In conversation: A primary care physician and a patient on health care for transgender people
By Jennifer Stranges
International Transgender Day of Visibility celebrates transgender people, their contributions to society and raises awareness of the discrimination they face. One of those barriers is in access to health care. Studies show transgender people are less likely to be screened for cancer, feel there are too few providers with expertise in transgender medicine and when compared to the general population, they are more likely to live in lower-income neighborhoods and experience chronic health conditions.
Dr. Thea Weisdorf, a primary care physician with St. Michael’s Academic Family Health Team, specializes in providing primary care to transgender and gender expansive individuals. Aleksander is a patient with Dr. Weisdorf. They joined us to talk about the simple ways health care providers can do better and why ‘trans care is health care’.
What was it like for you to find a primary care physician?
A: I moved to Canada from Venezuela in 2015 and became a permanent resident a year and a half ago. Venezuela is a very difficult country to live in even as a cis person, but for trans people especially, there’s very little resources to access. In the health care system in my country, you don’t have one primary doctor. In Venezuela, if you have a stomach ache, you go straight to a gastroenterologist. If you have eye problems, you go to an ophthalmologist. So the idea that you would go to a central person that just knows you was very novel.
My goal wasn’t to find a family doctor so I could transition. My goal was to find a doctor that I could convince to not misgender me. When I go to the dentist, my dentist misgenders me. I’ve kind of resigned myself to it; it feels like this is what I have to do to get care. But I thought, this is Canada! I would like to not grit my teeth when I see my doctor.
I searched “transgender care Toronto” and I found the page for St. Michael’s Hospital and it actually said, “We can refer you to trans-sensitive primary care.” I wasn’t expecting everything that I actually got.
What are the barriers to accessing care and what needs to be improved?
TW: Even though Aleks’ experience of health care in Venezuela is siloed, here in Canada that might potentially happen for someone seeking gender identity care. Someone may go to a family doctor who says they don’t do trans care or they don’t feel comfortable, so they’ll refer the patient to someone else if they’re thinking about surgical or hormonal treatments. That doesn’t work very well, and that’s my biggest goal for my career – to help other primary care providers. This is something that a primary care provider should have the ability to do – the only limit is their sensitivity and making the place welcoming. There’s nothing in trans care that isn’t in the abilities of a primary care provider.
A: This is kind of a good thing, but things in Canada are changing so quickly that it makes it harder to find resources about how transitioning works in this country. Information changes fast enough that if I find something that’s three or four years old, it’s now outdated.
TW: In the last five years, things have moved quite quickly, but we’re starting from a low bar. Embarrassing doesn’t capture it – it was so discriminating.
What’s currently working in the health care system to support transgender and non-binary people?
TW: Before Aleks joined my roster, we had a phone call so we could make sure it was a fit. Providing a patient with the opportunity to get a sense of safety before feeling like they have to commit is really important, because part of the issue for trans people is wondering if this is a welcoming environment and do they feel safe. When someone can ask questions and still be in their own space and environment, I think that’s a lot safer for the patient.
In medical school, as early as first year medicine, they’re doing a lot of integrated systems care with patients that represent the LGBTQ2A+ community. Year two medical students are graded on the fact that they have to introduce themselves with their pronouns.
On that note, why are preferred pronouns important for everyone to share?
A: If trans people are the only people sharing their pronouns, it’s very awkward. If it’s just us, then it feels like we’re outing ourselves. But when everybody does it, it feels like a level playing field and that it’s normalized. When I see a cisgender person with their pronouns on their LinkedIn or email signature, it tells me they’re an ally.
What do you wish all health care professionals knew?
TW: The basics are making someone feel welcome and safe. That’s a very easy thing to do even just by the physical space – a pride or trans flag automatically makes someone feel welcome, gender-neutral washrooms, and having staff use the same language when they greet people. Also, how systems work with forms and gender-identifiers – those are things that, whether you’re at a family clinic, emergency department or specialist office, need to be dealt with at a systems-level.
We need to encourage our health care providers that this is something everybody has the potential to do in a safe and sensitive way.
A: I have heard heartbreaking stories of people who have had a doctor for decades and then the doctor refuses to help or refers them elsewhere for transition care. My perspective might be more optimistic than many Canadians, because to me it is a privilege that I feel safe enough that I can discuss gender with a doctor. Even if it doesn’t go well, I can just go to another doctor.
Any final thoughts?
TW: “Trans care is health care” will be my rallying call until nobody wants to listen to me anymore. A lot of people had been harmed by misgendering, transphobia and not being provided care. There is no way we can call ourselves primary care providers and care for all different people without including people from the LBGTQ2A+ community. It’s a myth that we have to bust that trans care is “special” care. Half the time the patients of mine that happen to be trans aren’t coming to me for a trans issue, they’re coming to me for management of high blood pressure or tummy pain.
I want to share in Aleks’ optimism. When I hear his story or when I share with my colleagues, I feel very proud that there’s so much we can highlight about what we’re doing well, but I also think there’s a lot that we can continue to improve. I’m hopeful that we are on the right track.
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