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this post was submitted on 20 Aug 2025
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Transfem
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A few things.
Firstly, OP specifically said "Ideally without disclosing I'm trans". Your whole comment was unnecessary first off from the outset.
Secondly, you have grossly overstated medical necessity here. Hormonally trans women who have been on HRT are functionally much closer to cis women than cis men. Trans status is rarely relevant to any medical treatment that isn't specifically about reproductive organs.
Thirdly, trans status is a matter of life or death in the vast majority of the world. Medical necessity, even if it were as significant as you've tried to portray it as, means nothing if you get arrested or killed.
The moment I told my psychiatrist I am trans I was denied further care. Your advice is wrong and dangerous. See Ada's comment for more detail on why.
Edit: For more context I live in Norway where this is highly illegal. I've complained to both the hospital and to higher authorities, but to no ones surprise there's no response yet :)
Var det i bibelbeltet eller? Jeg spørre bare fordi jeg har ikke begynt med noe som helst enda og ville vite hvor vanskelig det kommer til å bli.
Kommentaren federer enda så svarer her på lemmy kontoen min i stedet. Nei var i en liten by i nordland, på vop. Det beste du kan gjøre er å flytte til oslo og komme deg inn på HKS om du er 30 el yngre. Du må bo i oslo for å få behandling der. Alternativene er riksen (som suger, de er onde, det tar veldig lang tid, og kan hende de bare sender deg hjem for å "ikke være trans nok"), eller imago (dyrt og kun over nett). Du kan forsåvidt også begynne med hormoner på egenhånd som jeg gjør. Vi har en lemmy community med lenker og ressurser, men den faktiske aktive communitien er på matrixen om du vil gjøre DIY. Det finnes noen leger som skriver ut hormoner, men da må man være heldig eller finne gjennom andre trans folk. ~~Om du er transmask er det også mulig å få tak i hormoner gjennom de som bruker steroider og sånt. Det er samme greierne.~~ Ah, ser ut som du er transfem <3
Legen min gav meg ikke store problemer fordi jeg er trans, han bare hjalp meg ikke forbi simple blodprøver. VOP var problemet for meg, og siden jeg var i en liten by hadde jeg ikke noen andre behandlere å gå til. De er redd for at det at du er trans skal være svært forstyrrende og gjøre det vanskelig å vite hva som er at du er trans og hva som er andre problemer. De var også redde for at hormoner (jeg tar ikke en gang blokker) skulle påvirke adhd medisin som er latterlig. Mange leger er nok også litt redde for hvordan det at du er trans påvirker andre ting fordi de ikke har kompetanse om det og fordi de ikke har tiden / ikke orker å sette seg inn i det. Du kan spørre folk på trans norge discorden eller transnord redditen om forslag til leger og frisører og sånt.
Håper jeg har svart på spørsmålet ditt <3
Edit: Skal sies jeg hadde veldig dårlig lege. Var vanskelig å vite om det at jeg er trans påvirket behandlingen jeg fikk av ham fordi den var ganske bais fra før
You are. And not only that, you're in a community aimed at trans folk, offering advice to trans folk who are aware of the reality of the situation in a way you very likely are not. That's not a good position to start from when it comes to offering advice. Doubly so, when your advice appears to be coming from a position of "in a perfect world" rather than from the practical realities that trans folk have to deal with in the world as it is.
As with all things, this depends on the context. Sometimes, it's relevant. Mostly, it's irrelevant. And sometimes, knowing causes doctors to make mistakes about our healthcare needs when they incorrectly assume our medical symptoms align with those of cis folk of our assigned genders (this is particularly likely if the doctor is not familiar with trans health care).
On top of that, there is a thing called "trans broken arm syndrome", in which doctors tend to immediately aim for HRT or transition surgeries as the cause of whatever ailment the trans person has. Again, this is particularly true with doctors that don't often treat trans patients, or worse, that hold anti trans opinions (even if they keep those opinions private).
Yet, even when it is relevant, telling the doctor can lead to all sorts of othering and exclusion. Sometimes, it's outright transphobia and misgendering. Sometimes, it's being isolated from other patients, because the medical staff don't know how to deal with you. Sometimes, it's just medical curiosity, where the doctor just wants to ask all sorts of irrelevant questions out of medical/personal curiosity, because they don't often deal with trans patients.
