The state of health care in the U.S. is at a dangerous point for many people who are going to be or are already negatively affected by the legislative changes. One of the most affected groups is that of the LGBTQ+, and more specifically trans/nonbinary folx. Many states have already enacted laws to restrict or prohibit the availability of gender affirming care for this population, and more are well on their way to doing so — all the while conveniently neglecting to recognize the ways in which cis-males and cis-females receive such care for things like low testerone or menopause respectively.
As a health care provider, it is unsettling to see the level of misunderstanding regarding best practice for medicine and what amounts to a blatant lack of research on the part of our legislators.
In the face of this fraught landscape, what can health care providers do to support our patients who need us the most? And I truly mean the most, because with suicide attempts at nine times the national average in 2015, one can only imagine what we will see in today’s climate.
Health care professionals should begin by ensuring that they understand what is available for best practice at this time. The World Professional Association for Transgender Health, or WPATH, Standards of Care is a great place to start, and the newest version was released in 2022. There is guidance on everything from primary care to gynecological/urological care, surgical intervention, mental health and more. This guide can also be used by those seeking care to better understand what you can (and should) expect of your provider. While no one should have to teach providers how to do their job, this can also be a resource to point those providers to if they are willing to learn. There is a difference between being willing to treat and having the knowledge to be effective at treating, so self-advocacy in this way can aid in receiving the care that is needed and deserved.
Providers and support staff also need to be aware and proactive in the ways in which they are documenting care. At minimum, pronouns/names should be used that affirm the patient’s identity (in office and in documents). And this should be expected from everyone that the patient interacts with. Typically, though, it is required to utilize legal names for the purposes of insurance coverage and reimbursement, so have systems in place for this. One should be prepared to do a bit more justification in documentation upfront and make appeals when asked for further proof of medical necessity.
Another point to remember is that some diagnosis codes are gendered and may need to be
adjusted. For example, utilizing a code like dyspareunia (pain with intercourse) is considered “female” because it involves vaginal penetration, so if used for a patient who has a male gender marker, you will likely get a denial, so consider a simple pelvic pain code. Also when considering hormone treatment, utilizing “endocrine disorder” versus “male hypogonadism” for those who are assigned female at birth, or AFAB, and seeking testosterone.
In my opinion, the most notable positive distinction that patients mention regarding medical professionals they appreciate is the following: Providers, listen to your patients. Make that little extra time to actually hear and validate a patient’s experience. Patients, find the people and clinics that are doing this work already and reach out. People doing this work well are going to be more than happy to help you get started, though they may be overwhelmed with patients right now.
The last piece of advice that I can impart is to be creative and work as a team. Providers and patients should be on the same side and work with each other to push for the best care available. Unfortunately, this will likely mean a little extra work for medical professionals and significant self-advocacy for the patients, but with that added effort, everyone will stand the best chance of a positive outcome.
Q&A with T. Hunter of the LGBTQ Center of Durham
T. Hunter (they/them) is the health case manager for the LGBTQ Center of Durham. They have their Bachelor of Science in psychology, master’s degree in Applied Behavioral Sciences and Master of Public Health.
1) What are some recent stories about LGBTQ+ rights that you think our readers should be paying attention to?
Readers should consider paying close attention to the snowball effect of legislative bans on queer and trans bodies, as well as reproductive bans in the state of North Carolina. Equality North Carolina (https://equalitync.org/) contains a wealth of up-to-date information regarding LGBTQ+ rights in North Carolina.
2) What do you wish readers understood about the state of LGBTQ+ health care in North Carolina?
LGBTQ+ health encompasses all different facets of health, not just LGBTQ+-specific health concerns, which often marginalize and ostracize our community. LGBTQ+ residents of North Carolina are constantly under attack from reproductive policies, anti-trans bills and the biases of nonaffirming institutes of health, which can exacerbate harm to individuals seeking out services. LGBTQ-identifying people are not a monolith; our outcomes are your outcomes, and health care impacts everyone (whether directly or indirectly).
3) What are three examples of innovative initiatives that are pushing back against anti-LGBTQ+ bias?
LGBTQ+ communities in North Carolina are resilient, supportive and creative in our approaches to advocacy and activism. For example, the LGBTQ Center of Durham hosts a Queer Health Fair twice a year, which brings Triangle area-based providers and businesses to a central location to show what they can offer to the community. The LGBTQ Center of Durham is also now the hub for Southern Queer Survivor Network, or SQSN, a program for LGBTQ+ survivors of domestic violence and sexual assault throughout the state of North Carolina. Additionally, there are reproductive justice programs (e.g., SisterSong) and family planning initiatives (Queer Family Health Fair) that intersect with multiple marginalized groups to provide education, access and resources.
4) Is there an undersung hero in LGBTQ rights in the state right now, in your opinion? Who is it and why do you think that?
Mandy Carter, the co-founder of Southerners on New Ground, or SONG, always deserves her flowers and recognition. Mandy is a Black, lesbian activist with a long history of LGBTQ advocacy through a social justice lens. She is truly a remarkable human being and a force. Dr. Mojgan Besharat, the founder of In Her Vision Foundation, also deserves her flowers. In Her Vision Foundation provides free eye exams, prescriptions and eyeglasses to people in marginalized communities (including LGBTQ+). Working with Dr. Besharat in the community has demonstrated just how important it is for LGBTQ+ folks to have access to affirming care in every aspect of our lives.
Kristen Murphy is a pelvic floor physical therapist and trained sex counselor at the Fosnight Center for Sexual Health in Asheville, specializing in inclusive pelvic health treatment. She has a doctorate in physical therapy.
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