July 6, 2022

Is it OK for a cis woman to refuse treatment from a transgender gynecologist?

Photo of transgender gynecologist Petra De Sutter from Open Dialogue.

Petra De Sutter is a gynecologist and politician, currently serving as the federal Deputy Prime Minister of Belgium. Would it be OK for a cis woman to ask for another female gynecologist, if Petra was the one assigned to her? 

Sometimes I get questions via tumblr over at my Trans-Express news blog. Some are genuine and well meant, while others are traps set by transphobes who aim at luring me into saying something they can use against trans people in general.

The following question might have been such a trap:
Do you believe that if a woman or girl requests a female gynaecologist, and the gyno is a pre-transition trans woman, the patient is transphobic for being uncomfortable or asking for a cis woman doctor? Genuine question.
There is, in fact, a good chance this questions was written by a British TERF (trans-exclusionary radical feminist). 

However, as I started thinking about the question I realized that this was an opportunity to say something more about the kind of bigotry we find in racism, homophobia and transphobia. So I wrote an answer.

Here it is:

Social conditioning

There are many levels of bigotry – being this racism, homophobia, transphobia or any other kind of aversion felt towards minority groups. The phobia can be conscious, deliberate and hateful, or it can be implicit and an indirect effect of cultural prejudices.

One of the ways society keep marginalized groups excluded is by conditioning its citizens to fear or loathe them. This is not only a mental process; it is an emotional form of conditioning.

Kids will, from a very young age, see that their parents and peers express distaste when meeting – or talking about – members of these groups.

The same adults will often use the same kind of expressions as when they talk about something diseased, rotten or corrupt. Kids pick up on these feelings. They develop the same emotional responses.

Bigoted narratives reinforce the phobias

This process is of course accentuated by the way the bigots present the children with narratives aimed at legitimizing this aversion.

We have all heard these stories: "The Jews are part of a world-wide cabal aimed at ravaging white women, sacrificing or kids and turning us all into Communists," or "Black people are primitive, lazy, violent and promiscuous animal-like beings who threaten white women and kids," or "Gay people are grooming good kids to become queer pedophiles."

Fascist propaganda is actually very much about presenting outsiders as a sexual threat to predominantly white women and kids. This tactic legitimizes policies aimed at oppressing those marginalized, and this oppression in turn creates more distrust and disgust.

This is the tactic the Republican party is using against LGBTQA people and immigrants in the US right now, and is a strategy exploited by the so-called "gender critical" TERFs of Britain.

Freeing yourself from phobias

Note that it can be hard to overcome such feelings of loathing and fear, since they are based on long term reinforcement. This means that someone who intellectually have understood the nature of transphobia or racism, and who consciously supports trans rights or the civil rights movement, may still harbor bigoted feelings.

Illustration: nadia bormotov
Indeed, getting rid of such feelings may take time. It often requires regular contact with members of the marginalized group, so that your subconscious come to see them as regular people and not as some kind of scary "Other".

So a woman who – because she has been raised in a racist or transphobic environment – feel unease about being cared for by a Black or transgender woman, may on one level be an anti-racist or trans-supportive person, but may – nonetheless – express racist or transphobic feelings. Because of this she continues to reinforce the negative biases of this world.

Is she a bad person? I wouldn't say so. But it would definitely help if someone helped her out of that state of mind.

Experienced as invalidating aggression

Dismissing a Black gynecologist because she is Black or a transgender doctor because she is trans, will definitely be experienced as a bigoted reaction. The doctor will experience this as aggression aimed at invalidating her status as an equal human being.

Now, the question posed is a bit confusing, as it is referring to the female doctor being "a pre-transition trans woman". A trans female caretaker who works as a woman will have already come out. She has transitioned, at least socially. She presents as a woman. She is a woman.

I know of no one who allows closeted trans women (i.e. those who publicly still present as men) to work as female doctors.

It might be the expression is not referring to this trans woman having socially transitioned. Instead the question might be alluding to whether she has been through hormone replacement therapy and surgery, so that she easily passes for a cis woman.

But that brings us back to the social conditioning: The unease someone feels from facing a woman who is visibly trans (or meeting a female doctor who is clearly a woman of color) is caused by a transphobic or racist culture that teaches us that transgender or Black women are dangerous, contaminated or inferior. That is clearly a transphobic or racist reaction, even if the patient's conscious intentions are good.

We cannot win the battle against bigotry if we continue to insist on keeping the marginalized groups segregated from "normal" society due to the misguided fears of prejudiced people. That segregation is in itself one of the instruments used to keep the oppressive system in place. This applies to bathrooms, participation in sports, as well as gynecology.


So what was the point of this question?

There is, obviously, a chance that this question was well meant and that the anonymous reader of my Trans Express blog truly is puzzled about what a cis woman is to do when she is facing a transgender doctor. This puzzlement is in itself a sign of bigotry, albeit a mild sort of transphobia.

However, it is also possible that the point was to make such the transphobic reaction of the hypothetical patient understandable and acceptable among cis women and cis men. 

This is one of the most efficient tactics used by TERFs. They appeal to the ingrained transphobic prejudices of cis women  and men or they explore their fear of men invading women's safe spaces ("the penis" in TERF lingo). 

Given the blatant misogyny and sexism found among many men, it is not hard to find vulnerable and wounded cis women who may fall for this ploy. They are genuinely afraid of a genuine cis male threat. 

