'Unwelcomed': Doctors’ Bias, Fixation on Sex Push Trans People to Self-Medicate

In 2014, the Supreme Court noted that trans people face a ‘pronounced discrimination in the field of healthcare'.

In the landmark NALSA judgment in 2014, the Supreme Court had noted that trans people face a ‘large and pronounced discrimination, especially in the field of healthcare’.

(Illustration: Aroop Mishra/The Quint)

Apurva (name changed), a queer man who works in Mumbai as a media professional, was only 17 when he was diagnosed with an autoimmune disorder – a condition wherein your immune system erroneously damages the healthy cells in your body.

"When I informed my doctor that I was queer, his demeanour changed. Phrases like unnatural sex were causally thrown at me," he told The Quint.

Apurva*, a queer person who works in Mumbai as a media professional, was only 17 when they were first diagnosed with an autoimmune disorder.

(Illustration: Aroop Mishra/The Quint)

Apurva – post his diagnosis in 2019 – was mirroring the symptoms of Infectious Mononucleosis, or mono, a sexually transmitted infection caused by the Epstein Barr virus.

"To rule this out, the doctor delved into my sexual history and ordered tests. But I sensed a lot of hostility in his approach – to the point I got uncomfortable and sought a new doctor," he added.

After similar negative encounters, Apurva became wary about seeking medical help altogether, and told himself that “sometimes you simply need to lie and hide who you are to seek the care you need.”

"It's tough enough to deal with a medical issue alone. The added pressure of self-censoring my speech, behaviour, and presentation just added to the misery. I decided to self-medicate until things got bad.”

Apurva* to The Quint

Apurva's experience isn't an anomaly. Several queer/trans people hesitate to access proper medical care after having faced discrimination, or due to a fear of it. In the landmark NALSA judgment in 2014, the Supreme Court had noted that trans people face a 'large and pronounced discrimination, especially in the field of healthcare'.

In the landmark NALSA judgment in 2014, the Supreme Court had noted that trans people face a 'large and pronounced discrimination, especially in the field of healthcare'.

(Illustration: Aroop Mishra/The Quint)

Even 10 years on, queer people continue to face stigma to the point that they would rather avoid accessing healthcare than disclose their gender or sexual identity.

Facing Stigma, Ignorance, and Humiliation

Over the years, Apurva found and created safe spaces with other queer people or allies where he didn’t need to censor himself or his identity. He even started working with a queer affirmative public health consultancy in 2021 that gave him access to sensitised doctors.

However, he recalls,

“Very recently, I had to step out of this bubble and seek care for my autoimmune condition at a well-reputed hospital in Mumbai. To note, this is one of the most expensive hospitals in the city, if not the country, that prides itself on providing pioneering care for its patients.”

“While taking down my medical history, the doctor arrived at the inevitable question about my sexual history. I decided to be honest about my sexuality (I had let my guard down in the last couple years). I was in for a shock. The doctor's behaviour flipped,” Apurva said.

Even four decades after the AIDS crisis in the 1980s and the persistent misinformation around HIV, MSM continue to face scrutiny and ignorance, affecting their access to quality healthcare.

(Illustration: Aroop Mishra/The Quint)

“Suddenly, the questions moved away from my autoimmune condition to a weird obsession with my sex life – the number of partners I had, what kind of sexual acts I indulged in... your typical, biased triage against MSM (men who have sex with men) patients.”

Apurva to The Quint

Even four decades after the AIDS crisis in the 1980s and the persistent misinformation around HIV, MSM continue to face scrutiny and ignorance, affecting their access to quality healthcare. In Apurva’s case, the medical professional’s biases led to them having to redo all their STD tests even though their tests were up to date.

The screenings required for his autoimmune condition were left out.

“I had to insist and assert to prescribe tests that I really needed done. A second opinion from a different doctor later confirmed that there was no need to redo the STD tests," he said.

In Apurva’s case, the medical professional’s biases led to him having to redo all his STD tests even though his tests were up to date.

(Illustration: Aroop Mishra/The Quint)

The tests re-confirmed that Apurva was STD-free, and his symptoms were ‘an autoimmune condition acting up’.

“But the doctor just lost interest. He won't tell me how I can move forward with the treatment, what I can expect, side-effects (of which there were a few) to the medication prescribed, and so on. It shattered my belief in the system all over again,” Apurva lamented.

Self-Censorship and Self-Medication

But even in cases where queer/trans people attempt to access care for sexually transmitted infections (STIs), the experience can be harrowing.

Jai (name changed), a journalist who reports on climate, civic issues, and human rights, told The Quint, “I was at a private hospital in Pondicherry to get an STI test. During a pre-test counselling, I was asked questions like how many guys I had sex with, if my parents knew about my sexuality, about my sex positions, and other irrelevant questions. Halfway through the counseling, I wanted to leave but I was aware of how important an STI test is, and so I carried on.”

