Cisgender Healthcare Needs

I thought I’d start my writing this time with a quote from Clay Stafford that well describes my goal for this blog. Clay has had an eclectic career, as an author, filmmaker, actor, composer, educator, public speaker, and staunch supporter of other writers. On his website in December (claystafford.com), he said:

“I align my essays such as this with my goal of helping writers succeed. I do this by offering advice from my experience, what worked for me, and what did not.”¹

Similarly I align my essays discussing how Marcie and I succeed in keeping our relationship alive by offering advice from my experience (in life and as a nurse), what worked for us, and what did not.”

Introduction

The healthcare needs of those who are trans are well discussed within the literature. However, Van Acker, Dewaele, Elaut, and Baetens² (from Belgium)agree with my observation that there’s not an abundance of research or recommendations regarding the healthcare needs of cisgender wives paired with trans women. Van Acker and colleagues also state that WPATH (World Professional Association for Transgender Health – wpath.org) recognizes the value of including the CIS partner in the care of the transitioning partner without providing specific guidelines for what this should look like.

This lack of attention to cisgender wives is not totally of healthcare providers own making, however. At the time most of my doctors, nurse practitioners, nurses, and physician assistants (referenced here as primary care providers, PCPs) were in school they were taught little to nothing about transgender patients, much less their family members.

When I was an instructor in a community health course ( 2017-2019) my co-instructors and I followed the curriculum established primarily by our predecessors. As specified, I spoke to students about the health care needs of lesbians, gays, and bisexual clients, but content on the needs of transgender patients or their partners was not included.

Topics related to the transgender community were addressed during campus seminars and workshops, but none of these paid much, if any, attention to spouses or partners. Thus we, as cisgender wives, can’t assume that our PCPs understands our healthcare requirements. If assistance is needed, we must ask. And many PCPs may not have an answer.

The remainder of this post will address three typical needs of cisgender wives, mental health challenges due to co-transitioning with our spouses, sexual health related to changes in gender identity for one or both of us, and our role in assisting our spouse as they go through medical procedures related to transition. As with previous posts, this one will not address kids or teens as I lack experience or expertise in that area.

Cisgender Wives Personal Healthcare Needs

This has been one of the hardest of the blogs I have written. Even without the references above, I felt early on that my healthcare providers needed to know I was married to a trans woman. What I didn’t know was exactly what I expected from them or how to approach the topic.

In my earlier drafts of this blog  I was working too hard to articulate needs of cisgender wives using the detail I would expect in an academic nursing paper. But in this case I’m not the nurse, I’m the patient. When I stepped back to gain perspective on my needs as a client, I realized my overarching desire was for my PCPs to ask me how I was doing. I was searching for recognition of the fact a trans relationship has two parties.

Obtaining this recognition was initially difficult because Marcie was hesitant to share the ongoing changes in her gender identity with others. So, I followed her lead, staying quiet. Plus, we had an ongoing relationship with our shared nurse practitioner. If Marcie hadn’t shared this information with her, at what point would it be acceptable for me to share? And, if neither of us shared, my NP wouldn’t even know to ask.

Looking back I recognize I should have spoken up sooner. But even with my professional experience I was too scared, too out of my league to even know how to begin with some of my concerns.

Marcie eventually talked with our NP about hormones. Although, as I expected, her provider had to do her own research. This opened up the conversation between the two of them. Although our provider had permission to share information about each other, this did not lead to her asking me how I was doing. I expect if I had brought up the topic she would have been willing to explore my feelings. However, I was still too uncomfortable with the whole idea of Marcie’s change in gender identity to do so.

When we moved to the southeast, this created a point in time where it was more logical for me to bring up the topic of Marcie being trans. The paperwork used by the clinic required I identify if I was married and if so, my spouse’s name. For this I entered Marcie, then in parentheses put her legal name.

This information still didn’t prompt my PCP to ask the question of how I was doing. Rather our conversations were about  updates on her condition, especially once she started to schedule surgery.

My annual physical is coming up soon. As readers know, I’ve had some rough spots this last year. In an ideal world, my PCP would not just ask me a general question such as ‘how are things going’ or ‘how are you feeling’. Rather, more directed questions such as ’how are you feeling about the changes in Marcie’s appearance’, ‘how’s your sleep,” or ‘are you still exercising even with Marcie being more house bound’.

Since I doubt my PCP will ask these question I’m going to try and make a point of relaying to her my reactions to Marcie’s surgeries. This won’t necessarily be easy, but I want her to become aware that she should be asking about my mental health during my visits, even if I appear to be fine.

Ideally she’ll also document my mental health in my medical record. While I’m not experiencing severe symptoms of stress at the moment, having this information in my record should help her to recognize any symptoms before they became critical.

An additional note for healthcare providers reading this blog is that besides being cognizant of the mental health needs of your clients married to trans folk, it’s also advisable that you attend to their sexual health needs. Changes in sexuality are often observed in one or both members of a trans relationship. A recommendation for counseling may become appropriate.

