This is my last day in Nashville. This summer has gone by fast and I have learned a lot. Cameron, Trevor, and I have knocked out quite the to do list while also having a good time. One of the reasons why I was looking forward to this internship was because it is in the South, a region I have only spent a couple weeks in for vacation. While I only been able to explore a bit, I have certainly learned about Tennessee and the challenges people face here in regards to access to health care. One group that I have learned a lot about these struggles from is the parents of trans* youth. The PFLAG meetings in Nashville tend to have mostly parents of trans* youth and many of these families are not only dealing with unaccepting schools but also accessing transition related health care for their kids. In general, many people will drive hours, even from other states such as Kentucky, to specifically Vanderbilt and other places in Nashville to access even primary care services.
I have learned more about structural competency, which is a lens I try to conduct my public health work through, how medical schools and hospitals run, more about the trans* community in the South and rural regions, Nashville, how to complete an IRB and conduct other research, and most importantly how to be a trans buddy (patient peer advocate).
I have had a lot of various opportunities while here as well. I have been able to participate in community outreach, research, and clinical care. All three of these aspects I am interested in and am grateful that I have have been able to do each. Some of the community outreach I participated in was going to PFLAG meetings and presenting at Meharry Medical College. While both groups had people in them that were either struggling with their childâs identity or unfamiliar with the LGBTQIA community, they both made an effort and were open to learning. Something else I think helped my experience was that everyone I have interacted with either at Vanderbilt or in the surrounding community has been welcoming. In regards to research, the Interns have been writing papers, analyzing data sets, collecting data, and submitting proposals. We have worked a professor from a different department, who has not only been friendly but bestowed on us academic advice as well. For clinical work, most of my Trans Buddy calls were in regards to resources so I did not actually attend many appointments or ER visits. However, I did shadow in the Emergency Department. All of the residents, nurses, attending physicians, paramedics, and other employees were friendly, welcoming, willing to let me watch everything, and were will to explain things to me. Even though things got pretty intense, I still have a good time and learned a lot. I also appreciate the patients allowing me to observe their care.
Other opportunities that I have had here were going to the Philly Trans Health Conference, meeting various highly accomplished people such as Dr. Harvey Makadon from Fenway Health, Dr. Marisa Richmond (who is also pro at feminist trivia), and my three supervisors. I also went to the Nashville LGBT Mayoral Forum.
I also want to thank Civil Liberties and Public Policy (CLPP) and the Reproductive Rights Activist Service Corp (RRASC) Internship Program for this opportunity and for their support. Â
After entering the twitter space for only forty minutes, Caitlyn Jenner had over 150,000 followers. What a beautiful day, I thought. What a beautiful day indeed when Laverne Coxâs #TransIsBeautiful movement can be exemplified by Caitlynâs placement on a Vanity Fair cover.
But I would like to juxtapose last weekendâs celebration against the climate for transgender people living in middle Tennessee where, according to the most recent data from the National Center for Transgender Equality, this community reports high rates of harassment (87%), mistreatment on the job (91%) and housing discrimination (17%).
In this state, transgender people experience employment and housing discrimination, and as a result, are more likely to live in poverty. Social support services and institutions meanwhile, are not equipped to support transgender people, compounding the cycles of violence and disenfranchisement that transgender people already socially face. For example, the sole explicitly gender-affirming homeless sleeping shelter in Nashville, Launch Pad, is only able to serve youth 18-24 two nights a week. With up to 40% of homeless youth identifying as LGBT, transgender homeless youth face substantial safe housing barriers most nights a week in Tennessee. Similarly, in this state, shelters for people who have experienced intimate partner violence are gender-segregated and do not accommodate transgender women, who are more likely to experience violence compared to other marginalized groups. Even when social service institutions are willing and able to serve transgender people, until all staff are required to undergo mandatory training to ensure they are equipped to engage with transgender clients with dignity and respect, including use of correct names and pronouns, many transgender people will opt to forgo support that comes at the cost of their identities.
It cannot be impressed enough that misnaming and misgendering are acts of discursive violence against the transgender community, a gesture toward what many trans folks would consider less than beautiful. This critique of language gestures toward the root of a structural issue where trans women are too often looked at as âothersâ, as festishized anomalies that validate and feed societyâs dismissal of trans women as less than human. Far too often, I hear stories of under-reported abuse targeting trans women. On the week prior to Caitlynâs coming out party, another trans woman was arrested for protesting on behalf of Freddie Grayâs death in Baltimore and placed in a male holding cell where she was subject to potential harassment and was fundamentally not being affirmed in her identity. In NYC, a trans woman was pushed into the subway tracks and then had trash thrown at her; this is a hate crime. In Nashville, a transgender woman was arrested on suspicion of sex work because she paid in cash for a hotel room; media outlets referred to her with a male name and pronouns. One transgender woman of color was killed every week for the first three months of 2015, and two transgender women of color, Alejandra Leos and Gizzy Fowler, were murdered in Tennessee last fall.
