A note about terminology in this post: Unfortunately, we’re forced to rely on the language of the kyriarchy when it comes to talking about gender identity and gender issues. The kyriarchy is pretty firmly convinced that people like me don’t exist, and if we did, we shouldn’t, which means that there’s not a lot of nonjudgmental language we can use to talk about gender issues. In this particular piece, I’m going to be using “assigned sex” to refer to the identity assigned to me at birth on the basis of certain physical characteristics and “gender” to refer to my gender identity. I am not happy with these terms, and they can be very exclusionary for a lot of trans* folks, but I’m not really sure what else to use here. I apologize in advance, and welcome alternate suggestions in the comments¹.

The doctor’s office is an area in which gender variance can become a particularly fraught issue. For the most part, a doctor can provide treatment to a patient without needing to know that patient’s assigned sex. When I go to the doctor for a chest cold, my assigned sex is not relevant; my gender is, because it’s important for the doctor to know which  pronouns to use when referring to me. Assuming that my doctor is a respectful person who likes to treat other human beings with politeness, at any rate.

However, there are situations in which a conflict between assigned sex and gender can actually be relevant and potentially be critically important. For example, a trans man can develop vaginal cancer. A trans woman can have a prostate disorder. And someone who is nonbinary or agender can have disorders which are more commonly associated with one assigned sex than another and these disorders may be missed due to binarist or transphobic assumptions. Not to mention the sexism inherent in some aspects of medical treatment, like the fact that women rarely receive timely treatment for cardiovascular problems, and the racism which allows doctors to disregard symptoms presented by some patients because “people like you don’t get X.”

This is life or death. There have been cases in which trans* people have been denied needed medical treatment out of bigotry or ignorance and they have died or become very sick. Nonbinaries and agender folks who have highly ambiguous gender presentations may experience missed diagnoses because of conflations between assigned sex and gender made by a doctor or care provider.

So, when do you disclose, and to whom, and how? Herein lies the rollercoaster ride of the doctor’s office.

You probably don’t want to do it on the forms you fill out in the waiting room. You want to mark your gender identity there so that staff know how to refer to you. And while forms are kept confidential, there’s a high chance for being outed. If you note that you are a trans woman, for example, a staffer may blab to another staffer, someone may use the wrong pronouns (out of malice or confusion), or you could be subject to abuse. That abuse could range from finding that there is never an appointment available when you call to see a doctor to being raped while you are under anesthesia. And yes, both of those things happen.

One might think that a good time to do it would be when the doctor enters the room; say “I am a woman [or whatever your gender is], but I want you to know that I am trans* because it may be relevant to my medical care, and I am asking that it not be entered in my chart for safety reasons.” But how do you know that your doctor is friendly to trans* folks when you’ve just met? What if the doctor enters with a medical student or nurse? Worse, what if you tell the doctor and the doctor invites a medical student in to gawk at the freak?

Once you have a relationship with your doctor and you feel safe around ou, you might bring it up then. “Hey, just so you know…” But that’s going to be awkward too. You run the risk of being treated like you were withholding information. You run the risk of realizing that your doc actually is not friendly. You potentially put yourself in danger. Especially when you have a situation like, say, a man politely asking to be screened for cervical cancer. Suddenly you’re a deceiver because your body isn’t “right” and who else knows what you might have been lying about.

I’m actually pretty fortunate in this regard. I have a body which is usually read as being in alignment with my assigned sex, even though it conflicts with my gender, and as a result, I receive medical care which is appropriate to my body; I am screened, for example, for breast and cervical cancer². But this is not the case for all trans* people, and requesting care which is appropriate to your body can be extremely dangerous.

This is the direct consequence of living in a society which is centered on a cis binary. If we lived in a society in which gender was recognized as a spectrum, people could feel comfortable making disclosures about their bodies when they were seeking medical care. They could be assured that they will get the care they need and be treated with respect in the process.

Boys don’t necessarily have penises. Girls don’t necessarily have vaginas. People aren’t necessarily girls or boys.

In the doctor’s office, this can be deadly.

This is a bit of a Western-centric entry in this series, because my experiences lie primarily in the West, where clothing is very much gendered. Thanks to the imposition of Western values on other societies, I think that gendered clothing is probably becoming more of an issue in places where it probably wasn’t in the past, but because the West is what I know, that’s what I’m talking about today.

Clothing. We all need it, for a wide variety of reasons ranging from adornment to conformation with social norms. Chances are reasonably high that you have at least a small array of clothes in your house. You might have some schlubby pants for hanging around the house and doing various messy projects, you have some nicer stuff for going out, perhaps even some fancy dress and formal stuff for more serious occasions. If you’re a cis binary, you’re pretty familiar with the clothes you are supposed to be wearing, because you’ve been raised with them. They might not always be comfortable and you might not always like them, but they aren’t likely to cause a gender crisis when you put them on.

