Okay, time for a little rant about Dr. Elitism. Dr. Elitism is a physician who lives inside all doctors, just waiting to pop out and say something great. Here’s one of my personal favorite lines:
“(S)He (thought/seemed/appeared) (s)he was X, but really (s)he was Y.”
Dr. E loves this phrase because it gives Dr. E the opportunity to show someone hir “real” self. Dr. E went into medicine because Dr. E loves diagnosing people, which to Dr. E means telling people what’s wrong with them and what to do about it. Dr. E seriously gets off on discovering “the truth.”
Sometimes, that drive is important. For example, it’s nice to inform a patient whom you’ve just discovered is insulin-resistant about hir condition and what might help hir manage it. This is not what Dr. E does. Dr. E doesn’t help patients manage their health, Dr. E tells patients what they should and should not be doing. I know that can be a difficult distinction to imagine, but those concepts are definitely different.
So, what brings me to Dr. Elitism today? One of Dr. Elitism’s favorite topics is Trans people. Why does Dr. E love transgender folks so much? Because they give Dr. E a chance to use this phrase:
“The patient appeared female, but was (biologically male/actually a man/had a penis/wasn’t really a woman.)”
“But MA!” You say to me, “isn’t that true? Isn’t a pre-operative transwoman biologically male?”
Yes and no, I say. Unfortunately, medical definitions of biological sex remain quite stringent and unreasonable. One of my personal favorite (non-medical) takes on this issue is Not Your Mom’s Trans 101 by Asher Bauer. Profanity aside, Bauer makes some excellent points that the medical community could wise up to, especially this one:
Sex is no more an immutable binary than is gender. There are intersex people who are born with non-binary genitalia, as I have already mentioned. There are people with hormonal anomalies. In fact, hormone levels vary wildly within the categories of cis male and cis female. Chromosomes, too, vary. If you thought “XX” and “XY” were the only two possible combinations, you have some serious googling to do. In addition to variations like XXY, XXYY, or X, sometimes cis people find out that they are genetically the “opposite” of what they though they were– that is, a ‘typical’ cis man can be XX, a ‘normal’ cis woman can be XY.
So what standards are we actually using to define biological sex? This is a topic that I will return to many times, I’m sure. Certainly, though, the penis/vagina binary is no good, and other secondary sex characteristics are similarly variable. I’m leaning towards believing that medical histories need to be much more complete in terms of sex characteristics, and much less “I wrote female which thereby means the patient has this, that and the other thing in her body.”
How does this relate to Dr. Elitism? Well, Dr. E, language is very important. Instead of the above statement, Dr. Inclusive would have said,
“My patient was a #-year-old female with (body parts, etc). She complained of (something which is relevant to her body parts.)”
Need a more specific example?
“My patient was a 55-year old transgender* female. Her medical history is notable for vaginoplasty, breast augmentation and 25 years of estrogen supplementation. She came to the clinic for a pelvic exam. Upon examination, I found a dark patch on the wall of her vagina, and subsequent testing revealed this to be a melanoma. Surgery was able to achieve clear margins without significant damage to the vaginal wall. I have recommended her for follow-up pelvic exams to monitor her for subsequent neoplasms.”
Well, I think it sounds pretty good. See yah, Dr. Elitist!
*There is debate as to whether to describe this patient as “transgender female” or “female with transgender history.” What do you think? Comment in the comments!