I entered the exam room to see two women dressed nicely, one with short hair sitting in the chair and the other, with shoulder-length hair standing by her side against the wall.
"Good morning," I said. "How are y'all today?"
"Not so bad," the sitting one said.
"Most times when I see a couple at the same visit I'll ask, 'Who goes first, age before beauty, or ladies first?' but I guess I should ask "Which lady first?'" They smiled.
"I guess I'll go first," said the sitting one, glancing up at the standing one.
"Super," I said, looking down at her chart. "How can I help you Pat?"
"Doctor, we'd like to share with you first that we prefer to be called by our gender neutral pronouns if you don't mind."
I paused a second. "Okay. And what might they be?"
"Well, I'm transgender and I don't identify with any male or female gender. So I'd prefer to be referred to as zie, zim, and zir in cases where you would use zie for the subjective she, and zim for the objective her, and zir for her in the possessive."
I processed that, then asked, "So is it accurate to say you are the "T" in the "LGBTQIA" acronym?"
"Actually, I don't identify with the male or female gender. This is called "genderqueer".
"Oh, okay." I wondered if she might be the "Q".
"Doctor, here's a list of the pronouns we prefer," zie said, and pushed across the table a 3x5 inch index card on which was typed a table of gender neutral pronouns, of which there were thirty, all inclusive of each six grammatical cases, subjective, objective, and possessive in the singular and plural. I studied it closely as my eyes glazed over. It took me less than half a second to realize I would not be able to memorize the thirty gender neutral pronouns in the time allotted for the visit. So I quickly committed to memory the commonly used grammatical cases of zie, zim, zir, with zie the subjective of what I usually refer to as he and she. And zir for the objective case him and her. And zir for the possessive his and her.
And then hoped for the best as the last thing I wanted to do, especially these days, was to offend anyone or make a mistake.
I asked zim, the sitting one, nodding to the standing one, "Does zie wish to use the same pronouns as you?"
The standing one, zie interjected, "Actually, doctor, I prefer a different set of pronouns since I was born a female but identify as a male. But in the interest of keeping things simple and not spend too much time on it it's okay for you to use the same pronouns for me that you use for zim." I considered this to be a polite and a welcomed waiver for which I was very grateful.
Turning to Pat, the sitting one, I asked zim, "Okay, again, how may I help you?"
"Well," she said, "for about six months now I've had irregular menstrual periods with unusual cramps. And I wouldn't be so concerned with it if it weren't for the fact that when zie and I started living together our menstrual periods were in sync, occurring on the same day of the month and same length of time. Things were convenient. But now they're very irregular."
After interviewing zim further and then performing a pelvic examination which revealed everything to be normal with respect to female anatomy, and also assuring that zie was not taking any strange herbs or Internet medications, I told her I thought zie suffered from a hormonal imbalance.
I said, "I think you would benefit from some supplemental estrogen and progesterone scheduled in a way to realign your menstrual periods. This is given to women...excuse me, biologically born women...who have this particular problem. I know you don't identify as female but you happen to have female reproductive parts that would respond to this medication. Would you be agreeable to taking that?"
Zie thought a moment. "I don't know. i mean if I were to take this medicine I would be affirming that I'm a female. Is there anything else I could take that wouldn't identify me as female? Do men take this estrogen supplement too?"
"Hmmm. Well, generally no, but I suppose it's given to a man who wants to become a woman. Then after they feel they've become woman enough then it is usually continued to help them keep their female-appearing physical features, like effeminate looks and breasts. But no, it's generally not given to men."
"Hmmm," zie pondered. "I don't know. I need to be true to myself and if i take a medication that's meant for women then I would be living a lie, of sorts." Then glancing up at zir partner asked, "Don't you think so, Chris?" Chris nodded.
I said, "Okay...and?"
There was silence.
I said, "Well, the other option would be to do nothing and see if your menstrual periods correct on their own. Also, a blood test might be helpful in ruling out other non-female related causes of your problem for which a non-female and non-male drug might be applicable."
Zie looked up at zir friend (or partner) who was standing beside zim, then thought to zieself about what zie should do, then said, "Doctor, I'm going to think it over and get back with you."
"Okay, that's fine. Just let me know if I can help." I then pulled up Chris' chart and asked zim, "How can I help you, Chris?" not forgetting that zie was born a female by zir admission but identified as a male.
Zie said, "Well, I was reading where testosterone can improve one's sexual desire. Is that something I might be able to get?"
It was then i woke up in a sweat and short of breath. I sat on the side of the bed, rubbed the sleep out of my eyes, walked to the bathroom, and looking in the mirror was very thankful to start a new day.