In some cases one or both partners of a trans relationship become non-monogamous. If so, providing education on  prevention of sexually transmitted disease and pregnancy may be indicated.

Caring for Health Needs of our Partner

Besides caring for myself, I’ve also been responsible for providing healthcare for my wife, particularly after the procedures needed for her transition. In my case I understood much of the ‘patient’ care aspect of managing her surgeries. Caring for her drains and bandages needed to manage bleeding wasn’t challenging, just time consuming. Getting her to cough and deep breathe, to take her pain meds, and helping her get in and out of her bed or chair were second nature.

I was, however, unfamiliar with guidelines for nursing care for the specific procedures she’d had and preferences of her surgeon in regard to activity, pain control, diet, etc. Here I was frustrated. I received a separate set of instructions for each procedure. These instructions amounted to over 9500 words  (21pages), in three different computer file formats.

This information was not individualized to her specific needs. The instructions were usually redundant and at times internally inconsistent. For example, one said ‘bedrest for three days’ and in another she was ‘encouraged to walk around the house on the day of surgery’. The organization of topics varied across documents making it difficult for me to summarize the information on a single topic such as pain. I needed over two hours to create a combined set of instructions I could use to help her. If I hadn’t been a nurse I might not have been able to figure which of the nine recommendations to follow. This approach of using a separate set of instruction for each procedure makes it easy for the surgeon and their staff but almost impossible for the patient to comprehend their partner’s overall needs.

To help with this problem I suggest you ask your wife’s surgeon for a copy of all post operative care instructions ahead of time. Read them before you go to her preop visit. If you are confused, write down your questions. Bring a large pad of paper to document the answers.

I found  that what was missing from the instructions was as important as what was present. These missing items related primarily to adapting a home environment to patient care. Before the preop visit think about how your partner will move around your home, get to the bathroom etc. If you identify challenges to which you don’t see a solution, ask a clinic staff member, particularly a nurse, for suggestions.

The information above on care for my wife was helpful but not essential for me because of my nursing background. What I wasn’t prepared for was the emotional impact the surgical changes would create. No one mentioned I might not recognize my wife, even after the swelling and bruising had resolved.

After the procedures on her upper face her appearance changed, but not dramatically. It was the reshaping of her jaw, cheeks, and chin that had the greatest impact on me. I had no concept of what feminization would look like in reality. Providing me with more ‘before’ and ‘after’ pictures with a discussion of what would change would have helped. As I’ve mentioned before it was adapting to the fact that she no longer resembled her sisters, which was hardest to accept.

A few other questions I wish that I’d asked that would have better prepared me for what to expect postop include:

1. What is the shortest and longest recovery period I could expect for someone like my husband? Physicians won’t give you a specific number for anything. They like to say, “it depends.” So phrasing my questions in the form of a range would have helped with my expectations for recovery. For example, had I been working this would have provided me with some idea of how much sick leave to request.
2. Given my spouse’s age and health, what complications do you expect with her? How often have these occurred in your practice? How long have you seen these issues take to resolve? The answers to these question would have helped us plan our future? When could we visit friends? When should we plan our yearly vacation? I don’t know about others, but my wife was a complication magnet (see other posts for examples).
   1. As an aside, surgery is not a perfect science. You actually want your surgeon to have encountered complications in their practice. Then they will have had experience in identifying their onset and in dealing with them.
3. What does full recovery look like? Try to get pictures of women of similar age, appearance etc. Looking at 20, 30 year or even 50 year olds and their results gave us no sense of what she would look like afterwards.
   1. Once she healed she looked great. She appeared to be an age appropriate, beautiful woman. So don’t assume from my comments that nothing good will come from surgery. “This” is what she wanted. I just didn’t understand what “this” was.

In summary, I want to remind readers that the healthcare community has not yet caught up on the needs of cisgender wives of trans folk. In all likelihood you will need to ask for the help you need, be that counseling, further information on surgical procedures, or something else. The good news is the increasing availability of other folks like us who have been through similar experiences. They have the potential to assist those of us following behind.

While Marcie and I have survived a long gauntlet of new care providers, procedures, and complications, we have come out the other side with our relationship intact and probably stronger. But we are just one example. If you have suggestions you would like to share with others please leave a reply below. I review all replies before they are released for publication. I always respect requests to remain anonymous.

My next post is planned for February 18^th. The topic for this discussion has not yet been identified.

My website needs updating and renovation for a variety of technical reasons. If you find the site it is not available at times during the next few weeks do not interpret this to mean that I have disappeared. I will be back. Thanks for your support.

References

1. Stafford, C. (2024) The four Ps of marketing: An Overview (Part 1 of 2),    https://claystafford.com/blog/the-four-ps-of-marketing-an-overview-part-1-of-2.
2. Van Acker, I, Dewaele, A., Elaut, E., Baetens, K. (2023). Exploring care needs of partners of transgender and gender diverse individuals in co-transition: A qualitative interview study, Healthcare, 11, https://doi.org/10.3390/healthcare11111535.

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