Hess Stinson described their experiences of childbirth as overwhelming, not just because of the pain, but having to tolerate the crude sexual jokes made by doctors and nurses that were based in cisheteronormativity, with which Stinson does not identify. As a Black queer nonbinary mother, Stinson reflects on never having space made for them to feel affirmed when navigating the healthcare system, where receiving care can often mean risking harm to their mental health.
“I wonder about the ways that I’m sometimes silent because I just want to seem like I’m easy to get along with, so maybe I can find a way to get out of this alive as a Black person assigned female at birth,” Stinson recalled.
According to the 2015 U.S. Transgender Survey by the National Center for Transgender Equality, 33% of people who accessed health care in the past year reported at least one adverse experience related to transphobia, with higher rates for BIPOC and disabled people. While people are often encouraged to get treated early for any health conditions they may have to avoid long-term health repercussions, cisnormativity can alienate gender-diverse people when attempting to do so.
There are often devastating mental health impacts of navigating cisnormativity when trying to access reproductive care, particularly if the person is also BIPOC, disabled, undocumented, or from another marginalized group. This can take a significant toll on mental health even beyond the risks of transphobic physical harm, which has intensified during President Donald Trump’s time in office.
Sabrina Sarro knows this well as a Black Haitian mixed race queer person of trans nonbinary experience. In 2019, they were confronted with transphobia in group therapy that was handled so poorly by the facilitator that it has made it impossible for them to engage in such group services since. They described being in group one day when a woman was talking about body dysmorphia/dysphoria and made the point about how she did not understand why people could get access to hormone replacement therapy, but she could not get speed from an endocrinologist to lose weight.
“When I get really uncomfortable and anxious, I lose my ability to articulate myself,” Sarro shared. “I didn’t want to diminish her experience, but what she was saying is just completely wrong. Like, she’s comparing two very different things.”
Sarro detailed how this discussion continued with them sharing an interest in top surgery, after which they were called “mentally ill, sick, and schizophrenic” while the group facilitator, a licensed therapist, failed to intervene. Sarro reflected on the trauma they experienced in a BIPOC space that turned out to be unsafe for them as a queer person, much like queer spaces can reject their Blackness. Sarro is now a licensed mental health therapist committed to holding space for gender-diverse people, especially given how they had been failed by groups and therapists who were supposed to support and care for them.
Angelique Geehan is not cis and uses any pronoun, but they often feel pressure to gender themselves, especially when advocating for their children with healthcare providers.
“When they have gotten hostile, it has usually been connected with indignation or perception that I’m transgressing whatever they’re perceiving by racial and cultural identities,” Geehan shared. While they reflected on how their name, features, and weight add microaggressions, Geehan noted how being East Asian could never compare to the risks of anti-Blackness in health care.
According to a 2021 journal article based on qualitative interviews with 11 trans and nonbinary (TNB) youth accessing health care, five parents, and five service providers, participants recommended four practical strategies for being more inclusive of gender-diverse bodies, experiences, and identities. These included not gendering anatomy and biological processes, using anatomy-based language, facilitating linguistic self-determination, and using narratives that emphasize self-determined TNB identities to empower and affirm TNB youth.
Lane Kantor, one of the researchers who published that study, is transmasculine and nonbinary. They are currently in medical school, where they see firsthand how much cisnormativity must be challenged. Kantor said that it was crucial for every member of the service provider team to be gender affirming from having all-gender washrooms in the physical space to ensuring the administrative support staff address patients by the right name and pronoun.
A 2019 journal article reviewed the experiences of Black transgender people and demonstrated that “gender affirmation was the only variable statistically associated with healthcare nonuse,” further confirming that the harm of cisnormativity for gender-diverse people needs to be addressed.
All the gender-diverse people interviewed for the study felt strongly that cisnormativity in health care had far-reaching negative consequences. Kantor reflected on the harms of using binary gender when instructing students in medical school, with the example of how a statement like risk factors with epilepsy medication for women of childbearing age would be medically inaccurate, as trans women of that age would not be impacted, while trans men would be inadequately screened. This is why Kantor, along with Stinson, Geehan, and Sarro all expressed the importance of having gender-diverse people with intersecting identities of marginalization in healthcare roles.
Geehan felt strongly that patients deserved a more rigorous idea of consent than what they had experienced from service providers, as they recall the violation of having a nurse grab and squeeze their nipple while they were having some difficulties feeding their firstborn child. This recommendation aligns well with Sarro’s interest in a community contract for groups that would do a better job of ensuring that gender-diverse people are not harmed as they were before. When thinking about how their experiences could have been improved, Stinson felt strongly that open-ended questions could have made space for them to share what they really needed.
Based on these experiences of gender-diverse people navigating the U.S. healthcare system, the harms of cisnormativity are undeniable. When asked for recommendations on how to better meet their needs, interviewees had no shortage of actionable steps that could be taken, if only medical professionals were willing to invest in challenging cisnormativity.