Author: Kade MacKillop<\/p>\n
Introduction<\/strong><\/p>\n Transmasculine individuals face unique roadblocks in seeking medical care, reflecting a wider, systemic invisibility of transmasculine lives. Research regarding the causes and possible solutions for this issue is important for the field of trans studies, in order to help bridge the knowledge gap on transmasculine-specific phenomena and dispel the invisibility and subjugation surrounding transmasculine knowledges of our bodies and our needs. This research is also necessary because medical neglect of transmasculine people leads to real-life negative health outcomes, and more broadly, it provides a lens through which to reimagine medical care in a way that doesn\u2019t overlook the specific needs of marginalized groups. In this paper, I\u2019m using the terminology \u201ctransmasculine\u201d to refer to binary and nonbinary transgender men, as well as masculine identifying gender-nonconforming or intersex individuals, not to conflate these identities, but to encompass more of the range of people affected by this issue.<\/p>\n Transmasculine people face specific discrimination in several spheres of medical care, particularly in accessing what is typically regarded as \u201cwomen\u2019s healthcare,\u201d reflecting larger bioessentialist assumptions that inform medical practice. These difficulties range from absence from medical research, a lack of inclusion in family planning, and unfamiliarity and discomfort of practitioners with transmasculine patients (Jaffee et al., Alpern, Sbragia and Vottero, Ramadan et al.).<\/p>\n We start with the base problem that transmasculine people are largely excluded from medical research. The varying effects of exogenous and endogenous hormone production\u2013especially how these variables interact with other treatments\u2013are largely unknown and rarely studied (Jaffee et al.), mirroring how earlier medical research excluded female participants and generalized results anyway. Although research has expanded to include cisgender women, the bioessentialist view that cisgender men and women are the only gender expressions worth studying devalues trans lives by not accounting for their specific medical needs. This harmful practice has real-world effects, with trans men citing that dealing with the medical system is so difficult that they turn to unregulated sources for their testosterone and other treatments (Qvistgaard).<\/p>\n Transmasculine individuals also face hardships in various aspects of family planning, with only about 6% of transmasculine people seeking fertility preservation although about 62% want to become parents, citing factors like fear of gender dysphoria and concern about misgendering and treatment by medical staff (Alpern). While factors like cost and preference for adoption certainly play a role in this statistic, trans men\u2019s concerns about treatment throughout this process demonstrate the social stigma surrounding transmasculine people who want to carry a pregnancy that serves as a serious barrier in their family planning. Equally important is the right to not carry out a pregnancy, though transmasculine people are often erased from debates around abortion. Abortion is frequently deemed a \u201cwomen\u2019s issue,\u201d and the place of men in this debate is often argued as theoretical, but for trans men it is a lived reality. In particular, the intersection of difficulty seeking trans care and difficulty seeking abortion care compounds for transmasculine people, making it doubly hard to access safe and legal abortions. While including trans men in this debate can feel uncomfortable, like it takes away from the importance of abortion access for women, activist Elias Fox Bova Schmidt points out that it\u2019s necessary to recognize that trans men are not a threat to the women whom this issue also affects, we are all working together against a system that aims to strip us all of bodily autonomy (Schmidt).<\/p>\n Lastly, trans patients report that provider\u2019s discomfort or lack of knowledge of trans bodies can lead to misdiagnoses, delayed care, and healthcare avoidance, especially in gendered fields that frequently cause anxiety and dysphoria, like gynecology and mastology (Sbragia and Vottero, Ramadan et al.). Healthcare avoidance due to these factors is a rampant problem in the trans community, with about 30% delaying or avoiding treatment due to discrimination. In particular, trans people who had to educate their health providers about transness were four times less likely to seek care (Jaffee et al.). This is a problem in itself, but is compounded by trans people\u2019s already higher prevalence of chronic and mental health conditions. Trans people should not have to bear the burden of closing the medical knowledge gap, especially since it exacerbates healthcare avoidance. Instead, providers need to shift away from a pathologizing \u201cdamage centered approach,\u201d that blames trans people for their specific medical problems and does nothing to tackle the systemic medical barriers that trans people face in accessing informed care, which in turn worsens their health (Riggs et al.).