When does it get better for trans* people?

It’s time.

It’s time.

I’m writing this blog post after the most amazing journey that started with this blog post (What it means to earn a perfect score on the Human Rights Campaign Corporate Equality Index | Ted Eytan, MD), that I wrote in November, 2012. It connected me to a trans* person and community, to information about one of the final hurdles the medical profession is going to overcome in service to LGBTI people, and all of humanity.

As this recent Huffington Post article mentions, Todd Clayton: The Queer Community Has to Stop Being Transphobic: Realizing My Cisgender Privilege, we are entering an era of unparalleled equality, where the world is learning to love better, and our President is able to say the word “gay” during his inauguration address. He’s also able to make a reference to Stonewall:

We, the people, declare today that the most evident of truths—that all of us are created equal—is the star that guides us still; just as it guided our forebears through Seneca Falls, and Selma, and Stonewall. . . . Our journey is not complete until our gay brothers and sisters are treated like anyone else under the law—for if we are truly created equal, then surely the love we commit to one another must be equal as well.

However, and in addition, behind and in front of the equality renaissance that our society enjoys, were trans* people like Sylvia Rivera and Marsha P Johnson. Today, a whole new generation of fellow human beings who are trans* are sharing stories through social media in the hope that they will be liberated to live the lives they aspire to lead.

Giving a voice to the voiceless

When I walked with passionate advocate for family/intimate partner violence prevention Brigid McCaw, MD (Giving the voiceless a voice using social media, family violence prevention, and a walk with Brigid McCaw, MD | Ted Eytan, MD), we talked about social media’s role in giving the voiceless a voice. If you look at my recent bookmarks, you’ll find a lot of web sites, tumblogs, youtube videos, books and movies that were recommended to me by people in the trans* community. They’re doing it – using the social medium to have a voice that should impress any member of a vulnerable population.

I found these people, by the way, through private communication attached to my blog, and eventually to in person conversations, and a visit to a local genderqueer support group in Washington, DC, to learn more.

The video and text postings and the in person stories that I heard/read are sometimes funny, often heartbreaking, often saddening, frequently determination-inspiring.

If you learned that a whole group of patients in our health system routinely go to YouTube, risking their privacy, their careers, maybe their lives to solicit funding for necessary care that allowed them to live, how would you feel about it?

How about the idea that they would bind their chests tight enough to compromise their lung function and stop exercising (what people like me consider a medical emergency), to manage their feelings of dysphoria?

Look at some of the web sites that were provided to me and see how you feel about it. Post your response in the comments.

There’s kind of a sense of normalcy about the striving for basic medical care/compassion and just to be visible that we shouldn’t want anyone to struggle with in society. And yet the stories show that people will do what they can in order to survive.

Read on to find out how they risk even more in their health care experiences.

Learning a new language

As I read the stories myself, I get a sense of what it might be like for a heterosexual person to read the stories and understand the lives of a lesbian or gay person. I recognize how little I know AND that it’s possible for me to learn. It’s reassuring to me that if I can be interested in the welfare of trans* people, that all of society can truly be interested in the welfare of all LGBTI people.

I also know from my own experience that it can be tiring to answer the same questions, again, and again, and again, especially when it seems the answers are not inspiring change. With that in mind, I try to ask questions carefully, and listen to the answer, with gratitude.

It is a new era

As I wrote in the blog post in November, one of the key criteria for earning a 100% rating on the Human Rights Campaign Corporate Equality Index is that an organization cover trans* care as part of its benefits. What this has done, is change the conversation from, “we’re not going to care” to “we have to care.” For people who might think it shallow for a rating system to be the catalyst for this shift in attitude, I’ll say that it doesn’t matter to me what the catalyst is, it’s the shift I care about.

And believe me, I’ve seen the shift in the LGB movement, from a government worker one day slamming the door in the face of a citizen to 24 hours later welcoming them with open arms. Love is love.

No health without equality, no equality without health

People who identify as lesbian, gay, bisexual can relate to the feeling of wanting to finally begin their lives as the person they truly are, without fear. As I learn from the trans* community, this feeling is similar. It seems that every dysphoric minute is a minute too many, an unnecessary waste of human potential. (I didn’t say that right – one trans person, on reading the post, offers this description: “Gender dysphoria has nothing to do with fear; it’s about feeling intensely uncomfortable, wrong, and embarrassed just existing in your body. It’s about also feeling disconnected from your body. Alien. Sometimes it’s about not being able to take a good long look in the mirror without having a panic attack. It’s about feeling no connection to your birth name, the pronouns that go along with your birth name, and other words that don’t match your gender: ma’am/sir, sister/brother, etc. This discomfort can be so intense that people would rather take their own lives than deal with it, especially when the doctors and important people in their lives don’t think they have a real problem. It drives some transwomen to castrate themselves, and it forces transmen to be unable to breathe properly for years.”)

The fear of poor treatment, as I learn, extends into so many aspects of life, not just employment but interaction with one’s own personal physician, who, for example, may not be told by their male patient that they have a cervix.

If we believe that the purpose of privacy laws is to allow people to be comfortable telling their doctor anything, they’re not the answer if people are deciding to submit themselves to the possibility of cervical cancer.

When trans* patients do provide information about their situation, I learn that they are submitting themselves to lack of healing and even humiliation within a health care system with boundaries to caring (see: When Health Care Isn’t Caring | Lambda Legal – 27% of trans* people report being denied care in the health care system).

I’m not a trans* health expert and I haven’t yet done a literature review of all the issues related to trans* people. Remember, I’m a family medicine specialist – we are equipped with unlimited curiosity not just about health and science, but the stories of the people and their communities that we interact with.

I’m choosing to be curious.

And grateful.

“You go to bars because of what drag queens did for you, and these bitches tell us to quit being ourselves!” – Sylvia Rivera, 1973 Stonewall Rally

Of course Love always Wins

I thought I’d write a post while on this journey to invite dialogue and conversation. I’ve already started some on Twitter and on this blog (see below: Twitter / WashHeightsBTTM: THANX !! BUT WE NEED RESPECT – … ).

As a kind of amazing honor for the work that my organization has done, I have been chosen to represent Kaiser Permanente next week in New York City to officially accept our 100% Corporate Equality Index award, along with the other 251 businesses who are best places to work for LGBT equality.

My whole awakening to all of this, by the way, happened when I downloaded an iPhone app that gave me disappointing information about equal treatment. It’s now a year later and equality is the norm not the exception where I work, and in so many other companies.

I’m taking the invitation to accept the award as an invitation to keep learning.

Lessons learned so far:

Think Regina Holliday-like determination.

Our generation is going to make it happen. Join us :).



Thanks, Ted, for raising this issue in such a compassionate and careful way and making me think about what I can do.

Thank you, Ted. Sharing this with colleagues now, both online and offline. The line that resonates most for me, personally, is “I recognize how little I know AND that it’s possible for me to learn.” Once a researcher (like me) finds out that you can listen more than ask — and learn more — there is no turning back to old ways of understanding, measuring, and reflecting public opinion and actions.

SusannahFox Susannah, thank you for writing and for sharing. There is a lot that is broken in the health and care for this population, more than I have seen in a very long time in any group of people, every comment reduces their invisibility, Ted

Ted Eytan, MD