Obviously, I would imagine you’d want your doctor fully aware of your biological sex, as well as your surgical history, in order to get proper treatment — so I don’t think being treated, respectfully and honorably, as a “trans woman” rather than a “female woman” is something bad in this case.
Again, I am a female woman. My doctor is the one who said as much in the letter to the Massachusetts Registry of Motor Vehicles when I changed the marker to F (for female) on my drivers license. And I seek out doctors who have treated trans patients before because most doctors don’t have a clue. But my doctor doesn’t treat me as a “trans woman, not a female woman.” She treats me like a woman, period. She is also my wife’s doctor and sometimes sees us both at the same time.
Sure there was the time at the ER when the intake nurse asked me when was my last cycle. Yeah, I told her I was trans, but I could easily have given some other reason for not menstruating, such as PCOS, but was reasonably sure it was safe to disclose. She didn’t treat me any differently than before she knew I was trans, so it seems I was right..
I mentioned it for a reason. Many have been denied care just for being trans (even when the complaint had nothing to do with sex or gender). In my situation, many other trans women, wary of discrimination or outright denial of care, might have lied. Especially since I was only there for a back injury.
So no, it’s not always necessary to tell your doctor, and any doctor who looks at me as some kind of second cousin to “real” women will not get my business. I’m fortunate, though, that I live in a very progressive area where there are many health professionals who work with members of the LGBTQ+ community and several who specialize in providing health care to trans people.
In other parts of the country where LGBTQ+ identities are ostracized, where it might not be safe to come out to a doctor, many trans people avoid going to the doctor unless it’s completely necessary. It is for something trans related — like prescriptions for hormones — they are doubly careful about selecting a doctor.