GIVEN a magic wand and the ability to change one thing immediately to improve health outcomes for transgender and gender diverse people, Emery Wishart would boost education and training for medical practitioners, so trans individuals don’t have to rely on word of mouth to access appropriate health care.
Mr Wishart, Services Manager at Transfolk WA, told InSight+ in an exclusive MJA podcast that while professional, appropriate health care was crucial to trans people, many avoided seeing a doctor because of previous bad experiences, much of it down to a lack of education in how to engage with trans people.
“I hear a lot of stories from other trans people, binary and non-binary, of going to see a GP or going to the hospital and being called by the wrong pronouns or using an incorrect name after they’ve made clear what name they want the medical staff to use,” he said. “Or even getting invasive personal questions that are completely irrelevant to the health care that they’re needing when they present to the service.
“If there was training that encompassed a lot of the missing content, that would be amazing. It would really change the experiences that trans and gender diverse people have in health care.”
Ms Penelope Strauss, a youth mental health researcher at Telethon Kids Institute in Perth, said in the same podcast that avoidance was a clear consequence of misgendering and other inappropriate experiences in health care settings.
“When trans people access health care that is invalidating of their identity or otherwise somehow discriminatory, what happens is a lot of people later on avoid health care,” Ms Strauss told InSight+.
“What that means is screenings get missed, follow-up appointments get missed, and what we see is that some health conditions that could have been treated earlier aren’t seen until much later, which obviously leads to quite poor health outcomes for some people.
“I would love for all doctors to understand that respecting somebody’s name and pronouns is just respecting that individual. I agree that training is needed, especially for things like hormones or how to refer somebody on or going through the informed consent process for various interventions.
“However, all of this comes back to this: when a [trans or gender diverse] patient shows up, listen to them, ask them how they’d like to be referred to, what name they use, what pronouns they use, and stick to that throughout every appointment. Even if, legally, on their medical file something else is written. Respect that patient face-to-face and use the name and pronouns they use.”
Ms Strauss is co-author of a Perspective published in the MJA on misgendering and experiences of stigma within health care settings. The article calls out the structural stigma – “intentional and unintentional policies and practices that result in restricted opportunities for stigmatized people” – inherent in medical training.
“This leaves doctors ill equipped to care for trans patients,” the authors wrote.
“Many lack knowledge of trans health, do not know how to refer to trans competent providers, and may also be uncertain how to respectfully address and refer to trans individuals. This uncertainty can lead to ambivalence around providing care and patient acceptance thereof.”
Mr Wishart, who was not an author on the article, said many doctors wanted to help but had no idea where to begin treating a trans person.
“I feel like there’s a lot of missing information,” he said. “GPs can have the very best of intentions and want to be very helpful, but [have] no information about how to do that and what’s respectful and what isn’t.
“It’s a priority and should be included in medical education, definitely.”
Ms Strauss recommended that GPs and other specialists contact the Australian Professional Association for Trans Health(AusPATH) as a first port of call.
“It’s important for GPs who do want to learn more to contact community organisations, to contact professional organisations such as AusPATH, who do run training.”
Position statements on the Australian standards of care and treatment guidelines for transgender and gender diverse children and adolescents, and on the hormonal management of adult transgender and gender diverse individuals can be found on the MJA’s website.
Despite the barriers, Emery Wishart is optimistic.
“There’s more and more visibility of trans and gender diverse people in the general community, in the media, in policy, and in people becoming more aware and wanting things to change,” he said.
“People want to be doing the right thing by trans people. So yes, I’m hopeful.
“There’s a way to go and it’s a bit of a process to get there, but there are a lot of good intentions.”
Ms Strauss agreed saying:
“The primary point here is that for any health practice that does want to change, the way to do it is to be led by local stakeholders, their local transgender and gender diverse people. Then that needs to be backed by system level reform and policies that change the structures around that health practice to make sure that everybody is respected.”
Mr Wishart, Services Manager at Transfolk WA, told InSight+ in an exclusive MJA podcast that while professional, appropriate health care was crucial to trans people, many avoided seeing a doctor because of previous bad experiences, much of it down to a lack of education in how to engage with trans people.
“I hear a lot of stories from other trans people, binary and non-binary, of going to see a GP or going to the hospital and being called by the wrong pronouns or using an incorrect name after they’ve made clear what name they want the medical staff to use,” he said. “Or even getting invasive personal questions that are completely irrelevant to the health care that they’re needing when they present to the service.
“If there was training that encompassed a lot of the missing content, that would be amazing. It would really change the experiences that trans and gender diverse people have in health care.”
Ms Penelope Strauss, a youth mental health researcher at Telethon Kids Institute in Perth, said in the same podcast that avoidance was a clear consequence of misgendering and other inappropriate experiences in health care settings.
“When trans people access health care that is invalidating of their identity or otherwise somehow discriminatory, what happens is a lot of people later on avoid health care,” Ms Strauss told InSight+.
“What that means is screenings get missed, follow-up appointments get missed, and what we see is that some health conditions that could have been treated earlier aren’t seen until much later, which obviously leads to quite poor health outcomes for some people.
“I would love for all doctors to understand that respecting somebody’s name and pronouns is just respecting that individual. I agree that training is needed, especially for things like hormones or how to refer somebody on or going through the informed consent process for various interventions.
“However, all of this comes back to this: when a [trans or gender diverse] patient shows up, listen to them, ask them how they’d like to be referred to, what name they use, what pronouns they use, and stick to that throughout every appointment. Even if, legally, on their medical file something else is written. Respect that patient face-to-face and use the name and pronouns they use.”
Ms Strauss is co-author of a Perspective published in the MJA on misgendering and experiences of stigma within health care settings. The article calls out the structural stigma – “intentional and unintentional policies and practices that result in restricted opportunities for stigmatized people” – inherent in medical training.
“This leaves doctors ill equipped to care for trans patients,” the authors wrote.
“Many lack knowledge of trans health, do not know how to refer to trans competent providers, and may also be uncertain how to respectfully address and refer to trans individuals. This uncertainty can lead to ambivalence around providing care and patient acceptance thereof.”
Mr Wishart, who was not an author on the article, said many doctors wanted to help but had no idea where to begin treating a trans person.
“I feel like there’s a lot of missing information,” he said. “GPs can have the very best of intentions and want to be very helpful, but [have] no information about how to do that and what’s respectful and what isn’t.
“It’s a priority and should be included in medical education, definitely.”
Ms Strauss recommended that GPs and other specialists contact the Australian Professional Association for Trans Health(AusPATH) as a first port of call.
“It’s important for GPs who do want to learn more to contact community organisations, to contact professional organisations such as AusPATH, who do run training.”
Position statements on the Australian standards of care and treatment guidelines for transgender and gender diverse children and adolescents, and on the hormonal management of adult transgender and gender diverse individuals can be found on the MJA’s website.
Despite the barriers, Emery Wishart is optimistic.
“There’s more and more visibility of trans and gender diverse people in the general community, in the media, in policy, and in people becoming more aware and wanting things to change,” he said.
“People want to be doing the right thing by trans people. So yes, I’m hopeful.
“There’s a way to go and it’s a bit of a process to get there, but there are a lot of good intentions.”
Ms Strauss agreed saying:
“The primary point here is that for any health practice that does want to change, the way to do it is to be led by local stakeholders, their local transgender and gender diverse people. Then that needs to be backed by system level reform and policies that change the structures around that health practice to make sure that everybody is respected.”
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