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← What doctors should know about gender identity

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Showing Revision 6 created 10/02/2018 by Brian Greene.

  1. About six months
    into my career as a therapist,

  2. I was working at a drug
    and alcohol rehab facility.
  3. I got a call from one of the nurses
    down at the detox unit.
  4. She asked me to come down
    and assess one of the new patients
  5. that had arrived earlier in the day.
  6. So I went down to the unit
    and had the pleasure of meeting Anne.
  7. Anne's a transgender female,
    and as her and I started talking,
  8. she was sharing with me
    about what brought her into treatment,
  9. but I could hear this fear in her voice,
  10. and I could see this worry in her eyes,
  11. and she began to tell me
    that she didn't fear coming into rehab
  12. and having to give up drugs and alcohol.
  13. Her fear was that the doctors
    that were going to be treating her
  14. would not treat her as her female self.
  15. She then told me about this ongoing pain
    that she has experienced her whole life

  16. of being assigned male
    but knowing she's female.
  17. And what she meant by that is,
    when she was born,
  18. the doctor held her up to her parents
  19. and based on her genitalia said,
  20. "It's a boy."
  21. She always knew she wasn't a boy.
  22. Many years passed and the feelings
    that she was feeling
  23. and holding all this in grew and grew,
  24. and she knew she had
    to come out to her family.
  25. And when she did,
    it didn't go over so well.
  26. Her parents said,
    "Absolutely not. You're not a girl.
  27. This is not how we raised you.
    We don't know what you're thinking.
  28. Get out."
  29. So Anne then found herself on the streets
    and in and out of homeless shelters,
  30. and it's here where
    she started using drugs and alcohol
  31. to numb this pain she felt inside.
  32. She told me about her journey of being
    in and out of hospitals and rehabs
  33. trying to get sober,
  34. and when she did, the health care
    providers and doctors
  35. wouldn't use the correct
    female name or pronouns.
  36. This caused her pain.
  37. You see, when I was studying
    to become a therapist,

  38. I wasn't taught how to work
    with transgender patients.
  39. I had no idea these would be
    the patients I'd be working with.
  40. But the more I worked with Anne
    and other patients like Anne,
  41. I began to see my mission evolve,
  42. and that was to make sure
    that the transgender community
  43. got their health care needs met.
  44. The more I looked into this,
    I saw how this very real fear
  45. of violence, discrimination
    and this lack of acceptance
  46. caused so many of these patients
    to turn to alcohol and drugs.
  47. And I also heard these horror stories
  48. of when these patients
    were seeking medical care
  49. and how they were treated,
  50. and how a lot of their
    medical needs were ignored.
  51. Now let me tell you about Leah.

  52. I had the pleasure
    of meeting Leah a few years back.
  53. She's a female and she has
    a wife and a child.
  54. See, Leah was also assigned male at birth
  55. and she knew since she was a young child
    that she was not a male,
  56. that she was a female.
  57. She hid it from herself
    and from everyone she knew,
  58. especially from her wife,
    until the age of 50.
  59. She couldn't take it anymore.
  60. She was like, I can't
    keep living like this.
  61. I gotta get honest.
  62. She was extremely scared to tell her wife.
  63. What if her wife said,
  64. "This is unacceptable,
    I want a divorce, get out"?
  65. To her surprise, her wife was accepting.
  66. She said, "I love you
    regardless of who you are.
  67. I want to help you in every way I can."
  68. So she talked with her wife,
  69. and she made the decision
    that she wanted to medically transition,
  70. and she was interested in being
    assessed for hormone replacement therapy,
  71. otherwise known as HRT.
  72. So she made an appointment
    with her doctor.
  73. She arrived on the day
    of her appointment early.
  74. She filled out all the paperwork,
  75. put the name correctly down there
    and waited patiently.
  76. A little bit of time passed and a nurse
    called her back to the exam room.
  77. When she got back there,
    she took a deep breath,
  78. and the doctor and the nurse walked in.
  79. She extended her hand to the doctor
    and said, "Hi, I'm Leah."
  80. The doctor looked at her,
    didn't shake her hand and said,
  81. "Why are you here?"
  82. She took another deep breath and said,
  83. "Well, I'm a transgender female.
  84. I've known this my whole life,
    I've hid it from everyone,
  85. but I can't do it anymore.
  86. My wife's supportive,
    I can financially afford it,
  87. I've got to make these changes.
  88. Please consider me,
    and let's evaluate me for HRT."
  89. The doctor said,
    "We can't do anything today.
  90. You need to go get an HIV test."
  91. She couldn't believe it.

