Sharing Our Results: QTBIPOC Needs Assessment for Central Texas

Black Trans Leadership of Austin, Out Youth, The University of Texas at Austin

Project Contributors:

Black Trans Leadership of Austin – Naomi Wilson, Tabitha Hamilton, Queen Austin, Rocky Lane, Zuri Richardson, Laïs Milburn, and Sha’Nyia Baltimore.

Out Youth – Cece Flores, Sam Clubb, Danisha Baro, Sarah Kapostasy, Kayla Witcher, Emelio Garcia, and Amy Haley.

The University of Texas at Austin – Dr. Stephen Russell, Dr. Phillip W. Schnarrs, Lexie Wille, Sheridan Aguilar, and Riya Chaudhry.

About this Project

The inspiration for this project was the lack of available data focused on the needs of queer and trans Black, Indigenous, People of Color (QTBIPOC).

Instead of a traditional research approach, we sought to create a community-led survey, where members of the community of interest (in this case, QTBIPOC) drive and design the research project, and locate researchers to assist in fulfilling their research goals.

Black Trans Leadership of Austin (BTLA) worked with Out Youth to create the survey questions over the course of several months. We leaned on the project team’s collective experiences to generate the major topics of the survey.

We found that people in the QTBIPOC community face housing, transportation, employment, safety, and belonging disparities and thus focused on these areas in the survey.

Our Results

It was important for our group to present our important findings in a few different formats, including:

• A one-hour lunch and learn presentation to providers and stakeholders in the community during the summer and fall of 2022

• A full report of our findings

• Issue briefs highlighting specific areas of findings, including: Healthcare and Mental Healthcare; Community Connection, Housing, and Transportation; Finances, Employment, and Legal; Community and Public Safety

• Videos! Including longer videos describing the background of the project AND brief videos featured on social media (and a YouTube Playlist!) highlighting our findings.

You explore all of our results in one convenient location!

Please visit:

https://txtranshealth.org/qtbipoc-na

DFPS and the Political Climate for Trans Youth and Their Families: A Panel Recap

This panel was held on July 20, 2022

Panelists:

Shelly Skeen (she/her) Lambda Legal

Sofia Sepulveda (she/her) Equality Texas

Ginger Chun (she/her) Transgender Education Network of Texas

Adri Pérez (they/them) ACLU of Texas

Moderator:

Sarah Kapostasy, LPC

This recap will start where the panel ended - with a recounting of what gives the impressive advocates and activists who participated in this panel hope, despite the difficult environment for trans youth and their families in Texas. 

The panelists highlighted the strength and resiliency of trans youth and their families, as well as all the allies showing up and speaking out against Department of Family and Protective Services (DFPS) investigations and other anti-LGBTQIA+ tactics perpetuated by politicians in Texas to score political points. 

Each panelist also mentioned being inspired by those fighting to maintain the right to make healthcare decisions without fear of repercussions and to protect the bodily autonomy of trans youth, including their fellow panelists.

We received an update about the current status of DFPS investigations, with Lambda Legal and the ACLU working hard to cease and prevent investigations into 3 families with open cases as well as seeking to protect any family in Texas who is a member of PFLAG. More about recent developments here: https://www.aclu.org/cases/pflag-v-abbott

Families can become members of PFLAG by donating $50 annually here: https://pflag.org/supportpflag

Additionally, if any family is contacted by DFPS for an investigation related only to gender-affirming care, you are encouraged to contact Lambda Legal: https://www.lambdalegal.org/helpdesk

Additional resources for families can be found here: https://www.txtranskids.org/toolkit, https://www.outyouth.org/support-for-families 

We also received information about what to expect during the next legislative session in January, which may indeed include more of the same in terms of attacks on the LGBTQIA+ community. 

In the meantime, however, it is important to be vigilant as additional opportunities may arise to stand up for the LGBTQIA+ community in the coming months. For example, on July 26th the House Public Education committee met to discuss “parental rights” related to public education, and given the anti-LGBTQIA+ proponents who tend to show up in such spaces, advocates were encouraged to show up and speak on this issue. 

To learn about more opportunities to testify, attend rallies or protest, or other direct action opportunities, sign up for news and updates from: 

Transgender Education Network of Texas: https://www.transtexas.org/get-involved 

Equality Texas: https://secure.everyaction.com/KR74XUWtBUix8clQ9S5NdA2 

TxTrans Kids: https://www.txtranskids.org/actions_events 

During the panel, we also acknowledged the difficulty of providing medical and mental health care to LGBTQIA+ folks and those who love them, particularly trans youth, in the current political climate. In addition to the friendly reminder that the Governor’s Directive and the Attorney General’s opinion are non-binding when it comes to mandatory reporting, organizations such as the National Association of Social Workers (NASW) are in fact supporting social workers who OPPOSE efforts to redefine child abuse to include gender-affirming care. 

