The reason why our medical system isn't meeting the needs of transgender individuals

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This article emerged from , which explores how sex and gender shape our experiences navigating Australia’s health system.

Five years ago, I decided to explore taking testosterone to feel more comfortable in my body, but along the way, I encountered ignorance in the healthcare system that made me feel unsafe, hopeless and at times, terrified.

I started by seeking a gender-affirming doctor from a list of such GPs compiled by an LGBTIQ+ community group, but these doctors are often in high demand and have long waiting periods.

I was keen to start the process, so I found another doctor who was near my workplace.

Thankfully, this doctor seemed empathetic and receptive to hearing about what being transgender and non-binary meant to me.

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This encouraged me to share intimate information with the doctor — someone who had a fair amount of power over the next steps of my life — and put myself in a position of vulnerability.

The GP said they would give me a referral letter to be able to proceed and I left feeling quite heard and hopeful about the experience.

This is why what happened next was so jarring.

While I had explained to the doctor that I referred to myself using ‘they/them’ pronouns and I was looking to start testosterone therapy, when I opened the letter, the first line read: “Max is a lady experiencing gender dysphoria”.

It was one of those slide-down-the-wall moments.

Of all the incorrect terms the doctor could have used — “woman” or “female”, for instance — the choice of “lady” felt the most disempowering.

I think the doctor understood me when I used phrases like “assigned female at birth”, but there was clearly a lack of understanding of accurate and appropriate language.

This fundamental ignorance zapped much of my hope about the process I was embarking upon and who it was safe to share my story with.

The costs of our trust deficit

I’ve since found other doctors I can trust, although there are still some gaps in their knowledge — especially when encountering non-binary people without ‘textbook experiences’.

There’s no standard experience against which doctors should be measuring that of others.

For instance, many doctors still aren’t aware of other options for hormone replacement, like micro-dosing, a smaller amount of testosterone than what is often prescribed to a trans man.

I asked my first prescribing doctor to start me on micro-dosing, but because he hadn’t heard of it, I ended up on a full dose.

A person with short brown hair and an eyebrow piercing poses for a photo wearing a white T-shirt with the words No Milk in My T printed on the front in a stylised italic black font.

Max is the founder of No Milk In My T, a brand that raises funds for gender-affirming surgeries. Source: Supplied / Sarah Malone

I was scared to hold up the process, and I didn’t want to wait. So I went with what the doctor said, despite what I initially wanted.

It was another disempowering experience — one of many that trans people have to go through to get the health care they need.

Unless I really have to, I try to avoid seeing other health professionals.

Except for going in for top surgery — the commonly used term for procedures to remove breast tissue — I’m fortunate not to have had to spend time in a hospital.

For example, the idea of talking to anyone apart from my current GP about sexual health is a terrifying prospect for me.

This lack of trust is the reason many trans people avoid going to the doctor, which can come at a huge cost to their health.

Recently, when I had to get travel vaccinations from a clinic I was visiting for the first time, I felt surveilled by the GP — as if I was being examined for a reason other than why I was there.

It’s an anxiety-provoking experience when you are giving someone consent to care for you and you feel their judgement stitched just below their Hippocratic Oath.

From what I’ve seen, this is a genuine and avoidable barrier to health care for many trans people.

Discrimination against transgender people in healthcare settings remains prevalent, research published in the Medical Journal of Australia in late 2023 shows.

Researchers found that half of 516 trans people surveyed reported at least one instance of discrimination when trying to access health care between 2020 and 2022.

Over 40 had been misgendered, 26 per cent had been asked inappropriate questions related to being trans when seeking care for unrelated issues, and 24 per cent had been ‘deadnamed’, i.e. referred to using their legal, rather than chosen, name.

What safer care looks like

So what does safer health care look like for me?

It’s a doctor who will fully inform me of any risks but leave me with the power to make my own decisions.

It’s someone who has a degree of openness; who can tell me what they can offer and what they can’t, and where I can go to get what I’m looking for.

In this sense, the referral system is really important. It means I can explore a variety of options and not feel as if it’s all on me to know what the next steps are.

Safer health care also means someone who will ask me what my needs are.

It’s someone who won’t make assumptions based on their experience with another non-binary person — because everyone’s journey is different.

Under current practice, a trans person often needs to say they have gender dysphoria to access hormone replacement therapy, so there’s pressure to paint yourself as a binary (a man or woman).

But this doesn’t mean doctors should have a binary understanding of what gender is and who trans people are.

While doctors often understand the idea of taking hormones to change your appearance, many are confused by the idea of someone wanting to take testosterone to feel comfortable in their own body but not wanting to look like a guy.

It needs to be a more open process because a lot of that stuff is not medical, they’re not medical issues, it’s a matter of understanding.

I truly hope that the problems I’ve experienced are mainly caused by a lack of education and training — because that’s something we can fix.

LGBTIQ+ Australians seeking support with mental health can contact QLife on 1800 184 527 or visit . also has a list of support services.

And for more stories head to , hosted by Kumi Taguchi. From sex and relationships to health, wealth, and grief Insightful offers deeper dives into the lives and first person stories of former guests from the acclaimed TV show, Insight.

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