My access to healthcare has become somewhat of a mixed bag. I’ve been fortunate enough to receive insurance under my family for twenty-four years. Dental, check-ups, and even braces. But ever since I came out as queer and then as a trans woman, services have been hard to come by, and added to that, even more difficult now that I’m uninsured.
In the case of my local community, I am lucky. Here in Chicago we have a variety of transgender-friendly and women’s health providers: Howard Brown, Chicago Women’s Health Center (CWHC), and Northwestern come to mind as institutions that serve the LGBTQ community with respect, compassion, and care. One institution, though, the CWHC, I’ve found myself in a bit of a struggle with due to their oversight of trans women care.
The CWHC does great work for women, or at least those who were assigned female at birth. Yes, I get it—services fluctuate and non-profit health centers are constantly in need of money. It’s difficult to serve everyone with limited resources.
I mean, on a practical level it make sense, right? There’s an estimated 50.8% of the U.S. population that are cis women,¹ while only 2% (by “liberal” estimates) are transgender—and that includes trans men, of course. When comparing reproductive health between trans and cis women, it’s apples to oranges to kiwis, or something. The point is, all bodies are different, but the essential functions of cis women are the same, while, for trans women, it depends on surgery status, hormone levels, and generally how your transition has effected health risks and benefits.
However, we do not live in a practical society. And particularly feminist institutions don’t function on “provide the greatest good for the most people.” Feminists operate with a keen eye toward institutionalized oppression. That’s how feminist health centers got started in the first place, right? They saw the systemic exclusion and non-prioritization of women in a male-dominated field, medicine, and decided to change it—to make it more accessible to women, to give them agency, and to be treated (mainly) by other women.
So it may be a no-brainer that these services should be served to transgender people too. Not so much.
About a year ago, Chicago Women’s decided to provide hormone replacement therapy (HRT), testosterone, to trans men and transmasculine individuals—not to trans women and transfeminine ones. A year or longer ago than that, they began a trans gynecology program for this same gender group.
This makes sense on a couple levels. First, they provided expertise on gynecological service to cis women, so all you really need is some transgender 101 information to make sure transmasculine folks are comfortable doing this check-up. Secondly, and more interesting, is the historical tie between cisgender women, particularly queer cis women, and transgender men. There’s a whole other explanation why these communities are closer together than cisgender and transgender women.
First, there are community-based reasons. While no one knows exactly the “origins” of the queer-as-orientation-and-identity community, it mainly came from transgender folks (both trans women and men) and cis women. But mainly it grew out of and was claimed the cisgender lesbian community as more trans men / transmasculine folks came out.
Simply put, trans women have been so historically marginalized by lesbian, gay, bisexual, and transmasculine communities (albeit in different ways and capacities) that we were never included with “queer” in mind. Hell, Silvia Rivera, a radical trans woman and one of the leaders of Stonewall, was banished from the “LGBT” community because people yelled at her “we don’t need any more drag queens in our movement.”
Second, there’s a more specific gender and sexual orientation explanation. Frankly, I believe a vast majority of lesbian and “queer” cisgender women, even those who will stand in solidarity with trans women’s rights, stray away from us sexually, romantically, and physically because of phallocentrism and something called “gender essentialism.”² This is very much a hang up from 1970’s second wave feminism.
But honestly, what does this all have to do with a small feminist health non-profit in Chicago? I think the larger issues of exclusion—historically, communally, intimately, sexually—have everything to do with receiving basic, comprehensive healthcare. Until cisgender women truly welcome trans women as sisters, partners, lovers, and feminists, this issue will remain a sore spot in the historical wedge between us.
So, the bottom line is that CWHC decided to provide services for trans men, including hormones, over that of other women: transgender women. Our shared history in women’s and LGBT communities informs why many “feminist” communities still favor those with a biologically-assigned vulvas over women who don’t. Hence how “women’s health” still does not mean all women. Women’s reproductive health means cisgender women’s health.
I don’t expect this to change overnight. I don’t expect everyone to think of trans women when they hear “women’s health.” I don’t expect CWHC to change overnight either.
But change does not happen by itself. I’ve organized a petition to push for comprehensive trans women’s health. “Equal access and equal care” must be the slogan. That is, if trans men can get gynecology exams, then we should have prostate exams. If you’re opening up testosterone hormone services, make sure you include estrogen as well.
We’ve all made progress so far. I’m pleased to see CWHC give an apology and start focus groups for transfeminine folksthat are finally happening. I encourage anyone who is transfeminine or trans female to give input on what your needs and our needs are.
Challenge women’s health institutions. Do it for all women, not matter what their “parts” are. Who knows, maybe in a few years we’ll have Planned Parenthood providing comprehensive care for all women everywhere.