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For Tristan Martin, a 34-year-old trans man living in North Austin, that fear became a reality last week when a Walgreens pharmacist refused to fill his testosterone prescription. Martin says his pharmacist’s explanation for not filling his prescription was that she was uncomfortable with the doctor’s instruction that the medicine be administered subcutaneously, meaning as a shallow injection under the skin. But, as Martin explained to the pharmacist, he’s taken the same meds for four years, with the same method, and never heard such an objection. Plus, Martin said that the pharmacist was only being asked to provide the testosterone itself, not the equipment necessary to administer it. He later attempted to reach Walgreens’ pharmacy department and store manager to ask about the situation but wasn’t able to reach anyone and never got any calls back. A store employee told the Chronicle they could not address the dispute. Tristan’s wife, Hayden Martin, said she received an apology from a Walgreens regional healthcare supervisor, after the supervisor contacted her on May 23. “He said there was absolutely wrongdoing and that it’s going to get figured out,” Hayden said. “He said he was going to reach out to the higher-ups and he’s going to let me know by Friday what happens.” Hayden Martin told us she was able to contact the pharmacist in question two days after the refusal to fill the prescription. “She would not give a reason as to why she felt the doctor was wrong,” Hayden said. “And she said, ‘I’m not comfortable filling it for ‘her.’ So automatically the assumption is that it’s just an issue of her not being comfortable with the fact that it’s testosterone for a trans man. So I, of course, asked her if this was the reason – because he’s a trans man – and she got very defensive and denied it. And then I tried asking for her name and her license number and she said, ‘Well, that’s not important information.’”

Recently, one of our readers, who wishes to go unnamed, sent us the following email:

On the 24th when I went to pick up my testosterone prescription at the Walgreens on Lomas & Carlisle, I was asked by the pharmacist why I took it, and when I told him it was gender affirming, he told me he wouldn’t fill it going forward… I want other trans+ folks in our neighborhood to know that this is not a safe pharmacy (I don’t regret reacting by sobbing loudly in the middle of a Walgreens, but I don’t want anyone else to have to go through that), and I want all our cis neighbors to know that this is a thing that is happening.

We reached out to the Walgreens location, and the person who answered (and who we will keep anonymous) confirmed that there is a pharmacist on staff who refuses to fill prescriptions for gender affirming medication due to their beliefs. However, they clarified that other pharmacists at the location would fill a gender affirming prescription if they were on duty, or the prescription could be filled at other Walgreens locations. Unfortunately, they were not able to provide further information as to the pharmacist’s name or when their shifts might be.

A year after KC investigation, another trans customer turned away from Costco pharmacy

The city’s Civil Rights and Equal Opportunity Department launched an investigation in October 2022 after a Star report about five transgender and nonbinary people who said they were denied their prescribed testosterone at the pharmacy. Costco denied the allegations. [...] Dave, whose name has been changed in this story to protect his identity as a transgender man, was grocery shopping at the Linwood Boulevard Costco on Monday when he decided to pick up some syringes. Dave has used insulin syringes for years to take his prescribed testosterone — their thin needles make his regular injections less painful. These small syringes don’t require a prescription, making them easy to obtain — and Costco offers a bulk pack of 100 at a nice discount compared to other pharmacies. At first, the transaction was painless: Dave asked for a pack of syringes and an employee asked him his preferred size and gauge. But when he mentioned that he uses them to inject testosterone, the tone of the conversation shifted abruptly. “They got weird about it,” Dave said. “The pharmacist, I guess, overheard and she came out and she’s like, this won’t work for testosterone.” Dave explained that he has used these syringes for his testosterone injections for years — and has even bought the same syringes at that Costco pharmacy before for the same purpose. Insulin syringes are regularly used to inject low doses of testosterone. But despite being an over-the-counter product, the pharmacist insisted that Dave needed a prescription before she would sell them to him. “She’s like, well, we won’t sell it to you unless you have your doctor call it in,” Dave recalled. He stepped aside to call his doctor’s office, but they were closed for Monday’s holiday. “I didn’t feel like arguing (with the pharmacist). So I just left.” An assistant general manager at the Linwood Costco said Wednesday that he was not aware of the incident and couldn’t comment on it. A pharmacy employee said that she and her coworkers are not authorized to speak to the media. A request for comment from Costco’s corporate office was not immediately answered. Dave called the Missouri Pharmacy Board Tuesday and was told that syringes only require a prescription if they bear the label “for Rx only,” which his syringes didn’t. Beyond that, he said he was told that the state gives pharmacists discretion over what they choose to dispense, as long as they don’t violate federal anti-discrimination laws.

