Trans 101

Today I had the opportunity to meet and do some planning with a few members of the amazing staff of the Bronx Community Pride Center (BCPC). We came up with some really exciting things that I can help contribute to, with a primary focus on transgender health and programming.

Vocab

So what does it mean to be transgender?

"This is a broad term indicating a person whose gender identity and expression do not 'match' the sex assigned at birth, in whole or in part." -- Community Healthcare Network

"Gender-non-conforming" is a related term, used to describe someone who does not identify as entirely one gender or another-- he/she may identify as a combination of the genders, or as another gender entirely.

It is important to emphasize that one's gender identity (one's sense of maleness/femaleness/other) is a completely separate concept from one's sexual orientation (heterosexual/lesbian/gay/bisexual/other).

Sex and gender are also not equivalent. Sex refers to physical/biological factors, and gender refers to social/psychological factors. Therefore, a person's sex (physical appearance) may not always completely align with his/her gender (one's identity or sense of maleness/femaleness/other).

So why does this matter?

Medical schools across the country are working to amp up their LGBT curriculum -- the Plus One Initiative -- because physicians have historically been notoriously uninformed and unprepared to care for members of the queer community. The fact of the matter is that even gaining basic knowledge as above serves as a foundation for increasing access to care for the queer community. Why? Because learning to use appropriate and culturally sensitive language opens a door for LGBT patients, affirming that you are committed to providing a healing, inclusive, welcoming environment for ALL patients, regardless of sexual orientation or gender identity.

Trans outreach

Speaking of welcoming environments, I am working to develop a relationship with the Bronx Community Health Network (BCHN), which is widely known as a trans-friendly health center that draws a strong contingent of transgender patients. With some help from the staff there, I am planning to develop a workshop for the Trans-Female group at BCPC, going through the gender transitioning process from a medical perspective and discussing hormone therapy, as well as the dangers of using black market hormones. Buying unregulated hormones and receiving injections from unlicensed individuals is unfortunately a major issue in the trans community, not only in the Bronx but also globally. Medicaid will not cover the cost of hormone therapy because it is considered "optional", and an unfortunate number of trans patients resort to sex work to earn the money to pay for hormones.

Savannah, the Transgender Program Manager at BCPC, shared some strong words of wisdom today with me.  Our job is not to alienate trans individuals by telling them that they have to stop performing survival sex or stop using black market hormones.  Our job is to inform them about the services we offer, provide a safe space where they can come for support, and hopefully over time develop a relationship of trust where they may begin to be more receptive to safer practices for their health.  We are hoping to conduct some street outreach to vulnerable transgender individuals some evenings this month to bridge the divide and begin to offer some safety net for this clearly medically underserved demographic.  


The emphasis is on harm reduction, including:

1. Needle exchange service for those who receive black market hormone injections
2. Distributing condoms to sex workers
3. Raising awareness about the Pride Center to encourage continuity and a support network

Savannah says that of the 30 or so intakes she has done with trans individuals she has connected with at BCPC, 100% of them have made the switch from black market to safe, regulated hormone therapy.  By approaching patients where they are, both literally and figuratively, we are in the best position to connect with patients, offer support, and improve health outcomes.