The gendering of clothing goes far beyond “skirts are for girls and pants are for boys,” although this is an obvious example of gendering. Buttons are on different sides in men’s and women’s clothing. Cuts are very different, with women’s garments tending to have a more fitted, tailored look, while men’s tend to be looser. Many clothing manufacturers make “unisex” and “women’s” clothing, underscoring the idea that “women’s clothing” is different and special and unique. Women’s clothing tends to be made with different colors, patterns, and textiles. Chances are high that, seeing something on a hanger, you can tell if it’s meant for a man or a woman.

Now, I do know some cis men who sometimes wear “women’s” clothing, for a variety of reasons. And I know lots of cis women who wear “men’s” clothes because they’re more comfortable, or because they fit better with their expression of gender identity. Some clothing stores have even capitalized on this by making “boyfriend” versions of women’s clothing; men’s clothing tailored for women, basically.

And I think that lots of people play with clothes and presentation in some very fun and interesting ways. I love seeing the ways in which people express themselves through garments, and the creative adjustments to fashion that people make in a wide variety of settings. I really enjoy looking at people who have clearly put some thought into their clothes and into how they are put together, and who pull it off. Whether it’s a wild look I would never wear which works perfectly with someone’s personality and expression, or simply a well-fitted conservative suit with just a hint of flair.

But for gender variant folks, clothing can become a snarled nightmare. Because clothing plays such a critical role in gender presentation, wearing clothes that fit your gender can actually be quite dangerous. Butch women, for example, are sometimes assumed to be men because of what they are wearing, and being outed as a woman can put them in a very unsafe position. Femme men who sometimes opt to wear skirts or other “feminine” clothing are assumed to be gay and mocked or beaten.

I’m not a binary trans person, so I can’t really speak to that experience at all, but given the struggles I experience and have experienced over clothing, I imagine that clothing is a pretty fraught issue for at least some binary trans folks as well as other members of the trans* community. Being told from a young age that you need to wear gendered clothing which conflicts with your gender identity is nothing short of heartbreaking.

For me, clothing is a constant struggle. When I wear skirts and dresses, which I like to do, I am read as a woman. I tend to wear more female-associated clothing in general because I like it and I like the way it fits, but I hate the way that it erases my gender identity as a result of the fact that clothing is so highly gendered. I hate the way that I have to erase myself, no matter what I wear; because of my body, if I wear a dress, I’m read as highly feminine. If I wear cut-off fatigues and a tee-shirt, I’m a butch woman. If I wear jeans and a cardigan, I’m a conservative and sensible sort of woman. I am always a “she” when people see me, no matter what I wear.

I can’t dress in a way which expresses my gender identity because my gender identity is not recognized, and doesn’t really exist, in the eyes of most people. I love dressing up at home and I have tremendous fun playing with clothing and my appearance, but I dread going out. Because I know that everyone who looks at me is gendering me, and I have no visible, clear way to express my gender. I can’t carry around a sign that says “genderqueer” all the time, after all.

I want clothes to be fun. I want to be able to enjoy getting dressed, to browse freely on all the racks in the store without judgment, to get excited about putting together outfits. Instead, every trip out the door takes away another little piece of me.

When cis binary folks meet new people, they generally don’t need to think about the gendering issue. They might accidentally be misgendered because people have preconceived notions about what men and women look like, but they can correct the misgendering in a relatively straightforward way, and the person making the mistake will usually be very apologetic. For trans binary folks this can be more complicated, because misgendering can be dangerous, not just socially awkward, but that’s a topic for an entirely different post.

For nonbinaries, it’s a strange place to navigate. Because people gender automatically, there’s no space to provide correct information about gender. And this means that, for the most part, we are misgendered from the start when we meet by people who fit us into a binary slot based on names, appearances, ways of movement, and so forth.

What do you do?

Do you say, “hi, my name is Xyz, and I am genderqueer, just so we’re clear on that”? Do you say “actually, please don’t use ‘he’ to refer to me, because that is incorrect”? Or do you just silently submit to being misgendered because it’s too complicated and too dangerous to get into specifics with people you have just met? This is a debate I have every single time I meet a new person. Do I identify and out myself and potentially expose myself to danger, or do I erase myself in the interests of not having to deal with it? And, by extension, can I correct misgendering later, once I am more comfortable with someone, or am I going to be entangled in a morass of binarism when I try?

This is a case in which a fundamental aspect of identity is erased with every new encounter. And in which trying to correct misidentification can lead to complications. There’s no way to know how serious these complications are until the cat is out of the bag.

