When forms ask for sex/gender… what’s a trans woman to do?

Dear Reader,

Earlier today I contacted a doctors office to set up a first appointment with one of their specialists. As it frequently goes these days, they emailed me a link to complete some intake forms online. While these forms were tedious before I came out, as a trans person, they’ve become really tricky. Here’s how it went today:

Name, address, phone numbers… Above first name, they asked for a title (Mr., Mrs., Ms., Miss, Dr.). Ok, I used to use “Mr”, but that doesn’t fit. “Mrs” has always been my wife. “Ms” feels a bit standoffish, and I’m a grown-up married woman, so I’m not a “Miss”. And I’m definitely not a “Dr”. I have to select one, so I guess “Mrs” is the closest match.

Sex… This was pre-filled from the information this doctors office received from my insurance company – “female”. Ahh they affirmed me by preselecting “female” – that feels good. But is it correct? In some ways, yes – aside from chromosomes, my sex characteristics are almost all either female or don’t exist. Yet in other ways, no – I’ve had decades of life with testosterone as my dominant sex hormone, which has impacted my body and my health, plus, I’m not 100% rid of male sex characteristics – I do still have a prostate (though it’s been rendered nearly non-existent by years without testosterone), and presumably, my chromosomes are XY (I’ve never had my karyotype done, so I can’t say for sure). Since this is a medical office, I have to play through a number of decisions and scenarios in my mind: do they need to know that I’m trans? Is any treatment likely to be dependent upon any of my sex characteristics? Are there any other answers on the form which would give them a more accurate idea of my body and it’s unique needs? On paper forms, I usually leave questions like these blank so that I can have a conversation with the doctor, but on this form, it’s a required answer, and I have three options: Male, Female, and Unknown. Oh, and there’s one more piece of information you might not be aware of: sex is one of those datum which the insurance company uses when making coverage decisions – they can and do deny coverage when a form has a sex designated differently than the one they have in their database; I found this one out the hard way a few years ago. So I decide that since it was pre-filled as “female” from my insurance information, I’ll leave it, so that I don’t risk having my visit and their services denied.

Employment Status/Occupation… straightforward and easy.

Race/Ethnicity… for me, straightforward and easy, but I question – do they really need to know this? Could my race/ethnicity affect care? They do have an option to decline to answer, but I decide to go ahead and answer on the off chance it could affect my care.

Sexual Orientation… This is a new one! I’ve never been asked this on a medical intake form. The options are (select one) “Straight, or heterosexual”, “Lesbian, Gay, or homosexual”, “Bisexual”, “Something else, please describe”, “Don’t know”, and “Decline”. Again, I wonder whether this information is needed for my care – I’m less sure about this, but perhaps there is some pertinence. So what am I? I’m attracted to my wife – who is a woman – and I am a woman, so “Lesbian” could apply. But when we were married, and for the majority of our marriage, we were considered (and considered ourselves) “Straight”. My wife is still straight – if she were to find herself in the dating pool, she would only consider dating men. And if I were to find myself in the dating pool, I would only consider women, so I guess that means “Lesbian” for this one. But this shows the inadequacy of such labels – to the outside world, my wife and I are in a lesbian relationship, yet my wife is a straight woman; for decades, we were in a straight/heterosexual relationship, and the only thing that changed was my understanding of myself. The quality of our love for each other didn’t change – so why does the label change?

Gender Identification… This isn’t new to me, but it isn’t commonly asked on medical forms. Here, the options are (check any that apply) “Male”, “Female”, “Transgender male/trans man/female-to-male”, “Transgender female/trans woman/male-to-female”, “Genderqueer, neither exclusively male nor female”, “Additional gender category/(or other), please specify”, and “Decline”. Once again, is this information needed for my care? Well, in for a penny, in for a pound, right? At least this question shows some awareness that non-binary people exist (would it have hurt to include an option for “Mx.” in the list of titles?), and this question is unique that it allows me to check more than one option. Since it is about Gender, I don’t have to wrestle with the questions about anatomy, biology, and the history of my body like I did with the question about Sex, but yet they use “Male” and “Female”, which are words typically used for sex (and not so much for gender). This illustrates the common practice of using Sex and Gender (and words referring to Sex and to Gender) interchangeably, which leads to the misconception that Sex and Gender refer to the same thing. Early in my transition, I could have honestly answered the questions as follows: Sex – Male, Title – Mr, Sexual Orientation – Don’t know, Gender Identification – Other – “Genderfluid”. Or a year into my transition, it could have been: Sex – Male, Title – Ms, Sexual Orientation – Lesbian, Gender Identification – Male + Female + Trans female/Trans woman/male-to female. Today, I answered, Gender Identification – Female + Trans female/Trans woman/male-to-female. My primary gender identity is “woman“; I just happen to be a woman who is also transgender.

That was just the first page of the form. The following pages dealt with things like Medical Conditions, Medications, Surgeries, Family History, etc. – again, things which often become complicated when you happen to be transgender.

Taking a step back from today’s forms, it’s striking how many forms we fill out in the course of our daily living: visit a new website – fill out a form for an account; sign up for a subscription of a magazine or one of those monthly boxes of cosmetics/perfumes/clothes – fill out another form; sign up for a library card – fill out a form; visit a loved one in a retirement community – fill out a form (especially in these times of COVID). While these forms often have reasonable questions – name, address, etc. – they also often ask for information which isn’t necessary to accomplish whatever you’re trying to do. Does a website need to know your sex? Does a library need to know your gender? Does a doctor need to know your sexual orientation? In some cases, there are benefits for sharing this information, but in many more, there’s no real need to share these things. Pay attention the next time you’re signing up for an online account or getting a loyalty card from a store, and see if they’re asking for things that they really need to know in order to serve you. And pay attention to the choices they give you, and see if they are being inclusive in their questions.

As for me, I’ll be mentioning my critique of the forms I completed today to the medical provider to see if we might be able to make a few adjustments and improve their forms. Personally, instead of them asking me for my title (Mr, Mrs, Ms, etc), I’d much rather they ask me for my pronouns (she/her/hers), as when I was on the phone with their office, I was repeatedly called “sir” – if they’d known my pronouns, they would have been less likely to have misgendered me that way.

In-form-ally yours,

Me

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