TRANSforming Health Care: Making Our Center More Inclusive For Transgender Patients

1. Erika Patterson, Ph.D. Stephanie Bagby-Stone, M.D. David Tager, Ph.D. Heather Eastman-Mueller, Ph.D. TRANSforming Health Care: Making Our Center More Inclusive For Transgender Patients Susan Even, M.D. Deneal Sullivan, R.N., M.P.A. Ann Nadler, M.A. Scott Henderson, M.D.

2. What is Trans? We utilize trans* as an umbrella term for people who transgress or transcend our normative notions of gender. This term includes but is not limited to those who identify as transgender, transsexual, bigender, gender queer, gender fluid, two spirit, cross dressers, or gender benders.

4. Overview • Transforming Our Center Initiative • What is Gender Identity? The Story of K • Health Disparities & Scope of Problem • Transforming Our Center • Hormone Replacement Therapy/Insurance • Questions and Discussion

5. Understanding Terminology I Gender (culture): social construction of masculinity and femininity; varies by culture and time Sex (body): biological; classification of people based on biological or medical characteristics Sexual Orientation (heart): who we love, are attracted to, or attach to sexually and/or emotionally, desire

6. Understanding Terminology II Gender Identity (mind): internal sense of masculinity and femininity; not necessarily visible Gender Expression (appearance): how we present ourselves as men and women—or somewhere in between or outside of normative trends, or with no gender,; includes clothing, hairstyle, voice, mannerisms

7. The Catalyst for Change • The Story of K (2006-2011) • Helping us to understand and respond

8. Health Disparities • National Transgender Discrimination Survey (NTDS; 2010), surveyed over 7,000 trans-identified and gender non-conforming individuals • 19% reported being refused health care • 28% reported being discriminated against in medical settings • 50% reported having to teach healthcare providers about their healthcare needs

9. Health Disparities II • The need for healthcare tends to be great in the transgender population due to high levels of societal discrimination, stigma and the trauma of rejection (Herek, 2007; Lev, 2004) • PTSD in gender non-conforming population almost 2x higher (Roberts, et al., 2012) • 41% of trans-identified individuals surveyed (2010) reported at least one suicide attempt • Yet only 28% of psychologists feel “sufficiently familiar” with transgender issues (Schneider, 2008)

11. Transforming Our Center • Gender neutral bathroom • Train staff—all roles • Paperwork/signage for trans-inclusivity • Check In Procedure • Implement Hormone Replacement Therapy (HRT) • Advocate for insurance coverage • Provide more culturally effective and integrated care for trans-identified students

14. Traditional Version Inclusive Version

15. Insurance Coverage • UM system wide coverage • “medically necessary treatment” • “AMA supports public and private health insurance coverage for treatment of gender identity disorder as recommended by the patients physician.”(AMA Ethical Guideline H-185.950)

16. “I wondered why somebody didn't do something. Then I realized, I am somebody.” - Unknown Author Dr. Even & Kate Bornstein, Gender Activist

17. Transition-Related Medical Care • Transition-Related Care increases Overall Care • Physician Basic Skills & Competencies: HRT 101 • Specific Challenges and the Learning Curve • Networking with other physicians • First Patients & Successes

18. HRT Quick Reference

20. Thank You! • For more information contact: • Susan Even, M.D. evens@health.missouri.edu • Scott Henderson, M.D., hendersons@health.missouri.edu