<\/p>\n In all of these examples, there lies a running theme; transmasculine people are invisible in medical practice. Research doesn’t include them, family planning doesn\u2019t account for them, and doctors don\u2019t know how to treat them. In this way, transmasculine knowledge in healthcare is a \u201csubjugated knowledge.\u201d This term was coined by French philosopher Michel Foucault to describe knowledge that is hidden\u2013not preserved because it wasn\u2019t deemed important\u2013or invalidated because the source is deemed not credible (Foucault). Transmasculine knowledge is a subjugated knowledge in the sense that our specific experiences are not recorded and dismissed as unscientific, though it is difficult to create scientific knowledge when knowledge production does not include you. Transmasculine knowledge as a subjugated knowledge provides an argument for its importance to the field of trans studies. By coding transmasculine ways of knowing about our bodies and needs as academic within the field, they can be de-subjugated and legitimized as ways of knowing within medical practice.<\/p>\n We\u2019ve established that the subjugation and invisibility of transmasculine people in medical practice leads to negative health outcomes, which leads me to challenge an idea proposed in the documentary Framing Agnes, that increased trans visibility correlates with increased vulnerability, especially for the most vulnerable members of the trans population (Framing Agnes). While this is certainly true, I would argue that this relationship is not linear\u2013more of a bell curve\u2013that invisibility when one\u2019s specific needs are subjugated also creates vulnerability. Transmasculine knowledge is vital to trans activism because it is uniquely subjugated by a bioessentialist, transphobic medical practice, and that specificity breeds vulnerability in real life. And trans activism is uniquely positioned to address this vulnerability, because it centers a group of people who subvert bioessentialist norms and in doing so demand the reshaping of normative systems. As argued in the academic paper \u201cBefore Trans Studies,\u201d we must not assume \u201cthe world will not accommodate our desires. We must again and again find out\u201d (Adair et al.). Our current medical system casts cisgender researchers as neutral and objective authorities on trans health, though we have shown this is not the case (Riggs et al.). Trans activism that centers transmasculine knowledges has the power to break down bioessentialist ideas in the medical field about what bodies and gender expressions merit research, constitute family, and possess valid knowledge. In addition to meeting the concrete needs of transmasculine people, this will help create a medical system with a more comprehensive understanding and affirmation of diversity for everyone with non-normative medical needs.<\/p>\n Annotated Syllabus<\/strong><\/p>\n The following sources provide a comprehensive understanding of the challenges faced, arguments surrounding, and joys of trans-specific family planning. While this is only one facet of trans men\u2019s unique relationship with the medical system, I found it difficult to provide a thorough evaluation of all the issues and solutions cited in my introduction with just six sources, so I chose to hone in on the specificities of this topic. The list is arranged in an order I feel provides a broad overview of the topic, evaluates specific examples and debates, and ends by investigating solutions.<\/p>\n Recommended Readings<\/strong><\/p>\n Lowik, A.J. \u201cTrans People and the Choreography of Reproductive Healthcare: Dancing Outside the Lines.\u201d Lanham: Lexington Books, 2023. Critical Perspectives on the Psychology of Sexuality, Gender, and Queer Studies. Bloomsbury Collections. Web. 7 Dec. 2025. <http:\/\/dx.doi.org\/10.5040\/9781978738492<\/a>><\/p>\n I thought the introductory chapter to this book by Dr. A.J. Lowik was a great jumping off point for this topic. The introduction starts with a quote from one of Lowik\u2019s interviews with trans people in British Columbia, where they describe navigating the healthcare system as a trans person as a \u201cweird dance.\u201d Lowik explores this metaphor in the rest of the book, with the introduction focusing on how reproductive healthcare is choreographed, with the doctor assuming things about the patient, among them cisness. Trans people are invisible in this choreographed relationship, so they must improvise weird dances to fit into this hegemonic system, in order to prove their normalcy and deservingness of care (Lowik). Lowik documents the varying ways trans people improvise and navigate the choreography in pursuit of diverse goals and safe, affirming care, making the argument that resisting this restrictive choreography\u2013creating our own dances\u2013gives us power to change this system. I think Lowik\u2019s metaphor of navigating healthcare while trans as a weird dance sparks thought and discussion about what this issue feels like for trans people, which in turn highlights its importance. Dance clearly focuses this abstract phenomenon on its effect on the physical body. The dance being \u201cweird\u201d for trans people showcases how it doesn\u2019t fit trans bodies\u2013it\u2019s awkward and painful\u2013and being forced to perform it anyway to receive care is indicative of the power dynamic at play, as does trans people not knowing the choreography to this normative dance. And Lowik\u2019s detailing of the improvisational responses to this dance shows more generally how trans people have to be savvy, and find ways to outsmart normative systems to meet their needs. All this clear imagery to bring people into what this situation feels like for trans people lays a strong groundwork for the rest of the syllabus.