OPINION | It’s Time to Stop Behaving As If Cisgender People Do n’t Benefit From Gender-Affirming Care

by Megan Burbank

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Last week, I was prescribed androgen blockers. It took seven minutes. After an online consultation, a dermatologist I never spoke to, but who looked at photos of my face, decided that, like many cisgender women before me, I could go on a drug to reduce the amount of testosterone in my body so I can have clearer skin. He wrote a prescription. It was filled immediately and the pills were sent to my home. The entire process was one of the easiest medical experiences in my life, and it made me one of many cisgender people who take androgen blockers or other hormonal treatments as part of our health care.

On Reddit forums, on women’s general-interest blogs, in before-and-after pictures, numerous freshly clear-skinned cisgender women sing the praises of this drug, to which they attribute all manner of benefits, from snatched waists to thicker hair to a general sense of amplified prettiness. And I get it. In a funhouse-mirror world of pandemic skips and semaglutide and Instagram filters and vapid arguments that heroin chic is coming back (no thank you please!) — and in a country with deeply sexist, racist, homophobic beauty standards — it’s easy to feel excited when you can feel reasonably good about how you look.

But this celebratory approach to androgen blockers is also an erasure of the fact that cisgender women are benefiting hugely from a drug that’s gatekept for transgender patients but not for us.

Because that’s what else this drug is also commonly prescribed for: Its feminizing effects mean it is often used in gender-affirming care. The only reason I was able to skate through a consultation to get on it is because the cosmetic goals I’m seeking happen to align with the sex I was assigned at birth.

Meanwhile, gender-affirming care more broadly is being targeted across the country through bans and restrictions from right-wing politicians adapting their decades-old anti-abortion playbook to attack yet another marginalized community. While this is happening, cisgender women are taking androgen blockers off-label without incident, revealing the deep-seated hypocrisy of these policies.

That double standard got me thinking about all the ways cisgender people benefit from gender-affirming care, and, in fact, how critical it is to our everyday functioning, even if we don’t think of it that way.

I certainly hadn’t. But once I did, it was everywhere: pills for erectile dysfunction; drugs to reduce baldness and facial hair in cisgender women; hormonal treatments to preserve bone density during menopause; fertility treatments; breast reductions and reconstruction; cosmetic procedures to enhance one’s alignment with traditional and trending modes of femininity.

Some of these procedures are life-saving and crucial. Some are elective. But they all share commonalities with gender-affirming procedures, and in some cases are identical. They help people feel more closely aligned to their gender identity when illness, infertility, age, or hormonal imbalances make it impossible without medical interventions. This is gender-affirming care, and cisgender patients rely on it all the time.

Before going on androgen blockers, I’d always supported access to gender-affirming care, but I didn’t see that I benefited directly from it, too. Obtaining androgen blockers with the ease one might encounter while placing an Amazon order made me see clearly how striated access to these drugs really is. It exposed the deep, hateful artifice of imposing barriers to identical drugs and related procedures only — or more often — when they happen to be part of gender-affirming care for transgender patients.

On top of this jarring disparity in access, I sensed something else in that initial medical encounter that’s missing from many conversations about gender-affirming care: trust. The drug I was prescribed can affect potassium levels in the body, and I was immediately entrusted with setting up appointments to get labs done monitoring mine. I received appropriate prescribing information about what I’d be taking, along with the risks and benefits. But the decision-making was all left up to me. There were no hoops to jump through. As a patient, I had agency, and was treated like the best possible witness to my own experience.

When it comes to medical care, we’re not talking about anything less than that. When treatment is respectful, it means our humanity and dignity are recognized by someone we feel we can entrust with the care of our bodies and the stewardship of our lives. When treatment is not respectful or accessible, it can lead to poor outcomes, painful experiences, and even medical trauma — and no one is exempt. So it’s time to recognize that when we remove barriers to politicized medical care, whether we’re talking about gender-affirming care or abortion, it benefits everyone who may need this care down the line, even if they don’t know it yet, and even if, like me, they mistakenly think it doesn’t apply to them at all.

If my journey into the world of androgen blockers taught me anything, it’s that getting treatment for a medical concern doesn’t have to be torturous or time-consuming. It can be efficient, respectful, and user-friendly. If you can dispense a drug this easily for some patients, there’s no excuse to make it harder for anyone else.

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📸 Featured Image: Photo via Jo Panuwat D/Shutterstock.com

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