I owe some thanks to the commenter who noted that I don’t actually have to write down all of my trans health thoughts in the same post. Yes, it seems obvious…now. I have a tendency to panic a little in the face of large tasks, though.
I’ve been wanting to write a post about how I got started seeing transgender patients. I’ve talked to several health care providers who have expressed interest in integrating transgender care into their practices, but don’t know how. I’ve also talked to providers who don’t particularly want to do trans-specific care (ie: hormones) but would like to learn more about how to be a trans-friendly provider. A lot of people that I talk to want to know why, as a non-trans person, I wanted to get involved in trans health in the first place. The simple answer is: because trans people are my friends and loved ones, and my community, and I want them to have good health care. The longer, more academic answer is that if you look at the data about health care access, transgender patients face many barriers to care. I find it unacceptable that someone would be turned away from care–or discouraged from seeking care–based on their gender identity or expression. If you want even longer answers, let me know and I can send you some journal articles about health care access and the effects of discrimination on trans people.
I had an advantage going into my training as a nurse practitioner, because I already knew that I wanted to provide LGBTQ folks with healthcare. Aside from a class about cultural competency that included LGBTQ info, I did not receive any extra training about transgender health. BUT…I was motivated to learn on my own, and I had professors who were supportive of that. I did class projects that focused on transgender health care, I brought trans speakers to the school to discuss general info and health care protocols, I worked with the administration on their non-discrimination statement (to include gender identity) and I integrated transgender health into my thesis project. At the end of all of that, I was at least as qualified to talk about trans health as any doctor coming out of medical school.
When it came time to look for a job, I decided not to look at any LGBTQ-focused health centers. My larger passion is for working with underserved populations, and I wasn’t actually very interested in working with middle or upper class gays. I decided to go for a community health center job and see what I could do with the queer health stuff once I got settled there. I was lucky–really lucky–to end up in a clinic with a very awesome, feminist, lesbian-identified doctor on the staff. She has done amazing things at our clinic, and she is a staunch advocate for nurse practitioner autonomy. After a few months of working there, I told her about my thesis topic (trans health) and that I was interested in LGBTQ healthcare. She was excited and introduced me to one of the only local therapists who sees queer/trans patients within our community (most trans-identified people in our area have to drive 30-40 min to see a therapist who has trans-experience).
The therapist and I met to talk about our experiences and our practice philosophies. She was excited to have someone to refer patients to who wasn’t 1) 30+ minutes away 2) an endocrinologist who follows the WPATH Standards of Care and 3) was familiar with the community. Once I started getting referrals from the therapist, I got nervous. I was excited about the chance to prescribe hormones for people in a way that I thought it should be done, but I was scared to do it alone. At that point, I had been in practice for a little under a year…long enough to stop freaking out about every patient, but not long enough to feel confident doing new things alone. Especially when the new thing is often viewed as a specialty best left to endocrinologists (not MY opinion, btw, but a common opinion among primary care providers).
I knew I had to seek out support, both to help me be a good provider, and to cover my ass in case the doctors at my clinic found out what I was doing and started freaking out. I joined a trans medicine email list. I started going to more LGBTQ medical conferences. I read through other clinics’ protocols for care. I talked to my doctor-ally about what I was doing, and she agreed to support me. She still co-signs every one of my charts, and I like it like that. She respects my autonomy and judgement, but I know that the medical world is full of people who won’t treat my decisions as valid without a MD signature at the end. And this is an area in which I really do want to cover my ass as much as possible. Sad but true.
So that’s where it all began. Now, 4 years later, I feel much more comfortable with all the curveballs that I’ve been thrown since those early days, but that’s a story for another day….