Transgender Awareness Week is November 13th-19th, leading up to Transgender Day of Remembrance on November 20th which honors the victims of anti-trans violence. Denial of healthcare is one of the most common forms of violence that affects Trans and Gender Non-Conforming (TGNC) people. At Access Health Louisiana (AHL), we are working to combat that violence by providing gender-affirming care with compassion and educating the public on the importance of these services.
As of October 2023, there have been 134 bills introduced in state legislatures across the country targeting gender-affirming healthcare; several of these bills have died in committees, or if passed, are being challenged in court. These bills, however, reflect the pervasive anti-trans sentiments that exist across the US. According to a 2021 Gallup poll, 69% of Americans say they do not personally know someone who is transgender. The lack of personal knowledge that most Americans have of TGNC issues has contributed to misinformation surrounding gender-affirming care and the life-saving benefits it offers to those who need it.
The World Health Organization (WHO) defines gender-affirming care as “any single or combination of a number of social, psychological, behavioral or medical (including hormonal treatment or surgery) interventions designed to support and affirm an individual’s gender identity.” Gender-affirming care (GAC) is accessed frequently by both cisgender and TGNC people. For cisgender folks, this might involve a woman getting breast implants following a mastectomy for breast cancer or a man taking testosterone to improve libido/help with erectile dysfunction. For TGNC folks, this might involve taking hormones that match their gender identity or getting breast implants or a mastectomy to have a chest that matches their identity. Regardless of gender identity, GAC is sought when there is significant distress caused by a mismatch between one’s gender identity and the physical characteristics that are present.
GAC is the best way to mitigate gender dysphoria, defined as a “marked incongruence” between the sex assigned at birth and the expressed gender that results in clinically significant distress or impairment. The distress caused by gender dysphoria can appear in childhood/adolescence, or in adulthood. When it appears in adolescence, behavioral/mental health support is typically the first intervention, followed by puberty blockers or hormone replacement therapy (HRT) if necessary. Recent public discussion has involved restricting GAC for minors, including a recent law passed in Louisiana that bans medical providers from prescribing hormones to minors for the purpose of treating gender dysphoria.
Access Health Louisiana is committed to providing the best care to our patients within these legal limits. Elizabeth Spence is a certified pediatric nurse practitioner who works with TGNC pediatric patients at our St. Bernard Community Health Center. In addition to providing medical transitions, she also offers behavioral health support to ensure patients are receiving comprehensive and compassionate care regardless of their transition journey. Spence believes that patients have the right to gender-affirming care at any age. “I believe that we all deserve the right to be whomever we choose without prejudice, judgment, or shame.”
Dr. Jon Chandler, a medical psychologist at AHL, implements a strategy called the RAINBOW© method, an acronym created to prompt patients, friends, family members, and colleagues to explore and improve upon their internalized biases, intersectionality, privileges, and disadvantages.
RAINBOW stands for Race/Ethnicity/Culture, Age and Generational influences, Inherited and acquired disabilities/diseases/disorders/drug addictions, Nationality and indigenous heritage, Belief system, Orientation, and Work/wages and socioeconomic status.
Specifically, when working with TCNG people, he uses his SAGE© model to help patients identify where they fall on each spectrum, including but not limited to: Sex (assigned at birth), Attraction/Actions (sexually, romantically, platonically, etc.), Gender (brain sex), and Expression (how they show their sex, gender, etc.). Dr. Chandler acknowledges that this is an especially cautious and delicate process when dealing with TGNC youth and their families.
Despite the recent anti-LGBTQ+ bills and laws, Dr. Chandler, Ms. Spence, and other carefully trained staff at Access Health Louisiana will continue to implement gender-affirming care because, as Dr. Chandler said, “it is needed, and it is the right thing to do.”
If you are searching for gender affirming care or LGBTQ+ informed primary care, please reach out to our LGBTQ+ care coordinator Milo Malone at (504) 226-2976 ext. 1022 or visit our LGBTQ+ Health Services webpage found here.
References
https://news.gallup.com/poll/350174/mixed-views-among-americans-transgender-issues.aspx
https://onlinelibrary.wiley.com/doi/10.1002/hast.1486
