How to navigate conversations about queer identity with your doctor.
Disclosing your identity to a new healthcare provider can be one of the most stressful parts of seeking healthcare as a queer person.
That’s not to say that most healthcare providers respond poorly. But most queer folks have experienced a poor reaction from a healthcare provider. It’s kindof a “not all men but yes all women” situation. You know - not all doctors are homophobic/transphobic, but all queer people have faced stigma in healthcare settings.
Unfortunately, a very common and completely understandable response to these kinds of experiences is to just avoid seeing the doctor.
But you deserve healthcare.
So let’s walk through what you should consider, expect, and practice so we can lower that anxiety just enough to get you to book that appointment.
When should you come out to your doctor?
First, let’s get prepared by thinking about when to disclose and when not to.
For some folks, it’s important to assert your needs in every interaction. For others, the stress of talking about identity isn’t worth it at all in a healthcare setting. For most, that decision will vary depending on the setting - for example, you may choose not to correct the person taking your blood at LifeLabs on your legal vs. true name, but you will have a detailed conversation with your family doctor about your gender identity.
Let’s dive into the two main factors that will determine whether you disclose.
Safety and comfort
Healthcare settings are stressful, and the less stress you can add the the situation the better. For some people, talking to a healthcare provider about their identity is really stressful. For others, being misgendered or feeling otherwise un-seen is worse. If you can, choose the option that puts you more at ease.
In some cases, disclosing your identity can pose a risk to your health or safety. For example, if a healthcare provider appears hostile and might refuse care because of your identity, or if you are accompanied by a family member you’re not out to, you may choose not to disclose your identity for safety reasons.
Medical necessity
It may be medically necessary for your healthcare providers to know:
Your anatomy
The hormones your body makes
The medications you’re taking
Surgical history
Your sexual behaviour
The reproductive anatomy of the people you have recently had sex with (recently usually meaning 3-6 months before the start of your health concern)
For example, if you’re a trans man who has legally changed your gender marker and have to go to the ER for abdominal pain, it’s extremely important to let the triage nurse know what pelvic anatomy you have.
It may be helpful for your healthcare providers to know:
Your pronouns
The pronouns and name of your partners
Identity labels you use
Any other personal information you think is relevant to your health or that would facilitate more comfortable interactions with this provider
Healthcare providers who are working with you to offer gender-affirming care, like hormones or surgery, may need more information than this, for obvious reasons.
If you feel a provider is crossing that line from clinical question to curiosity question, you can ask “Is that information relevant to my care today?”
Ultimately, the choice to discuss your identity with your providers is a balance of your level of comfort and the medical relevance of the information.
Talking about identity with healthcare providers
Now that you’ve decided when you’ll disclose and when you won’t, you’ll need to think about how you’ll do so.
When you’re in a healthcare situation, you’ll either end up disclosing because it comes up in conversation, or because you bring it up on purpose. Let’s explore each of those scenarios.
What to do if a doctor misgenders you or your partner
If you’re working with a new provider, or someone you don’t know well yet, there’s a chance that they’ll make an assumption about your sexual orientation, relationship, gender identity, pronouns, or something else. Do you know how you’ll respond?
Remember, if the assumption isn’t medically relevant and you don’t feel comfortable correcting them, you don’t have to do it. For example, if you’re bisexual and married to a cis man, your provider would be wrong about you to assume that you have a husband, but they’re not missing any important medical information if you choose not to point it out.
If it is medically relevant, or if you feel safe to correct them so you can have a more honest relationship, you should correct them.
Practice a brief, clear clarification. It’s more important that you make sure your doctor has the correct information than that you take care of any feelings of awkwardness in the moment.
For example, “I don’t use birth control because I’m in a monogamous relationship with someone who categorically cannot get me pregnant. They’re non-binary and use they/them pronouns.”
In a perfect world, your provider would simply acknowledge the correction and move on, but as you probably know, there are a broad range of responses that may come up.
Some overcompensate and over-apologize.
A few are skeptical and rude.
Others might ask you to explain more - which you may or may not want to do. If you’d rather save your limited time with your doctor for talking about your health concern, you could also practice a short redirection back to the topic at hand.
For example, “I think I’ve shared the information about my identity that’s relevant for today - can we refocus on my stomach pain?”
How to come out to your doctor
There are a few reasons you might bring up your identity with your doctor:
You want to establish a stronger relationship with them
You want to tell them about a health concern that involves your partner
Your partner is accompanying you to an appointment
You want them to use different pronouns or name than what’s in your records
You’re seeking gender-affirming care
Because you’re bringing up the topic, these are usually a little easier to navigate than the surprise ones we discussed above. You have a chance to prepare and practice ahead of time, and you can share just as much as you think is relevant.
What should you do if you have a bad experience when coming out to your doctor?
First of all, oof, I’m so sorry if this has happened to you. I’ve been there too, and it’s so unfair to have to experience that kind of stress when you’re just trying to get help.
Second, let’s get you through this!
In the moment
It’s really hard to prepare for these moments because peoples’ negative reactions are almost never predictable. Maybe they said something outright bigoted, but more likely they said something vaguely skeptical, asked a rude question, refused to treat you under the guise of it being “out of their scope”, or maybe ignored what you told them and continued making cis/heteronormative statements or misgendering you.
Do your best to redirect to the real reason for your appointment, and get through it the best you can.
After the appointment
By all means, do what you need to process the experience. Take some time to calm your nervous system, call a friend, rant about it on IG stories, DM me about it (seriously), or whatever else you need to get the anger and hurt out.
You are not obliged to follow up or solve the issue. If you aren’t up for it, and you feel that you can get the care you need without addressing it, you’re completely entitled to that decision.
But, if you want or need to address it, here’s how you might go about it.
If the provider in question is a physician in a private practice, you may not have any recourse - if that relationship is broken, you might need a new doctor. If it’s salvageable, you might try to salvage it.
If they work in a family health team or hospital, or are a student, resident, clinical fellow, nurse, or other type of practitioner who has a supervisor, you should be able to raise the issue, and likely switch providers if needed.
Many hospitals have a Sexual and Gender Diversity committee you can reach out to - they can listen to your story, and can take steps to fix the issue, either by educating your provider, or finding a new provider for you. (I did this and had a really good outcome.)
Family health teams should have a Patient Relations office you can talk to.
Otherwise, you can reach out to the supervisor of the provider you saw, like the attending physician or clinic manager.
I hate to have to include this section, because it’s a bummer to think about the worst case scenario. But unfortunately, this is a thing that still happens and it’s important to be prepared.
In most cases, though, sharing your identity with your provider will create a stronger relationship, help you feel more comfortable in your appointments, and ensure you get the best possible healthcare. It can be anxiety-inducing to put yourself into these interactions - being a patient is inherently vulnerable, and feels even more so when we have to share about deeply personal parts of identities - but it’s worth it in the end to get the care you need.
p.s. with a queer-affirming provider, these conversations will be as smooth as butter - all your preparation will be unnecessary and it’ll feel so so good to have found a practitioner who sees you as you are. If you need a little of that in your life, consider working with me!
This post is part of a series about navigating healthcare.
Start here with a guide to preparing for your next doctor’s appointment.
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