  92. She was furious.
  93. She was angry. She was disappointed.
  94. If her doctor treated her this way,
    how would the rest of the world treat her?
  95. First, he wouldn't shake her hand,
  96. and second, when he heard
    she was transgender,
  97. all he cared about was getting
    an HIV test and ending the appointment.
  98. He didn't even ask her
    any other questions.
  99. See, I can understand
    where Leah's coming from,

  100. because the years that I've worked
    with the community,
  101. I hear myths every single day
    that aren't true at all.
  102. A couple of those are:
  103. every transgender person wants
    to transition with medication or surgery;
  104. transgender people are mentally ill,
    this is a disorder;
  105. and: these people
    aren't real men and women.
  106. These are all myths and untrue.
  107. As this community expands and grows older,
  108. it is imperative that all
    health care providers be trained
  109. on how to take care
    of their health care needs.
  110. Back in 2015, a survey was done

  111. and found that 72 percent
    of health care providers
  112. did not feel well-informed
  113. on the health care needs
    of the LGBT community.
  114. There's a huge gap
    in the education and training.
  115. Today, in this talk,

  116. I want to offer a new way of thinking
    for three groups of people:
  117. doctors, the transgender community
    and, well, the rest of us.
  118. But before we do, I want to cover
    a couple of definitions
  119. that's going to help you wrap your head
    around gender identity a little bit more.
  120. So I hope you've got your paper and pen.
    Get ready to take some notes.
  121. So let's start out
    with this idea of a binary system.

  122. And what this means is,
  123. before, we always thought
    there was only two, male and female.
  124. Get it? Binary? Right?
  125. So we've come to find out
    that this isn't true.
  126. Gender identity is a spectrum
  127. with maleness on one side
  128. and femaleness over here
    on the other side.
  129. This spectrum of identities
  130. include identities such as
    gender-nonconforming,
  131. gender-affirming,
  132. gender-nonbinary,
  133. two-spirited, three-spirited,
  134. as well as people that are intersex.
  135. The term transgender is this umbrella term
  136. that encompasses all these
    different types of identities.
  137. But for today's talk, I want you
    to think about transgender
  138. as someone who is assigned
    a sex at birth that doesn't match
  139. with who they are as a person
    and their sense of self.
  140. Now, this is very different
    than biological sex.

  141. So gender identity is sense of self.
  142. So think of it as
    what's between your ears:
  143. sense of self, who you are.
  144. This is very different
    than biological sex, right?
  145. Hormones, genitalia, chromosomes:
  146. that's what's between our legs.
  147. Now, you may be thinking, "Dr. Kristie,
    I have never questioned who I am.

  148. I know I'm a man, or I know I'm a woman."
  149. I get it. You know who you are.
  150. This is how many
    transgender individuals feel.
  151. They just know who they are
  152. with that same conviction.
  153. It's important to know that there
    are many different types of identities,

  154. and I identify as a cisgender female.
  155. Now, for all y'all out there
    that like to know how to spell things,
  156. cis is spelled "c-i-s."
  157. It's the Latin term
    for "on the same side of."
  158. When I was born,
  159. the doctor held me up
    to my parents and said,
  160. "It's a girl."
  161. All this, based on my genitalia.
  162. Even though I grew up
    in a small farm town in Georgia,
  163. very much a tomboy,
  164. I never questioned that I was a female.
  165. I've always known I was a girl,
  166. regardless of how I was as a kid.
  167. Now, this is very different
    than someone who's transgender.

  168. Now, trans is a Latin term
    for "on the other side of" --
  169. think about transcontinental airlines,
  170. across, on the other side of --
  171. someone that's assigned a sex at birth
  172. and they identify
    on the other side of the spectrum.
  173. A transgender male is someone
    who was assigned female at birth,
  174. but their sense of self,
    who they are, how they live their life,
  175. is as a male.
  176. And the opposite is, as we talked earlier,
  177. a transgender female,
    someone that's assigned male at birth
  178. but lives their live
    and sense of self as a female.
  179. It's also important to point out here
  180. that not everyone
    that has a nonbinary identity
  181. identifies with the term "transgender."
  182. Just so nobody gets confused,
    I want to point out sexual identity,

  183. or orientation.
  184. That is simply who we're attracted to,
  185. physically, emotionally,
    sexually, spiritually.
  186. It's got nothing to do
    with gender identity.
  187. So just for a quick recap,
    before we continue on:
  188. gender identity between the ears,
  189. biological sex, just think
    of it between your legs,
  190. and then sexual identity,
    well, sometimes we use our heart,
  191. but it's here.
  192. Three very different identity spectrums.
  193. Now, the average medical student

