In this MD Newsline exclusive interview with psychiatric nurse practitioner Dallas Ducar and pediatrician Dr. Andrew Cronyn, we discuss the importance of incorporating LGBTQ+ health, in general, and trans health in particular, into medical education and clinical care.
How can we train medical trainees to help improve LGBTQ+ health disparities?
Dr. Andrew Cronyn:
“We need to start listening to our trainees because this next generation, they know what they’re doing. They’re just waiting for us to get out of their way. It’s incredible. I know a couple of people who have come out as transgender during medical school or residency who found that their fellow medical students and fellow residents were not the problem. It was the faculty around them who couldn’t figure out their name, pronouns, etc. Their classmates were like, ‘come sit next to me. This is neuroanatomy. We have to learn it.’
We also need to formalize LGBTQ+ health in curricula. We should be using examples relevant to LGBTQ+ health throughout the curriculum, building it into the curriculum, not only as problems but showing the many positive aspects of the LGBTQ+ community as well.
What I’m sad to see is that LGBTQ+ curricula developed by recent pediatrics trainees and medical students interested in pediatrics mirror the curriculum that my classmates and I taught our classmates 30 years ago. LGBTQ+ health shouldn’t be an informal thing that only certain people are going to go to. Build it into the formal curriculum. The research and information are out there. Science is not controversial. Science is science.”
“I agree with that. I transitioned when I was in nurse practitioner school in rural Virginia, and there were so many people in my way. I was one of those people who was like, ‘just get out of the way.’ We need to get some LGBTQ+ voices in positions of power.
I think improving LGBTQ+ health disparities starts with creating an inclusive environment within the health educational setting, which means actually showing up as allies when things get tough. For example, I remember taking care of a neo-Nazi man after the events in Charlottesville as a newly-out trans woman, and I had colleagues who were showing up for me. And that was a really powerful experience to be able to have allies at that moment.
So, I think showing up is really important, as is getting queer folks in positions of power. Nothing about us without us. Right?
So, specifically, if you’re doing research on trans folks, have trans voices leading the study. A lot of times that means creating spaces, doing research, and educating on issues specific to trans people with trans people, which is what we’re doing here at Transhealth Northampton. It means baking it into the system, such as offering scholarships for those who have been disproportionately marginalized, as trans people have been, even within the LGBTQ+ community.”
Can you please share with us how your practice, Transhealth Northampton, was born? How does Transhealth work to provide the best medical care for transgender and gender-diverse people?
Dr. Andrew Cronyn:
“There was a study done on trans health in this area, including Northampton, upstate New York, western Connecticut, western Massachusetts—all these rural areas. There was definitely a need for trans health services. A lot of people were driving 2 hours to go see a doctor and were waiting 6 months to be seen. And, of course, those logistics don’t work for many people.
A large part of that work was done by one of our social workers. And we found there were three big needs: primary care, including hormonal care, mental healthcare, and reproductive healthcare. So the team realized there was a need and decided from the very beginning that the practice model was going to be centered on transgender people. We see people who are transgender, gender-diverse, nonbinary, gender-questioning, and their families and communities.
As a cisgender provider at Transhealth, I am so fortunate because I am working on the frontline of trans health, which would not be a part of my experience normally. And the fact that my colleagues trust me in this way is just so amazing.
The majority of our employees come from the community. The chairman of our board is a trans man. Our CEO is a trans woman. Transhealth really is from the community and of the community.
I saw a patient yesterday who had heard all sorts of mythology about how bad top surgery is, how much it hurts, and how long the recovery period is afterward. Well, I’m able to pull in someone who’s had top surgery to talk about it.
And another person came to see me who has never met a trans woman and she is trans. And I can’t imagine how lonely and scary that must have felt. But, because of who we are, she will meet trans women here. She will get to see that the statistics that we see that are horrible don’t have to be people where people end up. That she can fight against anything she needs to and be strong, and end up being the CEO of her own company somewhere. And I think that is really important.
It’s also taught me a lot about learning when you stop talking and when you sit back, and you listen to what people are saying. Sometimes, that’s hard, as a white, cisgender male physician. Relearning that has been very important. And I’ve learned a lot.
At Transhealth, we have people telling their own stories, creating their own systems. That means I have to adjust sometimes, and that’s a good thing. I should have to do that in my life.”
Responses have been condensed and lightly edited.