In the Year of Our Internet, 2020, there is more conversation than ever before about trans, nonbinary, and intersex folks: who we are, how we know who we are, and what to do about that. As unprecedented numbers of people begin to understand themselves as trans, nonbinary, and intersex, it’s becoming more obvious than ever that sex ed and health care are often outdated and unhelpful when it comes to keeping our bodies healthy and safe. As a queer transman, I’ve had good experiences, bad experiences, and a lot of ugly ones, too. Here’s a little bit of my story and the six best tools I’ve developed for navigating birth control and sexual health.
I had a complete hysterectomy and oophorectomy (removal of the uterus, cervix, and ovaries) when I was 23 years old, after a decade of battling endometriosis with every health care intervention my (male) gynecologist could think of. I had always planned to become a parent via adoption, had reacted poorly to different methods of birth control, and had suffered horribly after two ectopic pregnancies. No matter what fresh hell my ovaries put me through, not one doctor would listen to my repeated requests for a hysterectomy until I began to medically transition.
Suddenly, the same gynecologists who had asserted that no woman in her twenties could be trusted to forgo the possibility of “natural conception” were nodding sagely at me and promising that I, a transgender man, would surely be approved for the (lifesaving, from my perspective) hysterectomy because childbearing was “obviously out of the question.”
Record scratch. What?! The idea that no trans man could want to conceive or carry a child is nonsense, but I didn’t correct my doctors because I wasn’t even surprised.
Though I knew I didn’t want to conceive or carry a child myself, I did ask my doctor about options for freezing my eggs, because I wanted to understand my future options (including using my eggs to create embryos to implant in a partner’s womb). Her demeanor totally changed. She grew deadly serious and her voice was almost a whisper. “If I thought for one second that you wanted to harvest your eggs, that you were lying to me about being trans, I would never do this procedure.” So of course I backtracked, not wanting to compromise my ability to get the hysterectomy, and assured her that my conservative family was freaking out (true) and it was only their question, and not mine (untrue). The message was clear, though. My gynecologic surgeon believed that even considering ways that I could have biological children was inconsistent with being a trans man.
In the years since, I’ve encountered even stranger, dumber, and crueler misinformation about conception, contraception, and sexual health for trans and gender nonconforming folks, including: Trans people can’t get pregnant or impregnate someone after starting hormones (not necessarily true!); trans people don’t need Pap smears (not necessarily true—if he or they have a cervix, Pap smears may be critical); trans people can’t get/give STIs (not true—this is similar to the myth that lesbians can’t share STIs and is total nonsense).
A bright side: health care and sex education are evolving as professionals in these fields are becoming more informed about trans, nonbinary, and intersex sexual health every day. The general public has more examples than ever of trans, nonbinary, and intersex folks who pick and choose medical interventions (or none at all). Every time I meet or read about another pregnant transgender man, I’m immediately transported to a Sliding Doors-style fantasy where my eggs were harvested by a supportive and competent doctor. They might be languishing in cryogenic repose even now, or there could be a great, weird kid roaming this great, weird Earth with 50% of my DNA.
Over the years, I’ve built a toolbox of skills for taking care of my sexual health despite the overwhelming misinformation out there. This includes methods for communicating with health care providers, lovers, and randos who stick their noses in my business (depending on the day, I’ll either shut them down or generously give them a TED talk). Here are six skills I’ve come to rely on:
For birth control: Bodies change all the time! Our age, health conditions, medications, and life events can all impact our ability to get pregnant or get someone else pregnant. Educate yourself with each new change in your health, whether it’s starting hormones, changing your dose, stopping menstruation, or having surgery.
Also, a lot of intersex people have information withheld from them as young folks, or don’t learn certain things about their bodies until puberty or adulthood. We all deserve to understand what our perfect, amazing bodies are capable of, and that means asking a lot of questions, doing your own research, and sometimes insisting on tests at the provider’s office (you can pick up some great tips for advocating for yourself at the doctor’s office from Virgie Tovar).
For sexual health: Sex lives change all the time! Your partners, their parts, and the delightful things you do with them may shift over time. Sex education is a lifelong journey—stay on top of current information about sexually transmitted infections (STIs) and other health risks that may be relevant to the types of sex you have, including but not limited to oral, anal, and vaginal* insertion.
