When you walk into a doctor’s office for the first time, you might be asked to fill out a slew of forms. Many include a box to check for your gender: male or female. But what if that’s not an easy—or a comfortable—question to answer? That’s just one example of what keeps many transgender patients from getting the medical care they need.
One medical practice is trying to make it easier.
Jayeson Watts welcomes a conference room full of OB GYN nurses at Thundermist Community Health Center with a simple question: Many transgender people have trouble finding primary health care, or put off getting the care they need because they fear discrimination. In this story, one medical practice in Rhode Island is trying to make it easier.
“How many of you have worked with trans patients?”
One hand goes up. That’s a familiar starting place for Watts, who is himself a transgender man. But he tells them that’s going to change, now that Thundermist has launched a Trans Health program. He’s been hired to manage it. And part of his job is training staff.
“So I want to make sure that you all feel comfortable and are prepared if you have a trans person that shows up in your care," Watts says. "How do we talk to them? How do we answer questions? How do we ask questions? How do we talk about body parts? How do we have these sensitive conversations?”
Nurses are usually pretty comfortable with body parts. But Watts says for transgender patients, they can be a source of anxiety. Imagine what it’s like for a transgender man – someone who was assigned the female sex at birth but who now identifies as male – who comes to an OB GYN clinic.
“Trans folks, particularly trans folks who own vaginas and cervixes, need to access women’s health services," says Watts. "And those experiences can be really uncomfortable, and could be somewhat traumatizing.”
Watts walks the staff through some basics about transgender people – from what it means to be transgender to the varieties of ways people transition, whether it’s changing their legal name, asking people to use a different pronoun, or getting hormone therapy or surgery.
Thundermist is undergoing its own transition to become more welcoming for transgender patients, a group Thundermist CEO Chuck Jones says has been underserved.
“The trans health community faces very serious disparities in health," says Jones, who began to realize just how serious the disparities are after a couple of doctors on staff raised the issue. For instance, studies show a big percentage of trans patients put off going to the doctor because they’re worried about discrimination.
“Over 40 percent of them have attempted to commit suicide, by some reports," Jones says. "And a good number experience issues with the competency of their health care providers, or friendliness, or even willingness of their health care providers to treat them.”
Some providers want to care for trans patients but don’t know how. So Jones and his staff organized clinical training for doctors and nurses. They changed all the bathroom signs – no more men only or women only symbols. It’s a work in progress, he says, but word is getting out. Now the health center sees several new trans patients a month, patients like Elliott, a young trans man.
“And I kind of stumbled across Thundermist when I came to urgent care with my wife and we saw transgender as an option on the patient intake form.”
We won’t use Elliott’s last name to protect his medical privacy. He recalls that moment as he chats with his Dr. Anna Filip in an exam room. Dr. Filip says that form is more significant than it sounds when it comes to making patients feel comfortable.
“It is the day-to-day and it is the details, like Elliott said. It is having the option to identify yourself as you see yourself on every form," says Filip, "with every person that you meet, and to have that identity respected.”
And once you build trust with a patient, Dr. Filip says, you can have the difficult conversations - which are not all about hormones or surgery. Filip says she spends most of her time counseling patients about preventive medicine.
“And making sure that the body that they have is taken care of until it becomes the body that they want, making sure that they are getting the preventive health care that should be done," Filip says, "like pap smears, or mammograms, or testicular exams, when they may not want to have those body parts.”
Elliott says he’s had some less-than-welcoming experiences in other doctors’ offices. But he plans to stick with Dr. Filip, for regular checkups and the specialized care he needs to maintain his identity.
“With the hormones, there’s a lot of blood work when first getting started, making sure levels are good in your body, making sure they’re not affecting other things that are going on. So it’s a lot of frequent doctor’s visits. So it’s really important that you have somebody that you actually want to spend a lot of time with," Elliott says.
“This is a core issue and people are not learning anything about it at all in medical school," according to Dr. Madeline Deutsch. She runs a center for transgender health at the University of California San Francisco. Deutsch says data on transgender demographics is hard to come by, but the population can’t be ignored.
"One in 200 people, in this country, we believe, exist somewhere on some kind of transgender or gender nonconforming spectrum," said Deutsch. "That is approximately equal to the population in the U.S. of people of native Hawaiian or Pacific Islander descent.”
Deutsch has developed a protocol for primary care doctors’ offices to follow when taking care of transgender patients. It’s the roadmap Thundermist followed to transform its clinics. Deutsch says that as transgender issues become more visible, she’s getting more calls from clinics that want to do the same.