A friend sent me this question, and this is my draft reply

[kaberett]

Content notes: cis-centrism, well-meaning cluelessness, gendering by the medical system.

I want to start out by saying, here, though I haven't to them - this is the person who taught me how to use my words, who taught me how to not take it personally when someone was having a bad day. She taught me all of this by example, and I am grateful to her, and so she gets time and effort put into answering this question, whereas most of the time, when people ask me this question, I'm likely to ignore it because I can't face wading through it again. But part of this is also that I want to get it right, and so I am very open to suggestions for improving clarity - particularly if you're not very familiar with trans stuff, or I'm the only out trans person you know, or whatever (I... think there are a few of you reading this? probably not many, though ;) - please do weigh in (but please also bear in mind that this is a difficult conversation for me to have, which is why you're getting quite such a scrappy first draft). Additional context: my interlocutor has an MSc, and her mum's a nurse - she's got a high level of background knowledge/understanding about pretty much everything except trans stuff.

I'm not wishing to offend in any way, I am merely curious as to your thinking. To me endometriesis is a very female thing, so it is surely more sensible to be sex specific in the articles? Why do you want them gender neutral? re this post (i haven't read the comments)
"Huh. Apparently the way to get trans-friendly research articles on endometriosis is to read only papers relating to chronic pain in teenagers, because then the default noun is "adolescents" instead of "women" or "girls". And *astonishingly enough*, using gender-neutral nouns doesn't impair understanding... "
You know me - I'm very happy to allow you whatever pronouns etc you want,.. please don't take offense.

Thank you again for asking!

There's a bunch of strands to my answer for this, so I'm afraid you're going to get a numbered list...

(1) I volunteer in sex education focussing on vulvovaginal and breast health - and a lot of the people who come to our community are trans men (men who, when they were born, had "F" written down as their gender marker - female-assigned at birth). One of the things we observe over and over is that FAAB trans people are really, really not comfortable seeking help and support from traditional "women's health" communities - when forced to choose between having their gender respected and seeking medical advice or reassurance, people will often choose the former, not the latter. This is why the community I help moderate is so valuable - people feel comfortable saying "my periods have changed in ways X, Y and Z since I started testosterone - do I need to worry?" because they know that they'll be treated as men throughout.

(2) The majority of people who have endometriosis have wombs and ovaries (though not all do - https://en.wikipedia.org/wiki/Endometriosis#Epidemiology ). However, this doesn't mean all of them are women - and, as above, treating endometriosis as a "women's problem" makes it much harder for men (and genderqueer people) with the condition to seek appropriate help.

(3) In clinical terms, especially with disorders or illnesses relating to endocrine and reproductive systems, "woman" or "man" doesn't actually provide much useful information. For example, the relevant information about my mum isn't "woman" - it's that she's a carrier of a bowel-ovarian cancer gene, and has had a radical hysterectomy following stage II cancer. For me, it's that I've got severe endometriosis with complete occlusion of the Pouch of Douglas, and distortion and restriction of my bowel. (This argument also comes up with relation to gender markers on passports - the Armed Forces, for instance, don't have gender markers on ID, because it's such a crude sorting that it's not terribly helpful.)

TO CONCLUDE:
- using gendered terms like "man" and "woman" in sexual, endocrine and reproductive health puts up significant barriers to trans people trying to access healthcare
- using gendered terms doesn't *actually* communicate useful information: there is no benefit to using "women" instead of "people" or "patients", but there is harm
- to first approximation, it is always better to use accurate, descriptive language - like "people with endometriosis" (or, in the examples I quoted, "adolescents with endometriosis") - than to use proxies that don't have a one-to-one relationship with the variable you're actually observing (like pretty much everywhere else ;)

I know this is a bit wall-of-text-y -- if you've got more questions (for any reason, but especially if I've been unclear!) please do feel free to ask away!

Comments

[wild_irises]

Well-spoken. I hope this person gets it.

[kaberett]

She has been absolutely fantastic about wrapping her head around the fact that she knows a real live queer person (i.e. me); she's a very soft-spoken grew-up-rurally Christian, and she is extremely knowledgeable and thoughtful and compassionate about a lot of things. Genuinely the only reason that the original question contains so many dog-whistles is that she has probably very literally never thought about this before, but like I said she is someone I am willing to make time for when it comes to 101 stuff.

