Trying to give blood as a non-binary person in Quebec

This post mentions physiology, transphobia, medical terminology and discrimination.

Please take care of yourself as you choose to read, or click away.

I began to give blood during the pandemic lockdown. I was going stir-crazy, and giving blood was a new way I could get out of the house and actually do something for someone else that held a very low risk of getting COVID-19.

Each time I visited the clinic, I let them know that my legal name was not the name I use in real life (each time, I got the run-around about having to change my name legally in order to be called my true name when I give blood), and that I was transgender – specifically non-binary, so to please just call me by my name, Rowan, and not “Madame Woodmass.” They always just waved me along to the next station, and I comforted myself with the thought that I just educated a few more people about what “non-binary” means.

Not 24 hours after I received my legal name and gender change certificate in the mail, I was at Hema Quebec to give blood. When I showed them the certificate, it was a very different energy than when I came out to them the previous times I gave blood. This time, I was whisked off into a nurse’s room after some hushed conversations, and the nurse asked me, “Have you had the surgery?”

I was appalled, and embarrassed. My legal gender is now “X”, and to be honest, I was not sure how to begin to delineate for her all the reasons this question made no sense, given the context, and was extremely invasive to ask without an explanation about why the information might be required.

I told her that I was not going to answer that question, and she continued to ask me questions, each more demoralizing than the last. (“Are you planning to transition?” “When will you become a man?” “Are you a man or a woman?” “What are your genitalia?”) Finally, at that last question, I stopped her, and I said that if she continued asking me inappropriate questions without explaining to me why she needed the information, I would be reporting Hema Quebec to the Human Rights Commission.

At that point she finally put me on the phone with a higher-up at Hema Quebec who listened to what had happened, and apologized profusely. She shared with me that Hema Quebec was about to change their system so that gender was no longer considered in the evaluation process for who could give blood, in preparation for the X gender option. She also said that everyone was to go through training with Fondation Émergence before October 2022, and that while it wouldn’t be perfect, it would be a start. She gave me her extension and said to call anytime.


Hema Quebec is now celebrating the fact that gay men1 and trans people2 “can now give blood” because of their new evaluation process. I have written to them to ask how they would measure hemoglobin levels for potential donors, now that transgender people can give blood, including non-binary people.

Here is my email:

Now that transgender people are able to give blood, I wanted to lodge some feedback with regards to how the system is set up.
First of all – this contact form forces me to select either “Ms.” or “Mr.”, which not only excludes non-binary people, but also doctors, married women, and other people who use other honorifics. There should also be an option to not indicate an honorific, as many transgender people I know prefer to be referred to only with their first name.
The other thing is with regards to gender. I was on the phone with a support representative today, and they told me that the reason non-binary people are not included in Hema Quebec was because there are different hemoglobin requirements for males and females. This is a transphobic view of gender, and not even a realistic one, as in Quebec, anyone can change their legal gender to M or F without any surgical interventions or taking hormones.
This means that (for example) a trans man who feels no need for gender-affirming medical interventions might erroneously be held to a different hemoglobin standard when giving blood, which might potentially be dangerous for him.
I would encourage Hema Quebec to begin to identify what information you need to collect in order to avoid this transphobic definition of gender that might put trans people at risk. For example: are hemoglobin levels based on dominant reproductive hormones in the body? Shape of genitalia? If you can name the actual physical attributes that will help you determine the hemoglobin standard for each client, it will prevent the increased health risk of trans clients giving blood, and pave the way for people with a legal gender of X, like myself, to be able to give blood.
Please let me know if you need more consultation on this issue, as I have alot of ideas.
Best,
Mx. Rowan Woodmass
they/them

Their patronizing response revealed that they did not understand my message, and is a good example of what I have faced in dealing with Hema Quebec:

Good day Mx. Rowan, 

We must meet certain very strict and specific eligibility criteria to ensure your safety.
Blood donations result in a loss of red blood cells and the iron they contain. A significant loss of red blood cells can lead to a decrease in the capacity of the blood to transport oxygen. This is called anemia. Before each blood donation, we ensure that you have enough red blood cells to give blood without any risk of becoming anemic; this is the hemoglobin test.

If the measure does not meet the qualification criteria (12.5 g/dL among women and 13 g/dL among men), the person cannot donate blood for health and safety reasons.

Women:
Furthermore, there are several reasons hemoglobin levels may be below normal (menstruation, dietary deficiency, frequent blood donations, etc.). In some situations, anemia (hemoglobin levels too low) may also be associated with iron loss (a molecule needed to make hemoglobin). Iron reserves take longer to recover than hemoglobin levels, particularly in women, for physiological reasons. Women with hemoglobin levels below the blood donation limit are prohibited for 84 days to promote sufficient recovery in the donors’ iron reserve.

Men:
Furthermore, there are several reasons hemoglobin levels may be below normal (dietary deficiency, frequent blood donations, etc.). Following a blood donation ban due to low hemoglobin levels, the hemoglobin level usually takes three to six weeks to get back up to an acceptable level for blood donation. That is why there is a 56-day delay.

In the hope that these clarifications will help you better understand the reason for this restriction. We thank you again for your commitment.

To learn more, consult Héma-Québec’s website or contact Donor Services at 1 800 847-2525.

Of course, I wrote back to them, saying that they seem to not have read my email, as I was pointing out the exact issue that is illuminated in their message back to me – it is extremely important that the correct blood hemoglobin levels be reached in order ensure safety in blood donation, which is why the assumption that all men have the same physiology and all women have the same physiology is incorrect and dangerous.

When I looked on their website regarding trans and non-binary people, I found the following statement:

Owing to physiological differences that make the distinction between people assigned as male and female at birth, safety measures are applied during a blood donation. These measures have been implemented to prevent risks that may harm the health of those donating blood products.

As a result of implementing gender-neutral questionnaires for blood, plasma and platelet donations, anyone wishing to donate blood products answers the same questions regardless of sex or gender identity. An evaluation by an Héma-Québec medical staff member is no longer required. A fact sheet for trans and non-binary people lays out the risk for donors’ health and is available at blood drives upon request. The sheet is also available to download here.

Note: While transitioning to gender-neutral donation qualification questionnaires for all blood products, Héma-Québec has also begun working on plans to improve its registration processes by making them more inclusive for trans and non-binary individuals, always without compromising security. We are working in close collaboration with research professionals at UQAM to consult LGBTQ+ communities in order to improve the blood donation experience for trans and non-binary individuals.

I intend to call the person I spoke with on the phone the day of my medical discrimination to discuss the issue of hemoglobin levels, as transgender people may be refused by Hema Quebec, subjected to dehumanizing language and questions by Hema Quebec staff, forced to try to conform to their assigned gender at birth when giving blood, or, perhaps worse, “pass” as their true and legal gender, which may mean an inappropriate standard for hemoglobin levels is applied.

The language they have used, that “safety measures are applied” at registration, is worrying to me, as they could justify any transphobic line of questioning or action in the name of safety. I would like to know before I donate: what will be asked of me? What should I be prepared to reveal about myself to Hema Quebec employees? I need to know: is it worth it to make the effort to donate blood as a non-binary person?

Footnotes

  1. While sexual identity alone no longer precludes a man from donating, you cannot have had anal sex within 3 months of giving blood, and you cannot be taking PrEP or PEP within 4 months of giving blood.
  2. By saying that transgender people can “now” give blood, they are erasing the experiences of trans donors such as myself who have been giving blood all along, tolerating being dead-named and misgendered along the way, or simply passing under the radar as a cis person.