September 2nd, 2016

Medicine for the Queer

By Domenic Fraboni

By: James Lee

James onstage with his band Sister Insider. PC: Chris Melamed

This is a happy story. A boy named Joey goes to his local primary care physician, Dr. Weber, with the desire to talk about his gender. Over the course of his freshman year in high school, he began to feel more uncomfortable in his skin. The way that society treated him as a young man weighed him down constantly. He spent hours every week on the internet in incognito mode, trying to Google how he felt and being overwhelmed with online resources. He just needed one trustworthy, educated friend to give him counsel. So he waited for his annual appointment with Dr. Weber and eked out enough courage to describe his disquiet.

Dr. Weber did not miss a beat – she immediately paged her psychiatrist colleague. Joey, after an hour conversation with the psychiatrist, was then equipped with the linguistics to think critically about his gender. Transgender, queer, questioning, preferred gender pronouns – Joey was introduced to an entirely different language that he did not experience in the context of his limited health education. The day after the appointment, Joey’s parents reached out to him and asked him if there was anything that he wanted to talk about. After all, he had seemed to be closed to them recently, and they wanted to give him support. He initially dodged the question, but eventually told them about his sleepless nights, his deteriorating mental health, his stress at school – all due to his wrestling with a gender that he never wanted.

Joey’s parents, coming from a liberal neighborhood of Seattle, immediately gave him a long embrace and thanked him for being so strong. They used their more sophisticated virtual experience to educate themselves on having a questioning child. They organized appointments with notably experienced psychiatrists, for both Joey’s and their own benefit. As sophomore year progressed for Joey, they began to reach out to endocrinologists and surgeons as Joey began to come up with a more concrete view of his gender. Joey came out to his class as genderqueer his senior year of high school, asking fellow students to use the pronouns “they/them/their” instead of “he/him/his.” Joey just graduated cum laude from an Ivy League school, and they are on a trajectory for solid success.

This is a real story. Given the constant media surrounding queer individuals being barred from bathrooms, assaulted in the streets, and shot in dark alleys, this story seems too good to be true. The above narrative is real, and Joey now works as a political activist for women’s health and queer youth, but the United States is not so kind to trans and gender-queer people as this story indicates.

This is a lucky story. Joey was clearly given fantastic circumstances to critically think about their queer identity. They had a primary care physician who did not shrug off an issue concerning mental health, a psychiatrist who was well versed in helping queer youth, parents who accepted them without a question, who actively educated themselves about raising a queer child, who had the financial means to provide Joey with psychiatric appointments and hormonal therapies. Joey had a supportive community surrounding them - social media allowing them to connect and network with other queer people, classmates who respected them, friends who did not turn their backs on them. Multiple factors in Joey’s life allowed them to truly carve themself into who they wanted to be.

This is not everyone’s story. Unfortunately, Joey’s story does not represent the majority of trans and queer youth’s lives.

Not every healthcare professional is a Dr. Weber. Medical school curricula often do not require students to attend workshops or classes about administering effective healthcare to queer people, so many doctors in our generation are absolutely clueless when it comes to using a preferred gender pronoun or conducting a respectful physical exam. Many primary care physicians, especially in underserved communities, have never interacted with a member of the LGBTQ community. Trans clinics, one of the few places that give interdisciplinary, holistic healthcare to trans individuals, are still few in number and spotted along the coasts.

Often, the communities surrounding queer people are not supportive. Trans people of color are often the target of hate crimes, physical and sexual assault, or murder in all kinds of settings, from prisons to city alleyways to the privacy of their home. Queer youth are kicked out of homes and left to fend for themselves. Even with supportive allies, many families with queer children do not have the financial resources to provide the best healthcare for their child nor the academic resources to educate themselves on how to properly respect their child. Barriers to a life like Joey’s are abundant.

This is a story we can improve. In patient care settings, we have to learn how to treat queer patients with respect. We have to be aware the trans population is highly diverse – some people bring their trans identity to the forefront while others leave that part of their identity in the background. Some are attempting to reconcile their queer identity with their religious, ethnic, or cultural background. As healthcare professionals, we have to sincerely try to understand where each queer patient comes from and administer healthcare in the best way. We can no longer fall back on generalizations based on gender; rather, we have to be aware of each individual’s uniqueness.

This discussion around queer patients extends not only to patient care, but also the research that we conduct and the policies that we advocate for. Often, the LGBTQ population is overlooked in healthcare policies and research because other healthcare inequalities (e.g. low income families, ethnic minorities, rural populations) take precedent. Over the last few decades, LGBTQ awareness has grown more prominent, but strides must be taken to specifically advocate for the trans and queer youth, who tend to be more stigmatized.

Here at the Mayo Clinic, deemed a hallmark of American healthcare, we have to educate ourselves about issues surrounding queer patients. As representatives of such a world-renowned medical institution, we have the responsibility to our patients to begin thinking critically about trans issues, seek out resources if we are confused, and prepare for the day when a queer individual sits in front of us in need of excellent healthcare.

Author Bio: James Lee is a native Seattlite, completing his undergraduate studies at Yale University before beginning his first year as a medical student at the Mayo Clinic School of Medicine. He is interested in pursuing Child and Adolescent Psychiatry, and he balances his studies with music, rock climbing, and wannabe hip-hop dancing.

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