1 Question, 5 Answers is a column where we ask different types of healthcare pros to weigh in on the same issue.
In 1973, the American Psychiatric Association issued a historic statement: It would be removing homosexuality from the Diagnostic and Statistical Manual of Mental Health (better known as the DSM). “We will no longer insist on a label of sickness for individuals who insist they are well,” the APA’s trustees announced.
While the LGBTQ+ community — an ever-expanding group that includes people of wide-ranging sexual orientations and gender identities — has made profound and lasting inroads in every sector of American in the years since, LGBTQ+ individuals face a wide array of health disparities, and many lack access to culturally competent preventive care.
But as Jessica Halem, an LGBTQ+ advocate and consultant put it, “Help is on the way.” Graduating classes of medical professionals include more queer and trans-identifying providers than ever, and LGBTQ+ practitioners working in the field today are revolutionizing what it means to provide inclusive, affirming healthcare for queer and trans patients. We asked five LGBTQ+ providers what their practices are doing to improve health outcomes for their queer, trans and gender-expansive patients.
Dr. Tamar Carmel (He/Him), MD
Psychiatrist and medical director of mental health services at the Central Outreach Wellness Center
Pittsburgh, Pennsylvania
Central Outreach Wellness Center has a unique setup in so many ways. It started as a small LGBTQ+ primary care and HIV clinic and has expanded over time. The clinic is primarily geared towards LGBTQ+ and HIV-positive populations, and a lot of our staff members are LGBTQ+-identifying individuals and HIV-positive individuals who are out about their status. We have a very nontraditional lens for what it means to provide healthcare. There’s a lot of social media outreach, texting and emailing to engage people in care. We started a PrEP-to-me program, doing virtual visits and sending patients PrEP and STI test kits in the mail. The clinic’s founder, Dr. Stacy Lane, is a wonderfully fierce woman. She really thinks outside of the box, considering how to meet unmet needs in healthcare.
As an out queer and trans person in medicine, I’ve experienced a lot of toxicity in the medical world. I understand how the queer community experiences trauma in medical settings. I have vowed personally to right those wrongs on a small scale, by being trauma-informed and meeting people where they’re at. Part of that is being open as a queer and trans physician; self-disclosure really goes a long way in building the therapeutic relationship and putting patients at ease. My ultimate goal is to help people live fruitful and fulfilling lives by providing high quality, culturally competent and affirming care.
One of the many cool things about our clinic is that our dress code is just black pants and a company t-shirt; they’re quirky t-shirts with positive affirmations and sex-positive statements — things like, “Undetectable = Untransmissible,” “You Are Strong” and “All Black Lives Matter.” That keeps the space positive and the air light. I don’t wear a doctor’s coat! I have always scorned the doctor’s coat. I hate the power differential it creates. I try to break that down as much as possible.
Being the sort of super-progressive, radical, breaking-down-boxes-in-healthcare clinic that we are, HIV is not stigmatized at all. A lot people on our staff are open about their HIV status and help our patients process when they learn they are positive. I think that brings a humanizing perspective, to connect with someone else, and recognize that it’s not something to be ashamed of. It really is helpful to talk to another individual who is living their truth and happens to be HIV-positive. It helps us reframe it as a chronic medical condition like anything else, and helps patients understand that even with HIV, you can still have the life that you want for yourself.
The thing that gives me hope is how much I see other physicians reaching out to us to figure out how to be queer and trans-affirming. Every profession has people who don’t want to keep up with the times – but I would say the vast majority are capable of change.
I hope there will be more and more out queer and trans physicians, and that we can continue to change what it looks like to be a physician in America.
Dr. Barbara E. Warren (She/Her), PsyD, CPXP
Senior director for LGBT programs and policies in the Mount Sinai Health System Office for Diversity and Inclusion, and assistant professor at the Icahn School of Medicine at Mount Sinai
New York City
We have a fairly large DEI (diversity, equity & inclusion) program at Mount Sinai … our commitment is both patient and employee-facing. We have more and more employees, providers, students and post-grad trainees coming into the system who identify as LGBTQ+. We are dedicated cultivating a safe, inclusive and supportive environment. We’re not just emphasizing providing resources to clinicians — which is still so important — but all the employees who make our hospitals run, everyone from security guards to radiology techs. Often, there’s not as much attention paid to the tools and resources they need to create an environment where patients of all backgrounds can receive the best care and be treated with dignity and respect.
I also recently became a certified patient experience professional (CPXP) which complements my role in LGBTQ+ diversity, equity and inclusion. CPXP is an emerging field of practice that focuses on improving all aspects of the patient experience in healthcare. Mount Sinai has a significant commitment to addressing structural and environmental barriers within our system, with an emphasis on anti-racism, and I serve as part of a systemwide team to offer training and support to mitigate unconscious bias at the intersections of the diverse identities and lived experiences of our patients and staff.
Central to our approach is ensuring that every Mount Sinai door that an LGBTQ+ patient walks through is welcoming and clinically and culturally competent. Everybody working in our system needs the tools and resources to treat all our patients with respect for their intersecting identities and lived experiences. That’s a tall order, and it is a work in progress. But there’s a real and full institutional commitment to LGBTQ+ inclusion in all of our work.
Dr. Jonathan Mathias Lassiter (He/Him), PhD
Clinical Psychologist, assistant professor at Rowan University, founder of Lassiter Health Initiatives
Glassboro, New Jersey
My specialty is multiculturalism and intersectionality. I’ve focused on drawing attention to the ways in which people have complex identities and understanding how those complex identities influence their health.