Just like the #BlackLivesMatter movement has brought the importance of black bodies to the forefront of our nationâs consciousness, I hope that the #BlackTransLivesMatter movement can also gain this recognition both in Tennessee and beyond. Transgender people have a right to public space and a right to access healthcare, education, and employment.
These types of resources and institutions must be held accountable to our fellow transgender citizens. Resources and institutions such as Tennessee Transgender Political Coalition, the Oasis Center, T-VALs, and Vanderbilt Medical Center's Trans Buddy program are doing impactful work to support this stateâs transgender community and should serve as models for all of our public and private institutions, but more can be done. Â
Trans is incontestably beautiful, and, as we approach PRIDE weekend, let us reflect on how we celebrate transgender people, not only as individuals, but as members of a community that launched the LGBT civil rights movement with Stonewall in the 70s, individuals who fundamentally changed the nature of clinical trials and drug research at the National Institutes of Health during the 80s, and yet, are frequently a forgotten letter in the LGBT acronym. Despite all the barriers transgender people continue to face, let us acknowledge and celebrate transgender vitality and resiliency as instigators of change. Â #TransIsBeautiful. #TransIsValuable.
It isnât perfect because youth under 16 still canât change their gender marker but considering that people couldnât change their gender marker at all in Ireland until this law, it is great. Letâs celebrate with some U2 (more under the read more):
Coming soon: MyTransHealth, an app connecting trans people to knowledgeable, reliable and affordable healthcare providers.Â
19% of trans people have been refused healthcare because of their gender identity. 50% of trans people have had to teach their doctors about trans-related medical care. 28% of trans people have been harassed in medical settings. This app is desperately needed. Follow them at mytranshealth.Â
Finesse of language of providers for the trans* community
Language in and for the trans* community is constantly changing. Medical terms, slang, and common language are all different and differ between communities based on identities, race, class, age, education, location, and their intersections. This language can even be difficult for trans* people to keep up with meaning it is even more difficult for cisgender people. Though I personally do not think different terms are that confusing, I am rather picky about language and pay attention to it. Because terms widely differ and change, this can be difficult for healthcare providers because if they even received education about trans* people at all, it may have been outdated information. However, I think it is important that providers who frequently work with trans* patients (and really any provider) to try to be as up to date in their language as possible.
Even though certain terms or phrases may seem minor, some are incredibly problematic (such as âsex changeâ) and some are incorrect and out dated though still frequently used (such as âtransgenderedâ). Using up to date language can show patients that providers care about their trans* patients and that they are willing to put effort into researching and reading the most up to date information.
People might say that I am overly sensitive but this is what I mean in regards to the finesse of language. Terms such as âtransgenderism,â though better than say, âtranssexualityâ or âtranssexualism,â are still pathologizing and invoke images of 1950s sci-fi experiments. Thought these words are in a medical context, that does not mean that pathologizing language needs to be used and more humanizing words should be used instead. Even other medical terms can be used; instead of saying someone with âtransgenderismâ say someone with gender dysphoria. Other terms I have seen are âbiological gender,â âthe condition,â and  âtransgender problems.â These terms are not necessarily awful but could be replaced with others that are less medicalizing, more humanizing, and show a greater command of language surrounding the trans* community. âBiological genderâ could be replaced by assigned sex at birth. I have seen ânatal [insert sex assigned at birth],â which I tend to prefer to âbiological sexâ or âgenetic sexâ but I think all providers should shift to sex assigned at birth. It also confuses sex and gender. âThe conditionâ is a tough one because yes, being trans* is a condition of being, but it is not universally seen by trans* people as a medical condition, which âthe conditionâ invokes. Rather I think depending on the context, âtrans* statusâ or âtrans* identityâ are betters terms to use. âTransgender problemsâ implies that being trans* is a problem and that it needs to be fixed. Providers are treating someoneâs gender dysphoria not their trans* identity.