“Criminalization has made it easy for pharmacists to deny my [testosterone] prescription, which has happened to me many times,” Artemis McGettigan, a trans student in Dearborn, Michigan, told Filter. “[Pharmacists] have told me in the past that ‘It’s corporate policy, they’re not allowed to fill that type of prescription … but I knew that was false because other CVS locations, for example, were able to fill it.” A CVS media representative told Filter that its policies “do not prohibit our pharmacies from filling testosterone prescriptions.”

CVS Pharmacist refused to fill my T

I have been on T for coming up on 3 years. I’ve never had any problems with any pharmacy I’ve gone to. I recently had to switch pharmacies and for over two weeks this pharmacist at CVS has given me the run around. “I need to talk with your doctor about why you need it” (which I’ve never had happen before). And then the next day would say “I need prior auth”. It’s been so long without my T that my period came back today and I am freaking out. So I sent a very frantic message to my doctors office. They called me about an hour later telling me the pharmacist sounded fishy and said “I’m not comfortable filling this prescription.” Ok? Your job isn’t to judge my prescription your job is to give me the medication my doctor decided I needed. The doctors office was nice enough to transfer everything to a different CVS close by and even apologized for not getting the pharmacists name. We did call to get his name. My partner is very nice and called corporate to file a complaint and the corporate pharmacist on the phone said that they do have grounds to deny a prescription only if there is not enough info or it’s fake. So they reported it as discrimination. Unfortunately I can’t take legal action or I would. Sorry this is more of a rant than anything. This should be illegal and nobody should work in healthcare if they’re going to gate-keep health. I truly hope this man gets fired. I’m trying to file a report to the state board of pharmacists because he can have his license revoked for discrimination. Thanks for listening.

My pharmacy tried to deny me my testosterone

Nurses and midwives accused of serious sexual, physical and racial abuse are being allowed to keep working on wards because whistleblowers are being ignored, a damning new report has found. Staff are too scared to report their concerns to the nursing regulator because of a “culture of fear” within the watchdog, documents seen by The Independent reveal. One whistleblower, speaking to this publication, drew parallels with the Lucy Letby case, accusing the Nursing and Midwifery Council (NMC) of being defensive and trying to protect their own reputation. They claim “deep-seated toxic conduct” within the NMC is leading to skewed and failed investigations. A review of NMC guidelines was launched after The Independent highlighted concerns earlier this year by speaking to staff who complained that the NMC was leaving nurses accused of sexual assault and domestic violence free to work unchecked.

Incivility is one of the most prevalent forms of interpersonal mistreatment. Although studies have examined the full range of experiences of incivility against nurses and other hospital personnel, very few studies examined the forms of incivility that patients face in a hospital. [...]

Participants most frequently reported experiencing insensitivity (38%) or affectively negative interactions. A majority explicitly used the word “rude” to describe their interaction. [...]

When the Doctor was a smart mouth and came in and said “congratulations you have a period” it ended up being a very serious infection. [Participant 290, 27 years old, Biracial, Woman]. Participant 290’s experience demonstrates some of the potential consequences of rudeness. In this case, the doctor was not only insensitive but gave an incorrect diagnosis. In addition, participants frequently indicated how insensitivity was also communicated through a “rough” touch when the doctor was examining them. The consensus was that insensitivity—verbal and physical forms—only made the participants feel worse when they are already in the hospital not feeling well. Participants (15%) indicated experiencing rudeness because of their identities. Many individuals explained how their socioeconomic status (SES)—specifically lack of health insurance—was a significant factor in shaping the treatment they received: I had a first time grand mal seizure and wrecked my vehicle. I do not have insurance, so the hospital I was taken to was so rude. I was brought in by an ambulance, they wouldn’t give me anything for the severe headache from the wreck and also from the seizure. They wouldn’t give me anything to keep me from throwing up. The only thing they did was give me an IV of Keppra to stop the seizures. After finding out I didn’t have insurance, they discharged me within 10 minutes. They took me to the bathroom to change clothes, they met me at the bathroom door, handed me my papers and pointed me to the door. I didn’t even get wheeled out after having a seizure and a wreck…[Participant 272: 28 years old, White, Woman]. [...]

…[I] was told in plain terms that those who don’t pay for their [insurance] have no right to complain about not receiving the best treatment [Participant 47: 34 years old, Latina/Hispanic, Woman]. [...]

