Many medical schools, mine included, are working to increase student understanding of transgender health issues. As a cisgender female who uses she/her/hers gender pronouns, I feel fortunate to have been able to learn, for example, the proper techniques for the exam of the penis and testes on an individual whose preferred gender pronouns were she/her/hers. This divorced for me the assumption that genitalia had any one necessary relationship to gender identity and was one of the most important physical exam experiences during my first year of medical school.
In July 2015, I attended a three-day Movement for Black Lives Convening in Cleveland, Ohio, where I — along with the other attendees — was charged with articulating how I would support making spaces safer and more inclusive toward trans, gender-queer, gender nonconforming, intersex and two-spirit people. On the second day, in a plenary session with approximately 800 people in the auditorium, we were asked to turn to the person next to us and state what we were planning to do when we got home to act on our commitments.
I turned to the beautiful woman standing beside me. She shared that as a transwoman she was going to continue her activist work in the black and trans community in Atlanta. I said I would do my part to learn more about trans health issues in the context of medicine. In particular, I could commit to helping educate fellow medical students about trans health needs, contributing to greater literacy of trans health care.
Two weeks later, I reached out to the same woman I had stood beside at the plenary session. I wanted to start making good on my promise and was moved to write about trans health for in-Training. But rather than writing a piece about trans health from the perspective of a cisgendered person — essentially “reporting” trans life from outside it — I felt it would be more educational to engage her in conversation and allow her to articulate the ways in which medicine could support trans health. My hunch was that there were few, if any, articles written with medical students in partnership with trans people, specifically addressing trans health needs from their own perspective. Here is my interview with Jennifer Lee Barnes.
Ashley Paige White-Stern: Can you begin by telling us your preferred gender pronouns, how you would like to be referred to in this piece and anything else about you that you’d like to share with an audience of medical students?
Jennifer Lee Barnes: Hello, I am Jennifer and I am a woman of trans experience. I am only open to pronouns that are in alignment [with that] of a female — she, her, Miss, etcetera.
APWS: When you and I met, you mentioned living in Atlanta. Can you speak to the climate there for the trans community? How safe do you feel, where do you go for emotional support and are your basic needs met, like food, housing, companionship and family?
JLB: For me, living in Atlanta has been quite acceptable — and it usually is for women of trans experience who are attractive. I feel quite safe, but I am always aware of my surroundings as any being should be. I have an extensive support system: friends, family and professionals, i.e. therapists and counselors. Currently I am able to provide for myself quite well — although it could be better. As far as companionship, I am without one, reason being [that] out of all of the individuals who try their hand with me, at some point, it always turns into just wanting sex or to only be with the external beauty they see and refuse to find my inward worth.
APWS: Can you reflect on the ways that you have had to use doctors in your life and give an example of a way in which a doctor has been especially sensitive to your needs? What about an example of a doctor who hasn’t?
JLB: Well, I am HIV-positive and I am currently undetectable. I have been blessed with a doctor who not only treats my HIV but also specializes in hormone therapy. He actually informed me of the physical change he could see before I even started hormone therapy. I am not experienced in a physician who has been unable to cater to my needs thus far.
APWS: The audience of this article is medical students, primarily in the United States. What advice do you have for future physicians regarding trans health care?
JLB: The best way you can make a transgendered woman feel accepted is by referring to her by her chosen name and pronouns. If you are unaware of it, please inquire about it. The best care you can offer a transgendered woman is the gift of being able to confide in you.
APWS: If you had 20 million dollars to spend on care for the trans community, how would you spend the money?
JLB: First, tw0 million dollars to research and create a hormone chart that directly pinpoints all hormones used to treat or alter each gender to better adhere to his or her preference.
Second, eight million dollars to locate the 10 highest transgendered populated cities [in the U.S.] and build a suitable housing and treatment facility for each city.
Third, 10 million dollars to create a unique health care plan to be used by transitioning individuals.
APWS: Can you say more about your first suggestion on the hormone chart? It sounds really interesting — would you see it as a physical paper chart, or something more interactive like a phone app?
JLB: I would first personally like to see it as a physical chart, but being able to see the different compatible “cocktails” of hormone therapy would be interesting through an app!
I hear you: there seems to be many options out there and more, better organized information could be helpful to patients and physicians. Addressing transitioning: I can imagine that it can be difficult psychologically and emotionally. I have also heard from trans friends that it is profoundly liberating. Have mental health professionals, like psychologists, social workers and psychiatrists been helpful to you? Are there ways in which they could have been more helpful but weren’t?
JLB: I have a therapist I visit every two weeks and I thoroughly enjoy and highly recommend all transgendered individuals to obtain one. I will say it took me three tries to find the correct one for me, though.
APWS: When you finally found the therapist you liked, what did they do to make you feel like they were really there for you? In other words, how did you know that you had found the right therapist?
JLB: Well, the moment I knew I had found the right therapist for me was when I was able to receive well wishes and joy in my discoveries of womanhood. My therapist is literally excited to hear my new endeavors and able to help me internally create positive space for dreams to be cultivated into reality.
APWS: Many medical students who are cisgendered are interested in contributing to the health and well-being of trans people as allies. One comment I hear a lot from students who want to support the efforts of activists is that they want to be sure not to replicate preexisting power inequities by drowning out the voices of those working in the movement. From your perspective, what are ways that cisgendered people can help support the trans community, even if we don’t work directly with trans patients?
JLB: The best way to adhere to being an effective ally or activist is to make sure your efforts are purely outside of your wants and solely based on the needs of the individuals you are looking to liberate, so to speak.
APWS: Thank you, that sounds like wise advice for all physicians: making sure that our desire to help isn’t ego-driven and is in service of our patients. Thank you again, Jennifer. We profoundly appreciate your willingness to share your perspective. All the best to you.
Contributing Writer
Columbia University College of Physicians and Surgeons
Ashley Paige White-Stern is an M2 at Columbia University College of Physicians and Surgeons. Her primary concern is making quality health care available to all people regardless of race, gender identity, age, ability, geography, class, or religion. She believes that medicine is a powerful tool for social change.