Trans Care is Primary Care

by Margaux Everingham

A few years back, one innovative medical professional realized that transgender kids in the Santa Barbara area were not receiving hormone therapy because local providers did not have sufficient education. This medical professional was Sofie DeVaney, a physician assistant (PA) with Santa Barbara Neighborhood Clinics (SBNC). She decided to learn about hormone therapy through various conferences on trans care and from the endocrinology guidelines in order to start making a necessary change in our community. In an interview with Max Rorty, a social worker for SBNC, we examined not only how providers have changed in Santa Barbara to better accommodate the trans population, but also how the medical community can continue to improve and serve all people. As Sofie specifies, “It is not trans care, it is just care for everybody.”

Many kids know they are transgender long before puberty. Supportive families, communities and medical providers can ensure that these children avoid the wrong puberty. For example, Jazz Jennings, who was assigned male at birth, knew she was a girl right away. Because she was safe to articulate herself in her family and she had access to a medical provider who knew how to block her male puberty, she was able to avoid growing facial and body hair and vocal changes.Transgender children require parental consent for all medications; therefore Jazz’s family was the key to her obtaining cross sex hormones that made it possible for her to go through a female puberty at the same time as her peer group.

Santa Barbara and SLO have long had providers who administer cross sex hormones to transgender adults, but Sofie is the first provider to help transgender adolescents. Sofie specializes in family medicine, not trans care. This is because trans care is not a specialty, it is part of being a practitioner. Accordingly, all primary care providers should prioritize mitigating the anguish caused by going through puberty in the wrong gender.

The functionality of hormone therapy is not the only thing that providers can help with. A causal reason for the improper medical care of both trans kids and adults is a mutual fear and misunderstanding. Many providers have not been educated in how to properly and compassionately care for trans people and many trans people have felt fearful of providers and the difficult conversations that inevitably ensue at the doctor’s office. To combat this, Max affirms that providers can have the maximum impact on health by asking a lot of questions. These questions should include things like, “what are you experiencing and what could we do better?” Sofie confirms that providers should not be afraid, “Jump on in.” It is understood that certain questions are not only medically relevant, but also critical. That being said, there is a way to go about these conversations that leaves the patient feeling comfortable and heard.

The idea behind the aforementioned questions is inclusion with intent. Max describes one instance in which the front desk employees went “above and beyond” to make their clientele feel comfortable.

SBNC front desk staff got really excited about the role they play in showing people a welcoming posture. This includes knowing people’s real names and not using their legal names. It also includes knowing pronouns and asking if they don’t know them. The front desk staff went so far as to make name tags with their own pronouns. “It is a solidarity move. I have mine and you have yours and I’m interested in yours. It is a type of institutional positioning. That has been the sweetest thing to watch to see how patients and the front staff react to that. To be intentional” Max explained.

This leads to the question, is this really going “above and beyond” or is this being an empathetic and worthy medical professional who is adhering to the hippocratic oath? It is important that we all use start to use our own pronouns and invite others to do the same. In fact, SBNC are not the only ones to suggest this type of inclusion. Lindy West is a social rights activist and the author. In an interview with Trevor Noah where she was discussing her book “Shout your Abortion”, West describes why she deliberately chose not to use the terms “women” or “women’s issue.”

“…it’s just more important now than ever, when this administration is openly hostile to trans people. I think those of us who are trying to be on the right side of history, and who genuinely care about other human beings, try to be inclusive in our language and, the fact is, it is not only women who can become pregnant. Trans men and non binary people can become pregnant and that is just reality. Why would I be deliberately inaccurate with the way that I speak?” Lindy West explains.

The thing that Max Rorty, Sofie DeVaney, and Lindy West all have in common is that they are actively working to change the dynamic institutionally. What they do and what they say is purposeful.

As an institution that does outreach to the underserved, DWW-SBSM is always working to better our care. We are happy to be an ally with both the SBNC and with the Santa Barbara Trans Advocacy Network (SBTAN), which provides educational services and safe spaces for transgender & gender expansive clients, patients, students, congregants and families.

DWW-SBSM is working hard to provide care to the most vulnerable population in the Santa Barbara area and staying at the forefront of research involving the social implications of health. People often make the assumption that homelessness in the trans population is a direct result of gender identity. Though the trans population has a 4x higher risk of homelessness than the general population, it is actually social support that is more closely correlated to homelessness than gender identity.

An article published in Frontiers of Psychology aims to explore the relationship between trans identifying individuals, social support, and homelessness. The authors describe how self-esteem can play a role in social support, “…knowing that the gender affirmation process enhances self-esteem, and that better self-esteem improves the social support network, the importance of providing hormonal therapy and surgical procedures becomes even more evident.” It is pertinent that medical organization provide the resources to all their clients so that they may be healthy both physically and mentally.

On a lighter note, Max was confident that within the next 20 years trans kids will stop being silenced or shunned by their families and their incidence of homelessness will match that of the general population. There has been no community pushback to the work done by SBNC and they are excited to be paving the way for other clinics to expand their services as well.

DWW-SBSM is a proud collaborator in this work. We continue to be an ally to the trans individuals in our community as well as the community as a whole. As a general rule, we could ask a few more questions and speak with a little more purpose.

 

 

 

Works Cited

The Daily Show with Trevor Noah. “Lindy West – Counteracting Dangerous Myths with ‘Shout Your Abortion’ | The Daily Show.” YouTube, YouTube, 3 Dec. 2018, www.youtube.com/ watch?v=GP79UoP4WY8.

Seibel, Bruna L., et al. “The Impact of the Parental Support on Risk Factors in the Process of

Gender Affirmation of Transgender and Gender Diverse People.” Frontiers in Psychology, vol. 9, 2018, doi:10.3389/fpsyg.2018.00399.

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December 21st, 2018|