Participants (26%) indicated what we categorized as containing elements similar to “gaslighting” or mistreatment in which participants’ experiences were minimized, doubted, questioned, second guessed, or denied by health-care professionals. [...] …I was told I was lying about being sick. I was told that I had lost 45 pounds in 2 months because of a mild cold, and that I was wasting their time. They tried to make me feel like I was a burden, and I was taking away from other patients who they implied were sick. Turns out I was sick, and I needed surgery. Going to a hospital out of town, they diagnosed my problem within 1 visit. [Participant 275: 34 years old, White Man]

Most research on aggression in health care relates to staff experiences about patient aggression. Research on patients’ perceptions of aggressive and transgressive behaviour in care relationships with nurses is limited. [...]

When it comes to competent care, some patients told stories of how expertise of care providers was questioned. One patient described a nurse provided pain-relieving medication while he is allergic to that product. In response, the patient’s daughter attached a list to her father’s bed listing products he is allergic to. Despite this list, every time her father asked for pain relief, that same product he is allergic to was brought to him. Another patient described a nurse accompanied him for an examination. He asked where she was taking him to and when she said it was to Nuclear Magnetic Resonance, he said he was not allowed to because of his pacemaker. He indicated the nurse had not gone through his medical file and was putting him in danger [...]

Patients told stories of being ignored by nurses or not treated as human beings. One woman described the nurse criticized her for not having to have worked a day in her life because of her long-term illness. Another man described dinner was put in front of him without a single word, no ‘good afternoon’ or ‘enjoy’. Patients also provided examples of a lack of gen- uine involvement of nurses in the nurse–patient contact. Various patients mentioned they felt like a number: . . .One thing that is very annoying is when two nurses are caring for you and they are conversing with each other over your head. That’s so annoying, you really feel like just a number. . . Furthermore, various patients indicated nurses are more concerned about the way care is organized than they are about the patient’s request. Patients mentioned nurses stick to their routine and are reluctant to deviate from it. One nurse distributes medication while another checks parameters of all patients. Patients describe they cannot approach the nurse about matters that are not part of his/her task at that moment [...]

Various patients gave examples of situations where they were not acknowledged or heard with regard to their own appraisal or expertise concerning their illness and health. Patients stated they themselves felt what they could or could not do, but nurses kept emphasizing and imposing things, according to guidelines and protocols, they should be able to do at a certain point in time. Several patients felt they were not heard: . . .I had two surgeries on my back. So the first day after the surgery, they said, ‘roll to the side and sit up’, of course that’s difficult. On the second day, they demand you get out of bed. But I felt worse, I couldn’t get out. And they didn’t believe me, the nurse didn’t believe it. ‘You’ve had surgery and according to the textbook, you should be able to get out of bed on the second day’. On the third day, they made a new scan and saw that those nerves had not been unblocked and on the fourth day I had another surgery. So they don’t listen, because that’s not possible, according to the ‘textbook’ you should be able to do this. . . [...]

When patients realize it is not self-evident to receive adequate care or do not feel in competent hands, they become more observant and vigilant. Patients describe they observe nurses carefully, check their medication and ask which examinations they are having and why. The care they receive is more outspokenly questioned: . . .They came to collect me for my hip. Ah, you’ve got a scanner appointment. She says: ‘it’s an MR scan’. I say: ‘an MR scan? I can’t do that because I’ve got a pacemaker.’ And she says ‘And now you tell me?’ ‘Listen here, missy, you walk in here and tell me to come.’ You’d be in there if you wouldn’t have said something, wouldn’t you! The battery can generate voltage which could burn your heart, destroying your pacemaker. If you’re not paying attention, you’re done for. You constantly have to be on your guard. . .

Whenever I would think of genderqueer (the term in vogue in my twenties) and nonbinary as positions, I would imagine them as truly heroic. As naming people who are able to exist in a space where others don’t see who you know yourself to be, but you just don’t care. Your sense of yourself is so strong you don’t need to change your body to get other people to see you in a certain way; you just know that other people are wrong and that you’re right and that’s okay. And I thought I could never be strong enough to do that. In my life I had associated it with the most unbearable dysphoria, the most unbearable gap between how I was seeing myself and how other people were seeing me, especially once I had taken on the pronouns he/him but was trying to transition without testosterone. So, I thought of nonbinary as this heroic position for a long time and then, more recently, I’ve begun to have doubts and think, well, maybe that’s not how it feels. 