There is always an LGBTQ+ lens to the work that I do with my patients, not necessarily in the discrete categories we define in western society, but because of my particular position as a Black cisgender, same-gender-loving male, and the ways I’ve had to navigate racism, homophobia and class discrimination. All of that comes with me in my role as a therapist. So when I’m working with LGBTQ+ clients, I’m not interested so much in categories of mental health or mental illness, I am much more interested in how they make meaning of life, how they live their lives in ways that go against those predetermined labels. I’m bringing in queer theory and mixing this with Afrocentric psychology theory, which places an emphasis on liberation.
As a faculty member in the psychology department at Rowan University, all the courses I teach deal with multiculturalism and human diversity, and have a social justice orientation. I am very intentional in making my classes and research lab not just tolerant but welcoming and affirming for LGBTQ+ students. For one, I am myself. I model what it looks like to be a scientist who is part of the LGTBQ+ community openly and proudly. Representation matters. I don’t shy away from that, I integrate it. That means we’re reading LGBTQ+ scholars in my classroom: we’re critiquing their work, we’re using their theories to inform the research we do. We’re reading LGBTQ+ scholars of color, and those who have different mental health and physical health statuses. If you’re working with me, you’re learning queer and Afrocentric theories, you’re learning intersectionality theories.
Whitney D. Davidson (She/Her), FNP
Clinician at FOLX Health, a digital healthcare services provider for the LGBTQ+ Community
New York City
The traditional medical community often takes a very heteronormative, cisgender-centered approach to medicine, and this can prevent patients from receiving appropriate wellness care, comprehensive sexual healthcare and the option of hormone therapy. Queer and trans patients can also face being misgendered or “shamed” for living their lives, and it can result in them disengaging from the medical system (as we sometimes call it, the “cis-tem”), because of those experiences. This can often lead to missed diagnoses and poor health outcomes.
I think the diversity of the people who work for FOLX Health is a huge factor in ensuring that we are walking the walk and not just talking the talk. My fellow clinicians are a beautifully diverse group of people, in terms of race and identity, that have been working to provide adequate LGBTQ+ healthcare for years. We are committed to ensuring that the gaps in care that have plagued the community are filled and our members can feel like they are able to live the lives they were always meant to live.
FOLX Health aims to create a space that offers a non-judgmental place for members to receive the care that the traditional medical community has not afforded them. A lot of this is based on the fact that we are members of the community, know what things can be missed and want to ensure it no longer happens. We are a digital healthcare service provider, offering personalized medical plans for LGBTQ+ patients. We provide customized plans for hormone replacement therapy (HRT) including at-home lab work kits, expert one-on-one telehealth visits with trans and queer-centric clinicians and even letters for document name change and surgery. In the future, we’ll be expanding to include STI testing and treatment, PrEP (Pre-exposure prophylaxis, a medication that protects against contracting HIV), and treatment for skin and hair loss issues that can be a side effect of hormone therapy.
Dallas Ducar (She/Her), MSN, APRN
CEO of Transhealth Northampton, faculty member at the University of Virginia Schools of Medicine & Nursing, Columbia University, Northeastern University and the MGH Institute for Health Professions
Northampton, Massachusetts
What interests me right now is the question of, “How do we create new healthcare systems that honor identity and the whole person?” I think the trans and gender-diverse community has a lot to teach America in terms of how to provide care. A lot of the core tenets of gender-affirming care are holistic and individual. Clinicians must follow patients’ leads, instead of assuming what they want. Throughout our history as a community, trans and gender-diverse people have looked to each other for healing and affirmation. I believe that Transhealth Northampton really honors that. We do that through research, expert care and fierce advocacy, to secure a health and affirming future for us all.
We’re looking at a larger systems approach; we’re really trying to serve the needs of the estimated 20,000 trans and gender-diverse folks in our area. We know people need primary care, psychotherapy, sexual and reproductive care; all of this really falls under the umbrella of gender-affirming healthcare, along with many other things. For me, one of the most empowering things in my own transition was when my grandmother bought me my first dress. That wasn’t a clinical care intervention! But that was a part of this support that we know is so vitally important for trans and gender-diverse folks and their families. So we are actively expanding what care looks like and who decides that. We are envisioning a space where we don’t just provide clinical care, but makeup tutorials, weight-lifting classes, tax preparation and more. This is really about expanding the scope of care.
Transhealth is independent and comprehensive in our care. One-hundred percent of our budget is dedicated to caring for the trans and gender-diverse community. We strive to build a team that is, in part, made up of trans and gender-diverse folks, because we want to make sure we’re representative of the community we serve.
There are so many myths out there. Many medical bans around the country claim that gender-affirming care is experimental, or not evidence-based, or claim that they are protecting youth. These are all false assumptions. This is rigorously studied medical care. There are dramatic positive benefits for youth who have gender-affirming care. We’re trying to improve access, but we’re also working to follow the evidence and be intentional, and to give parents the opportunity to connect with their children. The simple truth is that gender-affirming care affords each human the freedom to be who they are.
Trans people have always been here, and we will continue to be here: this is nothing new. We are trying to make visible what has been invisible in a safe way, and to emphasize that visibility in the care we provide. We are working to create new systems that welcome all voices to the table.
Responses have been condensed and lightly edited.