Iâm sure people will say that providers are busy and donât have time to read about such a small community of people. However, providers should be reading the latest medical science journals and research on the communities that they serve. Therefore, they should not only read the latest journal publications about research regarding trans* people but should also read works published by trans* people and educate themselves about the community from a patientâs standpoint. There are thousands of blogs, articles, images, and education websites that explain which language is and is not okay to say and why. These resources are not hard to find and are a quick read. Providers can also practice using the terminology with their colleagues, family, friends, and patients as well as in their research. Â
Last weekend I attended the 14th Annual Philadelphia (aka Philly) Trans Health Conference, which is organized by the Mazzoni CenterâPhiladelphiaâs LGBT healthcare center. The conference was Thursday through Saturday and featured workshops, vendors, and gatherings all focusing on trans* people with the specific lens of healthcare. It also kind of seems like the place to see and be seen for the trans community; there were younger âtrans celebritiesâ there such as Aydian Dowling, Skylar Kergil, and Chase Ross as well as older guys such as Diego Sanchez, Jamison Green, and Kylar Broadus (there did not seem to be as many trans women celebrities though there were some). I was able to connect with some friends from school too and meet some people that I knew from YouTube.
I tweeted some quotes from presenters I saw so check out @LGBTI_Health, and take a look at the (sort of) live play-by-play.
In general, I had a good time at the PTHC. I learned a lot, which was important for me. There were a lot of vendors as well who are doing interesting and important work. Some of the vendors that stood out to me were The Venture Out Project (wilderness trips for the queer community), Fenway Health (a leading LGBT clinic in Boston), Whitman-Walker Health (a LGBT clinic in DC that is apparently doing a lot of public health hiring), oSTEM (queer people in STEM), TransRecord (crowdsourcing patient reviews of providers), and the Trans Oral History Project (sharing stories within the trans* community). Due to the lack of a map showing where all the vendors are located, I think I might have missed some tables, which is disappointing.
The PTHC is an important conference because it does center trans* people and our health. From what I could tell, the majority of presenters were trans* as well, which is important. Because it was my first time at the conference, I am unaware of the history of the conference and what workshops they have had in the past, but there was a group of trans women who did know though. They were unhappy about the ratio of workshops focusing on trans men and transmasculine people compared to trans women and transfeminine people particularly in regards to workshops that focus on medically transitioning. Frankly, I am not surprised. Large conferences like PTHC often forget or do not focus on trans women and are sometimes like âan Old Boys Club.â I am a white trans man so I fit in and mostly have my needs/interests catered to. The lack of workshops catered to transfeminine people is unacceptable.
There were some closed workshops that were for people of color only, which is important. I am unable to comment further on how these went or if they catered to the needs to trans people of color. I do not know if there were workshops that focused on other intersecting identities either such as class. There were workshops on religion and being transmasculine and giving birth to a child so I think those were important conversations that were being had. Of course, please let me know if any of this is inaccurate.Â
I think it was helpful and important that I went to PTHC being a trans person in public health; I was able to see other work that people are doing and not doing. I think it is an important conference for every healthcare provider or person involved with healthcare/public health that works with trans* people to attend at least once if possible. Ideally, even providers who do not think they work with trans* patients would attend as well because chances are they do work with at least trans* patient and just donât know it.
There were times when workshops lost focus because of the lively discussion, which on one hand is great, and on the other, took away from the main point of the workshop. Particularly, some of the workshops I thought were going to be more lecture focused turned into discussions or were focus groups. Â It is not that I do not want to hear opinions or information from people other than the presenters but I like being prepared for what I am walking into. I also find that in general, conference workshops tend to become side tracked, which can be frustrating or disappointing even if the tangent is important.Â
Also, as the Trans Buddy intern, I was able to tell people about the program. Peopleâs reactions to the program were all positive. Some people had heard about Trans Buddy already and others who had not, thought it was a great idea.Â
Workshops, which were from 8:45-7:00, talk about trans healthcare in a broad definition. There were workshops about sexual health to hormones to mental health. Some examples of workshops were Know Your Rights: Healthcare and Insurance, Keeping Your Family Together with a Trans* Child, Increasing Engagement and Supporting Leadership of Trans Women, and Below the Belt: 101. I've highlighted below some of the workshops that I felt were really applicable to the blog and work. Â
Providing Equal Access for Transgender Populations by Willy Wilkinson, MPH
This workshop started out talking about cultural competency and the intersections of identity. However, the workshop quickly turned into a heated discussion about patients advocating for themselves versus bringing someone who can advocate for the patient. It was an interesting discussion/debate and is relevant to Trans Buddyâs work. However, I wish I was able to see the whole presentation.
Becoming an Empowered, Patient, and Caring Support Person by Ilene Corina and Kyle Schuessler
This presentation was by people from an organization called Pulse of New York who do patient advocacy work. They talked about bringing someone to the hospital or doctorâs office with you, how to pick an advocate, and how to be an advocate. There were also a few listening activities so we could practice just listening to someone else without interrupting. I thought this workshop was well facilitated, informative, and connected with Trans Buddyâs work.
