-
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)