In One Paragraph
The Problem
EMR or EHR Patient Databases
Summation
Notes on Why Discernment is Relevant
This information is for anyone, but I have tended to write it with the medical community in mind.
I’m coming at this as an old, former clinical social worker, transsexual since 1981, who has experienced society move from grudging acceptance of me to outright rejection. One of the most problematic ways this is expressed to me is medical abuse, not uncommon, the main reason I haven’t had a worthy doctor in years.
This link has notes on the differences between transsexualism and transgenderism.
In One Paragraph
When you hear doctors, pundits, or celebrities talking about “transgender” issues, listen to what they are and are not saying. Usually, it’s a gender-focused message—gender identity, gender transition, “gender affirming medical care,” “GRS,” “gender” surgery—about needing to be a “woman,” for example, but not a “female.” Please know: Requiring me to be about those issues, to not be myself with my own, is the bane of my existence and causes me more stress than all other sources in life combined. As such, I need to say that I’m not those issues, that if I were forced to live sexually male with a gender change, I would have died back in 1981. They should be valued as themselves, but so should I. My phenomenon is forgotten by society, slammed, said offensive if mentioned, and the end result is that what I am, my needs and goals, are erased. Yet I do exist, and my needs are real—just hated by genderism. Diagnoses and labels should be about what is really going on. Look deeper. Guard against salient distracting features. I’m “transsexual,” not “transgender.”
The Problem
Society asserts I make no sense when I say I’m “transsexual, not transgender”: “Because you did, in fact, change gender.” That focus on gender, which also downplays needed sex issues, is the transgender paradigm. I’m not disconnected from reality; I’m just saying my needs aren’t what society keeps saying they are, and if you refuse to speak or diagnose what I am primarily about, you demean me. I’m one of the few trans people who is exactly about what people say not to say, part of a phenomenon absorbed as something else, then erased, now forgotten without narrative.
The need to be the other physical sex is a different phenomenon from needing to be another gender yet not the other sex. This reality used to be recognized, and when you bring the sex issues out of the closet, you can see what I’m talking about. “Transgender” as an umbrella is a false grouping based on T sex issues denial. Needing to be the opposite sex from each other shows transsexualism and transgenderism to be two phenomena, not one. We may look similar, but one is herself as sex-and-gender non-binary—while the other is unable to be herself as the other binary.
Medical science can’t yet give me what I need: to be the other actual, physical sex—something that’s been with me, unchanged, every moment of my life—and repair the damage from before. Nobody put that need in the head of this 3-year-old kid from Kansas; it has to be neurological, an unrecognized intersex issue. After doing all medical science can do, the half-image of myself that remains as seen from the outside resembles something much more popular these days, but that is due to the limitations of medical science, not me.
Refusing the truth of a person’s life physical need harms the patient, violates the Hippocratic Oath, reduces cooperation with treatment, reduces willingness to accept care at all for any malady, and is bad medicine.
It’s not “old fashioned” to admit my need to be the other sex, transsexual; the sex issues are part of present reality and should be okay. Instead, it’s “new fashion” to deny it.
Life was hard in the 20th century, but it’s harder now. In the 1980s— Do you know how hard it is when you go to rent an apartment, and they look at you and say, “It’s not available”; or when you go to a required placement for school, and they take one look at you and say, “No”; or you go for a job and they don’t even want to interview you; or a boss wants you to spend the night with him; or when others look at you in stores or halls as you walk by…or when your entire family rejects you—or all these things at once? But in the 20th century at least I could share my narrative in a lecture or with a doctor and it was believed that my need really was to be the other sex, because of people who had been on TV, books that had been written.
But now, so far in the 21st century, I can’t even go to the doctor without being rejected, nullified, offended, told I need to be something else, that I must be about gender role, not the other physical sex, and it’s insulting or even transphobic to say so. This guts me to the core, is cruelty. Just the act of someone saying I’m not what I cannot un-be slams my heart more than you could imagine. The stance leads to other medical and social abuse, as well, and enables prejudice by reinforcing in those disposed that there is something wrong with what I am. I live with the ramifications of this every day.