Providing Trans-Inclusive Care in Sexual Assault Forensic Examinations (SAFE) by Cassandra Corrado
This workshops discussed how to conduct forensic exams that are validating of trans* identities and bodies as well as how to make hospitals more welcoming of trans* people in general. It also talked about which wording to use with anyone who is having a forensic exam. This workshop was also well facilitated. I did not know much about the specifics of SA forensic exams so this workshop was informative in that regard as well.
Stigma, Shame, and Black TMSM in Healthcare by Shaan Michael Wade and Drew-Shane Daniels
This workshop ended up being more of a focus group than a presentation. It was still informative though especially hearing from people who are trans* and providers. A point that was raised that I am thinking about is how working in the trans* community and being a member of the community can limit access to confidential care because you may run into clients, patients, and friends when accessing services for yourself.
Using Advanced Directives for Self-Advocacy and Planning: An Overview and Example of the Process by Roxanne Barreto, Sara Boyd, and Heather Zelle
Put simply, advanced directives are legal documents, which explain how a patient wants to be treated and what interventions they do and do not want if unresponsive or unable to make decisions. They are helpful for trans* people in that you can specify which name and pronouns you wantâincluding in which situationsâas well as saying that someone cannot take you off your hormones. I knew a bit about advanced directives from my EMT training but I learned a lot from this well facilitated workshop. Everyone should look into having an advanced directive.
WPATH Graduate Student Research Symposium in Transgender Health
This was less of a workshop and more of a presentation. Grad students gave 12-minute presentations on their research regarding the trans community. I was particularly interested in if any of the presenters would mention resiliency, which some of them did. Some of the research covered body image, suicide, healthcare in Kentucky, and trans* identities in India. Kale, one of my supervisors, was presented an award so I received it on his behalf.
Medical Myth Busting for Trans* Folks by Maxwell Parrish, CRNP
This presentation went over common misconceptions about primarily hormones. Even though I knew a lot of what was being covered, it was interesting to see what other people think and to hear a healthcare provider answer questionsâcompared to some person on the Internet.
Mental Health Issues and Transitions-Does it Really Matter? By julie graham, MFT
The presentation discussed the San Francisco Department of Public Healthâs program for trans people on Medi-Cal who want/need gender confirming surgeries. julie also talked about how mental health, medications, and substances can impact healing from surgery. This was an interesting presentation as well. I did not know that San Francisco had this specific program. As well as providing people with access to surgery, the program also coordinates transportation, food, etc.
The trans pride flag flying in front of Philadelphia City Hall (photo by Keanan).
I was asked by my supervisors to talk a little about why I'm doing this. What inspires me to do this work? It's a big question.
I am the Trans Buddy Project specific internâcompared to my colleagues Cameron and Trevor who are the interns for the Program for LGBTI Health (you'll hear from them later in the summer). I come from an activist and public health background. In high school I did a lot of work around creating safer schools for youth specifically LGBTQIA youth. Unfortunately, I am unable to do as much of that work now that I am in college. However, I reckon I engage in other activist work just in a different way.
What inspires me to intern at The Trans Buddy Program? Another big question. Well, I am a public health major with an emphasis on health disparities and gender. However, I am not only interested in community work and research but clinical care as well. I like how this internship allows me to participate in all three. I am able to meet trans people in the Nashville community and learn more about the Nashville trans community, read research papers and help with research projects, and then also meet patients and be a trans buddy. Being a trans man myself I wanted to work with my community and give insight that cisgender people just probably are not going to have. However, not being from Tennessee or even the South means I still have a lot of learning to do about the specific population I will be working with.
I'm involved at my college in trying to improve campus emergency and public safety (all on the medical side). Some examples of the work we do is trying to improve the relationship between the students and the county fire department and raise awareness around alcohol poisoning. Though that does not seem directly related to the LGBTQIA community because it is not overtly about marriage equality, youth homelessness, or trans people being murdered, view it as being about the LGBTIA community as well as being relevant to other marginalized groups. My major is specifically focusing on health disparities and gender specifically on the trans community. I tend to do this through a structural competency lens. Structural competency, in short, it looks at how race, class, gender, sexual orientation, etc and social structures impact health and outcomes.Â
I have always been interested in health and medicine. When I was four I would look at my momâs old EMT textbooksâI finally got my EMT license last year. When I started transitioning in high school I knew that I not only wanted to be involved with health and medicine but with the trans community as well. I learned more about public health and decided that is what I was interested in pursuing.
