Doctors: Allies/Gatekeepers

So it turns out that parts of the trans healthcare landscape in Singapore, and in particular my therapist, are much more excellent than I had thought.

I am hypothetically maybe possibly perhaps thinking about going on T, but not soon: a post for another time. Meanwhile though, I have been researching my options and thinking about things. One thing I have been wondering about is: do I, a nonbinary person, have to lie about being a binary trans man in order to get prescribed T?

I think that ideally, in order to achieve the most favourable health outcomes, healthcare teams should be allies and not gatekeepers in the medical decision making of trans people, but it is difficult. There are obviously many benefits to being able to be trust and properly communicate with your healthcare team. One would like to be able to discuss transition goals, doubts, fears, difficulties, anxieties, etc. with experienced professionals without worry that that would limit access to treatment. For example, it may be helpful to be able to engage productively with a gender therapist, instead of having that be just a test to be passed; trying to develop a therapeutic relationship while simultaneously pretending to be a whole other gender just sounds like a terrible idea. I’ve also heard the rather reasonable advice that if your doctor subscribes to outdated ideas about who should be able to do what to medically transition, you should find a new doctor who will able to properly support your transition rather than lie. This all makes a lot of sense, but sometimes you don’t know if such an enlightened unicorn of a doctor even exists within 500 kilometers of your tiny southeast asian country, and you know what you need, and just need to satisfy these people to get to it, you know?

I think that trans people have good reason to be suspicious of the medical establishment, which has a long history of gatekeeping based on dubious prejudice rather than any actual clinical evidence, and doctors who do not keep up with recommended standards of care even as those improve. These are things that are STILL happening. For some reason, the most/only widely known psychiatrist prescribing HRT and seeing trans people in Singapore has notoriously outdated ideas, and is known not to entertain anything other than binary trans “ever since I was a child…” stories. There are other doctors in the field, but nobody really knows what to expect from them. Finally, there is also very little information about healthcare professionals anywhere supporting nonbinary transitions.

All very troubling. In the end, I decided to try to discuss all this honestly with my therapist, whom I am seeing for non-gender related things, and hope not to have to find a new therapist at the end of it… I was not prepared for how completely on board she turned out to be.

I had mentioned being nonbinary to the screening psychiatrist, not expecting them to do anything with that information. I simply assumed that I’m the first trans person said therapist has ever seen. Heh. So it turns out that yes, she has seen other trans and nonbinary people, and also yes, she is aware of DSM V and WPATH standards of care, both of which now include nonbinary people. I am very happy/relieved/excited about this development in my relationship with my therapist, in addition to feeling a bit guilty for having had so little faith.

Clearly, I have the privilege of not urgently needing to go on T, and so was able to take the risk that honesty would lead to rejection. As a result here is a data point. You are welcome.

Hello! If you are in Singapore, please know that you have several options, some of which do not require lying :p Please seriously consider how your healthcare needs may best be met.

Doctors: Allies/Gatekeepers

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