LISTEN, KADJI. I DO NOT WANT TO BE YOUR NONBINARY HERO. I DO NOT WANT TO BE SEEN AS TRULY HEROIC.

They seem just. Obsessed, with this image of nonbinary people as "brave" for being visibly androgynous?

[J]: [...] But this is the problem because we don’t have an operative, positive account of what’s at stake in nonbinary trans femininity, so it gets filtered through these really superficial lenses. Like, “well, they get treated like shit all the time, but they’re really resolute, plus it’s empowering to have facial hair and wear lipstick,” and I’m like, yes, okay, but tell me more! I want to know. Kadji: Maybe my major question is why there isn’t more of a discourse about all of this? Even an intra-community discourse where questioning people could go online and hear “this is what it means to identify with this as opposed to that, this is what you do.” I don’t know if I should read that as a refusal or— Jules: Or just the impossibility of speaking outside a discourse of gender? Which in some ways, nonbinary is trying to do in a really sophisticated way, but which remains very hard. How can you simultaneously dissent from a system but still maintain its central presumption, which is that gender is a fundamentally important facet of the self? That seems like a really complex tangle that, technically, is not unique to being nonbinary. Even cis women have this problem to some extent, but there’s something really interesting in the nonbinary case that is not being unleashed. How can we understand the phenomenologies attached to different trans identities of this moment and what their claims are on the relationship between the self and the social? It seems like the contemporary taxonomy of gender identity and expression suggests that every identity position is valid so long as it is articulated and can therefore be respected, and in that sense it becomes devoid of content. How do you give an account of yourself in this situation?

This just feels like "I don't get nonbinary people" soaked in fifty-three layers of academic language, all to avoid confronting the fact that nonbinary people are nonbinary in the same way a trans woman is a trans woman. They just cannot help but insist that nonbinary people are "heroic" and "trying to [speak outside the discourse of gender] in a really sophisticated way," like they are truly only able to conceptualize nonbinary identity as a political move and act helpless about their ability to talk to a nonbinary person and take what they say seriously without secretly re-interpreting it as whatever bullshit they want (such as "nonbinary people think they are soooooo much better than us binary people!" looking at you, Jules.)

More exorsexism:

But one of the things you and I have been trying to understand is what’s the historical trajectory here to nonbinary. For a long time, the line between a faggot—a really effeminate gay person, a queen, or even a drag queen—and a trans femme was blurry and there is a lot of cultural anxiety about that slide in Western culture. That you might go all the way, that it might be horrifying and abjecting, or it might be something like the total freedom of feminization or castration, or even bottomhood (to which I laugh, as a femme top). It’s this sort of construct of the gay imaginary. But it also leads to this question: since there’s so little space for nonbinary trans femmes today and there’s a lot of pressure on them to put out something legible, they have to use this taxonomy of “oh, I’m not a man or woman, but I’m definitely not a man”—and then what? I’m always searching for the positive account that comes after “here is what I’m not,” and I’d like to see more cultural space granted to that. If you’re a nobinary trans femme that has a largely aesthetic component to your transition—say, makeup, clothes, and pronouns—what is it that differentiates you positively from the faggot as a gay boy or feminine person who is not a man? I want to underline that there has been precious little oxygen accorded to that, so this is not a criticism of any of these people. Not enough has been granted to them to affirm their desires. And since there is so much pressure in our contemporary taxonomy to separate gender from sexuality, it seems to make the situation even more impossible.

I am just. so confused by her confusion here? Once again, Jules, JUST TALK TO NONBINARY FEMMES ABOUT THIS??????? Why in the WORLD are you having this conversation with a binary trans man. What purpose does this serve except jerking each other off on how much nonbinary people confuse you and seem to have no phenomenological basis for their existence.

[Kadji]: So, I thought, okay, gay male culture has done its best to kill the possibility of faggotry, but here are nonbinary femmes bravely trying to resuscitate it as a living possibility rather than a site of abjection. But as time has gone by, I’ve started to wonder if maybe that’s not what they’re doing, and it’s still unclear to me because of the lack of a space for that kind of discourse, or a refusal to explain themselves in that kind of way. I’m quite surprised, given the amount of space that was devoted in the late 1990s to early 2000s to figuring out the butch/trans man proximity, that there’s still a vacuum for that kind of discourse on the other side. How do you know if you’re a gay man or a trans woman? How do you know if you’re a trans woman or a nonbinary femme? This contributes to my lack of understanding of what a phenomenological position for nonbinary femme might be. Again, I don’t know if that’s what any nonbinary femmes are trying to do, but if that is what some are trying to do, I’m not sure it’s working. As in, I’m not sure that enough people know how to read or respond accordingly to a trans femininity that isn’t either gay effeminacy or trans womanhood.

