Transforming health care

Many people experience anxiety before a visit to the doctor, but for transgender youth, that anxiety is amplified. There are few providers in Central New York who cater specifically to transgender populations, and some trans people have reported being harassed or turned away from seeking care.

In order to educate health care providers on the health issues of trans youth, the Q Center ACR Health hosted a day-long conference Nov. 11 called “Transgender Youth and the Healthcare System: Transition Your Practice.” The Q Center provides a safe space for lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth.

Mattie Barone, care manager at the Q Center, said more than 100 medical care providers, mental health professionals and parents attended the conference, which she called “the first time we’re really talking about [transgender youth health] here in Syracuse.”

“We’re really proud of it,” Barone said of the turnout.

The goal of the conference was to educate providers on how to be sensitive to young transgender or gender-nonconforming patients.

“We’re just asking for pediatricians that are culturally competent,” Barone said.

One of the conference’s speakers was Dr. Carolyn Wolf-Gould, the founder and director of the Gender Wellness Center, which is part of the Fox Hospital/Bassett Health Care Network in Oneonta. Wolf-Gould is also a clinical mentor for the World Professional Association for Transgender Health (WPATH), an organization that helps teach medical professionals to make their practices inclusive for people of all gender identities.

Wolf-Gould began caring for trans people in 2007, when a trans man saw a “safe space” sticker in her office and called asking for help. He was new to the area and needed someone to prescribe his testosterone treatments.

“’There’s nobody here that’s qualified to take care of me,’” Wolf-Gould recalled the man saying. She told him she wasn’t qualified either, but he said, “I can help you learn.”

Educating the provider

“Unfortunately, a lot of trans patients have to train their doctors,” Wolf-Gould said.

Barone said providers can make their practices more trans-friendly by educating themselves.

“You don’t have to be a specific type of doctor to prescribe hormones; you just have to know what you’re doing,” Barone said.

Wolf-Gould said she had to teach herself about the issues that transgender people face in accessing health care. She talked to other providers and researched transgender issues on the Internet.

Wolf-Gould recommended providers seek information from the Center of Excellence for Transgender Health at the University of California, San Francisco, and WPATH. The Center of Excellence for Transgender Health provides a wealth of information on primary care protocols for transgender patients, sexual health and fertility, standards of care and more. WPATH offers a transgender health certification course and outlines its own standards of care.

There are simple changes a provider can make to transform their practice into a trans-friendly office. Barone said offering more than just “male” or “female” gender options on patient intake forms can signal a more welcoming atmosphere to LGBTQ people.

“Having cues in your waiting room that you are affirming [helps],” Barone said.

The Gay, Lesbian and Straight Education Network (GLSEN) offers “safe space” stickers and posters for download or purchase on its website at glsen.org. Wolf-Gould suggested providing literature about gender and sexuality and adorning the office walls with posters signaling that the practice is open to all identities.

“Having a nondiscrimination policy is very important in your office or hospital,” Wolf-Gould said.

Advocate for your family

While education of both providers and patients is important, parents must be on board for a trans teen to get the best out of their health care experience. Barone said about half of her clients at the Q Center are younger than 18, so it can be close to impossible for teens to access health care without their parents’ permission or support.

“Be open. Be mindful of your child’s feelings. Listen,” Barone said. “Find the resources that are out there. … Make sure you’re advocating for your child.”

As Wolf-Gould said, often it falls to patients to educate health care providers on interacting with trans people.

“I tell people that they need to be their own advocate,” she said.

Wolf-Gould suggested that trans patient call ahead if possible to see if a health care provider is knowledgeable about trans issues and to be straightforward and calm in emergency situations.

“If they go to an emergency room, they need to learn a way to present themselves in a way that explains the situation,” Wolf-Gould said. “[They can say,] ‘I’m a transgender man and my parts don’t match how I present.”

Wolf-Gould also suggested having “allies around who can help pave the way” for health care providers to understand a patient’s gender identity, name and preferred pronouns.

Sometimes, providers are not as open-minded as Wolf-Gould and the other medical professionals with whom the Q Center works.

“Many don’t get medical care if they need it. Many get turned away from health care providers that don’t have the education or have prejudices,” Wolf-Gould said.

“Unfortunately, sometimes that means switching providers,” Barone said. “The wait lists are long.”

The Q Center refers trans youth seeking hormone therapy to the Joslin Center on East Adams Street in Syracuse or to Dr. Karen Teelin of the University Pediatric and Adolescent Center at Upstate Health Care Center. Teelin has worked with Dr. Irene Sills, whom the Q Center says is a “national leader in gender affirming hormone therapy for adolescents.”

There are a few local options for young trans adults, too.

“I’m driving kids who are 18 and over to Ithaca,” Barone said. The Planned Parenthood health center in Ithaca caters to LGBTQ people and provides hormone therapy.

Mental health is another important aspect of trans health care. A joint study from the American Foundation for Suicide Prevention and the Williams Institute showed that 41 percent of trans people attempt suicide. In the general population, that number is only 4.6 percent.

“If you have your parents on board, there is free therapy up at SU,” Barone said. Syracuse University’s Couple and Family Therapy Center offers the services of its master’s and doctoral candidates to individuals, families and couples.

In addition to referrals, the Q Center offers support groups for trans kids and their parents. The center’s staff also can help families navigate insurance coverage for hormone therapy and surgery. Barone said in the last 12 months, about 50 transgender youth and 60 to 65 parents have accessed the Q Center’s services.

“We’re here as a resource for anyone that needs it,” Barone said.