If medical staff are not accepting of me as I am, I will refuse them and ask for someone who is not prejudiced. I’ve learned to ask before allowing treatment, which is problematic, but I feel I must. Acceptance is free, quick, and easy, so if they refuse…it’s clear. Sometimes a doctor or nurse may want to say such as, “Don’t be difficult. I’m busy! Just let me treat you and get on to other things.” But if they do, it confirms prejudice, for in the time it would take to say that, they could have been accepting and put an end to the conflict.
Is there something so wrong with my need to be the other sex that people in this modern world can’t actually say the words? A doctor or university can’t accept me with it? It can’t be charted? I have to suffer smirks, corrections, lies (telling me one thing, charting another), and rejections in society for saying what I am and am not?
People who are different need equal acceptance in society, equal value, respect—and that should apply to people like me, too. I’m always astonished at people who insist on acceptance of diversity, but only if it’s a certain kind.
EMR or EHR Patient Data Bases
This is important, as over the course of years I have learned of Electronic Health Records (EHR) being used to seriously mis-represent my facts and preferences, even refusing to acknowledge I’ve had SRS, and using the threat of that to get me to expose myself to prejudicial staff, one of the many forms of medical abuse.
I should be able to be a pro-active part of my own health and records, including also my patient demographics. It matters that I’ve been female since 1981—anatomically, legally, socially. That is much longer than the 23 years of greater hell before. I have mixed biologoical / anatomical / hormonal / neurological issues that are not addressed by birth binary references.
We should be able to figure out how to respect the truth of a person inside and out—in person and in EHR—for all persons including those who wish to be non-binary or those needing to be the other binary. That won’t happen while we pretend the sex issues don’t matter or aren’t present.
Because this is medical per non-binarism, not social, no single/narrow solution will work in EHR: not chromosomes, not birth anatomy, not current anatomy, not hormone levels, not government IDs, not a statement of identity. For medicine, the whole picture needs to be there—which includes issues doctors, nurses, and associations fight against, and it should allow phrase answers not just one-word or coded answers taken from a list.
It used to be thought that the simple data field of “Sex” in patient demographics told the whole story, assumed that “female” = “woman,” that “her” sex orientation was for males, and it never crossed most minds that identity may vary, that sex and gender may not agree, or that needed sexual response may differ from “orientation.”
In my case, medical staff could make me happy by removing or nullifying gender references—under the transgender paradigm, they have become quite offensive and oppressive—and giving me medical credit where it’s due. It is not okay to treat the body and ignore the person inside. If an EHR data base does not provide these fields in patient demographics, then find another field there to input this data:
- Data from Governmental ID (type of ID, name, address, sex, date of birth, etc.)
- Sex: Female
- Gender Identity: No
- Sex Identity: Female
- Prefers Reference As: Female, transsexual, not transgender. This supplies the biological picture and interpersonal approach. (And please don’t treat me as transgender by asking for my pronoun preferences. My narrative is lost, but my phenomenon is still real.)
- and don’t use any gender coding.
I used to be a data processor, before I was a forensic social worker. You could ask me, or one of your own, how to help work with an existing, inadequate data base system.
If your EHR data fields don’t allow things like the above, then get creative with the fields you do have, input something in the wrong field but that explains. If you can’t do that, then use paper charts—but don’t tell me one thing and EHR something else, don’t lie to me or the EHR, because that could adversely influence treatment and sets me up for conflicts with other staff later.
And tell the EHR programming companies to include the fields you need.
However, just for more information and so you’ll see how minimal is my request, there are several other data fields that could be used if one wanted a more complete picture—one that fits all people without social labels of gay or trans. Many staff may blow a fuse seeing this long list, but real humanity is not always a simple “Male” or “Female,” with an “orientation.” Whether in EHR or not, staff should be aware of these kinds of things before entering a patient’s room for direct treatment reasons, and also including the need to ally with the patient, not alienate, to promote cooperation with treatment and improve outcome:
- Data from Governmental ID (type of ID, name, address, sex, date of birth, etc.)
- Prefers Reference As (could be anything)
- Chromosomal Sex (male, female, mosaic, etc.)
