Gender Affirmation: Healthcare’s New Frontier

SM: What are some of the challenges you face trying to reach young transgender and non-binary people of color?

LS: This population is very insular. Our consumers often do not trust a lot of people. Their networks tend to be small and close. It takes a lot of creativity to get the gatekeepers and their friends to engage with us.

SM: The idea of trust is a great segue way into the topic of gender-affirming care. I think it’s important to discuss how trust is built and broken within the context of gender-affirming care. Before we get there, what does gender-affirming care mean to you?

LS: Gender affirming care begins the moment I talk to someone on the phone about an appointment. I will say,” I identify as transgender. I know my legal paperwork says female and this name, Sheila. I would appreciate being called Luster. I see myself as trans-masculine. I want to say that up front.” How that person reacts sets-off a chain of events. You can actually hear it when someone shuts down on the phone. You get that awkward pause. Gender-affirming care is when that person is shocked but handles it like any other call. Gender affirming care looks like the person at the reception desk not showing any confusion or distaste.

SM: That person on the phone or sitting at that desk is a patient’s very first impression. How important is that first impression in a medical setting?

LS: I am born female. I was having some female issues. I had to go to the women’s clinic. The way they handled it in the back was great. The nurse said, “So I understand that you identify as trans-masculine, correct?” I said, “Yes.” Then she explained, “Our rooms are separated by male or female. We don’t have a gender neutral room. Which room would be more comfortable for you?”  But the person at the front was awful. God awful. Asked me If I was in the right place.

SM: How do we address that disconnect? I mean that nurse and receptionist are in the same building.

LS: We need to look at the patient experience holistically. There’s an assumption that the person at the front desk doesn’t’ have to worry about gender-affirming care the way a nurse or doctor does. In the hierarchy, they’re “just” administrative. How much difference could five to fifteen minutes out front make to the patient? Just get over it, right? Wrong. The people in those seats can make or break a patient’s connection to the care they need.

SM: And these are just the verbal cues. How can non-verbal cues support or hinder gender-affirming care?

LS: It would help if the pictures in your lobby weren’t all affluent-looking, cisgender, white couples. It’s the art on the walls. The magazines. Folks have started putting little rainbows somewhere in the space, so people know that it’s safe for gays and lesbians, maybe the bisexuals. Transgender is not a sexual orientation. A transgender person can identify as heterosexual, bisexual, maybe they’re asexual. Who knows? A rainbow flag for a transgender, non-conforming and binary (TGNC &B) person does not necessarily mean this place is safe.  It’s also the forms. Gender affirming care looks like forms that don’t force people to misidentify themselves, or check “Other.”  Gender-affirming care looks like providers who represent the same demographics of the people they serve.

SM: That has been accomplished at Mozaic, I am reading “A Message for Parents” on your website: “Mozaic staff and mentors are transgender, gender non-conforming, and non-binary. Most of us are people of color.” Mozaic is in that position to directly represent the people they are trying to reach. With that in mind, how does Mozaic provide gender-affirming care?

LS: We have a program called “Back in the Day.” We invite trailblazers and elders to tell us what it was like for them coming up. If you’re a young trans person of color, most of the stories you get are that you’ll be dead by 35 and the best you can hope for is to be a higher-class escort instead of working the streets. Or you’ll be a booster.[1] Something like that. We wanted to tell the stories of the survivors and the thrivers. People who have lived through incarceration, through being on the streets, to now owning their own homes. Let’s hear those stories.

SM: It sounds like “Back in the Day” carved out a space in the community at large for the transgender community to be heard and seen. In what other ways does Mozaic carve out these much needed spaces?

LS: We just did a trans women’s brunch for March’s National Women’s History Month. I had never heard of anybody doing a trans women’s anything during Women’s History Month. So, we decided to do something. We personally invited the mothers [2] that we knew, the trans women we knew and the people who support them. Forty-five folks showed up. We were packed. We ended up going thirty minutes over the scheduled time. There was a live feed on Facebook. Guests would come up and talk about their experiences as trans women.

