Is my job transphobic?

[vivariumvivariumsvivaria]

I am a health care professional. I work in sexual health. Most of my patients are female, an increasing number of whom also have a gender difference, which is why they land up in my clinic.

Is it transphobic to say to a person who has a condition which only affects female people that this is because of their sex? I have re-written patient information leaflets so that trans men and NB identified females have the correct language in the info, but the fact remains that it is a condition linked to their sex.

I'm a little worried because the Lib Dems and Greens have said that it is transphobic to refer too someone's biological sex if they have transitioned. I think their definitions leave me vulnerable to being accused of bigotry because sex is immutable.

I want to talk to HR about this, but, can't quite think about how to frame it without sounding like I'm, well, a bigot.

If you're worried about people who believe they are now the opposite sex you need to talk about conditions affecting those who are genetically female/male. They surely can't be in denial about that. I get talking to them sensitively but it's pure fact, whatever other language you use about them to make them feel comfortable.

I would seek out any guidance to be honest and cover yourself. If you don't agree professionally with what that guidance is, then question it or adapt, but I wouldn't go it alone to be honest. It's tricky.

My latest cervical screening leaflet mentions women which is nice and clear for all who know their apples from their bananas. They mention transmen and nonbinary.
What made me laugh was a line at the end... transwmen don't need screening... no shit... who is this message for, seriously? I'm going to bury it in a time capsule along with some other key items tbd.

Could you write an anonymous letter to HR asking for them to clarify this as the entire team are unsure of what to do in these situations? Ask them to send out a policy to all staff members to follow? You really need something.

Until then always use the simplest, most widely understood language to explain situations to patients. You are doing your job if you do this. If you try to sanitise your language to save someone's feelings and they don't understand the message, this could have disastrous health consequences for the patient and you professionally.

[quote EmbarrassingAdmissions]"It's because you have some vulnerable anatomy" would be much kinder.

The average adult literacy level in the UK is that of a 12year-old.
The average adult numeracy level in the UK is that of a 9year-old.
Health literacy tends to be pegged to the numeracy level. And this is before considering matters such as second languages or SLD.

I wonder what level of health literacy is necessary to understand "It's because you have some vulnerable anatomy." Likewise, is this phrasing "much kinder" or actively harmful if it were to lead to people avoiding appropriate healthcare?

I'd have some level of disquiet about terming a part of the anatomy as 'vulnerable' in a patient public health education setting.

Related: healthliteracy.geodata.uk/

www.e-lfh.org.uk/programmes/health-literacy/

www.reading.ac.uk/web/files/simplification/tech_paper_1.pdf[/quote]
I don't understand why the average literacy level being that of a 12 year old is relevant. Surely that just means that most people have reached adult literacy level by age 12. It's the average level, so normal level for an adult? 12 year olds are pretty literate, enough to understand what we're talking about here.

I think with individual patients who either do not understand or don’t want to accept the reality of what treatment for gender dysphoria has and has not changed about their physical body, it’s fine to completely ditch the leaflets that are aimed at the general population who understand and accept their own anatomy, (this would include most transgender people I think) With individuals with such strong detachment from their own bodies I guess you have to explain health issues in a way that doesn’t lead to instant denial and blocking out all subsequent info. So like, ´you have changes in cervical cells that could become cancerous.’ Patient says, ‘no I’m a man, only women get cervical cancer’. Dr says, ‘some men have cervixes, especially if they were born with a body that looks like the kind of body most baby girls have. You are a man with a cervix and we need to treat these bad cells on your cervix or you could get cancer and be very very sick’. If this person accepts ´most girls’ have a certain kind of body - with female genitalia however they like to describe that, then you’re away, they can keep handle their cognitive dissonance because ´most’ is not ´all’. Probably.
In any case the leaflets should be aimed at the majority of women or the majority of men, or a transgender men/women/ non binary individuals. Not at the small number of individuals requiring a bespoke communication approach.

Indeed. If medical professionals should be using language accessible to a typical 9 year old, should they be referring to "front bottoms" "boobs" and "the space in your tummy where a baby can grow"?