-- which is a long way of saying "thank you", so: thank you.

[pretty_panther]

Well said. Men can get endomitrosis just like women can and not just with trans* people. I found it world rocking to read that men treated for prostate cancer sometimes develop endomitriosis after their treatment. Talk about getting another slap in the face. But yeah, I agree with all of this.

[sorrillia]

"The majority of people who have endometriosis have wombs and ovaries..."

I feel like it might help to be more explicit that your point isn't just "people who don't currently have wombs and ovaries can have endo", but "people who have never had wombs and ovaries can have endo", since this phrasing seemed ambiguous about that?

[kaberett]

Mrr. Okay, I could maybe pull out the "some people with penises and testes also get endo" rather than leaving it implicit in the link?

[sorrillia]

I had just been thinking changing "have" to "have or have had". I'm also not sure it's really necessary, since it is in the link?

[kaberett]

Thank you! ♥

[stephdairy]

I am an ignoramus in both gendersplund and endometriosis, but it mostly seems sensible to me. In (1) I don't know what FAAB stands for, although having written that I now see it spelled out in the brackets after "trans men". Perhaps add "or FAAB" to the end of that bracketed phrase?

(S)

[kaberett]

If it makes sense to you, that's very reassuring :-) Thank you for flagging up that it would be good to define FAAB more explicitly - I was attempting to avoid repetition but that's perhaps not the best plan in this instance!

[tim]

That's very patient of you. I would have been yelling "there's your problem" and not being much more articulate than that after reading "endometriesis is a very female thing". I continue to not understand why people think that muddying up science with socially imposed assumptions helps us see the world as it is, rather than doing the opposite.

[kaberett]

As I've said, this is one of very few people I am willing to cut this kind of slack. ;) Most people would get ignored or shouted at!

[tim]

Yeah, understood :-) It's just... so insidious and frustrating that people think of "male" and "female" as terms with anything other than a sociological meaning (at least when applied to humans).

[jjhunter]

I like to think I have a bit more of a clue, but your beautifully clear breakdown here helped click the 'gendered terms =/= the actual useful information' bit into focus for me. As a scientist and as a poet, I have an almost religious belief in the power of more specific, accurate language to help people function better internally and collectively. The idea that it's so mainstream as to be effectively invisible for most people that they're using gendered language as a vague catch-all synonym for a whole bucket of disparate information and in the context of health it doesn't even get the useful information across for sure -- oh, that's not only offensive, that's frickin' imprecise with very real potential for physical harm on top of moral harm.

[kaberett]

Thank you. This is so, so reassuring to hear. ♥

[rainne]

Completely outside of the trans* issues, I have learned today that people who do not have/have never had ovaries and their accouterments can have endometriosis. I did not know this was a thing.

[pipisafoat]

+1

[kaberett]

If you want to be really horrified, look up details of extra-abdominal endometriosis. (Warning: it gets quite unpleasant.)

[rainne]

As utterly delightful as that sounds, I think I'll pass.

[shewhostaples]

This is really interesting, both in itself and in that it has got me thinking (again) about when it is and isn't appropriate to call people 'patients' (ten years proofreading radical midwifery publications will do that to you...)

[kaberett]

Hah, yeah.

[naath]

How very patient of you!

[kaberett]

♥

[alexseanchai]

Point two reads like a rehash of point one. Unless you're trying to point out that people who never had wombs/ovaries can get endometriosis too, in which case you are being less than clear, because my first thought on reading point two is hysterectomies.

[kaberett]

Yep, I am meaning that MAAB people can get endometriosis. I'll clarify that one.

[azurelunatic]

If you can stomach wading into it, some selected passages from #transdocfail may underscore why it's not just a personal distaste for being addressed as the wrong gender, and absolutely a mortal terror of being variously mistreated, abused, and possibly worse, in part (1).

[kaberett]

Mmm, I could probably link to my post as to Why I Don't Read #transdocfail? OTOH that would involve sticking a link to this name on FB, which I am rather less than keen on even if it is just in private messages... ACTUALLY do you know what I can just reference the hashtag and let her find stuff from there, thank you for the suggestion.