*I use words like “vulva” and “vagina” for my own trans body when discussing sex and health care, but I encourage you to use whatever language feels right—your lovers and health care providers will understand you if they’re competent and listening well. And if they don’t understand you, it’s not a match. You can also introduce the vocabulary that works for you by saying something like “before we do this exam, I’d like to tell you what language I’m comfortable with for those parts.”
Your own personal bullshit meter is your first line of defense against misinformation, and the wide world of research and second opinions is there to help you follow up. Sweeping statements like “you don’t need to worry about that” or “there’s zero risk for you,” even if they’re coming from a health care provider, usually merit a careful investigation to double check (see below for tips on where to look for this information). You can also ask your provider why they think your risk is zero, and they should be able to give you an evidence-based explanation.
When it comes to sex and dating, feel confident shutting down glib comments like “I don’t have STIs, I’m not a slut” or “You can’t pass STIs from scissoring.” Bodies are powerful and there are a lot of unpleasant infections we can pass to each other even when there’s not penis-in-vagina penetration in the mix.
There’s a ton of information out there, not all of it good, and not all of it current. New data about sexual and gender health emerges constantly, causing guidance for best practices to change just as often. The same skills you use for identifying false news articles come in handy here- check the date, the author, the organization, and their motives. Search engine results are only as helpful as your ability to identify trustworthy information.
Two good places to start when looking for trustworthy sources may be: Scarleteen, a sex and relationship information site for “teens and emerging adults” that is inclusive of trans, nonbinary, and intersex readers and InterACT, Advocates for Intersex Youth, who offer lots of free online brochures on different topics, including materials for friends and health care providers.
Your providers also have a responsibility to educate themselves, and you can suggest resources for them to look at. Examples are: Fenway Health, a Boston, MA medical clinic specializing in transgender health care, and the Centers for Disease Control and Prevention, which has a lot of resources for providers, including this big list. Both Fenway and the CDC focus more on transgender healthcare than intersex-specific information, but in many circumstances, information that’s applicable to transgender medical care may also be helpful for an intersex person.
It can be hard to find health care providers who affirm your gender, but the options are improving every day. If you have health insurance, you can call the patient information line (usually on the back of your insurance card) and request a list of affirming or specialist providers. Be clear about what you need: a specialized endocrinologist for an intersex person? A welcoming and informed urologist for a transwoman or nonbinary person? An affirming gynecologist for a transman or nonbinary person? A GLBTQI-informed and affirming therapist? The more specific your request is, the better your results may be.
Online searches and community referrals are invaluable for finding good providers. You can also cold-call a health care provider’s office and just ask them directly if they’re a good fit for your needs. Once you’ve got your health care team, stay vigilant. Even the most affirming providers may have old information, and everyone makes mistakes. You are your own best health advocate. Take notes, ask questions, get second opinions, and stick to your guns when you want to receive or refuse a medical test or treatment.
Remember: everybody gets exposed to different information. I’ve never once had a partner who had the exact same understanding of sexual health as me. This gap is just one more reason to keep the lines of communication open. Be prepared for them to understand things differently, and be patient/request patience as you look for information together when a question pops up, like “Can I pass my yeast infection to you?” or “What STI testing should we both be getting, and how often, based on the types of sex we have?”
If a health care provider (or lover) is saying things that land wrong, or not listening to your needs and questions, they’re not the right fit for you. Consult your own instincts and judgment on every sexual and medical decision, no matter how experienced your provider or lover is. If you notice some hesitation in your heart or mind, that means it’s time to press pause, do some research, spend some time contemplating, get a second opinion, or just get out. My instincts as a patient and as a sex partner have gotten stronger and more accurate every year, and I’m always learning more. My magic phrase, which has improved things in bed as much as in health care, is: “Sorry, I don’t fully understand what you mean. Can you walk me through that?”
As I’ve cultivated this toolbox in the years since my horrible hysterectomy experience, I’ve gotten much better health care (and had much better sex, thanks to strong communication). I had a very successful top surgery (removing the breasts while contouring the chest to look more masculine) where I felt able to advocate for myself better, and I brought a bossy friend along to help me just in case. I now have an amazing, queer primary care doctor who listens to me and stays up to date on the ever-changing best practices for transgender health care, especially hormone replacement therapy (HRT). I practice radical consent with my partners (verbal ask and answer before physical touch), which has totally changed my ability to identify and express what I want, and constantly builds trust and communication skills in and out of bed.
I hope that my toolkit is helpful for you, but ultimately, you’ll find what works for you with trial, error, and patience. Your body is perfect, and you deserve great sex, communication, and health care.