He added that all the medical professionals who knew he was there for an STI test ‘gave judgmental looks.'

Even in cases where queer/trans people attempt to access care for sexually transmitted infections (STIs), the experience can be harrowing.

(Illustration: Aroop Mishra/The Quint)

That experience affected the way he approached healthcare. He recalled,

“A few months after the incident, I had an anal abscess, which is a swelling caused by an infection and has nothing to do with your sexuality. But still I was hesitant to visit a doctor because I didn't want to face judgement as a bisexual person who has anal sex.”

Jai to The Quint

“I just consulted with a medical student over text, and I treated myself for that, which could have gone wrong. Fortunately, it didn't,” Jai added.

Similar practices of self-medication are far too common.

“As a transgender individual, the fear of encountering discriminatory attitudes from healthcare providers has led me to avoid hospitals altogether. To cope, I've resorted to self-medication through pharmacy purchases without proper prescriptions,” Santa Khurai, who's secretary of the non-profit All Manipur Nupi Maanbi Association and author of The Yellow Sparrow, told The Quint.

(Illustration: Aroop Mishra/The Quint)

“I've seen some of my friends spending hours on city-specific subreddits trying to find a doctor who is queer affirmative. It is unfair, infuriating, and disheartening. I wish people realised that discrimination in healthcare is literally a life and death issue,” Khurai added.

(Illustration: Aroop Mishra/The Quint)

Khurai further pointed out that there is a gap between access to healthcare in government hospitals vs private hospitals. “In Manipur, a state plagued by corruption and lawlessness, accessing government hospitals is daunting for transgender people. While private hospitals offer better care, they are expensive and that is prohibitive for many, including myself, who live hand-to-mouth,” Khurai lamented.

'This is Not a Phase or a Fad'

Nym (name changed), a 37-year-old non-binary person, is currently hesitating to approach an endocrinologist because they are wary of explaining their desire to transition, adding that they experience gender dysphoria.

“In my case as an AFAB (a person ‘assigned female at birth’), a transition would involve some amount of T (testosterone), but with the end goal not being full transition into a man. This is complicated for me to understand what and how I hope to achieve these changes. I fear being dismissed by doctors, even those who have treated binary trans people,” Nym said.

The Transgender Persons Act, 2019 mandates that the government ensures medical facilities provide care to transgender persons (including for gender-affirmative procedures). However, ‘transitioning’ in the medical field is still largely seen in binary terms – as MTF (‘male to female’) or FTM (‘female to male’) which doesn’t leave a lot of room for non-binary individuals.

“I am not sure how to convince them that I need this, that this is not a phase or a fad, or for that matter, that I am even real. It is very difficult for doctors trained in our medical systems to think beyond the gender binary, and I am not sure many of them have the openness of mind to provide services or treatment to people who want to de-gender themselves.”

Nym to The Quint

Nym recalled an experience with a gynecologist when they were in their early 20s that affected their trust in the healthcare system.

“When I was in my early 20s, a gynecologist who I had consulted for my PCOS wanted to scare me into losing weight as a form of treatment. She showed me a diagram of a body with breasts that had facial hair on the face, chest, stomach, legs and arms, and said, ‘If you don't lose weight, you will look like that’,” they said.

“I didn't have the courage to tell her that I already did look like that because of hirsutism and that I had come to like the way I looked because it affirmed my feeling of not being entirely ‘woman’.”

Nym

The Problem of Transphobia

Kalki Subramaniam, a transgender rights activist and founder of Sahodari Foundation, explained to The Quint that despite an increased 'tolerance' within the medical community, 'underlying transphobia still exists'.

"And why that exists is because the medical fraternity, including doctors, nurses, and other technical staff in a hospital, are not sensitised. They never study about handling trans people or LGBTQIA+ community as a part of their education in colleges, institutions, and universities," Subramaniam added.

This lack of sensitivity directly affects queer/trans patients' physical and mental health, especially when they don't receive proper information about their treatment.

As Apurva put it, “Discrimination in healthcare affects our quality of life. Healthcare just doesn't stop at health, it spills over into your mental health, your ability to work and earn, your financial stability, and your social life.”

So, what can be done?

Another trans expert, who did not want to be named, said a ‘definite policy to address queer healthcare’ is the way forward.

“Being hesitant because of the discrimination is not going to help us queer folks. Sadly, there is no way but to acknowledge the issue. Until there is a definite policy to address queer healthcare, there will be no change. Queer folks should just make up our minds, be strong and brave and face this, I guess. No other way,” they added.

Kalki Subramaniam added,

"Both government and private hospitals should have regular sessions and trainings for doctors on handling vulnerable communities – and how the medical community can give healthcare services without prejudice. Unfortunately, such trainings have not been initiated on a nationwide scale."

Kalki Subramaniam to The Quint