Trans people face huge disparities in regards to accessing proper healthcareâas well as economically and raciallyânot only in regards to transition related care but just basic care for say, the flu. The trans community is a resilient community though. Yes, trans people, especially trans women of color, are being murdered but there are also other trans women of color doing important and successful organizing work as well as surviving and thriving (hell, they started the whole movement).
In regards to healthcare directly, trans people are able to build community and share resources and information especially through social media platforms in order to access the care they need. Of course, all of this depends on the privilege that people do and do not have (income, education, specific identity, how they are read by society, race, etc.). This resilience is starting to become recognized by researchers as well. The National Center for Transgender Equality and National Gay and Lesbian Task Force study, National Transgender Discrimination Survey (Grant et al. 2001), talks about resilience not only in terms of accessing healthcare but also in employment, etc. Some graduate students presenting their research at the Philly Trans Health Conference also discussed resilience in the trans community. Â
I think there are a lot of forms of activism, a lot that can be done within those aspects, and that all forms intersect. Even though the activism I do is not marching in the streets and the subject manner is not overtly related to human or civil rights, I do not think that it is any less important. As long as my work continues to keep marginalized communities and the intersections of oppression centered then I would like to think the work I does matters or at least can make some difference. Â
Grant, Jaime M., Lisa A. Mottet, Justin Tanis, Jack Harrison, Jody L. Herman, and Mara Keisling. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011.
Not sure which pronouns to use for a patient? Politely ask in a private area which pronouns they want you to use referring to them in person, in their medical records, and when talking to family/friends. For example, a patient might not be out to her family so she wants she/her/hers to be used when she is alone but when her family arrives she wants providers to switch to a different set of pronouns. Same goes for name as well. If you mess up, apologize, correct yourself, move on, and donât make the mistake again.Â
Excerpts from my essay, âRevealing Caitlyn Jenner: My Thoughts on Media, Privilege, Healthcare Access & Glamourâ on JANETMOCK.com â
âTo make any trans person a symbol for an entire community is an unfair task. No one can speak about the varying, intersecting and layered ways in which trans people experience the world. That is why itâs necessary to create a space for nuance and to amplify the voices of those who often are not heard.â
ANDÂ
âWhat enables Jenner to penetrate media the way she has is privilegeâŠIt doesnât make her a bad person. It doesnât make her undeserving. It doesnât underwrite her talent, savvy and accomplishments. Privilege enables her access to more conversations, more opportunities, more spaces which can appear as if sheâs eclipsed leaders of a movement that has been active for decades, fueled by a community that is ravaged by economic instability, lack of access to knowledgable affordable healthcare, overpoliciing and incarceration, stigmatized, criminalized survival economies like sex work, high HIV infection rates, the ability to live safely and freely as their true selves, and disproportionate violence against trans women of color.â
AND
âNot all trans people care about putting people at ease. Let me be clear about that. Yet for many, presentation is vital and essential, especially for trans women where blending in is a matter of safety. To be able to make your way through a world that so often carries so much resentment, intolerance and misunderstanding about trans people, âlooking the partâ as Jenner says, is a life-saving privilege, one that many trans people due to economic barriers or the randomness of genetics and puberty frankly will never be able to access.â
The official mission statement: The Trans Buddy Programâs goal is to increase access to care and improve healthcare outcomes for transgender people by providing emotional support to transgender patients during healthcare visits. We emphasize a patient-centered approach, with the goal of empowering the patient to make informed healthcare decisions. Trans Buddy recognizes the importance of intersectionality to our direct care practice, and we therefore aim to work with people of all identities with compassion and respect.
Need a buddy?
Services We Provide
We provide transgender people seeking care at Vanderbilt University Medical Center with support services for:
1) Scheduled primary care or clinic appointments;Â
2) Emergent care on an on-call basis; and,Â
3) Transition-related care, including a) cross gender hormone therapy visits and b) gender-confirming surgical procedure appointments and aftercare.
Make An Appointment
To request a buddy for an immediate or future appointment, please call (615) 326-5185.
If you are not a patient but have an inquiry about the Trans Buddy Program, please contact the Program for LGBTI Health at [email protected].
Disclaimer
The Trans Buddy program does not provide or influence medical services, medical advice, financial assistance, transportation, or other support services outside of the Vanderbilt University Medical Center.
What is this blog then?
This is a place for Keanan, Cameron, and Trevor to share their thoughts, experiences, opinions, and whatever else they might to desire to share during their summer in Nashville and working for the VUMC Program for LGBTI Health and The Trans Buddy Program. Â
