What doctors should know about gender identity Kristie Overstreet
About six months
into my career as a therapist,
I was working at a drug
and alcohol rehab facility.
I got a call from one of the nurses
down at the detox unit.
She asked me to come down
and assess one of the new patients
that had arrived earlier in the day.
So I went down to the unit
and had the pleasure of meeting Anne.
Anne’s a transgender female,
and as her and I started talking,
she was sharing with me
about what brought her into treatment,
but I could hear this fear in her voice,
and I could see this worry in her eyes,
and she began to tell me
that she didn’t fear coming into rehab
and having to give up drugs and alcohol.
Her fear was that the doctors
that were going to be treating her
would not treat her as her female self.
She then told me about this ongoing pain
that she has experienced her whole life
of being assigned male
but knowing she’s female.
And what she meant by that is,
when she was born,
the doctor held her up to her parents
and based on her genitalia said,
“It’s a boy.”
She always knew she wasn’t a boy.
Many years passed and the feelings
that she was feeling
and holding all this in grew and grew,
and she knew she had
to come out to her family.
And when she did,
it didn’t go over so well.
Her parents said,
“Absolutely not. You’re not a girl.
This is not how we raised you.
We don’t know what you’re thinking.
Get out.”
So Anne then found herself on the streets
and in and out of homeless shelters,
and it’s here where
she started using drugs and alcohol
to numb this pain she felt inside.
She told me about her journey of being
in and out of hospitals and rehabs
trying to get sober,
and when she did, the health care
providers and doctors
wouldn’t use the correct
female name or pronouns.
This caused her pain.
You see, when I was studying
to become a therapist,
I wasn’t taught how to work
with transgender patients.
I had no idea these would be
the patients I’d be working with.
But the more I worked with Anne
and other patients like Anne,
I began to see my mission evolve,
and that was to make sure
that the transgender community
got their health care needs met.
The more I looked into this,
I saw how this very real fear
of violence, discrimination
and this lack of acceptance
caused so many of these patients
to turn to alcohol and drugs.
And I also heard these horror stories
of when these patients
were seeking medical care
and how they were treated,
and how a lot of their
medical needs were ignored.
Now let me tell you about Leah.
I had the pleasure
of meeting Leah a few years back.
She’s a female and she has
a wife and a child.
See, Leah was also assigned male at birth
and she knew since she was a young child
that she was not a male,
that she was a female.
She hid it from herself
and from everyone she knew,
especially from her wife,
until the age of 50.
She couldn’t take it anymore.
She was like, I can’t
keep living like this.
I gotta get honest.
She was extremely scared to tell her wife.
What if her wife said,
“This is unacceptable,
I want a divorce, get out”?
To her surprise, her wife was accepting.
She said, “I love you
regardless of who you are.
I want to help you in every way I can.”
So she talked with her wife,
and she made the decision
that she wanted to medically transition,
and she was interested in being
assessed for hormone replacement therapy,
otherwise known as HRT.
So she made an appointment
with her doctor.
She arrived on the day
of her appointment early.
She filled out all the paperwork,
put the name correctly down there
and waited patiently.
A little bit of time passed and a nurse
called her back to the exam room.
When she got back there,
she took a deep breath,
and the doctor and the nurse walked in.
She extended her hand to the doctor
and said, “Hi, I’m Leah.”
The doctor looked at her,
didn’t shake her hand and said,
“Why are you here?”
She took another deep breath and said,
“Well, I’m a transgender female.
I’ve known this my whole life,
I’ve hid it from everyone,
but I can’t do it anymore.
My wife’s supportive,
I can financially afford it,
I’ve got to make these changes.
Please consider me,
and let’s evaluate me for HRT.”
The doctor said,
“We can’t do anything today.
You need to go get an HIV test.”
She couldn’t believe it.
She was furious.
She was angry. She was disappointed.
If her doctor treated her this way,
how would the rest of the world treat her?
First, he wouldn’t shake her hand,
and second, when he heard
she was transgender,
all he cared about was getting
an HIV test and ending the appointment.
He didn’t even ask her
any other questions.
See, I can understand
where Leah’s coming from,
because the years that I’ve worked
with the community,
I hear myths every single day
that aren’t true at all.
A couple of those are:
every transgender person wants
to transition with medication or surgery;
transgender people are mentally ill,
this is a disorder;
and: these people
aren’t real men and women.
These are all myths and untrue.
As this community expands and grows older,
it is imperative that all
health care providers be trained
on how to take care
of their health care needs.
Back in 2015, a survey was done
and found that 72 percent
of health care providers
did not feel well-informed
on the health care needs
of the LGBT community.
There’s a huge gap
in the education and training.
Today, in this talk,
I want to offer a new way of thinking
for three groups of people:
doctors, the transgender community
and, well, the rest of us.
But before we do, I want to cover
a couple of definitions
that’s going to help you wrap your head
around gender identity a little bit more.
So I hope you’ve got your paper and pen.
Get ready to take some notes.
So let’s start out
with this idea of a binary system.
And what this means is,
before, we always thought
there was only two, male and female.
Get it? Binary? Right?
So we’ve come to find out
that this isn’t true.
Gender identity is a spectrum
with maleness on one side
and femaleness over here
on the other side.
This spectrum of identities
include identities such as
gender-nonconforming,
gender-affirming,
gender-nonbinary,
two-spirited, three-spirited,
as well as people that are intersex.
The term transgender is this umbrella term
that encompasses all these
different types of identities.
But for today’s talk, I want you
to think about transgender
as someone who is assigned
a sex at birth that doesn’t match
with who they are as a person
and their sense of self.
Now, this is very different
than biological sex.
So gender identity is sense of self.
So think of it as
what’s between your ears:
sense of self, who you are.
