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The transgender and gender-nonconforming (TGNC) community has a real pot problem, only it isn’t what you think. My problem isn’t with the fact that trans people smoke pot more frequently than other groups, even though that’s generally true, with 25 percent of self-identified frequent users versus just 8 percent in the general public. My problem is that we can’t talk openly about our substance use.

When I mentioned the early draft idea for this article—an investigation into whether or not cannabis might help transgender folks find some form of relief from gender dysphoria—the topic piqued a lot of interest among every trans, gender-nonconforming, or nonbinary person I spoke with. I thought, with such widespread cannabis usage evident among TGNC people, there had to be a reason why, right? So, I went in search of answers.

In my search, I spoke with many healthcare professionals, including doctors, nurses, lab technicians, and pharmacists, in addition to several others who work in the cannabis industry.

There was a common trend in every conversation: nobody wanted to go on the record with their comments, out of fear for their jobs.

In private, these professionals told me how they weren’t afraid to speak to patients about cannabis use, but that they also understood why some patients might be reluctant to give honest answers about their substance use.

Many patients are afraid that being honest might limit their treatment options, like being denied surgeries or being restricted from hormone replacement therapy. Others have commented that they were afraid of “feeling judged” or “even more gatekeeping.”

To that end, one healthcare professional I spoke with shared one improvised solution: promising patients that if they talk honestly about their substance use, they won’t report it in patient records, thereby preventing insurance companies from ever finding out. It was more important, they said, to maintain the patient’s trust in their primary care provider than it was to include that information in patient records.

The larger problem here is that there isn’t an easy answer to this conundrum, either. If healthcare professionals are working on behalf of patients and against insurance companies when it comes to cannabis, how much is our science really progressing? If such a silencing effect and stigma still exists around even legal use of cannabis, here in Colorado of all places, what does that say for how our doctors feel compelled to work around the system in order to provide better patient outcomes?

There is promising research out there that suggests better answers are forthcoming with regard to gender development. A February 2014 study published in Psychology reports, “[iI]t has been suggested the image of sex organs of [transgender people] are ‘hard-wired’ in the brain in a manner which is opposite to that of their biological sex.” This is only preliminary research, of course, but it’s a heartening message for some in the community: it underscores that there may still be important medical differences about what it means to be transgender, about when and how gender development occurs, and many in the community are cheering for further results.

But while we cheer for more results, the truth is that we may never know how much more frequently the TGNC population consumes cannabis compared to cis people. Part of the problem is a lack of consistently reliable patient data, which itself is subject to error because it, too, relies entirely on self-reporting. And with both healthcare providers and their patients seemingly reluctant to share this kind of information out of fear for how insurance companies might wield it like a weapon, that situation doesn’t look like it will change any time soon, in a meaningful, regulatory sense.

Even with a general unwillingness to speak on record among the healthcare professionals I interviewed, some pointed me to research that already exists.

Authorities in the medical community have generally concluded that, while there may be some therapeutic benefits for ailments such as chronic pain, nausea, sleep, and MS-related spasms, much more research is still needed to confirm any potential benefits for other medical conditions.

Let’s be clear: the jury is out when it comes to health benefits from cannabis. Nobody is anywhere close to confirming that cannabis can help treat gender dysphoria or alleviate symptoms of feeling like your body might be “wrong.” But without a change in how openly we can talk about cannabis with our medical and mental health professionals, we will continue to lack consistently reliable data about how vast the pot “problem” is among TGNC community members.

Most healthcare professionals told me they would rather know about substance use than not know. We have a pot problem as a community, but it’s not entirely our fault. Healthcare professionals, in this case, just want to help—and we should let them.