The Trans Aware Cancer Care community researchers have created a zine titled “A Guide for Allies to Improve Trans+ Access to Healthcare.”
The zine can be found here at Heyzine, and will soon be available in print at a sliding-scale price through Penfight.
Text from the zine
This zine features insights from our community work on cancer service experiences and from our own personal experiences as trans+ individuals.
This zine has been created with love. Please read with an open mind and an open heart.
Trans Aware Cancer Care
Trans Aware Cancer Care (TACC) started as a project aiming to document trans+ people’s experiences of cancer services in the UK. It quickly broadened into research exploring trans+ access to and experiences with healthcare.
We used arts-based, participatory research to highlight systemic barriers and discrimination, and to show how affirming care can rebuild trust and improve cancer outcomes.
Ninety-two art contributions were gathered and assembled into a large trans pride flag, representing diverse experiences of healthcare, from affirming and compassionate care to significant harm, discrimination, and avoidance of cancer screening.
who we are
TACC is led by a group of community researchers who are all part of the trans+ community and have some form of lived experience.
Each of us has unique experiences in different areas, and we all brought something personal to this project, which expanded it into the beautiful thing it is today.
What is this zine about?
There’s a need for change and a need to spread awareness on trans+ issues and what this means for us trying to access cancer services. The stories and information in these pages highlight why we need allyship now more than ever.
We created this zine to help allies find ways to support trans+ people and to clarify what allyship could mean.
Throughout, we share artwork from Trans Aware Cancer Care, community-based knowledge, and some of our personal experiences.
According to the 2021 Gender Identity Census in England and Wales, 0.5% of the population do not identify with the gender assigned at birth. 0.1% of those are trans men, 0.1% are trans women, 0.06% nonbinary, and the rest either did not elaborate or provided a different gender identity.
These numbers put trans+ people in a significant minority, meaning we are unable to represent or defend ourselves without allies. These allies must exist everywhere, and it is really important that they exist in healthcare.
We know health professionals are overburdened, but every bit of support helps.
I didn’t expect to find myself
Reflection from Katie (they/he), community researcher:
The Trans Aware Cancer Care project brought me closer to the trans+ community. I feel like I really belong now. Not just part of me but the whole of me, queer, fat, neurodivergent, loud and sweary. Masc and non-binary, both but neither.
I have felt so seen and held by the community over the past year. We had the most intense conversations about healthcare, oppression and illness. We also shared stories of trust, safety, love and family. I felt their love and acceptance throughout. There was no shame, no judgment. I was finally able to be loud and proud. I will be forever grateful for the stories, space and love shared with me throughout this project. Thank you all.
People’s stories
“They always ask for the gender I was born as”
“In a referral to the GIC, the notes stated word for word, “She thinks she is a man”. I don’t think. I know.”
“I feel that I have been treated as female and have been too overwhelmed and tired to argue with professionals quite often.”
“I’ve had a lot of hospital admissions for self-harm and suicide attempts, and never once has it even felt like an option to share my identity and gender preferences.”
“I have had multiple bad experiences of cervical screening where I have been misgendered & bullied by nurses for finding the experience traumatic. It took me 3 years to have a ‘successful’ screening after multiple attempts!”
“This is a visual of some of my exhaustion before I have even entered the healthcare setting – I am chronically ill, queer and a parent and have experienced a lot of shame and prejudice from all the ways I have been treated and how I have been perceived.”
“I will never get a cervical screening because my doctors are transphobic and don’t respect my personage. I could get cervical cancer at any point and may never know until it’s too late. This fact is more bearable to me than receiving care and being treated as a woman.”
“Doctors will try to remove my binder; they don’t know what it is. They have no idea what to do with me. I have to do my own ECGs.”
“Referred to Steps 2 Well-being for anxiety and depression unrelated to my struggles, I mentioned in passing that I was trans so that I could ask them to call me by my chosen name, but made sure to stress that it was separate from the issues I was calling about. When they called me back, they refused to see me because they are not specialised in gender related health care.”
“I was told waiting times would be longer because I was trans and they needed someone who was “comfortable” with assessing me. I was in A&E resus with a heart condition.”
Allyship and validation
A lot of trans+ folk go into healthcare appointments braced for a negative experience, so if they’re met with validation instead of dismissal, it can really stand out!
Validating statements, coupled with a simple question of “How can I help make this better?”, can take you a step further toward improving the care journey for your trans+ client.
