Disparity, Dysphoria, and Deadnaming: Addressing the Health Care Gap for Transmen

According to a study published in the Journal of General Internal Medicine, only 29 percent of providers were comfortable providing a cervical cancer screening to a transgender man. Eleven percent flat-out refused. Legacy aims to tackle the disparity.

By Barrett White

 

Accessing health care can sometimes feel like an uphill battle regardless of who you are. But for minority populations, the disparity is even higher. Higher still, is the disparity in access to proper care for transgender individuals. For a transgender man, access to an OB/GYN clinic can be awkward at best, and downright degrading at worst.

Despite the barriers to care that transmen face, the importance of accessing that care persists. Like with any person who has a cervix, cervical cancer is a potential issue that transmen should not ignore. That being said, like with any individual, your health care is personal and should be tailored to you and your individual needs. For example, if you have elected to have bottom surgery, your chances of contracting HPV, which can cause cervical cancer, may decrease.

According to the Canadian Cancer Society:

• If a transman has had a complete hysterectomy that included removing the cervix, and he has no history of cancerous or precancerous cervical cells, then he will not need regular Pap tests.
• If a transman has had a hysterectomy that left his cervix partially or completely intact, then he will need regular Pap tests.
• Transmen who have had a colpectomy (removal of the vagina) or colpocleisis (closure of the vagina) as part of bottom surgery such as hysterectomy or metoidioplasty, cannot have a Pap test.

In addition, contraception is another crucial part of a preventive well care exam for transmen. Hormone replacement therapy (HRT) is not an adequate contraceptive, so if a transman who has retained his uterus is exposed to sperm, pregnancy is possible. Discussion of sexually transmitted infections including the mode of transmission and means of prevention is critical. Counseling on the proper use of condoms and dental dams is important.

No matter how necessary preventative care may be however, a transman’s experience in an OB/GYN office could make or break his decision to return. Placing his comfort and confidence in the hands of his physician is no delicate decision. Legacy OB/GYN provider, Dr. Pamela St. Amand has been caring for transmen with Legacy for over five years—and has been in the practice for nearly 40—and actively works to carefully address the disparity.

“Beginning at age 21, cervical cancer screening is recommended,” Dr. St. Amand says. “If a transman still has a cervix, it’s important for that periodic screening test to be carried out every 3-5 years.”

“Cervical cancer is very preventable with screening. New on the horizon is primary HPV screening, which may not necessarily require a speculum exam, so it’s much less invasive,” she continues. “However, the difficulty in either test is dependent on how much gender dysphoria that the patient experiences in regard to the examination itself. It is very important to have a full discussion with the patient about what is involved in an exam before even considering proceeding. Shared decision-making is important.”

It’s not just the physician who plays an important role in making sure that the patients who pass through the clinic doors feel welcome and comfortable. Clinic staff are often caught by transgender individuals “deadnaming” a patient, or refusing to refer to them by their preferred pronouns.

“Our electronic medical records provide plenty of opportunity for recording a patient’s preferred name and pronouns so that they are easily accessible to anyone who opens the patient’s chart,” Dr. St. Amand says. “Patients just need to know that you care about them and truly do see them for who they are. Our staff from the front desk to the clinic halls are all aware that we see transmen and are trained to be sensitive to this patient population and to use the patient’s preferred name.”

In health care settings, providers need to do better for transgender patients. At Legacy, physicians like Dr. St. Amand are making strides to drive healthy change in this community in ways that matter.