I’m a trans man and I need a gynaecologist
CHENNAI: When Bharat visited a gynaecologist a few years ago, the doctor was initially confused why a bearded young man was approaching her for a pelvic exam. It took some time to explain to her that he was a trans man who had retained his female reproductive organs though he had undergone hormone replacement therapy (HRT).
“I had undergone a mastectomy but the doctor advised me to wait till I was 35 before I had a hysterectomy. So I need to visit gynaecologists for my check-ups but many of them are surprised. Some are judgmental and treat me like I am abnormal, so I feel alienated and don’t feel like going for appointments,” says the 28-yearold. This is just one of the numerous healthcare issues faced by trans men.
That’s why the Supreme Court’s recent landmark judgment, providing clarity over the Medical Termination of Pregnancy Act and Rules (MTP Act), is significant for the rainbow community. It stated that the term ‘woman’ in the judgment would include “persons other than cis-gender women who may require access to safe medical termination of their pregnancies”, recognising the healthcare and reproductive rights and needs of the trans and queer community – not just the right to safe abortions but also medical screenings and gynaecological care.
“People assume that when transmasculine people take HRT, their periods automatically stop, but that’s not always the case,” says Tarun, a Chennai-based man of trans experience and LGBTQIA+ affirmative counsellor. “It varies from person to person and depends on genetics and family history. They can get abdominal cramps and need to reach out to a gynaecologist.
But not all doctors are affirmative (acknowledging the existence of diversities in gender identities).” Taking testosterone can also cause vaginal dryness, making intercourse painful, says the trans activist. “Some may want to have sex and carry a baby to term. Whether it’s for pregnancy or abortion, care is often not available to transmasculine people,” says Tarun, adding that many suffer from pelvic inflammatory diseases, vaginal itching or atrophy, sexually transmitted infections, atrophy of ovaries when it has been retained after hysterectomy, and abdominal cramps.
“Often, people end up self-medicating, putting themselves at risk.” Some community members like Tarun are not happy with the judgment, as it clubs transmen with cis women. “Grouping people of other identities as women is dysphoric,” he says. Advocate Sudha Ramalingam feels that the judgment is a welcome step forward. “It is much needed, especially as trans people are often not seen as persons who are worthy enough. I am glad the courts are now addressing this issue and any shortcoming it has can be addressed later.”
Other members of the community, like Mumbai-based transman Mridul, say the SC verdict is very heartening. “For the first time, the court has recognised the difference between cis and transgender people. Also, not all trans people transition medically. Many are forced into marriages and give birth,” he says.
“And even if people opt for HRT, not all may do a hysterectomy. All of them need medical and gynaecological care, as doctors ask for regular screenings if they have a family history of cysts or ovarian cancer.” However, gynaecological care is often not accessible, says the trans activist.
“Though there are many campaigns on menstrual hygiene, they target only cis women, trans men are not on the radar,” says Mridul. A visit to a gynaecologist can be a scary experience for even cis women but for a trans man, it can trigger gender dysphoria (defined as the unease that results from a mismatch between a person’s gender identity and assigned sex at birth).
“Most doctors assume the person walking in identifies as a woman, so even the way they talk or pronouns they use are not right,” he says. Very few trans men can afford a hysterectomy. “They often come from underprivileged backgrounds, have no steady job or income, and are disowned by their families,” says Tarun. The ones who do opt for a hysterectomy face a new set of challenges.
“My doctor was very understanding but since I had a beard and looked like a man, he didn’t know which ward to put me in as cis women may feel uncomfortable with a man in their midst,” says Mridul. Chennai-based gynaecologist Dr Prabha Swaminathan, who has been working with the trans community, says transmasculine people also need gynaecological care.
“Sometimes, instead of breast removal, they have only the fat sucked out. If so, they need mammograms as cancer develops in the ducts. They also need access to contraception, correct information about it, access to the HPV vaccine, which prevents cervical cancer; screening for STIs, as well as pap smears and support if they need abortions,” says Dr Swaminathan.
“Taking testosterone also increases the libido, so they can suffer from depression if they are unable to find a partner who is sensitive to their needs.” There is also a need for more awareness and sensitisation among the medical community, she says.
“That’s why the National Medical Commission released an advisory regarding the LGBTQIA+ community and the necessary changes in the competencies of its competency-based medical education curriculum.
The body also ordered publishers and medical schools to edit textbooks and curricula to exclude discriminatory and unscientific portrayals of lesbian, gay, bisexual, transgender, and intersex people,” she says. “Definitive questions about it also need to be included in question papers so students read up and are tested on it.”
Courtesy : TOI
Note: This news piece was originally published in timesofindia.com and used purely for non-profit/non-commercial purposes exclusively for Human Rights .