Through our research we found that healthcare concerns were often confirmed by repeated bad experiences. Enough to make people explicitly refuse to attend cancer screenings and generally avoid healthcare.
“However, the Mixed squares show that just one good experience can be empowering enough to change a person’s perspective and restore much of that trust. “
-Excerpt from the TACC Report
Title of square: Validation is strength.
Description of square: A quote from my doctor during my diagnosis of depression. This made me feel validated and that I was working with someone who understood my experiences and needs.
Story of square: Recently, I was diagnosed with depression and prescribed a course of medication. When I informed my G.P. that I was genderfluid, they were very supportive and respectful. They even asked how well I felt supported by my wife with my transition. They offered extra support and suggested that I use that positive relationship to validate my experience further to improve my mental health. Very kind and positive.
Being rude by mistake isn’t the end of allyship! The trick is to keep trying until we consistently get things right. To help this process, practitioners can:
- Have humility around getting things wrong;
- Be aware of the power dynamics as a practitioner;
- Try not to take it personally when trans+ people challenge or correct;
- Build rapport so patients trust enough to share what does and doesn’t work for them;
- Respect the person as an individual.
- Recognise your own assumptions and biases. We all have those, and it is better to face them than deny them.
- Ask questions and hold yourself and others accountable to foster better understanding. Even when it makes others uncomfortable!
- Use inclusive language in your practice. If you can mention it, mention it.
Meeting a trans+ person and don’t know what to do?
- Recognise your own assumptions and biases.
- We all have biases; better to face them than to deny them!
- Mistakes are normal, just keep trying!
- If you think you’ve been rude: remain calm! Just apologise, correct and carry on.
- Remember: people are individuals, and they are best placed to know what does and does not work for them.
- Getting corrected isn’t a problem!
TL;DR: respect them as a person just like yourself!
“But I’m cis and conform to the standard views of my gender. There’s no need for me to specify my pronouns. Why should I?“
Here’s an example of the importance of making terms mainstream: in the past, gay/lesbian people would use subtle terms to refer to their significant others, to keep themselves safe.
Nowadays, this has been adopted by many heterosexual couples as well. If it weren’t, it would be pretty easy to single out a gay/lesbian person, potentially putting them in danger.
If both cis and trans+ people announce their preferred pronouns, it would be more difficult to tell who is trans and who isn’t.
By making “preferred pronouns” more mainstream, like putting them on name tags and email signatures, as an ally, you make sure to create the space for a trans person to do the same without fearing being outed or singled out.
You can be the person who insists things get better!
Trans+ people face exclusion from healthcare on multiple levels. Even something as simple as changing gender markers can mean choosing which cancer screenings to miss out on! We find ourselves fighting against a system that wants to deny our existence.
Title: “Hi! We hate you”
Having lunch at Nando’s with my friend, when the GP called to let me know I have to choose between my identity and healthcare. You can’t change your title with us yet:
Why?
– Oh, because of the cancer screenings for women, of course. Is that alright?
[I look at my friend, at the other tables. “No”, I think.]
Yeah, sure! [I say]
Pronouns DOs and DON’Ts
Do
- Share your pronouns first
- Correct yourself and others once, and move on
- Try to encourage the usage of pronouns in signatures at your workplace
- Assumptions will always happen, no matter what, because we are people. The best way to fight those assumptions is by checking, and asking questions.
Don’t
- Pick and choose who to ask for preferred pronouns
- Make a big deal of apologising when you make a mistake
- Make assumptions, especially in a professional environment
Alt text:
NO!
“You can’t have the morning-after pill unless you prove to me you’re capable of getting
pregnant.” -pharmacist
YES!
“Here is some information about pelvic screening. I’ve checked that it uses gender-neutral language, and I’m here to talk you through it if that helps. Just tell me what you need.” – Practice Nurse (AKA legend)
Impact is more important than intent
If we accidentally say something hurtful, it’s easy to distance ourselves from the impact by pointing to our intent, by saying “I didn’t mean it that way” or similar. Often, this does not change the impact that has already happened.
When focusing on intent, we tend to shift the focus to ourselves rather than to the affected party. A way to tackle this, as an ally, is by practising accountability and self-reflection.
Focusing on the harm caused allows us to mindfully approach our future actions and learn from our mistakes. This way, we make room for compassion in our lives for both ourselves and those around us, instead of focusing our energy on guilt and shame.
