Trans Health, Women’s Health, and Inclusion

Considering the recent discussion prompted by FWHC’s Trans Health Initiative (this article gives a good summary of the issues and historical context), how “trans inclusive” at a women’s health center means inclusion for trans men, means the provision of care no woman needs for trans men, and does not mean that trans women are welcome (usually we are not), it is necessary to examine how things should be.

In our cisnormative society, certain body parts are associated with women, and others with men. In our patriarchal society, men dominate spaces where they are welcomed at the expense of women’s comfort and, at times, safety. In our patriarchal society, health care for men is prioritized and normalized over health care for women. The feminist response to this has involved the creation of women’s clinics and health centers, which provide medical care specifically for women in an anti-misogynist safe space.

Because of cisnormativity and the history of feminism actively creating cis-only women’s spaces (whether by the creation of new spaces or the expulsion of trans women from existing inclusive spaces), these clinics are created to only serve cis women. Because of feminism’s cissexism, and history of turning a blind eye to the male privilege possessed by trans men, such spaces have not only welcomed trans men, but changed themselves to accommodate trans men (de-gendering themselves while still excluding trans women and training people in providing care for trans men, including care no woman needs).

Including trans men in a women’s space, of any kind, while excluding trans women, is an act of transmisogyny. De-gendering a women’s space while keeping it DFAB-only, is an act of transmisogyny. Claiming a women’s space is “trans-inclusive”, as these places do, while excluding women who are known to be trans, is an act of transmisogyny.

Further, this inclusion of trans men in women’s health centers has created an asymmetry in trans health care that mirrors and amplifies the patriarchal gendered asymmetries in general health care. Because of patriarchy, men’s health is prioritized over women’s. In women’s clinics, trans men’s health is prioritized over trans women’s to the point of excluding the latter while making special programs for the former. By de-gendering what was created as a women’s safe space, spaces have been created where trans men can receive body-specific care in a respectful manner. Equivalent spaces for trans women have not been created. The asymmetry where trans men’s care is dramatically prioritized over equivalent care for trans women exists in the whole society; what happens in women’s clinics is a microcosm of the entire society and not a special phenomenon that ends at the clinic door.

These inequalities of care include trans women being denied our rights to equitable and affirming health care, while trans men not only have that access granted (contingent on the same requirements as other access to health care in the US), but have similarities in health care needs to cis women used as justifications to allow them into, or to degender, women’s space. The fundamental rights in question are:

  • Every person has the right to receive health care specific to their body, in a manner that is affirming of their identity and self-descriptions and sensitive to issues of body dissonance.
  • Every person has the right to have their health care recognized as belonging to their gender. Specifically, trans women’s health care is women’s health care and trans men’s health care is men’s health care.
  • Women have the right to not be excluded from women’s anti-misogynist safe spaces on account of their history of how they came to womanhood. This includes medical spaces.
  • No person should be denied body-specific health care because all health care for the relevant body parts is provided in a women’s space in which they are unwelcome, or in places that are inaccessible for reasons such as distance.

In practice, what this would mean is:

  • Trans women would be able to get care provided at women’s primary care centers, including HRT and any body-specific care it is feasible to train staff for (to the same level as cis women receive at that clinic). Trans women who require body-specific care outside of women’s health centers should be able to expect respectful care that does not misgender them.
  • Trans men would have access to spaces that specialize in body-specific care for body parts they share with cis women. This care is to be provided in a respectful manner.
  • Women’s primary care centers would not include trans men.
  • Birth designation is never to be used as a dividing line between who can access a health resource and who cannot.
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