was my very last option in a region which was extremely hostile to the medical treatment of women with transsexual bodies.
I was more naïve then. Having been on EEI for a few years, I thought it was the “right thing to do” to voluntarily disclose to the clinic before my first visit that my body was transsexual. That voluntary disclosure resulted in the clinic sending a terse letter, via post, one week before the appointment — some five weeks after the appointment was first made by phone. The letter informed that the clinic had taken it upon itself to cancel my appointment without further comment.
A respected friend — a cis lesbian woman — referred me to that clinic. It’s where she went for routine health care. Upon hearing the cancellation, she was stunned to learn that her clinic had treated me so crudely (her word, not mine).
This non-consensual cancellation meant I had to forcibly halt my EEI regimen for several months until I was able to move to a new region and have it prescribed again. The disruption resulted in a lowered bone density, which was the probable contributor to a micro-fracture of one of my toes about six months later.
That experience taught me a sharp lesson: for a woman like myself, I had to shut up to live, or I could speak up to hurt myself further. This is why I was dead silent in trauma care on the day of my accident, and this silence is probably why I was able to recover fully from my life-threatening injuries.
Holistic care should never have to come down to conditional humanity, under any circumstance.
The Feminist Women’s Health Center, as it now operates, advocates for a conditional humanity. This is neither a feminist precept, nor is it beneficial for a lot of women whose numbers are too small to produce exclusive clinics locally, but far too great to simply be barred at the door of a purportedly feminist-forward women’s health resource.
The Feminist Women’s Health Center has made a mistake which it can remedy. Please do so posthaste. Please do so, knowing that women like me are never going to go away.
If anything, more and more of us as trans people are voicing ourselves in earlier cisnormative corridors. It behooves your clinic to admit, treat, and respect all trans women under a best practices care model of informed consent so long as you publicly maintain that you’re a feminist women’s health resource.
Try to use this as an opportunity to take the lead, to educate, and to advocate for some of the most vulnerable, most underserved women you’ll ever know in your locality: CAMAB women. Stop worrying and learn to accept and embrace the plurality of our experiences as women.
We bleed, too.
Sincerely striving for feminist social justice,
|||| Patience Newbury
Cisnormativity 