Because, you see, when you issue a correction about your identity, people are often surprisingly resistant. They’ve already identified you and your protest challenges their worldview. It raises uneasy questions about whether gendering is appropriate, and about the nature of gender in general. There are lots of people who genuinely believe that there are only two genders: cis male and cis female. These people get a lot of air time, even in places which are supposedly supportive to trans folks, nonbinaries, and so forth. And their prevailing attitudes make it very hard for people with variant gender expressions to feel safe.

Every time you confront and correct a misgendering which is based on the gender binary, you aren’t just asserting your identity and making sure that someone understands how to refer to/think about you. You are actively fighting a very entrenched system of attitudes, and that means that you are going to encounter pushback. Potentially lots of pushback. This is a case in which the personal is political and identifying myself really is an act of activism.

I have literally been informed that I am “just being difficult” for asserting my identity and asking that I not be misgendered. I’ve been informed to my face that I am “making things up” and “pretending” something. That I am trying to pull some kind of trick. I’m told that it’s “too confusing” and then I am asked to educate someone about my identity. Or informed “well, that’s fine, but I am going to keep on calling you ’she’.” And I’ve heard all sorts of nasty things said behind the backs of trans* folks. We’re “disturbed” or “troubled” and “faking” and “being unreasonable” and “who ever heard of this” so it must not be real. People think that it’s safe to say these things around me because they make assumptions about my gender and I am exposed to the full spectrum of trans* hatred as a result.

And, you know, I was having a conversation with a friend the other day about the gender conversation with children, because her young son had started asking about the difference between boys and girls. And I thought “how would I approach this conversation with a child?”

With, say, a three year old, concepts like assigned sex and gender identification are, I think, a little bit too complicated. But saying “well there are boys and girls and boys have penises and girls have vaginas” makes me very uncomfortable. It erases intersex and trans* people. It hides our very existence with two neat little categories. And it teaches children to gender, and to believe that they can gender accurately and with confidence.

I get not wanting to overwhelm people with new information. I get that confusing people does not accomplish anything. But when you lay out the boundaries that way from the very start, it reinforces them and that, I think, is a problem.

I don’t really have an easy solution to this. Gender identity and assigned sex are so complicated that I have trouble explaining them to adults who are open to the idea of gender variance and who have a vague grasp on the vocabulary, and I can’t imagine how to frame the discussion in a way which makes sense to a child. You don’t want to alienate with information and words which have no meanings attached at that point in development. But you also don’t want to oversimplify. Or to make the mistake of assuming that because someone is a child, ou cannot understand things.

Or to make the mistake of going the other way, and having a child teased and tormented for being accepting of gender variance and for challenging norms about sex and gender. This is a case in which providing protection is as important as making sure that children have accurate information and that makes it a hard place to navigate.

I wonder what a difference it would make to trans* kids to know, from the start, that sex and gender are difficult and complicated things. Could you say “that’s a really great question, and the answer is actually pretty complicated,” and go from there? And say “we will probably be talking about this more in the future?” Having a penis doesn’t make you a boy. Having a vagina doesn’t make you a girl. Should we be enforcing the cis gender dichotomy by telling children this?

My friend’s child happens to be assigned male, but he sometimes gets mistaken as a girl and asked if he is a girl or a boy. The correct response, of course, is “none of your business,” and my friend has worked with him on various creative responses to that question which all say “none of your business” in a reasonably firm and polite way. But most of those responses are grounded in “does it matter?” rather than “how do you know I’m either?”

I’ve written on several occasions about the lack of a gender neutral pronoun in English. This is often viewed as a pressing problem in the context of the desire to stop masculinizing the unknown; when discussing a hypothetical or unknown person, it would be nice to not use male pronouns to do so. And, you know, that is a very legitimate concern and it’s one which should be addressed, because using male pronouns as generics does, in part, prop up the kyriarchy by creating a male default assumption.

But there’s another avenue in which this becomes a huge issue, and that’s when it comes to talking about people who are nonbinary. In this case, you are talking about the known, and you are usually misgendering the known. People who don’t know me use “she” and “her” all the time to refer to me, and it makes me cringe. Every time. Even though I say it doesn’t bother me. (Oddly enough I usually don’t mind being referred to as a woman, which illustrates the complexity of gender identity and labeling.) In the social justice sphere, people are more likely to use gender neutral pronouns to talk about me, either because they don’t want to make assumptions about my gender, or because they  know that I identify as genderqueer. But, beyond that, I get ma’m'd and she’d and her’d and there’s pretty much nothing I can do about it.

I’m actually in a fortunate position, in that my name is gender neutral. In fact, people often assume that I am male when they just have my name to go on, which is one reason why I try to be careful about distributing pictures of myself because I am often misgendered as female. (Even in headshots; although I have a somewhat masculine facial structure I have long hair and that’s assumed to be a female trait.)