SM: It sounds like a wonderful event.

LS: It was. A lot of the mothers and aunties of the younger folk were there and they pass that information down. We have already had two folks in our target demographic come in, because somebody from the brunch told them about us and the services we offer.

SM: Which services are the younger trans folks in your demographic drawn to the most?

LS: We have our clothing closet called “Threads Revisited.” A lot of these younger folks are getting put out of their homes without any clothes. But it’s not just come and get some clothes. It’s having somebody help them with fit, or how this bra goes, or this slip goes. If you’re a trans man with hips, you might need to know if these pants hit you just right, so that doesn’t give you away. It has been one of our most successful programs.

SM: I would also like to talk about what happens when we don’t get it right. When that trust is broken – whether it’s intentional or not, well-meaning or not – how do we get it back?

LS: I wish I knew the answer. The continued efforts of Mozaic, Equitas Health, clinics, doctor’s offices to do a better job are a great start. But how do folks know we’re doing a better job when a lot of times they just leave and don’t come back? I’ve left doctor’s offices before and never gone back. Even to the detriment of my own health. Sometimes, I did go back.

SM: When you did, what made you go back?

LS: Part of it is the resiliency of my personality, and deciding my health was more important. But, if you don’t have that, that’s when people commit suicide or die of things they shouldn’t be dying from. Gender-affirming care isn’t just about using the right pronouns. It’s a matter of life and death. We have to keep bringing it up, keep talking about it, because people’s lives are at stake.

SM: You mentioned your visit to a women’s clinic earlier. Did you let them know about your negative experiences with their reception desk?

LS: I did. I made it all the way to my car. Then I turned around and went back to the reception desk. I said to her, “My experience here was great in the back. What wasn’t great is what I went through calling here and speaking with you at this desk. That part wasn’t good. I just wanted to let you know that, so maybe it won’t be like that for the next trans person that comes in here.”

SM: She must have been gob-smacked.

LS: She was. She just sat there and then I left. Maybe some of what I said sank in. Who knows?

SM: That took a lot of courage and a lot of self-awareness. If you had been a 19-year old Mozaic consumer, would you likely have had that same courage and self-awareness?

LS: Chances are, when I was a 19-year old trans person of color, not only would I have not made it past that desk to the appointment and the care that I needed, I wouldn’t have even got past the phone call to make the appointment. I would have hung up.

SM: You think so?

LS: I know so. We have to do a certain amount of teeth-pulling just to get some people into a community space created for and by trans folk. We’ve had just as many people dragged in here by their parents than have come in on their own. Parents tell me, “I can’t watch my child go through this. I’ve been trying to get them to come here, so finally I just brought them myself.” We have to work through that.

SM: How long does it take?

LS: One of our consumers loves to give feedback and suggestions. Loves to see what we’re working on. But when we told them we need their voice on our Youth Advisory Committee, they didn’t see their voice as necessary or powerful. It has taken three years and many hours of relationship building, and they are now thinking about attending a meeting. There’s just so much distrust, especially of the medical field, that we have to overcome.

SM: Besides building these relationships, what else has to be done to overcome this distrust?

LS: We need a radical uprising to demand equitable health care. That’s what we need. We need something, and maybe it’s COVID-19, to stoke a fire in us to demand the healthcare that we deserve. For this year’s National Trans Visibility March in October, I am pushing for healthcare, healthcare, health care as one of the major platforms. I’m hoping more and more trans people will demand affordable and affirming health care. It’s not going to happen if we don’t get out there, be visible, and go after it.

[1] Booster: a person who shoplifts from retail stores for resale at a discounted price.

[2] Mother: leaders in the trans community who raise younger members of the community as children of their own.

Sean Moseley is a copywriter at Equitas Health.