<\/p>\n Transforming Family. Directed by R\u00e9my Huberdeau, Transgender Media Portal, 2012.<\/p>\n I felt the documentary Transforming Family is a great transition from Lowik\u2019s paper, because it takes trans people\u2019s relationship with reproductive healthcare out of the academic and theoretical, instead showing the lived realities of trans people navigating this system. While it is an older documentary, the themes explored stay relevant, from navigating pregnancy, IVF, custody, and family dynamics in a world that largely doesn\u2019t understand or accept trans people\u2019s relationship to those things (Transforming Family). What I found most impactful about this documentary were the testimonials of the queer families interviewed themselves. While this documentary certainly delves into the pitfalls of this experience, for example trans and nonbinary people stating that pregnancy itself was great but the problems all started when they went outside, it also highlights the joys. As one trans man in the documentary put it, family planning \u201cgave [him] the opportunity to be dad,\u201d which wasn\u2019t something he ever imagined he could be. These interviews open a window into the lives of the people whom this subject affects, which goes a long way to making its importance feel more concrete by creating a tangible connection with the audience. For this reason, this documentary belongs in the syllabus to show readers the real life families that are born of trans people\u2019s safe and affirmative access to reproductive health care.<\/p>\n Schmidt, Elias. \u201cRoe Is Gone. What Happens for Trans Men?\u201d Our Bodies Ourselves, 1 December 2022.<\/p>\n This opinion piece by trans activist Elias Fox Bova Schmidt explores the flip side of family planning, explaining the reality of trans men’s specific experience with abortion. Schmidt starts with his own experience feeling \u201cout of place\u201d in reproductive justice spaces, which is a sentiment many transmasculine people share. Even among people who would otherwise be trans allies, when it comes to abortion we \u201cjust don\u2019t exist\u201d (Schmidt). He raises the alarm at this sentiment, not for theoretical academic debate, but because trans men need reproductive justice, we can\u2019t be erased from it when targeting abortion access directly affects us, with trans men facing additional physical and emotional risks from lack of reproductive choices. While centering trans men in this debate can feel like it takes away from women, Schmidt concisely addresses several debates in the field, arguing that trans men\u2019s place in this debate is not theoretical, unnecessary, or anti-feminist, we all need to work together to take down oppressive systems that aim to strip us all of our bodily autonomy (Schmidt). Schmidt\u2019s perspective adds to this syllabus through its candid and clear explanation of the direct real-world implications of excluding trans men from reproductive justice, which is particularly important for this topic because of how serious the real-life consequences are. His speaking to his lived reality adds to this point as well, by providing readers with a firsthand perspective of how scary it is to have your voice erased from a debate that can affect you so fundamentally.<\/p>\n Lowik, A. J. \u201cReproducing Eugenics, Reproducing while Trans: The State Sterilization of Trans People.\u201d Journal of GLBT Family Studies, vol. 14, no. 5, 2017, pp. 425\u2013445. https:\/\/doi.org\/10.1080\/1550428X.2017.1393361<\/a><\/p>\n Taking it back now to Dr. A.J. Lowik, this time for a more nuanced look at how reproductive politics reflect global systemic discrimination against trans people. Lowik cites how in many places around the world, trans people have to undergo sterilizing genital surgeries in order to have their gender legally recognized. They name this forced sterilization as eugenics, comparing it to the reproductive wars waged on Black, Indigenous, incarcerated, and disabled people, recognizing the similarities in how the strategy is used to uphold normative sex and gender roles (Lowik). When applied to trans people, these eugenicist practices also serve to target non-normative family structures, and are played off as \u201cin the best interest of children.