This is very different
than biological sex, right?
Hormones, genitalia, chromosomes:
that’s what’s between our legs.
Now, you may be thinking, “Dr. Kristie,
I have never questioned who I am.
I know I’m a man, or I know I’m a woman.”
I get it. You know who you are.
This is how many
transgender individuals feel.
They just know who they are
with that same conviction.
It’s important to know that there
are many different types of identities,
and I identify as a cisgender female.
Now, for all y’all out there
that like to know how to spell things,
cis is spelled “c-i-s.”
It’s the Latin term
for “on the same side of.”
When I was born,
the doctor held me up
to my parents and said,
“It’s a girl.”
All this, based on my genitalia.
Even though I grew up
in a small farm town in Georgia,
very much a tomboy,
I never questioned that I was a female.
I’ve always known I was a girl,
regardless of how I was as a kid.
Now, this is very different
than someone who’s transgender.
Now, trans is a Latin term
for “on the other side of” –
think about transcontinental airlines,
across, on the other side of –
someone that’s assigned a sex at birth
and they identify
on the other side of the spectrum.
A transgender male is someone
who was assigned female at birth,
but their sense of self,
who they are, how they live their life,
is as a male.
And the opposite is, as we talked earlier,
a transgender female,
someone that’s assigned male at birth
but lives their live
and sense of self as a female.
It’s also important to point out here
that not everyone
that has a nonbinary identity
identifies with the term “transgender.”
Just so nobody gets confused,
I want to point out sexual identity,
or orientation.
That is simply who we’re attracted to,
physically, emotionally,
sexually, spiritually.
It’s got nothing to do
with gender identity.
So just for a quick recap,
before we continue on:
gender identity between the ears,
biological sex, just think
of it between your legs,
and then sexual identity,
well, sometimes we use our heart,
but it’s here.
Three very different identity spectrums.
Now, the average medical student
spends about five hours learning
about the LGBT health-related needs
while they’re in medical school.
Now, this is despite us knowing
that there are unique health risks
to this community.
And there’s an estimated
10 million American adults
that identify as LGBT.
Most doctors that work
with transgender patients,
they learn trial by fire.
That means they figure it out
as they go along,
or the patient ends up spending their time
trying to teach the doctor
how to take care of them.
Many doctors don’t feel comfortable
asking about gender identities.
Some don’t feel like it’s relevant at all
to their medical care
and others just don’t want
to say the wrong thing.
Many doctors who say
something inappropriate
or they say something negative,
they may not be coming
from a malicious or mean place,
they may have never been trained
on how to care for these individuals.
But this can’t be accepted
as a norm anymore either.
So what happens to a transgender male –
for a quick recap, that’s someone
who is assigned female at birth
but lives their life as a male –
what happens when this transgender male
goes for their yearly gynecological visit?
How that doctor treats that patient
will set the whole tone for the office.
If that doctor treats that male
with the correct pronouns, correct name,
gives dignity and respect,
it’s highly likely
that the rest of the staff will too.
So that’s a little bit
about my thoughts on doctors,
and now let’s move on
to the transgender community.
I’m here talking about fear,
but y’all know who
is really fearful, right?
It’s the transgender community.
Earlier I shared the story about Anne
and how she was so worried
about going into treatment
and not being respected
as her female self,
and then Leah who was scared
about how her doctor would react,
and the second
that he didn’t shake her hand
and ordered that HIV test,
her fears came true.
The transgender community
needs to be empowered
to speak up for their health care needs.
The days of remaining silent and taking
whatever treatment you can get are over.
If you don’t speak up
for your health care needs,
no one’s going to do it for you.
So what about the rest of us?
A lot of y’all, maybe in the next week
or a couple of months,
are going to have
a doctor’s appointment, right?
So let’s say you go
to your doctor’s appointment
and when it’s over,
you feel worse than you did
when you got there.
What if you felt dismissed by the doctor,
that they ignored your needs,
or you even felt judged?
That’s what happens for many
of the 1.4 million transgender adults
here in the US
if they’re lucky enough
to get an appointment.
Now, you may be thinking,
“Why is this important to me?
I’m not transgender.
I don’t know anybody that’s transgender.
Why should I even care?”
Think of it this way.
A transgender individual is human,
just like you and me.
They deserve competent
and trained health care providers,
just like you and me.
So let me ask, if you don’t
mind raising your hand:
Do you know or have you met
anyone who is transgender,
gender-nonconforming, agender, intersex,
two-spirited, three-spirited?
Thank y’all so much. Lovely. Thank y’all.
Every one of y’all
who did not raise your hand,
in the very near future
you will get the opportunity to meet
someone that falls into one
of these identities, I guarantee it.
The number of this
community is increasing.
That’s not because it’s a fad
or the new thing to do.
It’s safer to come out.
There’s more awareness.
There’s more visibility.
There’s more safety, so people
are speaking up about their true self
like never before.
That’s why it’s so important
that our health care system get on board
and make sure that our doctors
and health care providers are trained
to approach these patients
with dignity and respect,
just like we expect.
I remember being
in my 11th grade literature class,
with one of my favorite
teachers, Mr. McClain,
and he shared this quote by Heraclitus
that sticks with me to this day.
Y’all may have even heard it.
It’s, “The only thing that is constant
is that things will change.”
Familiar, right?
Every single one of us
face changes in our lives,
and often when we’re faced
with these changes,
we’ve got some difficult
decisions to make.
Will we remain in fear, stay stuck
and not grow?
Or, will we face fear with bravery,
evolve, take the opportunity to grow?
Every one of us face new things.
What will you do?
Will you remain in fear,
or will you grow?
I invite each of you, doctors,
the transgender community
and you and I,
to face fear together
as we walk into this brave new world.
Thank you.
(Applause)