Transgender Patients Create Their Own Networks Of ‘Safe’ Providers

RAD Remedy pools and vets referral lists of doctors, nurses, dentists from LGBT organizations. (Jesse Costa/WBUR)

RAD Remedy pools and vets referral lists of doctors, nurses, dentists from LGBT groups. (Jesse Costa/WBUR)

A nurse looked at the couple: a man of medium height with a large belly and a tall, thin woman. The nurse handed the woman a small paper cup and asked for a urine sample.

“Well, that’s not really going to work because my husband is the one who’s pregnant,” the woman said. Then Karl Surkan, a transgender man who teaches gender studies at MIT, took the cup.

“Well, then I guess I need a urine sample from you,” Surkan remembered the nurse saying to him.

Jonathan Pauli, left and Karl Surkan are the co-founders of TransRecord. (Martha Bebinger/WBUR)

Jonathan Pauli, left and Karl Surkan are the co-founders of TransRecord. (Martha Bebinger/WBUR)

Other nurses and doctors might make the same mistake. Transgender men are pretty unusual in OB offices and maternity wards. The nurse in this case wasn’t hostile, Surkan said, just “not knowledgeable about the existence of masculine-looking people who are pregnant.”

Still, Surkan would give the nurse a low score on an online provider rating system he co-founded late last year — Transgender and genderfluid patients log in, name a provider, and respond to eight questions that identify a doctor, nurse or counselor as transgender friendly — or not.

“This is a population that is heavily medicalized,” Surkan said. From the pre-transition period, through a gender change, to potentially decades of hormone therapy, these patients will be frequent users of health care. Continue reading


Gender Divide: Trans Youth Face Higher Mental Health Risk, Study Says

With the tragic death by suicide of transgender teenager Leelah Alcorn still in the news, Boston researchers are reporting that many transgender youth may be particularly vulnerable to a variety of mental health-related problems.

The new study published in the Journal of Adolescent Health found that transgender youth faced a higher risk of being diagnosed with a mental illness or related problem, compared to non-transgender teens.

Specifically, the study says:

Compared with non-transgender youth, transgender youth had an elevated probability of being diagnosed with depression (50.6% vs. 20.6%); suffering from anxiety (26.7% vs. 10%); attempting suicide (17.2% vs. 6.1%); and engaging in self-harming activities without lethal intent (16.7% vs. 4.4%).

Researchers suggest that primary care doctors should address gender identity more directly and routinely screen transgender adolescents for mental health concerns.

Sari Reisner, a research scientist at the Fenway Institute who was the lead author on the survey, says gender affirming care by pediatricians can have a positive impact on a child’s future mental health outcomes:

“Gender affirmation is a very important part of a person’s identity. If a person is not being seen for who they are it can be very distressing. So pediatricians present a very important entry point into care and can get youth who need services to the right place.”

According to the study:

…it is recommended that primary care providers include gender identity as part of a basic patient history. Training programs and continuing education programs for primary care providers and mental health providers should include gender identity education.

Providers should familiarize themselves with community resources for transgender youth.

Patients with a transgender identity or history should be recognized as having higher risk for mental health concerns and should be carefully screened and evaluated.

Patients identified with co-occurring transgender identity and mental health concerns should be seen by a mental health provider who is qualified to provide evidence-based care with sensitivity to the diversity of gender identity and expression.

Continue reading

12 Tips For Nurses And Doctors Treating Transgender Patients

Massachusetts is drafting rules that will define the transgender services insurers will be required to cover. The Association of American Medical Colleges (AAMC) has just released guidance on training doctors to treat lesbian, gay, transgender and gender nonconforming patients. And Boston University Medical School has what Dr. Joshua Safer, a professor there, says is the nation’s first transgender medicine curriculum focused on the biology of gender identity.

