No matter where Washington State University transgender students reside, there are healthcare providers that are familiar with their health needs and provide a welcoming environment. Finding them, however, can be challenging as not enough doctors, nurses, counselors and other medical personnel have been adequately trained to serve them well.

This was the general feeling shared during last month’s symposium on gender-affirming healthcare held on the WSU Pullman campus.

During the first-of-its-kind gathering organized by WSU Pullman’s Gender/Identity and Sexual Orientation Resource Center, Women’s Center, and Cougar Health Services, over 80 healthcare providers from the Palouse area discussed the importance of providing gender-affirming care and the challenges transgender, who often identify as trans*, and non-binary students often face when they visit the doctor.

“Sometimes it’s a simple gesture like using a patient’s preferred name and pronouns that can make a big difference in how welcomed a transgender or non-binary student feels in a clinic,” said Amy Sharp, director of the Women’s Center. “A lot of physicians and nurses haven’t thought about the importance of this or been trained to make it part of their routine.”

Gender can be viewed on a spectrum. People who identify as non-binary do not consider themselves to be male or female. Instead, they identify somewhere in between.

A lot to learn

Transgender students often seek out a variety of specialized services including gender reassignment surgery, hormone therapy, breast augmentations, hair removal, speech and occupational therapy, counseling, and prosthetics.

Abby Howard, a physician assistant in Cougar Health Services, said there is a lot to learn and it can seem daunting for healthcare professionals at first. When Howard trained to become a physician’s assistant over six years ago, she said specialized care for transgender and non-binary people was not part of her curriculum.

“It can be intimidating partly because gender-affirming care is still relatively new,” said Howard. “There isn’t a lot of good data or guidelines to help guide us so it’s important to be upfront with patients about what we know and what we’re not sure about.”

While the nuances of specialized healthcare can be complex, Howard said just being a good listener and kind with patients goes a long way to making them feel valued. She said her best teachers are the students she serves.

The human factor

Amber Graham, a WSU residential education director with a transgender history, said she has been pleased with the healthcare she has received here, but has struggled with her health insurance company not wanting to use her preferred name and pronouns.

“The human factor in all of this is a really important component,” Graham said. “Are you in this for the care of your patient or something else? I don’t want to have to deal with this damaging impact every time I make a call.”

Jaime Bowman

The impact can indeed be devastating. Dr. Jaime Bowman, director of the Longitudinal Integrated Clerkship and associate professor in the WSU’s Elson S. Floyd College of Medicine, said a person undergoing gender change is already under a lot of stress worrying about how their friends, family, and society are perceiving them. When they are unable to find a healthcare provider where they feel safe, respected and heard, it further compounds their anxiety.

Howard said the suicide rate among this population is nine times higher than the general population.

“Doctors and nurses wear scrubs for patient safety and we should treat patients with dignity and respect for the same reason,” Bowman said. “Even if I’m the only one who affirms their preferred name the entire day, my patient might rethink how they are able to cope in society.”

Speaking from experience

Bowman knows first-hand how fear and misinformation about the LGBTQ+ population can impact a family. When she was six years old, an uncle she adored revealed he was gay and her parents barred everyone in her family from contacting him. They feared that by touching him, or eating off the same plate, would make her gay. Bowman was finally able to reach out to him when she left for college and learned how devastating it was for him to lose the people he deeply cared about at a time he needed their support the most. He died of AIDS during Bowman’s first year of medical school.

“After what happened to my uncle, I wasn’t about to let that happen to anyone else,” Bowman said. “I knew I had an opportunity to help prevent that kind of mistreatment in healthcare.”

The impact of referral

Specialized health care services are hard to find, and not all providers are aware of them.

“Doctors don’t have to be perfect and know how to perform every kind of procedure,” Graham said. “But knowing who can provide the services is important and something they should be able to share with their patients.”

Bowman said learning best practices of gender-affirming healthcare is part of the core curriculum for students in WSU’s Elson S. Floyd College of Medicine. Due to its complexities, it requires an interdisciplinary approach in both learning and in practice. The medical students rehearse how to properly ask patients about patient sexuality, about what kinds of information patients seek and why, and how to gather information in ways that make patients feel safe.

Howard has attended two training sessions on gender-affirming care at Swedish Medical Center in Seattle and received additional training online. She and others regularly share what they learn with the entire staff at Cougar Health Services and believes it is important for them to keep updating their knowledge base as new information becomes available.

“It’s our policy at Cougar Health Services to make everyone feel welcomed and we want the LGBTQ community to know they can definitely find the care they need here,” Howard said. “If there’s something we are unable to provide, we have good contacts in the community who can take care of them.”

The symposium provided a unique opportunity for WSU and community healthcare providers to come together, listen, learn, discuss, and share their own experiences. Due to its success, Sharp said the planning team will explore ways to expand the conversation across the WSU system.