\u201d Lowik calls for the end of this state sterilization that targets trans parenthood, instead recognizing legal gender changes based on self-determination. This text is important to the syllabus because it uses sterilization as an example that sheds light on the bioessentialism, pressure to conform to normative standards, and focus on binary sex characteristics that so many trans people face in order to have their gender recognized, like a trap door (Gosset et al.). In particular, the conforming to normative standards by either being trans and sterile, or cis-presenting and having the choice to have a family is the underlying problem of so many of the family planning challenges transmasculine people face, and this paper does a great job highlighting that, as well as arguing the importance of undoing these binaries and recognizing that neither transness nor families have to conform to certain sex characteristics.<\/p>\n Greenfield, Mari, et al. \u201cA Guide to Providing LGBTQ+ Inclusive Reproductive Health Care: Pride in Birth.\u201d Routledge, 2025.<\/p>\n I thought this evidence-based guide with information and tools for healthcare workers to provide informed, safe, and affirming reproductive care for queer and trans individuals was a necessary addition to the end of the syllabus. This guide takes an interdisciplinary, in-depth approach to all the types of reproductive care LGBTQ+ people may access and how to provide gender affirming care from experts in the respective fields. This is an incredibly immersive guide and can be overwhelming to tackle. The introduction provides a clear general overview of the state of the relationship between queer people and reproductive healthcare today and the importance of improving it, and the table of contents and glossary can be browsed by subjects of interest. While it is mainly intended to be a guide for healthcare workers, I thought it was a good practical addition, as much of the syllabus has centered the theories, issues, and personal experiences surrounding this topic, with not as much of a focus on approaches to improve medical practice as a whole. Each of the contributors to this guide have a different relationship with trans family planning, many of them in medical practice to some extent and all of them queer. I found their firsthand experiences and concrete strategies to make medical practice more trans-inclusive adds actionable ways forward to the syllabus.<\/p>\n Guttman, Miriam. \u201cAn Interview with Seahorse Parents.\u201d Foam, 20 January 2022.<\/p>\n Lastly, I wanted to end with a celebratory project, artist Miriam Guttman\u2019s interviews, photoshoot, and short film following the pregnancies of four trans men, who refer to themselves as \u201cseahorse parents,\u201d in reference to the only other known species where males carry pregnancies. Her aim with the project was to \u201cchallenge prevailing cultural ideas of femininity and masculinity,\u201d which is evident in the whimsical, loving seahorse-themed photoshoot with pregnant dads and their babies (Guttman). Similarly to Transforming Family, I thought this visual representation of trans parenthood added something to the syllabus that words can\u2019t quite grasp. In both the photographs and the short film, the love these men have for their kids is so tangible and easy to see, and shows the importance of trans-inclusive family planning in a way that just can\u2019t be explained with theory and statistics. As one of the subjects puts it, \u201cThis project shows our budding families in the most beautiful light. This is also a moment for our children to look back to and see how beautiful and normal and loved they are.\u201d This project also features several shots of pregnant trans men\u2019s bodies, which are very seldom seen, especially so intentionally and respectfully as in the natural, dreamy element of the water. It looks so natural. In this way, I think it has a very powerful effect of naturalizing pregnant transmasculine people and trans families, and showing that non-normative pregnant bodies are different, and that\u2019s beautiful.<\/p>\n Works Cited <\/strong><\/p>\n Alpern, Sharon, et al. \u201cWhy fertility preservation rates of transgender men are much lower than those of transgender women.\u201d Reproductive BioMedicine Online, vol. 44, no. 5, 2022, pp. 943-950, ISSN 1472-6483, https:\/\/doi.org\/10.1016\/j.rbmo.2022.01.003<\/a>. Accessed 26 Nov. 2025.<\/p>\n Gossett, R, et al. \u201cKnown Unknowns: An Introduction to Trap Door.\u201d The MIT Press, 2017, pp. xv-xxvi.<\/p>\n Jaffee, Kim D, et al. \u201cDiscrimination and Delayed Health Care Among Transgender Women and Men: Implications for Improving Medical Education and Health Care Delivery.\u201d Medical Care, vol. 54, no. 11, 2016, pp. 1010\u201316. JSTOR, https:\/\/www.jstor.org\/stable\/26418256<\/a>. Accessed 26 Nov. 2025.<\/p>\n Michel Foucault, \u201cTwo Lectures,\u201d in Power\/Knowledge: Selected Interviews and Other Writings, ed Colin Gordon (New York: Pantheon Press, 1980), p. 81.<\/p>\n Ramadan, R, et al. \u201cInfluence of gender modality on the delivery of breast cancer care from diagnosis to treatment: A systematic review.\u201d International Journal of Transgender Health, vol. 26, no. 3, 2024, pp. 528\u2013543. https:\/\/doi.org\/10.1080\/26895269.2024.2351448<\/a>. Accessed 26 Nov. 2025.<\/p>\n Riggs, Damien W, et al. \u201cEnsuring an inclusive, trans-led future for the field of trans health.\u201d International journal of transgender health vol. 25,4 619-622. 1 Jul. 2024, doi:10.1080\/26895269.2024.2370607<\/p>\n