From J.K. Rowling to the Clinic
Our favorite wizard’s image has been tarnished. J.K. Rowling, the once-beloved author of Harry Potter, has decided to establish herself as the trans community’s Lord Voldemort with her recent comments. “If sex isn’t real, there’s no same-sex attraction. If sex isn’t real, the lived reality of women globally is erased,” she tweeted on June 6 in an outburst of annoyance over a Devex article’s refusal to label people who menstruate as women. “I know and love trans people, but erasing the concept of sex removes the ability of many to meaningfully discuss their lives.”
Rowling’s comments are, first off, biologically false. An estimated two percent of people have genitalia, chromosomes, gonads, and hormones that don’t fit neatly into our societal definitions of male or female. Sex is not a rigid binary, and in portraying it as such, Rowling denied the existence of millions of intersex people, who already suffer abuses when they are surgically forced into such binaries at birth.
Rowling, however, clearly did not mean to target intersex people or the nuances of sex assignment in her tweets. Rather, in deciding to once again glorify assigned sex and reject the validity of gender identity, she directly addressed the trans community. You can exist, sort of, but you are wrong, she suggested to her trans followers—as if trans identity is not legitimate, as if trans people are somehow misled in their conceptions of self.
I’m not here to villainize Rowling specifically. But I’d like to point out that the medical implications of her tweet don’t stop at scientific misconception. Because in truth, we can recognize a reckless dismissal of trans identity in many corners of our society. When we see it acted upon by those whose actions directly impact our health and well-being—health care professionals, lawmakers, law enforcement—we understand just how life threatening such attitudes can be.
Rowling’s mindset is the same mindset that enables medical providers to either degrade their trans patients or neglect them due to a woeful lack of knowledge about their specific health care needs. Trans activists, through their stories, provide first-hand accounts of this. In a piece for Vox, for example, transgender reporter Katelyn Burns described a pharmacist canceling her estrogen prescription out of confusion over “why a man would need female hormones.” Later, when she had a urinary tract infection, a physician who “grew physically uncomfortable” with Burns’ gender identity rejected her assertions about her own health. Believing she had an sexually transmitted infection instead, likely due to false stereotypes of trans people’s promiscuity, the physician asked her invasive questions about her sex life in front of her kids.
Here, we see Rowling’s dehumanizing attitude—its denial of and misconceptions about trans identity—translated directly from Twitter into the clinic. It is a problem so pervasive that experts have suggested that the dearth of professionals with appropriate understanding poses the single biggest current threat to trans health.
“We walk into any given health care situation not knowing whether doctors are going to treat us well, whether we’re going to get high quality care, whether any given, random health care person is going to be terrible to us,” said Mari Brighe, a writer and transgender woman, in an interview with NPR. She herself experienced discrimination after being denied emergency care while suffering a severe flu.
Medical neglect of trans patients creates more than discomfort. When medical providers fail to afford their patients basic respect—when they fail to cultivate trust and provide comfort—it can mean life or death. In a nationwide survey, 40 percent of trans people reported having attempted suicide or having depression. Studies have suggested that gender affirmation can go a long way in reducing these struggles, and one might hope that trans people would find such support in medicine, whose entire ethos centers on healing. But 21 percent of transgender people reported experiencing harsh or abusive language from their medical providers, meaning that for many in the trans community, the doctor’s office represents yet another source of alienation.
2020 has certainly not been kind to public health, but it has posed a particular threat to trans health. Experts at UCLA’s Williams Institute note that COVID-19 social distancing orders may further harm trans people’s mental health by creating isolation and financial strain while decreasing access to gender-affirming surgery, all of which might heighten risk for suicide. Moreover, previous patterns of medical abuse mean that should transgender people develop COVID-19 symptoms, they might be less willing to seek care. The lasting mental and emotional effects of medical neglect of trans people amalgamate into a mess of inequality during the pandemic.
All of this makes the Trump administration’s recent announcement particularly cruel. The Department of Health and Human Services has narrowed the Affordable Care Act’s Obama-era definition of gender identity from “male, female, neither, or a combination of male and female” to what Office of Civil Rights director Roger Severino calls “biological sex” only—no word on those whose biological sex does not fit the binary. Though the Supreme Court’s recent ruling to protect trans workers from job discrimination may bolster legal challenges to this re-definition, for now, protections against sex discrimination in health care no longer apply for trans people.
Rowling denied trans identity in her tweets, medical providers denied it in the clinic, and now, the Department of Health and Human Services has denied it by law.
This time, these erasures might grow an even more direct connection to death: for trans activists such as Burns, memories of a darker past loom large. She recalled the 1995 death of Tyra Hunter, whose trans status led an EMT to refuse to transport her to the hospital, or the 1999 death of Robert Eads, a trans man denied treatment for ovarian cancer by his physicians. The health care system already fails trans people through a lack of compassion and understanding, but now, providers with particularly deep prejudices may revert to actively harming them as well.
Of course, transphobia’s reach extends far beyond the language of public figures like J.K. Rowling and Roger Severino, and far beyond the biases of health care providers. Even away from the medical system specifically, trans people—and Black trans people in particular—face constant threats to their lives.
On May 27, one day after protestors in Minneapolis first took to the streets over George Floyd’s murder, police officers killed Tony McDade, a Black trans man, in Tallahassee. Prior to his murder, McDade had also recently been “violently attacked by five men as bystanders cheered on while live streaming his beating on social media,” wrote Ashlee Marie Preston, a Black trans activist.
“We can’t examine Tony’s circumstances, without examining the system. Tony’s struggles at the intersections of racism, transphobia, carceral captivity, and socio-economic disparity are worth taking into consideration,” Preston said.
We all live at the intersection of multiple identities. But societal intolerance means that Black people stand at a particularly dangerous crossroads. And where life and death are concerned, medicine and public health are inevitably part of the conversation.Last time, I wrote about how the Black Lives Matter movement combats not only police brutality, but also the public health crisis that our carceral system has created. Black trans activists have pushed this narrative even further with their All Black Lives Matter movement. To respect their demands, we must start by tackling the transphobia that surrounds us in relatively innocuous forms—Rowling’s identity-denying tweets, for example. We must stop it before it reaches medical clinics and legal policy to threaten trans lives, and before it fuses with racism, violence, and police brutality to attack Black trans lives in particular.