I live in a very trans inclusive country, with protective laws. I'm openly trans, and wear a trans flag dog tag, and a trans flag arm band. Yet one of the few situations where I won't openly out myself unless I have no other choice, is when dealing with medical staff who don't recognise those flags. And I do that, because the folk who don't recognise the flags are the folk more likely to other me, more likely to be confused by me, and more likely to ensure that my interaction with them is as uncomfortable as possible. And that's in a safe, accepting country. Imagine what it's like for folk who live in places where transphobia is not only common, but sometimes legally mandated...
Which is to say, each and every trans person navigating healthcare has to decide for themselves how to walk this tightrope. And general advice of "you should tell them" suggests you're not familiar with the lived realities of trans folk, despite working in a hospital
While its true that there can be implications for the efficacy and side effects of medication if you're doing hrt. You can also check for those interactions before you get your prescription or ask someone who you know to be safe. It's going to potentially be safer than being denied care all together. a lot of places are extremely transphobic if not in policy then in the personal prejudice of people generally.
could you kindly share some examples? How would this differ from just ... being your gender, i.e. the way estrogen works in the body will impacy how medications are metabolized, but the end result is that the medication works similarly as in cis female bodies ... is this what you mean?
I don't know of any interactions with HRT generally and would like to learn...
The medical system lost its privilege to know everything about me at all times long ago. It's positively lousy with conservative quacks, who not only lose all sense of professionalism when it comes to gender minorities but downplay cis womens' medical issues too.
Do you understand this is a global problem?
how is it vital medical information? what difference does it make?
Just another cis guy speaking confidently over minorities
sure, but the real sin is being confidently wrong, lol
there seems to be real confusion, the main misunderstanding being that trans people really are their assigned sex, it betrays a kind of persistent essentialist thinking
it's a complicated topic, so I prefer to just invite that nuance - what are the differences? If they're right and I'm wrong, I'm sure that can be demonstrated - the worst case for me is that I learn something and grow.
These conversations are especially absurd given the fact that women weren't even included in clinical trials until the 90s, and for the most part medicine still doesn't even differentiate cis women, let alone intersex and trans people.
What it feels like is like a line is being crossed with cis people when I am a woman in a medical context. They were maybe willing to tolerate I am a woman socially, but the idea that I'm a woman "biologically" is like a third rail somehow, it's dangerous and against truth, etc.
Consistently I'm told it's important to disclose being trans for medical reasons, but I have yet to hear why, I never get an explaination that makes sense.
My doctors aren't even telling me this. Instead I think it's a kind of acceptable and anxious expression of latent transphobia, a desire to maintain a boundary between the social gender which has been expanded and made open to trans possibilities, and the "biological reality" which must remain fixed.
This is the same anxiety that lead universities to stop karyotype testing as an exercise for students, because so many find out they are intersex who perviously thought they were "normal". There is incredible anxiety around sex and gender and a desire to see things a certain way, and trans and intersex people complicate that way of seeing.
Telling trans people that disclosing their trans status in medical contexts on the surface seems defensible, but it seems to me that it may be more motivated by a desire to reduce trans people to their assigned sex in medical contexts, which in the end is less about good medicine and more about cis-sexist norms.
Yeah. I've yet to have a medical professional gender me correctly in reports. I'm a man who thinks he's a woman to them. They all seem so pleasant until I read their reports and see what they were actually thinking.
Edit: This is Jorunn btw :P just with my lemmy account
https://piefed.blahaj.zone/post/236212#comment_1057480
Edit: Besides, it's nuanced. Disclose if necessary. Don't disclose otherwise. It can cause us a lot of harm as others have gone into detail on to always disclose that we are trans. You don't know what you are talking about.
Edit: What I have to do in one of those countries you blindly assume is a-okay with trans people is I have to specifically look for doctors and medical professionals that are known for not mistreating queer or trans people. This is stuff we talk about and share with each other all the time. I'm not an isolated case.
absolutely, I have to find everything through the trans community - what dentist to see, my hairdresser, etc. Doctors are some of the most important to be vetted by the trans community first.
What are some examples of the biological implications and risk factors? As far as I can tell the only one I can think of (and the only one my doctors told me to disclose) is that I have a prostate, but risks of prostate cancer are very low when estrogen dominant.
Either way, assigned sex is often arbitrary and a can be a poor indicator of the medical situation, e.g. 20% of intersex individuals are trans and may or may not have typical anatomy of their assigned sex. So communicating you're a trans woman gets misunderstood as "I'm male", which is not the correct conclusion.