Dr. Joshua Safer and Dr. Jennifer Potter (Courtesy photos)

Dr. Joshua Safer and Dr. Jennifer Potter (Courtesy photos)

Like I said: brand new stuff. But what do all these new rules mean for the doctor or nurse, in an examination room, who meets their first transgender or gender-fluid patient?

Here’s some advice from Dr. Safer, associate professor of medicine at Boston University Medical School, and Dr. Jennifer Potter, associate professor of medicine at Harvard Medical School. (Dr. Potter is a co-author of the AAMC guidelines.)

1) When greeting a new patient, or one you haven’t seen for some time, you cannot assume anything about their gender identity based on the masculinity or femininity of their appearance or the timbre of their voice. To avoid making mistakes, ask each new patient how they identify, what name they prefer to be called and what pronouns they want you to use. Note: Pronouns may be male (he), female (she), they or another gender-neutral option. Continue reading

Survey: Transgender Discrimination In Mass. Public Spots, Health Effects Seen



By Qainat Khan

On a break from her job near South Station, Vivian Taylor was on her way in to use the station’s ladies’ room when a man suddenly blocked her way, she recalls.

“Where do you think you’re going?” he asked her, threateningly.

“I didn’t want to have a confrontation while I was at work, but it was a very unsettling experience,” said Taylor, a transgender woman who served in Iraq in 2009 and 2010. “For about the next half hour, that fella just stood there — as if he was on guard — standing there glaring at me in front of the door to the bathroom.”

A survey out today suggests Taylor’s experience is not uncommon. The results, based on 452 responses, show that almost two-thirds of transgender and gender non-conforming Massachusetts residents experienced discrimination last year in public places, including transportation, retail and health care settings.

The survey, conducted by The Fenway Institute at Fenway Health and the Massachusetts Transgender Political Coalition, found that respondents who reported discrimination had an 84 percent increased risk of adverse physical symptoms associated with stress — such as headaches, upset stomachs and pounding hearts — and a 99 percent increased risk of emotional symptoms compared to respondents who reported no such discrimination in the past year.

“It’s a hard thing to have to go through the world just having to be that conscious of your own safety,” Taylor, who was a respondent on the survey, said. “That’s a very stressful experience, to just always know that it’s possible that somebody is going to come after you for no other reason than what you look like, or how you dress, or what your voice sounds like.”

The survey also found that 20 percent of respondents postponed or did not seek health care because of prior discrimination in a medical setting. Five percent of respondents said a health care provider refused to provide them with care because of their gender identity. Continue reading

His? Her? They? Understanding The Latest Gender Identity Language

We took a close look at transgender issues last week through the eyes of one teenager and his family. We heard from many readers who wanted to know more about the way teenagers and 20-somethings think about gender. Of course, not all younger people are rethinking gender and not all the people rethinking gender are young, but there is something happening that wasn’t when I graduated from college in 1984. So, if you want to learn more, here’s one personal story: It’s written by Alex, a Smith College undergrad who uses the pronoun “they.” Alex identifies as gender queer, but is not out to family members, so we’ve agreed not to use Alex’s last name.
–Martha Bebinger

pamphlet on gender identity written by Carlin Soos, a gender queer college student in New England)" href="//">New terminology (from a pamphlet on gender identity written by a gender queer college student in New England)

New terminology (from a pamphlet on gender identity written by Carlin Soos, a gender queer college student in New England)

The name my parents gave me means ‘grace.’ It never quite fit me, my clumsiness manifest in the tables I bump into, the ink smears in my writing, the awkwardness with which I try to reclaim and adjust to a body that has never felt like it belonged to me. This body, short and thick, with a uterus that is incapable of regulating itself without additional hormones and breasts too large to hide, is a body that marks me, irrefutably in most people’s eyes, as ‘female,’ or ‘woman.’ Even when I cover up, wear tight sports bras and loose sweaters, I get called ‘girl’ or ‘she,’ and it makes the pit in my stomach tighten. But at the same time, the few times I have been called ‘sir,’ I haven’t felt any better, and I have no desire to become instantly recognizable to the general public as male, no sense that testosterone-fueled facial hair or having my breasts removed would make me feel more at home. Neither extreme fits the person I know I am.

