Before booking a medical appointment, Fito does something that most people would never have to do: he opens a WhatsApp group of trans men from all over Chile and checks an Excel file. There appear, separated by region, the names of “trans friendly” professionals, those recommended by others because they respect pronouns, understand transition processes, and know how to provide care without questioning their identity.
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“It’s not just showing up and booking an appointment at any health center, ensuring good care regarding your pronouns, identity, and gender,” he says. “So, the doctors you can go to are quite limited.”
His experience is not exceptional. A study developed by Corporación Miles on the role of midwifery in the care of transmasculine people in the Chilean public system concluded that about 70% of health professionals admit to not knowing the screening guidelines for Human Papillomavirus (HPV) and cervical cancer in this population.
The report also highlights problems such as lack of specific protocols, insufficient training in gender diversity during undergraduate studies, and limitations inherent to the organization of the public system. As a consequence, the quality of care often depends on the personal initiative and sensitivity of each professional, generating very different experiences between one facility and another.
Lleysi Tamarin, a midwife at Corporación Miles, perfectly remembers the first time she attended a trans man. She was an intern at a hospital and, although her main concern was to provide respectful care, she also felt the uncertainty of facing a reality for which she had never been prepared.
“In undergraduate studies, there is no strategy, not even a manual on how to care for people who are trans in general,” she recalls. Therefore, before starting care, she opted for the basics: introducing herself, asking the person’s name and pronouns, and validating their identity.
Over the years, she gained experience by taking courses and specializations on her own initiative. However, she insists that this reality should not depend on the personal interest of each professional. “There are health professionals who graduate without having basic knowledge to be able to attend to or respond to the needs of trans people,” she states.
According to her explanation, most content related to sex-gender diversity appears as workshops or optional activities, but rarely forms a mandatory part of the university curriculum. As a result, some midwives end up learning on the job while others never receive specific training.
The research confirms this perception. Chile has a National Health Policy for Trans and Gender Diverse People, which establishes that all health teams must have training to provide respectful and discrimination-free care, as well as guarantee access to sexual and reproductive health for this population. However, in practice, both professionals and patients acknowledge that significant gaps persist in training, protocols, and clinical experience.
The lack of training has concrete consequences for those seeking care. Fito recalls that for a long time he avoided consulting because gynecology caused him discomfort. “It’s very associated with women’s health, and that made me somewhat uncomfortable,” he explains. Still, he knew he needed preventive check-ups.
When he finally decided to book an appointment, the experience confirmed his fears: “I went to a medical center because it was urgent, and they told me: ‘No, you have to go to the urologist.’ And I told them: ‘No, I need a midwife.’”
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It was not the only episode. He also remembers being called by his old name in waiting rooms, endocrinologists who refused to attend him, and professionals who conditioned the start of his transition on certificates or external evaluations. “I had several bad experiences that invalidated my own experience,” he says.
For Lleysi, these types of situations are not isolated cases. They are the result of a system that still operates without common criteria: “Currently, it is very subject to the will of professionals, there is no uniformity in how trans people are attended to.”
She recalls, for example, the case of a trans man from San Javier who consulted about contraception and was denied it by a professional who was unaware of the scientific evidence regarding the use of contraceptive methods during hormone therapy. “It was a professional who had incorrect or outdated information about contraception in trans people,” she recounts.
The study also challenges a deeply ingrained idea, which is that midwifery is limited to pregnancy or the care of cisgender women. Fito acknowledges that for much of his transition he didn’t even know that a midwife could support him.
“Later I found out that the midwife could also accompany my transition process,” he says. Until then, all the information he received revolved around endocrinologists and surgeons, while everyday doubts like the effects of testosterone on the uterus or genital changes went unanswered. “If I had had this support from the beginning, the process would have been much cooler,” he reflects.
That support, Lleysi explains, is part of the role of midwifery, which not only includes gynecological check-ups but also counseling on sexual health, contraception, prevention of sexually transmitted infections, education, and support throughout the entire transition process. However, she insists that tools are needed to perform this role: “The creation of protocols is fundamental. Having everything subject to individual will is extremely complex.”
Despite the difficulties, both agree that respectful care can completely transform the experience. Today Fito works at Corporación Miles and receives part of his care from the same midwives with whom he shares the workplace.
“I think it has been the best moment of my sexual and reproductive health as a trans person,” he states. For Lleysi, that is precisely the horizon the system should move toward: “My ideal world would be that people could express themselves freely, ask all the questions they have, and go to a health service without fear of being judged or criticized.”
Fito shares that desire. “That they validate our existence. We are people, we have blood just like everyone else,” he says, concluding: “Get informed and dare to care for us. That’s the basics.”
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