NASW Social Workers Support Trans Kids and Families: https://www.naswtx.org/page/votervoice?vvsrc=%2fcampaigns%2f92266%2frespond 

Further still, major medical associations, including the Texas Medical Association, continue to support gender-affirming care as best practice and life-saving: https://www.texmed.org/TexasMedicineDetail.aspx?id=59040 

As providers, we are a critical part of the support network for trans youth and their families during this time. It is important that we continue to provide medical and mental health care.  Many thanks to those who took the time to attend the panel and/or read this recap, and for the work you do every single day. 

I Am Transgender Medical Panel

by Naomi Wilson, Lauren Rodriguez, Dr. Aliza Norwood, and Cassidy Laminack, LPC, LMFT and Sarah Kapostasy, LPC,

Please enjoy this recording of a panel sponsored by the Central Texas Transgender Health Coalition presented at the Osher Lifelong Learning Institute at UT Austin on April 7th, 2022. Panelists including Naomi Wilson, Lauren Rodriguez, Dr. Aliza Norwood, and Cassidy Laminack, LMFT, LPC discussed the benefits of culturally responsive medical care for the trans and gender diverse community.  

Gender Affirming Hormone Replacement Therapy and Non-Binary Care

by Sarah Kapostasy, LPC and Julie Thompson, PA-C

Out Youth and Black Trans Leadership of Austin recently conducted a needs assessment of 50 QTBIPOC individuals in Central Texas. We are excited to share the full results of this survey at a later date. In the meantime, I’m happy to report that the majority of individuals seeking gender-affirming care in our sample, including hormone replacement therapy, reported having access.

At the same time, it is important that we are attentive to the quality of care provided, as prescribing HRT can have significant nuance. In particular, recent attention has focused on those who identify as non-binary and their struggles seeing care in a binary system, as described in this article from last year: https://www.thelily.com/these-nonbinary-patients-were-seeking-trans-health-care-but-in-a-binary-system-they-felt-invalidated/

So, we feel fortunate to have been able to host Julie Thompson, PA-C the Medical Director of the Transgender Health Program at Fenway Health in Boston for a recent webinar presented on April 28, 2022. Julie discussed the nuances of prescribing hormones and provided tips for working specifically with non-binary patients on medical affirmation.

You can view the recording of this webinar until July 7, 2022. We encourage all medical providers in Central Texas who were unable to join us to check it out!

"Don't make me read my child's obituary": Texas risks lives by banning gender-affirming care

by Dr. Aliza Norwood

Originally published in Salon.com: https://www.salon.com/2022/03/29/dont-make-me-read-my-childs-obituary-texas-risks-lives-by-banning-gender-affirming-care/

Reproduced with author’s permission

I'm a primary care internist in Austin, Texas, and have provided gender-affirming care for adults as part of my practice for eight years. I'm also the sister of a transgender man who suffered greatly before he transitioned. Growing up, I witnessed first-hand how gender-affirming care can save lives. But in Texas and other states, those lives are now being threatened by the very institutions that are supposed to protect them.

On March 11, instead of seeing patients in clinic, I sat in the back of a large auditorium at the Texas Department of Family and Protective Services (DFPS) and listened to stories of trauma for hours. Each story started with the same phrase: "My name is —, and I'm here to read a statement from the family of a transgender child who is too terrified to be here." One by one, community members stepped up to read statements to DFPS council members from transgender kids and their families submitted from across the state. Brave family members and transgender youth also stood up to speak themselves, despite the extremely personal nature of their testimony and the great personal risk.

One mother spoke of how she did not initially support her transgender son's transition when he came out. She choked back tears as she described coming home one day to find her son unconscious on the floor of his room. I watched a council member blot away tears as this mother poured out her soul, explaining that his suicide attempt convinced her to listen to him and how, with treatment, he is now thriving and happy. Another family pleaded with the council, "Don't make me read my child's obituary." These parents described making difficult decisions driven by an unconditional love for their children, and an intense fear that the unthinkable could happen — that a state agency could take their children from them for loving and supporting them.

I too was there on behalf of others. I am trained as an adult physician, but I went to represent my colleagues in pediatrics who can't risk putting their patients and themselves in danger by speaking up. Due to political and financial pressure from Gov. Greg Abbott, clinics that care for transgender youth have been shutting down to avoid persecution.

Texas legislators say they are protecting youth by banning gender-affirming care, but the data shows the opposite. In 2020, a staggering 52% of transgender youth reported considering suicide. More than a dozen studies have shown that gender-affirming care for youth improves anxiety, depression and thoughts of suicide. Yet instead of following the guidance of every major medical organization, legislators have shown a disdain for the lives of transgender youth, going so far as to remove LGBTQ suicide prevention information from state websites.

