Helping transgender people see themselves in the health-care system

“The most important way of reducing discrimination is to see yourself in your health-care system.”

That’s how LGBTQ health activist Marni Panas summed up what transgender visibility means to her in episode 47 of The Re:Pro Health Podcast, a show about sexual and reproductive health produced by medical students at the University of Alberta.

Panas, 50, said she knew from the age of six or seven that her experience wasn’t “what was expected” for boys and young men, but it took many years to develop the language to articulate how she felt and find a “concentric circle” of supportive people who could help her live as her true self.

Podcast host and second-year medical student Vienna Buchholz hopes the next generation of doctors will provide care that makes that transition — and a healthy daily life — easier for transgender people in the future.

“It’s really important for physicians to be equipped to serve people with many diverse identities, whether it’s race, culture, religions, sexual orientations or gender,” Buchholz said. “Historically, gender diversity has not been reflected in medicine, and that can be damaging medically, emotionally and socially because it means folks might not seek care and their overall health will suffer.”

The International Trans Day of Visibility is held each year on March 31 to celebrate trans people and raise awareness of the discrimination they face worldwide. Folio asked Julia Chronopoulos, assistant clinical professor in the Faculty of Medicine & Dentistry and clinical lead for the Rainbow Clinic at MacEwan University Health Centre, to tell us more about what safe and welcoming health care for transgender people should look like.

First, a few definitions

According to the 2019 census test, an estimated 0.35 per cent of Canada’s population identifies as transgender, including non-binary and Two-Spirit individuals.

“Gender identity is not to whom you are attracted, but who you are on the inside,” Chronopoulos clarified in a Re:Pro episode on providing transgender care.

“Just knowing someone’s gender identity is not predictive in any way of their sexual orientation, and knowing who someone wants to have sex with is not predictive of what their genitals or identity might look like,” she said.

The label “transgender” may include people of any age who were medically assigned as female at birth or male at birth but who self-identify as a different gender, including non-binary individuals who may identify with neither gender or both at different times, and Two-Spirit people, which can mean different things to different Indigenous individuals. Transitions can involve physical surgery, hormone treatment, a change to their legal names, new clothes and voice training, but each person’s journey is different and deeply personal.

These identities have been “pathologized” in the past and treated as illnesses needing specialized care, Chronopoulos said in a Folio interview, but she believes most of these patients’ health-care needs, including most aspects of transition, could easily be met by family physicians like herself, with just a few changes to ensure patients feel safe and welcome.

“It's not special care. It is exactly the same care that we are attempting to provide to all of our patients,” Chronopoulos said. “We’re talking about basic human dignity and safety and inclusion, and I really think the onus is on us as a health-care system to do better at providing that.”

Basic medical needs going untreated

Canadian research shows that 17.2 per cent of transgender individuals don’t have a family doctor, and that number is higher for those who are both transfeminine and Indigenous or persons of colour, and those who are under-housed.

Chronopoulos said many gender-minority people are reluctant to seek care not only for their gender and sexual needs, but also for basic medical issues. As a result, they suffer unnecessarily with a range of common, treatable problems such as “diabetes and hypertension, mental health concerns and ingrown toenails and sprained wrists and carpal tunnel syndrome.”

Chronopoulos asks people to put themselves in the shoes of a transgender person trying to seek care.

“Imagine: how would you navigate a hospital where you couldn’t use the bathroom?” she said. “Or a family medicine waiting room where every poster included no one who looked like you? How would you feel in our health-care system if you couldn't find a space to manage your blood pressure where you felt welcomed and included, or safe from being harassed verbally or even physically?”

Creating safer spaces

At the Rainbow Clinic, staff introduce themselves with their own pronouns (she/her, him/his, they/them) as an invitation for patients to share theirs. The intake paperwork asks people what their gender identities are, whether it matches what’s on their health-care card, and who their emergency contacts are, rather than their husbands’ and wives’ names. Instead of calling patients “sir” or “ma’am,” staff address patients by their full names. Every washroom has a change table, and the posters on the wall show gender-diverse families living their lives.

While Chronopoulos is proud of the Rainbow Clinic, she says its existence means there’s still much work to do across the health-care system.

“The day I'll know we've made it is when we don't need Rainbow Clinics anymore, where people say, ‘I can just go to any family doctor's office, I can go to any emergency department, I can go to any hospital ward and know that I'm fine and I’ll be taken care of.’ We're not there yet.”

Inclusive care is everyone's responsibility

Chronopoulos, Panas and Buchholz all find hope in the interest medical students take in learning how to deliver more inclusive care, whether it’s through expanded curriculum like the courses Chronopoulos teaches at the U of A, or student initiatives such as the Re:Pro podcast or the annual Inclusive Health Conference, held last weekend. 

“It’s exciting to see the next generation really engaging with these topics and actively making it their responsibility to improve everyone’s knowledge and exposure,” Chronopoulos said.

“I know it will take a long time to get to the point where folks from gender minorities are not so marginalized, but we are seeing progress in medical schools,” Buchholz said. “It’s a continuous conversation and it’s amazing and so appreciated when folks with lived experience continue pushing for change.”

Panas told the Re:Pro audience she has no regrets. 

“Being trans, being non-binary, being yourself, is beautiful,” she said. “I used to fear if I was to share my authentic self that it would be a barrier in my life, but living authentically truly has become my superpower.

“I just hope that people can find their ways to be their true selves in this world.”

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