The ploy also works on sexist men who think that women are so weak that they have to be protected at all times by strong men  in a world full of male predators like themselves.

But notice how this rhetoric turns the oppressed (trans women) into the oppressor. The victim is now the cis woman coming to the clinic. Being"forced" to consult a transgender doctor has now become an act of violence. Being "forced" to "play nice" is now a threat to women's power and female independence.

The threat to the transgender woman is completely glossed over. The fact that she, on a daily basis, faces the same misogyny as the cis woman is dismissed. The fact that she in addition to sexism and misogyny must face transphobia is conveniently forgotten.

If the TERFs can get support for the idea that it is understandable that cis women feel unease around transgender trans female doctors, they have also gained support for the idea that trans women are men.

The acceptance for this unease becomes an acceptance of their transphobic narrative.

This is why I think that it is extremely important that trans people and their allies see through this tactics and show people that trans women are women too. Trans people are people too. The fear scenarios painted by TERFs and other transphobes have no foundation in the real world.

The tactics used by TERFs is the same as the ones used by the extreme right in their attacks against women, people of color, gay and lesbians. By parroting the right wing talking points, the TERFs are pouring gas on the current fascist resurgence found in countries like Russia, Hungary, Poland, Britain and the US. Their defense of a banal and misleading gender binary is playing straight into the hands of men and women who wants to bring us all back to the 19th century.

That is not feminism. That is destructive bigotry.

See also: "White supremacist danger narratives",  by Ashley C. Rondini


  1. Jack, your article brings up interesting questions. First and foremost, though, I am starting from an awareness that trans people (of any stripe) are as normal as anyone else. I often say that "trans" is simply another adjective that describes me, including woman, right-handed, grey-haired, engineer, and so on.

    I thus think that sure, anyone (cis or not) has full freedom to choose, select, or change ones medical providers. Yes, they might be a TERF or generally misogynistic but we cannot control that and even if their reason for wishing another (in this case, non-trans) physician I really think the trans provider should be gracious and helpful in supporting their desires.

    Through that we can hope that the patient will not leave the office with their prejudices underscored. Instead, someday, they may start to wake up to a new awareness that we're as normal as they are.

  2. I see what you are getting at, Emma, and a person's right to chose their own health service provider is important. I agree.


    I know of a lot of instances in Norway where patients have refused help from doctors and nurses of color. Is it their right to do so? I am not sure about Norwegian legislation regarding this right now (I suspect it is not OK), but let us say it is legal.

    Would it be morally right? I would say no, as it is clearly represents a racist kind of aggression, even if the patient is not consciously aware of their own bigotry.

    Would it be right for society? No. Because an acceptance of this behavior hospitals or a homes for the elderly would signal to all others that this society thinks racist reactions like this one are within the realm of acceptable social behavior.

    This would also imply that society thinks that it is OK for people to invalidate people of color in this way, implying that the preferences of the white racist patients trumps the rights of the non-white caretaker.

    Ditto for trans doctors and nurses.

    That can't be right!

    Is it possible to do something about this given that we want to protect the individual's right to chose a doctor or a nurse that does not threaten their safety?

    I think that is possible. If the patient dismisses a doctor the first time they see them, the motivation is most likely based on bigotry. If they dismiss them the second time they are given an appointment with them the refusal is most likely based on personal experience. The first reaction is not OK, the second is not, as I see it.

    1. Hi Jack, you make excellent points and, indeed, I'd thought about writing a little about racism.

      All of these examples of rejection are morally wrong, I could not agree more.

      But racists exist, So do TERFs. People who are against a woman's right to choose (and doctors who support them), anti-vaxxers, religious fundamentalists who refuse medical treatment for their dying children.

      I believe that holding the moral high ground is the best way to live and perhaps eventually convinces those who are prejudiced that they may have been wrong.

      I can and do pass moral pass judgement on these people (internally or sometimes, with friends). But I also respect their right to their beliefs and choices.

      I draw the line at disrespect, discourtesy, and expressed hate. If I were a cis woman who didn't want an exam or treatment from a (trans) woman gynecologist that would be terribly awkward for sure. I think there are several cases to consider:

      1. When I first meet the doctor and believe she is trans I could say, "I don't mean to be rude, but are you trans? If so, I must insist on another doctor to do my exam."

      I'd suggest that the (trans) doctor smile and say, "Yes, I'm trans, and while I don't understand your concern I respect it. Please wait a moment so I can see if another is available."

      2. When I first meet the doctor and believe she is trans I could say, "I don't mean to be rude but... are you trans?"

      The doctor might smile and say, "Why, yes I am."

      To which she might say, "Awesome, just curious!", lay back and prepare for the exam.

      3. When I first meet the doctor and believe she is trans I could say perhaps with a wrinkle in my forehead, "Are you trans?"

      The doctor might smile and say, "Why, yes I am."

      To which I might respond angrily or with disdain, "Oh my god, you people. No no way. Get me out of here. I will never allow someone like you to touch me."

      I'd suggest that the (trans) doctor continue smiling (as hard as that might be and say, "Oh. Well, while I don't understand your concern I respect it. Please wait a moment so I can see if another is available, or would prefer to go elsewhere?"

      In all three cases the doctor holds the moral high ground and doesn't provide the patient with fodder that she can replay later with her friends to throw the doctor (and trans people in general) under the bus. But hey, she may and probably will anyway. There's nothing we can do about that. Some people are jerks!


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