I should also state I obviously disclose my trans status to doctors who are providing care like HRT, or who need to know for other reasons (e.g. a gyno who would perform a prostate exam through the vaginal canal).
But my question is for contexts where it's not appropriate or necessary to disclose trans status, such as walk-in clinics or ER visits.
I assume you are cis from your comment, but you should know it's not just the prejudice and mistreatment that motivates not disclosing trans status (whether overt bigotry, or other forms of discrimination like "trans broken arm syndrome"). When you tell someone you are trans, it immediately undoes your gender in their eyes. It can feel dehumanizing, and it also comes with a lot of bad assumptions (e.g. that biologically I'm not different from other men, but also that I must be like a man in other ways, too).
For that reason I find it's actually better to just disclose necessary information without framing it as being transgender - I disclosed that I was born without a uterus, and I disclosed the hormones I take and in what amounts, etc. which is what they need to know.
EDIT: I should mention, I've responded to a similar comment in the past, I'll throw that inline here for convenience:
click here to expand my prior response
EDIT2: another way trans status might impact health is for directing them for certain kinds of care that impact the community, such as testing for HIV, connecting with drug abuse resources, etc. - but that's rather generic and less of the kind of "biological implications" you mentioned, but it's an angle I hadn't thought of before (if we were thinking about policy choices this would be something to consider, but in terms of what I as a trans woman should do, it feels less relevant).
Nursing student here - probably a solid half of the disease processes we study have "male/female sex" listed as a risk factor. A good chunk of lab values have different ranges for male vs female.
That said, I have no idea if those are intrinsic to the sex, or to the hormone levels, so HRT might completely negate or flip those differences.
I'd run this by your HRT doc. They'd have the best understanding on what your transition is or isn't doing on a physiological level and which other docs would be able to provide better care if they know you're trans.
Generally it's best not to hide things from your doc, but if revealing that info is being treated as "I'm male" then that's not doing you any favors, since your physiology is not that of a male. And again pointing to the HRT doc, they'd be able to help you articulate that distinction to other docs.
You've actually hit on a major reason why disclosing isn't as simple as you think it is.
Sure, a good chunk of values have different ranges for male vs female, but the normal ranges for cis folk and trans folk are not the same.
Hormones are the obvious example, but there are large parts of the body that respond to the endocrine profile that we have after hormone replacement. Heart attack symptoms, body fat percentages, resting heart rate, blood oxygen levels, iron levels etc, are all shaped by our hormone profile, not the hormone profiles of cis folk.
It entirely depends on the specific medical issue, but in general, it's the latter more often than the former.
It's not always that simple. On top of the fact that it's not realistic to see the HRT doc every time you have an unrelated medical issue, the other aspect is, as you're probably aware, sometimes, the patient knows more about their health care needs than the treating doctor, because we need to become experts in a way that a GP does not. If your doctor isn't a specialist in trans care, they're just as likely to give you conservative, incorrect information that was drafted in a time when trans health care even less understood than it is now.
As you're a nursing student, I want to give you some advice. When you are dealing with a patient that isn't "new" to their situation, whether it's trans health care, or long term illness etc, you need to allow for the fact that the patient likely has a lot of lived expertise in dealing with their situation, and broad, general advice is rarely going to be useful to them.
Knowing biology, I'm sure it's complicated and any generalization will be false. For example, there might be genetic conditions that derive from having two X chromosomes that we could argue are intrinsic to the sex (or more accurately, intrinsic to that karyotype), but for the most part my understanding is that differences relevant to lab ranges are mostly mediated by hormones, so I use female ranges.
Either way, my PCP seemed to indicate I shouldn't disclose trans status but that the one exception was that I eventually need to find someone for prostate exams once I hit that age (if I hit that age, I guess). The endo that prescribes my HRT has never mentioned whether I should disclose or when to.
I should say, even when my medical chart was shared across hospital systems and my gender dysphoria was listed in my chart, the ER doctors didn't seem to do uptake or change the way they treated me, even when I walked through my HRT and explained I couldn't be pregnant. They still thought I was a cis woman and asked if I could be pregnant - I think people mostly just operate based on what they see, and it's a shock when you say you are trans. It creates an extreme chilling effect sometimes, people stop meeting your eyes, or even interacting (sometimes interacting through a third party instead, like a cis family member). I've even talked to a neurologist through the details of my vaginoplasty and he didn't seem to do uptake that I was trans. Unless I say the words, they just won't put the dots together. (Meanwhile a trans woman at Sephora's will clock me from across the store.)
