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appointment and schedule an exam.  When the patient arrives for that appointment, there is always a reason he is unwilling or unable to perform a pelvic exam at that visit.   This physician, when confronted about the importance of Pap smears, and when the patient expressed concern about the more prevalent polycystic ovarian syndrome seen in FTMs, was uninterested in seeing medical journal articles related to the gynecologic health of FTMs.  Is this pompous arrogance or malpractice?

Neither of these clinicians knew the pharmaceutical difference between Depo-testosterone and Enanthate, or the traditional dosage for FTMs.  How can they ethically be prescribing testosterone, if they are so unaware, and unwilling to educate themselves.

Likewise, these physicians seem to be unaware of the fact that bio-males and FTMs can have the same range of testosterone measured by our blood.  When testosterone ranges for FTMs come back in the 500-800 range, physicians often note that that is "quite high", when in reality this is an ideal blood level range for bio-men.  One physician noted, "You probably have higher testosterone levels than I do and I'm a man."  Certainly this statement implies that the FTM patient is somehow less than a man, or at least less than he is.  Is this his machismo speaking or his medical expertise?
When an FTM patient had excessive acne and wanted to pursue medical options, his physician replied snidely with "We could put you on progesterone, that should do the trick".  This insulting, disrespectful comment, let alone the fact that the physician refused to treat his acne, resulted in an additional eight months of near-scarring acne.  This physician just viewed the dramatic increase in acne, directly associated with the introduction of testosterone, to be funny, something to make light of, teasing that the only "cure" would be to put this patient back on an estrogenated/progesterone hormone balance.  Rather than working with the patient, and acknowledging the embarrassment of profound acne for this patient, as well as the discomfort, the physician chose to let this patient go untreated, and feel a sense of betrayal from his physician who would only suggest female hormones to resolve his condition.

Another physician does not believe that his patients are competent to inject their own testosterone.  While he prescribes insulin and syringes to his diabetic patients, he requires that nearly all FTM patients come into the office every 2 weeks for their injection.  (One 10ml vial of testosterone and needles costs between $45 and $100 and lasts a self-injecting FTM approximately 4-6 months.  Each visit to a physician to be injected costs $40-60, totaling $320 - $720.  Somehow this doesn't seem very equitable or ethical.)  This physician also prescribes injectable estrogens for his MTF clients as well, since it pathologizes their condition and forces them, too, to come in regularly for their hormones.  Rather than doing what is best for the patient, he does what's best for his bank account.  Medicine should be egalitarian, offering comparable care to all patients.  Is this physician taking advantage of trans patients because he knows they will do whatever it takes to get their hormones?  Is this unethical on the part of the physician?  Should trans patients be willing to be financially mistreated and socially inconvenienced "just" because they are trans, and should this physician view trans healthcare differently than he does non-trans care?

As trans people we enter into relationships with our MDs believing that they are good, kindhearted, and will do us no harm.  This basic tenet is, unfortunately, frequently not the case.  Physicians do mistreat trans patients, care for trans people differently than the non-trans, and often do cause us emotional harm (and all too often, physical harm) by either disrespect, lack of knowledge, unwillingness to listen, or intentionally abusing their power over the desires and medical needs of their transgendered patients.

As trans people, we seek physicians who are known to be trans-friendly and trans-aware.  We know that we will often be denied care or overtly discriminated against if we see a physician that is not known for working with the gender community.  However, because these providers are often acutely aware that they are a limited commodity, they often use their position to assert their power and dominance.  How much power can they wield, how

many thrusting stabs at our integrity can they make, before we stand up and demand equal, respectful care?  Because physicians often believe that we want hormones, or want special treatment, they don't treat us impartially, or with the same level of regard as they do their non-trans patients.  Do they realize the extra level of trust we put in them?  Do they notice when their behavior is verbally abusive or preferential?  I doubt it.  Most abusers aren't aware that their behavior is anything other than normal.

Trans people so frequently allow abusive behavior to continue, since we fear not being able to live in the way we wish to, and need to.  We cower before our physicians who "allow" us to see them, often groveling for the medical care we deserve, and we typically think nothing of it.  Just as the abused wife, we keep going back for more, allowing the sting of our physicians words, their lack of tact and sensitivity, to hollow out our core.  One strike after another.  We often don't notice that we have become bruised because we believe this is how it's supposed to be.  We often don't know a different way to exist and relate with our "helping professionals", so we keep coming back, each time acquiring another insult, poor treatment, lack of appropriate medical intervention, or other physically and/or emotionally damaging "care" from people who fully believe they are entitled to strike us down, verbally lash us, and treat us with less respect than they would treat their family pet. Rather than enhancing our lives and strengthening our bodies, they contribute to our mental pain, weakening our self-esteem and playing off of our need.  We are optimistic that they will change, hoping this phase of ill-treatment will pass.  Yet it never does.  We end up, sadly, becoming "optimasochists", continually optimistic, yet submitting to a constant state of masochism from their never-ending abuse.  How can we help break this cycle of abuse of transgendered health care seekers, who are repeatedly exposed to what would be considered malpractice if a non-trans person were subjected to this form of "care"?