Gay and Lesbian Medical Association 20 th Annual Conference Toronto, Canada October 26, 2002 Four Steps to Providing Health Care to Transgendered People Presented by Samuel Lurie Transgender Training and Advocacy Email: [email_address] ; Web: www.tgtrain.org
2001-2002 Needs Assessment of Health Care Providers showed: Face-to-face key informant interviews with providers around New England, funded with support of New England AIDS Education and Training Center
Experience with a range of transgendered expressions but lack of information on populations, terminology, differences
Desire to treat TG patients respectfully but admitted discomfort and lack of tools for specific interviewing/assessments.
Concern and frustration with lack of information, studies and research
Concern and frustration with lack of treatment guidelines, referral contacts and ways to advocate for transgender clients.
Time constraints create an overarching barrier in building trusting relationships with clients, and trusting relationships are integral to quality care
Died after paramedics withdrew treatment at scene of car accident.
Photo by Mariette Pathy Allen Robert Eads Died of ovarian cancer; refused treatment by a number of GYNs; difficult for FTMs to seek/receive GYN care. Billy Tipton Did not seek care for bleeding ulcer for fear of trans status being revealed. “Outed” in mass media upon his death. Photos from Remembering Our Dead, www.gender.org/remember And Transsexual, Transgender and Intersexed History, www.transhistory.org Alexander John Goodrum Trans activist and writer, died in a psychiatric facility.
Step 4- Agency-related issues to provide services
Don’t just add “T” without doing work to understand what it means
Train all staff--receptionists, security guards, director
Make in-take forms trans friendly, i.e. include “chosen name” not just legal name; include more than M/F
Don’t make assumptions about sexuality or transition goals
Respect confidentiality, choices and fluidity
Honor presenting gender
Challenge transphobia—in staff and community
Have consequences for repeated anti-trans behavior
Have Unisex bathrooms!
“ Working with someone going through a gender transition is a joyous part of medicine. It’s very similar to feelings obstetricians have about facilitating birth.” -Edward Cheslow, MD
Protocols for Hormonal Reassignment of Gender from the Tom Waddell Health Center, 2001, www.dph.sf.ca.us/chn/HlthCtrs/HlthCtrDocs/TransGendprotocols.pdf
Harry Benjamin International Gender Dysphoria Association (February 20, 2001). Standards of Care for Gender Identity Disorders, Sixth Version . www.hbigda.org/socv6.html
Oriel, K. A. (2000). Medical care of transsexual patients . Journal of the Gay and Lesbian Medical Association 4(4): 185-193
Post, P, (2002), Crossing to Safety: Transgender Health and Homelessness , Healing Hands: A publication of the Health Care for the Homeless Clinician’s Network , 6 (4), June 2002. www.nhchc.org/Network/HealingHands/2002/June2002HealingHands.pdf
Bockting, W and Kirk S, editors, Transgender and HIV: Risks, prevention and care . Bringhamton, NY: The Haworth Press (2001) Originally published as a special issue of International Journal of Trangenderism 3.1+2 . Available online at http://www.symposion/ijt
Clements-Nolle, K., Marx, R., Guzman, R., & Katz, M. (2001, June). “HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention.” American Journal of Public Health, 91(6), 915-921.
Keatley, J and Clements-Nolle, K. Factsheet: What are the Prevention Needs of Male-to-Female Transgender Persons? University of California, San Francisco, Center for AIDS Prevention Studies, (2001) (English and Spanish versions) www.caps.ucsf.edu
Gender Identity 101: A Transgender Primer by Alexander John Goodrum, a publication of TGNet Arizona, www.tgnetarizona.org
Intersex Society of North America ; www.isna.org The organiation founded and led by intersex people, committed to ending isolation among those born with intersex conditions and eliminating shame, secrecy and unwanted genital surgeries for people born with intersex conditions.
For a copy of the Needs Assessment “Identifying Training Needs of Health Care Providers Related to Treatment and Care of Transgendered Patients: A Qualitative Needs Assessment” contact the author, Samuel Lurie, at firstname.lastname@example.org