hey there. i'm nonbinary and i really want to transition (have been for years) but i have an incredibly awful fear of doctors due to trauma, so the idea of trying to transition absolutely terrifies me. do doctors perform any kind of invasive exams before prescribing hormones (genital exams, etc) that i should know about? right now transitioning feels like a fantasy that I'll never achieve. i feel lost and afraid.
I have personally never heard of or experienced a genital exam as a prerequisite for hormones. If it helps you, here’s what I went through, roughly in chronological order:
Physical exam—height, weight, blood pressure (both sitting and standing because I have autonomic issues), and physically pressing on my abdomen to check for liver tenderness. (I don’t know if the last one is common practice, because that’s been a mystery pain for me for a while, so it could have been specific to my history.)
Between my first and second appointments, I had bloodwork done—it looked at baseline T levels, cholesterol, thyroid function, fasting glucose, white/red blood cell count, and general haematology.
The second appointment was a psych evaluation—asking both about my diagnostic history/emotional state, and giving a very rudimentary screening for symptoms that would be considered to “impair reality testing”. They also asked during this appointment if I was sexually active, and gave me a brief rundown of how testosterone might affect that (changes in drive and how it’s not birth control, mostly).
The psych evaluation also included, effectively, a diagnosis of “gender dysphoria” as required for prescription treatment. This involved the doctor asking me questions about my identity, how long I’d known I was trans for, and how first puberty impacted me emotionally. Some of these questions were about secondary sex characteristics—”how did you feel when you started developing breasts”, for example.
The third appointment was bloodwork analysis and me signing a bunch of consent forms to show that I understood, and then he gave me the prescription.
This is a lot of involvement with the medical system, especially if you don’t normally go to the doctor with any frequency. I don’t know what your specific triggers are, but I can’t think of any reason they would need to tell you to have a genital exam—the physical assessments are to screen for health conditions like high blood pressure or high cholesterol that could be affected by hormones.
If being physically touched by a doctor for things like putting on a blood pressure cuff or having blood drawn would be a trigger for you, I’d encourage you to vocalize this if you’re able and feel safe to do so directly to the doctor or nurse who’d be doing the exam. With trauma, it’s really hard to speak up about this, especially if you feel like you’re back in the traumatizing situation—it’s totally, completely understandable that this would be terrifying for you. But doctors who are any good at what they do will take steps to help you be comfortable if they’re able to and aware of your needs for space and aware treatment. This goes double for many doctors who specialize in trans care—they’re already working in environments where their patients may be distrustful of the medical system for a variety of reasons, and where a much higher proportion of the population has trauma of some kind. If you go to a doctor and you don’t feel like they’re taking your trauma seriously, you have the right to walk right the fuck back out of there. Nobody will make you get hormones. That’s driven entirely by you. This is a situation in which you have the control over your medical experience and the right to stop it at any time.
I’m not going to tell you how to handle your trauma, because that’s extremely not my place and you know yourself better than anyone. I will say that the fact you’re considering medical transition with this additional obstacle is extremely brave and reflects some very admirable self-awareness in how you’re considering what might be a problem for you. If you have access to services in your area where a doctor will offer a preliminary consultation before doing any physical or mental exam stuff, that might be a good thing for you to access—that way, the doctor can tell you specifically what they do during their evaluations, and you can be best equipped with information you need to feel safe and secure in a situation that’s been previously traumatizing for you.
The wpath guidelines do indicate to discuss a schedule of genital exam based on risk (different based on age, sexual activities). I have known trans people who have had genital exams as part of their pre-hormone exam, but it’s Not typically required. Remember that the patient bill of rights allows you to decline any part of the care process, and to outline how it’s provided (“please let me know if you’re going to have to touch me in any way, even on my hand”) (“at this time I’m not comfortable with that type of exam”). There may be certain types of care certain doctors won’t/can’t give without certain exams but the gold standard of care down not require a genital exam before providing hormones, just to discuss timing of the exam based on your level of risk. (Hormones can increase the risk of certain types of genital cancers that these tests can detect). Mod mayhem
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