“When societies experience big and rapid change, a frequent response is for people to narrowly define who qualifies as a full member of society”
-John A Powell, The Guardian
The attacks on trans+ people are frequently repeated, but most are easily debunked. Usually, this can be done by simply asking for the evidence that there’s actually a problem (the vast majority of claims are based on pure speculation). The only reason these attacks work at all is that they’re rooted in scare tactics, and scared people are easily motivated to turn on others.
Recognise your fear, however deeply buried within you. Acknowledge it. We are all influenced by media and the messages that surround our day-to-day lives. It is not your fault for being part of society, but it is your responsibility to be aware of your thoughts and actions.
Accountability
Whose job is it to be an ally for trans+ people?
The answer is: if we want any real change to be made, this needs to be a joint venture across professionals, not just those sitting at the EDI desk.
If one healthcare professional is an ally, whereas the majority of their colleagues remain uninformed, and if an individual repeatedly makes mistakes, the harm they cause in their care could be significant.
If the staff is full of allies, but the systems in place lack the appropriate inclusive measures, you get similarly bad results. This begs another question – who is in charge of the systems, and with such a broad subject as a “system”, how do we ensure accountability is held by the appropriate people?
Demand more of your employers!
It should not be your sole responsibility to change your environment. There should be educational materials available for you and your colleagues to understand trans+ issues and needs, and to better work with trans+ people.
If there isn’t any demand for it! Ask about it, follow up on it. Knowledge is power, and it is no small feat to be able to obtain that knowledge in your workplace.
Most acts of allyship aren’t grandiose changes that make the news. They are small, necessary steps that will eventually lead to a change that you may observe in real time.
Overwhelm is a leading cause of compassion fatigue. Do not put the world on your shoulders. Sometimes all you really need to do is ask a question.
Alt text
MR. MISS. Her.
DON’T GET MY HOPES UP!
Your letters HURT
Title: Choices
Description: Envelope with Mr. Letters with Her/Miss.
Story: Letters are addressed with my right name & pronouns, but letters will always misgender me and sound insensitive. Don’t put the right things on the envelope, but the wrong things in the letter.
TOLERANCE VS ALLYSHIP
Reflection from Drago (he/him), community researcher
In my experience as a minority across a number of different communities (immigrant, queer, trans), I have found my voice carries very little weight in arguments. Without allies, my words will almost always fall flat. One cis person speaking up has led to changes I myself have tried to implement for months or years. This is the unfortunate truth we need to acknowledge and use for our own benefit.
Tolerance is not allyship. Tolerance only requires you to be quiet.
In the context of our current world and politics, tolerance is not enough to change things. Real changes come with action, and that action is in your hands.
Use your voice. Voice your concerns, challenge biases, your own and other people’s. This is how you can be an active ally.
Above all, extend kindness to yourself. Only then can you really begin to extend it to others. Do not blame yourself for your privilege, but do use it.
You ask, still, what can you do as an ally?
The paragraphs and resources overwhelm you; maybe they confirm things you already know, or they don’t apply to the questions you ask. Here is a summary of what you can do:
- Show your support with the things you surround yourself with. Maybe a book, a picture, a card.
- Share your support with your words, with your actions.
- Ask questions, demand change, and always add love to every step you take.
Radical Tree of Transformation
Elliott (they/he), community researcher
In the radical tree of transformation,
Things start at the roots,
In the soil.
We can observe the leaves,
The branches,
We can see how they fall,
Their form,
How they move in the winds of society.
But we will not change this tree,
Rid it of its infections,
Unless we come to the soil it was planted in,
Until we look at the roots,
How the infections have interlaced themselves
throughout the bark,
and in the rings
Then we must wonder,
How will we know a healthy tree if we’ve never seen one?
How much of our work then has to be tending to the soil
So we can know what a tree of care
Would actually look like
Glossary of terms
- Binder – tight clothing/compression garment used to flatten one’s chest for gender affirming purposes
- DEI – Diversity, Equity and Inclusion
- GIC – Gender Identity Clinic
- Masc – derived from masculine. An umbrella term used for gender expression that aligns with masculine roles.
- Misgender – refer to someone using terms (title/pronouns) that do not align with their gender identity.
- Trans+ – umbrella term used for all and any individuals that do not fully identify with the gender assigned at their birth
Resources
For more information, including video, report, and art book, click here.
OUTpatients LGBTIQ+ Cancer Charity