NOTE: The following event took place during my very first rotation site at an HIV clinic.
Without a doubt, she had one of the firmest handshake I have ever felt from a woman. She stood tall–at least 6 feet–and shoulders broader than most men. I met—we’ll call her XY (based on the XY sex-determination system)—during my morning rounds with Dr. L, the medical director at XYZ-HIV clinic. We only met for a brief moment but I can tell that XY was a gentle, loving, and kind spirited individual–with subtle display of toughness. She exuded warmth and kindliness with her smile–but her smile faded quickly.
“I feel so depressed,” she said in her conflicted, soft voice whilst staring down onto her feet—with a noticeable attempt to evade direct eye contact.
“I was so happy for awhile, I don’t know what happened,” she continued as Dr. L encouraged her to open up. “I just don’t feel like myself and the person I see in the mirror everyday, that’s not even me anymore,” she went on, “I want to feel normal again, I need to continue my medications—the ones we decided to stop awhile back,” XY continued. Dr. L agreed and we left the room.
I quickly glanced over XY’s charts as we made our way back into the office—and for a split second, I thought I had mistakenly grabbed the wrong chart. Her medical record clearly indicated a name belonging to that of the male gender. After connecting the dots and realized I just had my first transgender patient encounter.
XY was born a man, diagnosed with HIV many years ago, and have since been seeing Dr. L for treatment. XY’s continues to struggle with self-identification and often find herself veered off course in her journey of self-exploration. Initially, XY came out feeling extremely uncomfortable being assigned a male gender by birth. She developed deep desires to become the woman that she have always wanted to become all her life. She chose to start her medical transitions with hormone pills. XY was at peace with her new feminine identify for a period of time. At some future point in time, XY began to feel conflicted once more with familiar amounts of uncertainty about who she wants to be. She felt emotionally exhausted and long for the feeling to be masculine once again. At this point in time, he discontinued hormone therapies and transitioned back–aligning himself with his birth assigned gender. Fast forward to present day (a few months later), XY arrives at the clinic–feeling depressed, and having the absolute need to feel “normal” again. She was truly a case of two lost souls in one body.
Contrary to popular misconception–what XY is experiencing is not a mental disorder but “gender dysphoria”– according to the American Psychological Association (APA) (per the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders–DSM-5)1. Gender dysphoria is a condition where a person experiences discomfort and emotional distress because they are not the “gender” their assigned “sex” is expected to be. What’s the difference? Sex is one’s biological status–assigned at birth. Gender is one’s social identity through behaviors, activities, and roles constructed by society. Dysphoria is often accompanied with severe anxiety, distress, depression, and suicidal ideation. Due to social injustice and prejudices against member of this minority group, they often live with internal conflicts and fear.
Although inconceivable progress has been made in the LGBT (lesbian, gay, bisexual, and transgender) communities, transgenders (in particular) still experience a great deal of discrimination and are easy targets for hate crimes. The National Transgender Discrimination Survey found that 63% of their participants experience some degree of discriminatory acts that include–but not limited to–bullying, harassment, and even denial of medical services. Transgenders are two times more likely to be unemployed and four times more prone to property.2 The LGBT community still faces many health disparities and challenges–as the world continue to have turned its back on.
I debated over an extensive period of time before choosing to publish this piece for I could not decide my stance on the issue. There exists a constant internal conflict between my political beliefs (the Constitution), faith, moral values, professional ethics, and role as a soon-to-be healthcare provider. It is not easy not to judge, for judgment is what differentiates us from other primates and makes us who we are. Quite frankly, it was difficult for me–initially–to accept the LGBT movement (more specifically transgenderism) because it was exceedingly progressive and liberal–even for my liberal taste. But the more I educated myself on the movement and build an understanding for the validity of transgenderism, I felt more bigoted. I felt small, narrow-minded, and selfish.
The medical transitioning process can be very painful, expensive, and potentially take years to achieve. Logically, for someone to willingly endure so much pain and suffering, I cannot fathom the kind of misery they must have stomached to find the rigorous transitioning process necessary. Everyone deserves to be happy and for that, I respect their courage. Who am I to judge? Who am I to say what’s wrong and what’s right? It all boils down to this–it should not offend me if I am not involved in the decision-making process. We are all entitled to the same sets of rights and freedom set forth by our Founding Fathers. We are all human–we are worth the same and need to be loved, respected, and certainly accepted by one another regardless of our choices and preferences. Essentially, don’t we all want the same things in life? We want to be free, we want to avoid suffering, and we want to be treated justly and with respect. I challenge you–especially professional healthcare providers–to practice without prejudice and preconceptions, and–ultimately– to provide unbiased healthcare services. Grant every individual an equal chance to have optimal healthcare access that they so very much deserve. Take the time to listen and learn from your patient’s struggles. The impact could enrich someone’s and your own life experiences.
Here are some transgender friendly tips to use in practice:
- Do not assume a person’s sexual orientation
- Which pronounce to use? He/she? You ask! Don’t beat around the bush.
- Practice 100% confidentiality
- Be patience with patients who are still identifying their gender and role in society
- Avoid compliments (which could also be offensive)
- Listen to your patients, let them express themselves
- Respect patients and their choices
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C.: Author.
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