Most people see gender as a binary — male/female — with no or little wiggle room. However, I have always seen it more as a spectrum, with masculinity at one end and femininity at the other and lots of murky grey space in-between. I occupy this grey space, this unknowingness, this refusal to fit into one prescribed box. I happen to belong somewhere between neutral and masculine, flitting between men’s clothes and women’s depending on how much I want my body to be on display. I am most at home in women’s jeans and a men’s sweater. Continue reading

Answers To Your Sex, Language And Transgender Medical Questions

We wrap up our series on living transgender with your questions from our Friday live chat:

Why are so many young people comfortable with the idea of “genderqueer”?
How’s sex after sex reassignment surgery?
Which sports team do transgender students play on?

Answers from you and the panelists follow.


From left to right: Unger, Moureau and Levi. (Courtesy)

Dr. Cecile Unger, OB/GYN who trained at Brigham and Women’s and Massachusetss General Hospital and is currently a fellow at the Cleveland Clinic where she is training in Female Pelvic Medicine & Reconstructive Surgery and developing a subspecialty in transgender women’s surgery and health.

Bianca Moureau, transgender advocate. A former patient at Boston Children’s Hospital, Bianca transitioned from male to female when she was 14. She was the first person in the country to have Medicaid pay for her surgery. Now 26, Bianca is applying to law school.

Jennifer Levi, runs the Transgender Rights Project at GLAD and specializes in transgender legal issues.

Question from Margaret: Is there an age cutoff for surgery? That is, can someone be “too old” for gender-changing surgery? I have a good friend, born male, who has been transitioning to female for about two years now. She’s in her mid-50s and has been taking hormones most of that time.

Response from Cecile Unger: Margaret, as someone who sees these patients, I can say that there is absolutely no age of patients discover their identity later in life while some patients choose to wait. Many individuals undergo surgery in late adulthood.

Comment From Kelly: [I ] would love to hear you discuss the concept of “genderqueer” and the generational divide. Continue reading

One Teenager’s Female-To-Male Story: Going Through Puberty Twice

Dr. Annie Brewster
Guest Contributor

Zachary went through puberty twice, first as a girl, then as a boy, after he started taking hormones. “The second time was a lot better,” he said. “I got excited when my voice cracked, and when I started to smell different,” though he adds that excitedly telling friends that you smell really bad is kind of a conversation killer.

Zachary is transgender. He was born female but he has always known, even before he could articulate it, that he is male. His journey has been challenging, and he suffered from depression for many years as a result. But he is now a confident, happy, inspiring young man.

Zachary was born as one of three triplet girls; but he has always known that he is male. (Photo: Marilyn Humphries/Greater Boston PFLAG)

Zachary was born as one of three triplet girls; but he has always known that he is male. (Photo: Marilyn Humphries/Greater Boston PFLAG)

Last month, Zachary, 19, graduated from Methuen high school. He’ll start Wheelock College in the fall, where he has received the four-year, $20,000 annual Passion for Action scholarship for his demonstrated commitment to community service, leadership and scholarship. He plans to become a social worker with the goal of working with LBGT (lesbian, gay, bisexual, and transgender) kids.

Medically, a transgender person can choose to pursue hormonal treatment and/or surgery in order to bring the biological sex closer to the gender identity, though no intervention is a necessity. For female to male trans people, like Zachary, the surgical options include removal of the reproductive organs, “top surgery” (mastectomy), or “bottom surgery” (construction of male genitalia). For now, Zachary has chosen to pursue hormones, removal of his uterus and ovaries and top surgery, but doesn’t feel that he needs to have bottom surgery. He stresses that this is a personal decision, and that no two transgender people are the same.

Sexual orientation among transgender people is equally varied. Zachary identifies as bisexual. Continue reading