  194. spends about five hours learning
    about the LGBT health-related needs
  195. while they're in medical school.
  196. Now, this is despite us knowing
    that there are unique health risks
  197. to this community.
  198. And there's an estimated
    10 million American adults
  199. that identify as LGBT.
  200. Most doctors that work
    with transgender patients,
  201. they learn trial by fire.
  202. That means they figure it out
    as they go along,
  203. or the patient ends up spending their time
  204. trying to teach the doctor
    how to take care of them.
  205. Many doctors don't feel comfortable
    asking about gender identities.
  206. Some don't feel like it's relevant at all
    to their medical care
  207. and others just don't want
    to say the wrong thing.
  208. Many doctors who say
    something inappropriate
  209. or they say something negative,
  210. they may not be coming
    from a malicious or mean place,
  211. they may have never been trained
    on how to care for these individuals.
  212. But this can't be accepted
    as a norm anymore either.
  213. So what happens to a transgender male --

  214. for a quick recap, that's someone
    who is assigned female at birth
  215. but lives their life as a male --
  216. what happens when this transgender male
    goes for their yearly gynecological visit?
  217. How that doctor treats that patient
  218. will set the whole tone for the office.
  219. If that doctor treats that male
    with the correct pronouns, correct name,
  220. gives dignity and respect,
  221. it's highly likely
    that the rest of the staff will too.
  222. So that's a little bit
    about my thoughts on doctors,

  223. and now let's move on
    to the transgender community.
  224. I'm here talking about fear,
  225. but y'all know who
    is really fearful, right?
  226. It's the transgender community.
  227. Earlier I shared the story about Anne
  228. and how she was so worried
    about going into treatment
  229. and not being respected
    as her female self,
  230. and then Leah who was scared
    about how her doctor would react,
  231. and the second
    that he didn't shake her hand
  232. and ordered that HIV test,
    her fears came true.
  233. The transgender community
    needs to be empowered
  234. to speak up for their health care needs.
  235. The days of remaining silent and taking
    whatever treatment you can get are over.
  236. If you don't speak up
    for your health care needs,
  237. no one's going to do it for you.
  238. So what about the rest of us?

  239. A lot of y'all, maybe in the next week
    or a couple of months,
  240. are going to have
    a doctor's appointment, right?
  241. So let's say you go
    to your doctor's appointment
  242. and when it's over,
  243. you feel worse than you did
    when you got there.
  244. What if you felt dismissed by the doctor,
  245. that they ignored your needs,
  246. or you even felt judged?
  247. That's what happens for many
    of the 1.4 million transgender adults
  248. here in the US
  249. if they're lucky enough
    to get an appointment.
  250. Now, you may be thinking,
    "Why is this important to me?

  251. I'm not transgender.
    I don't know anybody that's transgender.
  252. Why should I even care?"
  253. Think of it this way.
  254. A transgender individual is human,
  255. just like you and me.
  256. They deserve competent
    and trained health care providers,
  257. just like you and me.
  258. So let me ask, if you don't
    mind raising your hand:

  259. Do you know or have you met
    anyone who is transgender,
  260. gender-nonconforming, agender, intersex,
    two-spirited, three-spirited?
  261. Thank y'all so much. Lovely. Thank y'all.

  262. Every one of y'all
    who did not raise your hand,
  263. in the very near future
  264. you will get the opportunity to meet
  265. someone that falls into one
    of these identities, I guarantee it.
  266. The number of this
    community is increasing.
  267. That's not because it's a fad
    or the new thing to do.
  268. It's safer to come out.
  269. There's more awareness.
    There's more visibility.
  270. There's more safety, so people
    are speaking up about their true self
  271. like never before.
  272. That's why it's so important
    that our health care system get on board
  273. and make sure that our doctors
    and health care providers are trained
  274. to approach these patients
    with dignity and respect,
  275. just like we expect.
  276. I remember being
    in my 11th grade literature class,

  277. with one of my favorite
    teachers, Mr. McClain,
  278. and he shared this quote by Heraclitus
    that sticks with me to this day.
  279. Y'all may have even heard it.
  280. It's, "The only thing that is constant
    is that things will change."
  281. Familiar, right?
  282. Every single one of us
    face changes in our lives,
  283. and often when we're faced
    with these changes,
  284. we've got some difficult
    decisions to make.
  285. Will we remain in fear, stay stuck
  286. and not grow?
  287. Or, will we face fear with bravery,
  288. evolve, take the opportunity to grow?
  289. Every one of us face new things.
  290. What will you do?
  291. Will you remain in fear,
  292. or will you grow?
  293. I invite each of you, doctors,
    the transgender community
  294. and you and I,
  295. to face fear together
  296. as we walk into this brave new world.
  297. Thank you.

  298. (Applause)