Transgender patients receive specialized health care in Western Massachusetts, with long waiting lists
States across the country are working to restrict the rights of LGBTQ people, including in sports, education, and health care. But many transgender people have already felt underserved by mainstream medicine, even in relatively liberal states.
Some western Massachusetts providers have begun to focus on this population, including a new clinic that almost exclusively serves trans patients.
Many members of the LGBTQ community say it’s time.
Nuri Sherif has been telling their doctors for years that they don’t want kids. Providers generally dismissed it as the fleeting belief of a young person.
“It was like, ‘Just wait, honey’, kind of thing. Like, ‘You’re gonna change your mind,'” Sherif mentioned. “I’m like, ‘No, I’m pretty sure I won’t. “”
But when Sherif had their first appointment at the Transhealth clinic, via zoom, the provider, a trans man, didn’t question that decision at all. He even went further.
“He was the one who said to me, ‘Have you ever thought you’d want to have a hysterectomy?'” Sherif recalled.
Sherif, who is 29 and non-binary trans, was assigned female at birth. They are already taking testosterone and planning to undergo superior surgery, which includes removal of the breasts. Sherif thought it needed a provider with a real understanding of gender issues – willing to listen to what Sherif wanted – to suggest removing her womb.
“[The Transhealth doctor] was the first to be like, ‘Yeah sure. You want that organ out of your body, do you think? said Sherif. “And that was cool.”
That kind of sensitivity is why Transhealth opened in Northampton a year ago, in May 2021, as a clinic for transgender patients. It was created and initially funded by Western Massachusetts philanthropist Perry Cohen, an LGBTQ-focused entrepreneur. cohen now chairs the board of directors of Transhealth.
One of Cohen’s first hires was CEO Dallas Ducar, who helped survey the local community about their health care needs.
“A lot of people said they needed to teach their provider how to provide gender-affirming care,” Ducar said. “And they should be the ones teaching you.”
In 2016, Ducar herself transitioned while working as a psychiatric nurse. While running the clinic’s business, she said she relied on some of her own challenges to seek health care, including constantly having to correct the sex in her medical records or justifying the care she received. she was looking for.
“The the data show that if you are trans you are more likely to be discriminated against [against] in healthcare settings. And if you’re a trans person of color, you’re much more likely to be discriminated against than not,” Ducar said. “And we know that if you’re being discriminated against, you’re much less likely to show up for that medical visit again or really commit to your health care.”
Now that Ducar represents Transhealth in various settings, she said she needed to go public with her personal story. Occasionally, after national media coverage, she will receive hate mail from people in other parts of the country, which has led the clinic to take additional security measures.
“We try to make sure the doors are locked, that we have an exit plan, that we have a good relationship with local law enforcement,” she said. “Just to really make sure we’re as safe as possible.”
Beyond safety, she says, the clinic’s priority is to provide non-judgmental care. Rooms include rainbow flags and other artwork, dim lighting, and no tile.
“We really wanted to make it a space that didn’t feel sterile. It didn’t necessarily feel like an exam hall,” Ducar said. “There is so much trauma that has been perpetuated in the medical systems. We wanted it to feel different.
That’s why they also offer non-clinical services, including a transitional clothing swap and a community space for theater practice.
Once a week, after clinical staff return home, a theater troupe leads theater exercises and different forms of performance and expression for LGBTQ youth.
The theater’s co-director, Shai Kuper, himself a trans-health patient, said having a free space to practice acting serves as a kind of mental health care. Also, he said, “we see it more as a way to validate and affirm our community.”
But having the idealism to start a new health center is one thing. Making it work in the US healthcare economy is another. Ducar said at first they couldn’t predict demand.
“We could have hired contractors and no one could have shown up,” she said. “So instead, the opposite happened and we were inundated with requests immediately.”
She said it’s been difficult to hire enough vendors, so waiting lists for new appointments are long.
“How can so many people still need care and how can so many people arrive with such complex needs, and have simply not been cared for throughout their lives?” said Ducar.
As a primary care clinic, Transhealth treats all of its patients’ needs, both mental and physical. But gender-affirming care, including hormone treatment, is often at the forefront. It was Z Belfer-Shevett’s call.
In college, Belfer-Shevett, who is non-binary trans, decided to take hormone therapy.
When they talked to their regular doctor about it, “she went straight into all the potential side effects and logistics about it,” Belfer-Shevett said. “And I ended up feeling really uncomfortable and, like, I was kinda in over my head and she didn’t really know how to react to what I was saying. I was just very unsure of getting good care.
Belfer-Shevett, who is 23, received a doctor’s prescription for hormone therapy, “and didn’t start it because I felt too weird.”
With the pillbox in their cupboard, they saw an article about Transhealth in the newspaper and then waited four months for a Zoom appointment. They felt like the doctor, a trans woman, knew a lot more about gender-affirming care — right down to insurance coverage.
“[She said], “Here on page 14, section C, here is the relevant information you need to review. That’s exactly what they cover,” Belfer-Shevett said. “Like she just got it, she knew exactly where to look.”
Belfer-Shevett received the same hormones prescribed by her previous doctor, but this time they took them.
Transhealth isn’t the only medical practice in the region focusing on trans care. At Oxbow Primary Care, part of Cooley Dickinson Hospital, about half of the patients are LGBTQ.
“I am continually moved by the complexity of people’s backgrounds and gender identities,” said Oxbow Medical Director Dr. Miranda Balkin.
Balkin said part of treating trans people is do not always considering gender first. Balkin referred to what is called “trans broken arm syndrome” – when a trans patient will have a basic complaint, such as a broken arm, and a provider will immediately assume the problem is sex-related.
For example, Balkin recalled one of her patients going to a specialist for an eye condition and being told it was due to the hormones they were taking. Balkin told his patient that was ridiculous.
“There is no physiological pathway by which your testosterone could cause this eye problem; it makes no sense,” Balkin told his patient. “‘You keep taking your testosterone, which you need for your gender dysphoria, because you’re going to feel really bad if you get away with it the way they want.'”
Balkan said providers should also keep in mind what organs a trans person may still have due to their sex assigned at birth.
“People who have a cervix need pap smears. People with prostate need PSA checks,” she said.
Like Transhealth, Balkin said the Oxbow Clinic is trying to hire more providers to keep up with demand. At the moment they are booking new patient visits for 2023.
“I don’t think there is enough care available yet. So I think there’s definitely room for both of us,” she said.
Transhealth said it exceeded 1,000 patients in its first year.
Ducar said the center’s current focus, in addition to hiring, is on financial independence once start-up money runs out. They plan to start their own pharmacy or create a trans care research division so they can get government grants.
In the meantime, she has had to accept the limits of what a medical clinic can do for the transgender community.
“We cannot prevent someone from being discriminated against in all aspects of their life. We can’t prevent someone from not having gender dysphoria,” she said. “We can do our best and carry on knowing that we’re not going to solve everything overnight.”
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