Nine years ago, when I spotted blood in my ejaculate, I made an appointment to see my urologist. I quickly found myself to be the only woman in the waiting room. A handful of men surrounded me, and I could see the gears turning in their heads, wondering why a person who presented as and looked like a woman was waiting alongside them.

“Is your husband in there?” said the man two chairs to my right. As a transgender woman, passing as the gender I align with is one of the most joyous and validating feelings. For those of us who have gone through male puberty with masculinizing factors, aligning our external social presentation with our innermost core identity of gender requires both effort and luck.

If we were not in a doctor’s office, I would have remained sociable and continued the conversation. But here, I tried to avoid it, hoping to prolong the secret that the urology appointment was for me. “No,” I said with a polite smile.

The waiting room brought up all too familiar feelings: anxiety, uncertainty, and the fear of what the remaining men would say or think if I was outed. It also highlighted one of the core tensions in seeking quality health care as a trans person: We need providers to honor our gender identity beyond the simplistic frame of biology while being attentive to biological needs often linked to sex.

As I approached the front desk, a receptionist inquired if I was checking in on behalf of my husband. A second receptionist—the one I had spoken to on the phone to make the appointment—pulled the first to the side and whispered that the appointment was for me, and that I was a transgender woman.

The first receptionist stammered, apologized for the confusion, and handed me a clipboard to fill out my medical details. I sat back down, feeling incredibly self-conscious. Now the entire waiting room likely knew of my situation, that I—like all of them—had a prostate that needed to be examined.

The expectation of rejection and the cost of self-policing has profound effects on transgender lives. We are forced to live a life of vigilance, knowing our gender can shift in the eyes of the public at any moment. This is exhausting, and it can also have devastating health consequences. In a 2020 survey conducted by the Center for American Progress, 28% of transgender respondents said they had postponed or avoided necessary medical care in the past year out of fear of discrimination. Such fear inspires some trans people to cut off their history, drawing a clear line from the moment they transition and choosing to not look back on their “former” lives. But those lives also contain medical history that our bodies can’t discard.

Because of this, doctors’ visits often feel like a forced “outing,” where we have to disclose our history in order to receive an accurate diagnosis. Despite the legal and professional rules that govern medicine, medical professionals are still, in the end, human. Some are accepting and tolerant, others are indifferent and ignorant, and still others are just plain spiteful.

When I had my hip labrum cartilage repaired, I knew the bottom half of my body would be naked on the operating table, which meant my penis would be out in the open for all the doctor’s assistants to see.  The fact that I’d be under anesthesia and unconscious didn’t deter me from making an effort to boldly declare my womanhood while unclothed. I got a pedicure two days before my surgery and picked a bright fuchsia color—the same one I’ve used for over a decade—that I thought might help minimize the chances of being misgendered by the nursing staff as I waited for surgery.

But the day of the procedure, a snobbish blonde nurse looked me dead in the eye and called me “he” as she handed my medical chart over to my surgical coordinator. I made a polite attempt to correct her, but she kept referring to me as “him” and “he” to the other nurses. Finally, the surgical coordinator came to my side, rolled her eyes, and said with a nod: “I know, I know. Just ignore her. She’s just a bitch.”

Tragically, this experience is routine for trans people seeking health care. In a poll conducted by KFF and the Washington Post, 31% of trans adults reported that a health care provider had refused to acknowledge their gender identity, using instead their sex assigned at birth. Health care providers need to acknowledge our core identities even as we need to divulge our raw and tender histories. And precisely because this process can be so excruciating, it is critical for the transgender community—and the medical sectors that support us—to be consistent and precise with our language around gender, sex, and medicine. We must emphasize that being trans is about being seen for who we are as individuals rather than merely our biology, while also advocating for the quality, compassionate health care that our biology might necessitate.

Underlying all of this is the frustrating reality that doctors are fallible and sometimes misinformed, which means we must speak up for ourselves when the situation demands. Infuriatingly, the 2020 Center for American Progress survey found that one in three transgender respondents had to “teach their doctor about transgender people in order to receive appropriate care.” That was the case when I asked my general practitioner for a full panel of STD tests, only for him to ask if I had sex with men.  I was so afraid to come off as double queer—a transgender bisexual woman who had anal sex with men—that I lied and said I only dated women. “You don’t need the HIV panel if you don’t have sex with men,” he said. I was shocked at his ignorance, and to this day regret not speaking up to inform him that the spread of HIV isn’t restricted to anal male-on-male intercourse. I can’t help but wonder how many additional people he misinformed due to my reticence.

I remembered the cost of remaining silent while at a doctor’s visit last summer, when I needed an X-ray. “Are you pregnant?” the nurse asked.

“No,” I replied, “I can’t get pregnant.”

She looked at me with one raised eyebrow. “How old were you when you had your hysterectomy?”

As good as it would have felt to continue to play along as a woman who was born female and had gone through puberty as one, I instead chose discomfort. When I told her I was transgender, she nodded, thanked me for my transparency, and proceeded to strap the lead vest on my chest.  As the X-ray machine began to whirl, I smiled. It took bravery to own that moment of authenticity. But being honest with my nurse translated into better care for myself—and maybe the next patient she works with, too.