I'd be worried about a 9 year old unaware of the proper names for theor body parts tbh

Fellow HCP here. No you are not being transphobic using the correct teriminology, you have to in order to assess yuor patients properly and give them appropriate care. No matter what someone's gender identity they have to be treated as their biological sex. You work in an evidence based profession. Yes these matters have to be handled sensitively but you have to be accurate and use facts, no matter how upsetting that may be.

For anyone who is interested in statistics about the level of literacy in the population and what literacy levels mean (by notional age band) plus their implications for the activities of daily living:

Entry Level 1 is equivalent to literacy levels at age 5-7. Adults below Entry Level 1 may not be able to write short messages to family or read a road sign.
Entry Level 2 is equivalent to literacy levels at age 7-9. Adults with below Entry Level 2 may not be able to describe a child’s symptoms to a doctor or read a label on a medicine bottle.
Entry Level 3 is equivalent to literacy levels at age 9-11. Adults with skills below Entry Level 3 may not be able to understand labels on pre-packaged food or understand household bills.
Level 1 is equivalent to GCSE grades D-G. Adults with skills below Level 1 may not be able to read bus or train timetables or understand their pay slip.

literacytrust.org.uk/parents-and-families/adult-literacy/what-do-adult-literacy-levels-mean/

I didn’t know I had a cervix at either 9 or 12!

But I knew I was a girl

They should know enough to not have to discuss in the terms pp mentioned above.

EmbarrassingAdmissions Do you work for the literacy trust?

@Ereshkigalangcleg

This dancing around a minority of statements has led to ridiculous social media posts and quotes in the mainstream media such as:

"10% of people suffer from endometriosis"

Which "people" would they be? And which number does that refer to, the proportion of both sexes who suffer endometriosis or the proportion of the one sex that can get it?

The quoted post, and also If you start referring to things as happening to "people" then it could lead to a reduction of funding . Because 25 percent of 66 million people sounds less worrying than.50 percent of 33 millions people.

If 10% of people have endo, this doesn't sound like a really big deal, and because it looks like it could affect anyone, a decision by the state to reduce the budget for research and treatment looks like "equal opportunities defunding".

If 20% of women have endo and 0% (to five decimal or more places) of men do, this looks like a really big deal for women and any state's decision to reduce the budget for research and treatment is very obviously discriminatory defunding.

If we can't talk about biological sex, we can't talk about this.

@Faffertea We need doctors to take your approach.

I suppose because you can transition and not have surgery or I guess even if you do have surgery. You are still ar risk from sex related illnesses like prostate or cervical cancer as an example.

Changing how you present yourself doesn't mean you don't have a prostate.

0% (to five decimal or more places) of men [have endo]

Pulling that figure out of thin air because, even if we concede TMAM, there are very few transmen and most are on testosterone, which limits endometrial growth.

Surely we also need to speak in the language that females who do not have a gender identity but accept their sex as immutable understand and use to describe themselves.

It is hugely harmful when females are unable to talk about their own sex organs and functions in language they understand.

"I'm a little worried because the Lib Dems and Greens have said that it is transphobic to refer too someone's biological sex if they have transitioned."

The Lib Dems and the Greens are talking shite. I think that should be your starting point, not trying to genuflect to political parties who are NOT in power and extremely unlikely to ever be. I'd go so far as to say these parties are currently imploding.

Have you tried approaching Counterweight before going to your HR - they may give you the strategies and confidence to do so and get everything sorted. I am sorry you are in this position.

counterweightsupport.com/seek-support-from-counterweight/

I'm fairly sure a transman is well aware that they are 'female', whatever their gender identity. If they choose to deny or ignore this then I don't know how you can really usefully help them, I'm afraid.

So far I've read about a transman who very nearly died of kidney failure but was totally pleased with being treated as a man, and seen the story of another transman who had a stillbirth after complaining of stomach pains but didn't mention their female biology. In those two cases at least, identité comes before anything else.

I don't understand, a doctor has never said to me that a medical problem such as a breast lump, is because of my sex. That's so basic.

I just can't imagine any situation where you would say 'Oh you have a problem with your cervix, because you are of female sex'

Surely you would just say you have a problem with your cervix? 🧐🤨

a doctor has never said to me

The issue in question here is leaflets, not one-to-one interaction.

You could use a woman's name as examples of people with this problem so 'Maria visited her doctor after discovering a lump etc.'
'Jane's first symptoms were .....' Also a picture of a woman's silhouette.