All of this can feel ridiculous, but also humiliating and frustrating. "I had to prove that I had no desire to give birth to children," Javier said. "You need a mental health professional to tell you what to do with your reproductive organs." It was especially frustrating for Javier to have to prove that he would not one day wish to become pregnant, because it was his capacity to become pregnant that made him so uncomfortable with his body. "The idea of pregnancy in general was an extremely dysphoric idea for me," Javier said.
There have long been institutional barriers between transgender people and medical gender transition. From psychiatrists to insurance companies, there's a significant history of protocols that transgender people have to comply with and submit to in order to receive treatment. Historically, institutional gatekeepers have effectively controlled gender transitions, often bending people to conform to social standards of gendered appearance and behavior and thus postponing—or even preventing—their transition altogether. This can feel alarming to patients who are dependent upon transition in order to survive. "Why did I need a letter from a therapist who doesn't know me to tell me I'm trans, and then to charge me $200 to write me a letter?" Javier asked.Radix pointed out that transgender people used to be required to have reconstructive genital surgery in order to legally alter their sex identification, which amounts to sterilization through the excision of reproductive organs. "Hysterectomies were therefore done for legal reasons," Radix said, adding that this practice has increasingly been identified as a violation of human rights. However, "despite changes to laws, there are still 23 European countries and many states that still mandate this."
I can never have a period again even if I stop taking testosterone.
Transgender health care remains woefully under-researched, and, according to Radix, trans men's reproductive health is even more poorly studied. The existing studies on transgender medicine generally they center trans women's mental and sexual health, Radix explained. This is partially due to a lack of funding, but also because trans men are intentionally "excluded from research (especially in HIV/STI prevention research)."
According to Javier, another issue is the fact that some trans guys struggle to find a form of contraception that doesn't make them feel badly about their body. "Most trans men don't realize that there are birth control options that are not as invasive as they might think," he said.Trans guys who are having sex with cisgender men have multiple options of birth control available, including an IUD or the tri-monthly injectable DepoProvera. The traditional birth control pill wouldn't be advisable for trans men who are hormonally transitioning, because it is generally comprised of a cocktail of drugs that include estrogen, but for guys who aren't taking Hormone Replacement Therapy (HRT), the standard pill works just fine."Fortunately, providers are becoming much more aware of the diversity of sexual behaviors and identities of transmasculine people," Radix explained, citing "important research" being put out by Dr. Sari Reisner of Boston's leading transgender health provider, Fenway Health, and the work of Dr. Juno Obedin-Maliver of the University California San Francisco. These researchers are "highlighting that trans men have specific reproductive health and education needs, especially those who identify as gay."As Javier sees it, the specific problems trans men face in accessing crucial health care can be curbed through an increase in visibility of transgender men and the specific issues they're dealing with, alongside an expansion in society's understanding of gender and sexual diversity. But it is also critical to have providers who understand trans medicine.
Most trans men don't realize that there are birth control options that are not as invasive as they might think.
There are staggering rates of discrimination against transgender men by healthcare professionals. One study found that 42 percent of transgender men "reported verbal harassment, physical assault, or denial of equal treatment in a doctor's office or hospital." One story from 2015 illustrates this: a transgender man in Minnesota alleged that he was subjected to a litany of abuses while being treated at a local healthcare facility. Javier isn't surprised by these stories or statistics; he knows that medical environments are often unsafe for transgender men.But while there are so many obstacles to care, there are also places that are going out of their way to provide compassionate treatment to trans patients--places like Callen Lorde, where Radix works, as well as Planned Parenthood, where Javier works, which offers transgender hormone therapy at 26 out of 57 local affiliates. They don't use labels like "gay" or "straight" at his office, and they're proactive about identifying and using the correct pronouns for patients and employees alike.Because trans people confront injustice throughout their lives every day, and discrimination in doctor's offices is so prevalent, Javier believes that having compassionate physicians is useful to helping trans people feel comfortable enough to receive the care they need. Given that reproductive healthcare is deeply personal, it makes sense that responsible providers would want to do everything in their power to make their patient comfortable. "Say you pass as a guy," Javier said. "Going into a clinic and being like, 'I need an abortion?' I can't imagine how that would feel."