- Current Sex Characteristics, Primary and Secondary
- Sex Needed to Be
- Sex Identity (Identifying as a male or female. In desired non-binarism [transgenderism], it is common to state identity with a sex they don’t actually want to be)
- Gender Needed to Be
- Gender Identity (Identifying as a man or woman. Sometimes one may state identity with a gender they don’t actually want to be)
- Sexually Active or Not (It is common for transgenders to falsely claim celibacy, at least in the beginning with someone, to take the attention away from sex issues and re-direct to gender issues. Transsexuals are far less likely to do this.)
- Sexual Response Needed When Active (not who one is in bed WITH but who one is in bed AS; to respond sexually as a male or female)
- Sex Orientation (the sex to which attracted, note that in gynandromorphophilia, common re desired non-binarism, this differs from gender orientation)
- Gender Orientation (the gender to which attracted, note that in gynandromorphophilia, common re desired non-binarism, this differs from sex orientation)
- Major Surgeries
- Prescriptions
And for God’s sake, don’t let gender-not-sex-focused people tell you to hide these vital T-sex-issues so that other people aren’t embarrassed.
Summation
“Accepting Diversity” is a joke if I have to be what you say (transgender), see things like you say (as if about gender). Inclusion is a joke if I can’t even be included in my own medical files and must only be mentioned as something else, sometimes with euphemisms that are also about gender.
Even if logic is not sound, if science is not real, if I am wrong…never say I’m about gender. Do not group sex and gender then say I’m about gender while you minimize sex issues. That is the narrative of transgenderism, not someone like me, transsexual.
My need and narrative is not “to be on a continuum where I feel more comfortable”—that is transgenderism—but to actually be female; not to be non-binary but to be the other binary. I’m not about clothes or makeup or or pronouns. Needing to be just female says it all as it does for the other 4 billion females on this planet.
In the face of millions who say I shouldn’t have this need, I cry to the heavens it is real, it is okay, and I am okay with it.
Self-revelations evolve over time. The lesson of my life is we must accept ourselves, that however much that may hurt at the time, it can be far less than lying to others and ourselves.
“Acceptance” as something else is not acceptance; it’s rejection.
If sex issues are part of your concept of gender, and you can’t see how they’re real and relevant, treated differently in non-binarism, then you shouldn’t work with non-binary people.
Society insists on hiding my sex needs so that a larger minority can hide theirs—expects me to collude with my own suppression—and when they do, isn’t it recognized as hurtful? In history, when other minorities were expected to pretend they were something else, or at least to behave as if they were something more palatable, to minimize an unwanted difference, to mimic their oppressors, haven’t we recognized that as prejudice? Think gay people as an example. Don’t we later grow to see the prejudice we held? People are real people with their real needs even when society hates them, the weight of difference heavier with hate.
Notes on Why Discernment is Relevant
Sex and Gender are two different things, even two different kinds of things.
Needing to be the other sex is a different phenomenon from needing to be another gender but not the other sex.
If people don’t want the genitalia of the other sex, they don’t want to be the other sex. The being of a sex is much more than just genitalia, but not choosing the other genitalia does mean being the other sex is not desired.
So far, medical science can’t change one’s chromosomal sex and repair the damage done by the wrong sex prior to that—but sex is defined by other things as well, including anatomical, legal, and social. Don’t let current limits of medical science be a reason to reject what the person needs, has obtained, and who the person really is.
Diagnosis, acceptance, and inclusion should reflect what the person is really needing, is about, is trying to do—not what is most obvious from the outside, even if medical science isn’t yet totally able to treat the issue. To avoid this is to hurt and alienate. Not all trans people should be grouped as per gender, and certainly not when the grouping defaults to gender-not-sex.
If “misgendering” (using wrong pronoun) is abusive of transgenders, then refusing to accept the needed sex of a person is far worse.
Making diagnosis, acceptance, and inclusion about gender issues, and eschewing sex issues, is suppressive and socially oppressive.
Treating someone as you prefer, not as they are/need to be, is depersonalizing and leads to social and medical abuse.