For an ongoing relationship with a primary care doctor or a specialist for a new health problem that my GP has referred me out for, sure. For something like the dentist or an urgent care doctor because I have an ear infection? Absolutely not, I’m not trying to deal with trans broken arm syndrome.
If I have concerns about medication interactions I’ll ask the pharmacist at my local LGBT health center. The odds of there being a medication only cis men can take (for reasons other than fetal health) or that the dosage is going to be drastically different because of my sex rather than my hormonal profile, medications, and weight is vanishingly small.
I assume by "cis men" you mean "biologically male" (roughly including trans women?), and while this is an idea that hasn't been revised much in the hospitals, that idea is a bit broken and scientists have moved on from the idea of "biologically male/female", either way - what I was wondering is what even is an example of such a medication? I don't know of any medication that would be so different for men vs. women that a trans woman would need to be treated differently than cis women.
Generally the drugs that metabolize differently (or are dosed differently) between sexes (broadly speaking) are going to be the same whether you are a cis or trans woman (assuming the trans woman is on estrogen), because estrogen seems to mediate a lot of those differences.
Can you think of an example? I don't know of any!
I wrote cis men because I’m a trans man and was talking more about a hypothetical medication that would harm me if the doctor thought I was a cis man and didn’t out myself. But yeah, I’ve never been able to get an answer from anyone on how urgent care is going to kill me if I don’t tell the doctor I’m trans before I get antibiotics 🤷♂️
🤦♀️ sorry about that mixup, I hate it when I make bad assumptions like that 😬 also, glad you're here!
and yeah, I have no clue either ... I'm open to being wrong, but my doctors aren't telling me I need to disclose I am trans. To the contrary they seem to indicate I shouldn't, and were clear the one exception was to get prostate exams past a certain age, a concern that is suspicious, and may be a bit misinformed, considering it is based on the assumption of risks from male levels of androgens. I have a relative with prostate cancer currently taking medication to block androgens to treat the cancer, for example ...
Though I am in the U.S. so my doctors might be more concerned about my disclosure given the context. I was also at the time getting care in one of the worst anti-trans states.
Yeah. The best way to lower risk of prostate cancer is to lower testosterone levels. And the best way to stop it growing if you do develop it, is to lower testosterone levels, and add estrogen. And they rarely, if ever choose surgical intervention when it comes to prostate cancer. So, despite being at the age where a cis man would have to start thinking about this, it's not something I plan on investigating, given that I've got a reduced risk profile, and I'm already on the same medication they use as treatment...
right!? I find it so strange they are treating my prostate like it's in a cis man's body ... one guess is maybe the time before transition adds risk because there was exposure to male levels of androgens? But then ... I'm already on the treatment for prostate cancer ... something just doesn't make sense here and it feels like blind policy being implemented on the assumption that I'm "male", exactly the kind of mistaken view I don't want to perpetuate by disclosing I'm trans.
No worries, this is literally the transfem community!
And yeah, I get all the relevant exams that my GP (who I’m out to) thinks I should get, I disclose what medications I’m on, beyond that it’s my discretion because it’s not their business.
Not that I'm accusing you of anything, but this is a hypothetical that I hear a lot from transphobes (ie, "would you take the medication only for "biological" men / women despite being a trans woman / man? If so, ha ha! You admit to being your AGAB really. If not, ha ha! You die).
Other than questions of what anatomy is physically present, I've never heard of (and sincerely doubt the existence of) any case where birth sex is relevant.
Yeah, I say hypothetical medication because as far as I can tell it remains that. Medicine is complicated enough that I’m not willing to rule it out as inherently impossible, but if such a thing exists I doubt we even know about it, given the sorry state of medication trials with regards to treating cis men as the default human.
Assuming you're not a trans woman, nobody asked you. Maybe don't go blundering into minefields.
This is a vibrant thread that sparked informative discussion about trans people's interactions with healthcare. None of this would have happened without someone blundering in here and saying something uninformed.
Anyone is welcome to participate in this community, including cis people.
yeah, but I wasn't asking for cis perspectives on this, and it feels more like the thread has been hijacked and taken a direction I wasn't intending. It's making me think having a community where cis voices are not allowed might be a good idea ... To be honest, this isn't the first time this has happened either.
Finding new doctor is the worse experience every.
Here in public health your town gets a few of them, and you can only change between those.
The procedure takes days, more days to take new appointments and then to suffer the issues again.
That is really shit. You get no spoons to even start again.