WHO GIVES A FUCK IF PEOPLE KNOW HOW TO RESPOND TO US. for a lot of nonbinary people its live illegibly but openly or be in the closet forever and want to kill yourself because there is no space for you. I hate to pull the "we have dysphoria" card, but like, WE DO HAVE DYSPHORIA TOO, YOU KNOW? for a lot of nonbinary femmes there is no fucking "project" other than living a life that makes you feel real despite never being given any social reality. They go on to talk about how butches apparently have more cultural legibility, but I do not understand why the "faggot" or femboy or drag queen is not seen as a nonbinary femme equivalent? There is plenty of hostility from cis woman butches towards nonbinary and transmasculine butches. I guess the point is that all of those rely upon the assumption of attraction to men.... but so does butch, and there are gay transmascs who still identify as butch, butch4butch (which for some was a way of being a gay trans men when the option did not seem available) has always been treated negatively, and once again. Why is nonbinary identity being judged around people can get what we are by looking at us?

& then there's the same old bullshit about how transmascs have always had more cultural space and "reasons to transition" (what?), alongside a quote in which she says "and who the fuck in this world is allowed to desire to be a woman?" tell me you know nothing about how misogyny works. People raised as women are expected to desire to be a woman, obligated to do so. I do not know why the fuck people cannot get it in their heads that yes, womanhood is treated as a lesser state of existence, but for those who are expected to fulfill the role of daughtermotherwife, that lesser state is what they are meant to be happy with. They also claim there is "so much more cultural space for mascs, including nonbinary, and there’s so much more history (for butches and non-binary mascs)." Which. Fucking. Where.

ultimately, i think this final part of this interview hits more clearly on what issue they are taking with nonbinary people:

[Kadji] This is a hypothesis, but I do think today’s taxonomies seem more confusing than ever—though perhaps that doesn’t feel true to people who are coming into their genders today. But I believe that they are more confusing than they are helpful to actual queer and trans people. [...] And so, I imagine that today, when there is a huge proliferation of options and the options often overlap or are synonymous without substantial phenomenological accounts to differentiate them, and the pressure to come into a true self has never been greater than it used to be—it seems just flabbergasting and impossible. What I’ve realized is that I believe that the matter of gender is practical and relational. It’s not about who you are inside, it’s more about how you would feel most comfortable in the world. It’s not Who are you? but How do you want to live?  Had that been the discourse when I was coming up, I would have breathed a sigh of relief. I don’t have to figure out who I am on the inside, I just have to figure out how I want to live.

look, i'm a pragmatist and a phenomonologist, i also see gender as being to some degree inherently practical and relational. but as a nonbinary person, i do not have the luxury of living the way that makes me feel fucking comfortable. my feelings of being nonbinary are not abstract, they materially impact me. nonbinary identity is about survival, to me, point blank period. survival comes first, survival is where the term nonbinary/genderqueer/whatever terms we use emerges because it emerges from us no longer being able to live without giving voice to our sense of otherness.

demanding nonbinary provide a phenomenological account that satisfies binary "transsexuals" who define their transsexuality opposed to nonbinary people, using the language of "gender is practical and relational, not who you are inside," maybe i'm being dramatic here when i say this, but its a threat to nonbinary survival. patriarchy makes us illegible and then we are punished i mean critiqued i mean "we're just asking questions!!" for not being legible. because we practice, in Jules' words, "nonbinary idealism" and are all rich white people who are just doing this to be heroic and make ourselves look more #woke than binary transsexuals.

anyways, shoutout to one of the people in the comments who said:

you two talk as though non-binary femmes (heroically, but also for fun) put on some makeup and change their pronouns and thereby become illegible. for my part, i have always felt illegible (how is that for a phenomenology of non-binary gender). most of the answers to your questions here are in your own the text if you begin from the assumption that non-binary people have a genuine experience of their gender as neither men nor women.

^ literally exactly the point. Jules and Kadji are exorsexist and fundamentally do not seem to grasp the idea that nonbinary people feel nonbinary and that feeling nonbinary has a real impact on your life regardless of whether you want it to or not. They literally cannot, or refuse to, see nonbinary gender as functioning the same as their genders, and so treat nonbinary people like a peculiar species of not-quite-trans with mysterious motivations, and not just like normal fucking trans people.