And, you know, I understand why binaries do it. They’re working with what they know, which is that people are either male or female, because that’s what they have been exposed to. They’re never been confronted with gender variant people, and they reason that if it looks like a duck (woman) and it quacks like a duck (woman) then it must be a duck (woman). For someone with a clearly feminine or masculine name, there’s pretty much no hope if you want to not be gendered.

Automatic gendering is really problematic, though. Even binaries don’t necessarily identify with the gender which they may resemble. I know lots of men whom people think are women and I know lots of women who get sir’d because they have variant gender expressions, or they simply don’t meet with someone’s private definition of gender. In other words, even binary gendering is often wrong.

Whenever a new person is encountered, gendering is one of the first things that people do. It makes people extremely uncomfortable when they can’t determine someone’s gender. Someone like me, who looks like a pretty classical “woman” seems like a safe bet for female pronouns. Which actually is a pretty classical example of why you should avoid gendering people.

So, what are you supposed to do?

Well, you should probably just ask which pronouns people prefer. While it might seem absurd to you to ask someone who looks, say, very obviously like a man which pronouns that person prefers, the answer might surprise you.

You’re doing two things by doing this. You’re alerting the person to the fact that you want to make sure that you are using appropriate pronouns, as a mark of consideration and respect. You’re also alerting the person to the fact that you are creating a safe space for expression of gender variation. When you say “which pronouns do you prefer,” it signals that you do not gender automatically, that you are aware of variations in gender expression, and that you are respectful of self-gendering.

I can’t tell you how many times I’ve been in situations where I want to correct people, but I do not feel safe. Because I do not know how people are going to respond, so I remain silent. If someone asked me which pronouns I preferred when we were introduced, it would relax me tremendously. It would let me know that I am in a safe environment. Likewise, being asked how I want to be referred to would be a big help; I don’t actually use my legal name except on legal paperwork, but people often assume it’s the name I want people to use because people use it to introduce me.

This is another case in which taking steps to include nonbinaries may be perceived as stepping on the toes of binaries, especially cis binaries. But, you know, it’s not. There are plenty of binaries (even cis binaries) who are misgendered and may well appreciate being asked which pronouns they prefer. Likewise, lots of people get introduced with the wrong name/a mispronounced name, and would appreciate a chance to correct it without causing a scene. And while some pushback may be encountered, and there may be environments in which it is not safe to ask about pronouns (because signaling that you are an ally can, unfortunately, be dangerous in some settings), in which case you should not endanger yourself by asking, I think that the benefits outweigh the costs.

Never assume that the name other people use to refer to someone is that person’s right name. Always ask. Whether it’s “how do you prefer to be called” or “I believe your name is Cindy, is that right,” it can save someone discomfort and embarrassment. Likewise, don’t assume that the pronouns other people are using are correct; get the answer straight from the horse’s mouth when it comes to finding out about things like this.

You may inadvertently open up a discussion, in fact, by giving someone an opportunity to self-identify and to correct improper pronoun usage. Someone who  has been chafing at the wrong pronouns may well be delighted to have a chance to say “hey people, you have been using the wrong pronoun.”

It might sound ludicrous to think that someone would allow ouself to be misgendered, repeatedly, but it happens. It’s awkward and embarrassing to correct the wrong pronoun usage, especially when correcting pronouns may expose someone to physical danger, ridicule, gender policing, etc. Creating a safe space to talk about the tremendous variation of human gender will help people feel more comfortable when it comes to self identifying.

I want to add another note about names which is actually not specific to the binary/nonbinary issue. People, please punctuate and capitalize names the way people want them punctuated and capitalized. Doing things like capitalizing someone’s name when that person prefers lower case, or ignoring punctuation, is profoundly disrespectful. It signals that you don’t care about what this person wants to be called and how this person wants to be identified. Try to mirror name usage (e.g. my name and nom de plume are ALWAYS presented in lower case, there is NO REASON to uppercase them) and if you aren’t sure about how someone wants to be capitalized/punctuated/spelled, ASK. And when someone corrects you if you make a mistake, please be polite, apologize, and fix it.

It may not seem important to people with names which are cased and which lack punctuation, but it’s really important to those of us who do use punctuation and who opt for lower casing. Punctuation in particular may be the result of trying to transliterate a foreign language name, in which case it provides clues to pronunciation, making it important to retain it EXACTLY AS WRITTEN. Every time I see my name written out incorrectly, it upsets me and it signals to  me that the writer does not respect me. It’s not like there aren’t a plethora of examples of how I want my name written right on this very website, including at the top of every single post.

You can call us pretentious and unreasonable, if you want. But keep in mind that I retain your spelling, capitalization, and punctuation without comment (and will gracefully correct when I get it wrong), and maybe you should consider doing the same for people with names which may look unfamiliar and “funny” to you.