When a person is transitioning to a new gender identity, safety and trust are paramount.
So Hartford HealthCare created the Center for Gender Health because bias, ignorance and stigma are all too common, even among doctors and other medical professionals, staff members say.
Since the website launched in July, referrals have been coming in at a steady pace, with 100 so far, said Laura Saunders, director of the center.
Beau Triba, who identifies as “a non-binary transgender man”, knows how many pitfalls there can be, living in a world that doesn’t understand or doesn’t care. The Center for Gender Health is different, he said.
Since starting treatment at the centre, Triba said, “It’s been really good. They make sure they call you by the right name, even when they call you on the phone. …And they are also very good with patient-centered care. They really focus on what the patient needs and wants and that’s really positive.
For Triba, it is important that he is treated with respect, until he is called by his preferred pronouns (he accepts either “he” or “they”). Beau is not his birth name, although he has yet to legally change it, he said.
“I’ve had medical care from other places, and they’re not always good at getting my pronouns right, even when they know and have been told,” he said. “Sometimes even doctors get it wrong and make a mistake, but it’s really hurtful, because it’s just not recognizing who you are.”
Triba, 21, from East Hartford, said doctors even raced him between his primary care doctor and his transitioning doctor, even when the issue was unrelated to his gender. “So I think it’s all in one place, that’s really good, because there’s none of that. It’s just all at home,” he said.
The center, part of Hartford HealthCare’s behavioral health network, will one day offer care to all LGBTQ people, according to its director, Laura Saunders. Now, it offers a wide range of services for transgender people, including psychiatry, chest and facial reconstruction (surgery is performed at Hartford Hospital), gynecology, hormone therapy, and primary care. Voice therapy is also referred to speech therapists in the health system.
“It’s nice that you have a gender-informed therapist if you need one, or even just have my primary care physician educated on the nuances of my gender,” Triba said.
Triba started out as a member of Saunders’ intensive outpatient program. “It was sort of our LGBT program for people who needed intensive outpatient care and it was really helpful for my gender journey,” he said. “Just being called Beau all the time was really nice.”
At the center, Triba said he felt like he mattered and was accepted for who he was, and the obstacles in his journey had been removed.
I feel like things are moving much faster than before.
— Beautiful Tribe
“I feel like things are moving a lot faster than before,” he said. “There’s a lot of waiting time when you’re transgender or transitioning in any way because everyone wants to make sure you’re making the right choice and proving you are who you are. With the center, there are far fewer obstacles to cross because they can talk to each other and communicate.
Triba is in the early stages of his medical transition and is collecting letters from doctors and others to prepare for surgery, which he says is difficult. “It takes a lot of motivation to ask these things from providers like my psychiatrist and my therapist [who] were both very supportive and really wanted to help me.
But even they didn’t respond quickly and having to ask multiple times “takes a lot of nerve,” Triba said.
Derek Fenwick, who helped start the center and will become deputy director, has been researching the transgender community, “to figure out where the need is and why these people aren’t getting services and how Hartford HealthCare can support that.”
What he found was that community members “are already underutilizing health care in general. And so we wanted to be able to have a space where they feel supported, affirmed and they can really come into our system and know that they’re going to be able to get the care that they need,” he said. “And once we grow up, we’ll get all that comprehensive care as well.”
Saunders said the lack of use of the healthcare system is “usually based on fears about stigma and rejection. These people don’t want to have to educate their suppliers. And often they have to.
As an example, Saunders said she heard the story of a transgender woman who went to an orthopedic surgeon “because she had a serious problem with her elbow. And this doctor said, well, you need to see your transgender doctor for that. And as far as I know, elbows are elbows; we all have elbows.
“It just demonstrated a glaring lack of understanding of the needs of this community,” Saunders said. “And it was an extremely rejecting experience. …And that’s why this initiative is so important because we’re really going ahead and saying that Hartford HealthCare is here to meet your needs, whether it’s through the Center for Gender Health or through the referrals we can do in other medical disciplines.
Fenwick said stigma and discrimination can have huge physical and mental health consequences. “It’s more difficult in today’s world with all the social media going on,” he said. “These people are still on social media too. And that’s just at the forefront, the discrimination that exists, but particularly within the medical community.
If a doctor ignores gender-sensitive terminology “it turns them away, and they don’t even want to access care in another type of medical setting,” Fenwick said. “If they come to a behavioral health center, if they have a negative experience, which happens for a lot of these people right at the front desk, they don’t even want to go to the dentist, they don’t even want to go see a GP So it really has lasting effects.
Each person’s journey is unique, Fenwick said, so it’s important to listen to each story and understand each person’s needs.
The center respects the standards of care issued by the Global Professional Association for Transgender Healthincluding the letters Triba had to get, following a biopsychosocial assessment, to show he was ready to transition.
“A lot of times it’s the surgeons, the doctors, the endocrinologist who will be looking to say that they have the ability to figure out what they’re going to do to get hormones, and there’s no other kind of co-occurring mental health conditions that may affect them…when they start transgender hormones,” Fenwick said.
WPATH standards have evolved over the years with shorter wait times. “You’ll find people who don’t think we should be following standards of care,” Saunders said. “But in our system, we made the decision to support an individual’s transition as much as possible in an emotionally safe and supportive way without creating barriers to care.”
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One of the benefits of the center is that everyone operates to the same standards, Saunders said. “When you have surgeons or disparate medical disciplines that don’t have a connecting point, like we’re trying to create here at the Center for Gender Health, each follows their own standards,” she said. “So we’re trying to create more unity in the way we work with trans and gender non-conforming people, so that it provides more consistency and support in their care.”
The center also saves the hassle of looking for different specialists, such as surgeons, urologists and gynecologists, Saunders said. “The LGBT community uses word of mouth and social media a lot,” she said. “But sometimes it can give you the wrong information. So what we’re trying to do is really provide coordinated care, reduce barriers, and improve access.
Besides the outpatient intensive therapy group, there is a support group, which existed before the center but was suspended during the COVID-19 pandemic. “As we continue to grow, we will be running a different kind of therapy group for people going through any phase of medical transition,” Saunders said.
There are also co-worker resource groups, where people from similar ethnic and racial backgrounds meet monthly to discuss common issues. Shipman & Goodwin offered pro bono legal services for things like changing birth certificates, driver’s licenses and social security accounts.
“We’re working to really help build their coping skills, to understand the experiences of the family of choice,” Fenwick said. “Many of these people are also rejected and discriminated against within their families. And so we’re trying to change that and recreate a new type of family. Because family of choice is huge for the LGBTQ community.
The center accepts anyone from the age of 17 and has had referrals for people in their 50s. For more information and referral forms, go to hartfordhealthcare.org/services/gender-health.
Ed Stannard can be reached at [email protected]