Medical Gatekeepers.


Okay so in this post I’m going to specifically be talking about medical gatekeepers in relation to how many are making medical access difficult for people who are trans and/or fat. And when I say medical gatekeeper, I’m referring to the people who control the access to different medical services, the people who determine what health insurance covers, among other things. For many fat and/or trans individuals, there are so many different hoops to jump through in order to access competent care from health professionals.


One of the reasons I want to write about this is the double standard for providing medical services (like hormones) to cisgender people versus trans and intersex people. Ronnie Ritchie drew a comic for Everyday Feminism about this specific issue, addressing that many doctors seem much more willing to prescribe hormones for cis individuals versus trans and intersex individuals.

There are ads marketing testosterone treatments for cis men experiencing low t and estrogen is available for cis women experiencing menopause or who had their uterus removed. But getting hormones to start transitioning while trans can be significantly more difficult. There’s a certain amount of having to prove their gender in order to get hormone replacement treatment or anything else related to transitioning that trans individuals have to go through. Ronnie Ritchie drew another comic related to  how there’s no such thing as trans enough and wrote a postscript comic about the first.

And that’s just one part of this issue because there are many other obstacles faced by trans individuals relating to all sorts of medical care. While things are slowly changing, there are plenty of insurance plans that have explicit exclusions for covering transition related care and according to a 2011 report, nearly a fifth of trans people have been refused health care because of their gender identity.

Insurance is just one part of the problem as well: finding a transgender competent doctor and/or medical office can also be difficult. Beck Bailey wrote about his experience going to the ER for a skiing related injury and having to constantly act as an educator on trans issues to the people providing care while he was recovering. Elissa Miolene wrote about similar situations in which transgender patients were denied care at Georgetown Hospital in Washington DC. Moilene highlighted some experiences from Mara Keisling (the executive director of the National Center for Transgender Equality) and said among many other things that:

The time she headed to the hospital at 2 AM to help a transgender male friend because the attending physician did not know how to treat his ovarian cysts. Or when a 15-year-old transgender male client went to the emergency room for a respiratory infection, only to be given a gynecological examination. Or the nursing student who called Keisling one night, asking how to properly give emergency room treatment to a transgender patient. When the student had asked her professor the same question earlier that day, he replied that when he worked at a New York hospital, “they usually just let those freaks die.”

Another reason I wanted to write about medical gatekeepers was because of a post by Rebecca Hiles about her experience being fat and how medical fat shaming prevented her from being diagnosed with cancer for several years. In that post, Hiles is very open about her experiences with medical fat shaming and how it nearly killed her. She wrote at one point:

Were it not for physicians who tried to treat something beyond my fat, physicians who saw my whole health rather than make assumptions in an otherwise healthy 20-something, I would still have cancer inside of me. I would still be sick. I would still be sitting in showers at night, coughing and vomiting.

Lesley Kinzel wrote one article about why fat shaming by doctors really matters, saying that:

…when people argue that doctors are entitled to weight bias, they are overlooking the very real danger that weight bias can and does lead to serious consequences for fat patients, when doctors assume that an ovarian tumor is just weight gain caused by overeating, or that asthma is just a patient being “out of shape,” or that fibromyalgia is just laziness.

There have been plenty of instances where I thought about going to see a health care professional about one issue or another but because of past experience with medical fat shaming, I didn’t go. There have been so many times in which I’ve been worried about something regarding my health but knew if I went to go see someone about it, I would just be paying them to tell me to lose weight and not actually look into the issue.

Of course, these are just two ways in which medical professionals are gatekeepers for health care.