These politicians are targeting extremely vulnerable children and pushing disinformation to gain political support. Despite fear-mongering, gender-affirming care for youth follows well-established, age-appropriate standards of care. This means that for young children, that care includes just supporting them socially, by using the name and pronouns they prefer. Adolescents with gender dysphoria are much more likely to identify as transgender when they are in adulthood; for them, temporary puberty blockers can be considered while they undergo counseling with trained mental health professionals and physicians before moving to less reversible treatments such as hormones. Genital surgeries, often referenced by legislators and even DFPS leadership, are in fact not recommended for minors by current guidelines.

The real danger here is denying high-risk youth medically indicated, life-saving care while ripping them from supportive families.  Family rejection is extremely common when transgender people come out to their family, something I hear about from most of the adult transgender patients I see. Transgender adults who are rejected by their parents are twice as likely to attempt suicide and have higher odds of alcohol or drug abuse. That's why it's so shocking that Texas is trying to find the few families that are supportive of their transgender children and teens and actively tear them apart.  

As local and national businesses take a public stand against this immoral order, so must our neighbors and friends. If everyone could hear the stories I've heard, many more would be moved to speak up. No parent should have to decide between going to prison and withholding necessary care from their child — care that could literally save their lives.

QTBIPOC Resources for Texas

In honor of Black History Month, the Central Texas Transgender Health Coalition would like to share the following resources for community members, as well as medical and mental health providers, related to care for QTBIPOC folks (Queer and Trans Black, Indigenous, and People of Color). 

Black Trans Leadership of Austin has partnered with Out Youth and the University of Texas at Austin to develop a questionnaire to help us capture a more accurate snapshot of our communities needs and wants. It’s no secret that our system is flawed and doesn’t prioritize the Black Trans and Gender Diverse agenda. It actually forces us to live life on the margins of society. It’s time to create real data and use our stories to advocate for meaningful change. 

If you or someone you know is interested in taking the questionnaire to earn a $60 gift card before February 28th, 2022, please visit https://btla.squarespace.com/btla-questionnaire-for-the-advancement-of-qtbipoc-in-central-texas to learn more and request a link. 

If you are a provider and you are interested in learning more about the results of this questionnaire and community input sessions, please stay tuned for more information about opportunities to learn more starting in July of 2022. 

The mission of the Black Trans Advocacy Coalition is to help improve the black transgender human experience by overcoming violence and injustice in the world through the power, value, and love of all people! Founded in 2011 and based in Carrolton, TX, this national organization advocates for policy change while also attending to the immediate needs of the community by providing basic needs, housing, employment, and health care support. They also throw one of the most fun conferences you can attend, hands down. More information: 

https://blacktrans.org/#Help 

https://btac.blacktrans.org/ 

allgo nurtures and celebrates queer people of color by building, educating, and mobilizing communities toward a just and equitable society.

We do this through cultural arts, wellness, and social justice programming by: supporting artists and artistic expression within our diverse communities; promoting health within a wellness model; and mobilizing and building coalitions among groups marginalized by race/ethnicity, gender/gender identity, sexual orientation/sexual identity in order to enact change.

https://allgo.org/ 

What’s In the Mirror is a 501c3 Organization and Healing Justice Social Movement that provides mental health awareness and suicide prevention to communities of color through art, advocacy, and affirming care with a focus on women, youth, and LGBTQIA+ persons.

The organization provides the Connect to Care Initiative, a program connecting communities of color, including LGBTQIA+ communities and persons living with HIV, to mental health services. Connect to Care Initiative is a part of the Art Heals Project, a healing justice movement focused on the intersectionality of mental health and HIV prevention/ Persons living with HIV/AIDS through advocacy, art, and affirming care to marginalized communities.

https://whatsinthemirror.org/ 

Boundlessness

by Angelica Oscos, LMSW

Every being is an art creation,

Capable of reaching self-actualization.

Fear and worry are crippling.

Confidence is swiveling.

Acceptance exists.

If in doubt persit!

Community IS here to support.

Don't let yourself fall short.

We all deserve to have this experience,

Remember you are full of resilience.

Disordered Eating in the Gender Diverse Community

by Katie Hardison

Clinical Dietitian

In 2018, the Trevor Project partnered with the National Eating Disorders Association (NEDA) and Reasons Eating Disorder Center to complete the first national survey of LGBTQ youth focused specifically on the relationships between sexual orientation, gender identity, eating disorders and suicidal ideation. This first of it’s kind survey found that:

• 40%  of respondents who identified as gender non-conforming and genderqueer, 

• 39% who identified as transgender male,  

• and 12% who identified as transgender female -  

had been diagnosed with an eating disorder. 

For the last 4 years, I have worked as a dietitian with transgender and gender diverse youth, many of whom have disordered eating patterns. As with disordered eating patterns in cisgender folks, the cause of these disordered eating patterns is multifaceted and often difficult to determine.

Patients have told me that they changed the way they eat so they could decrease their chest/hip size, stop their menses, or reduce their musculature. Some patients have begged me for foods that will increase their chest size or some have cried that they are too scared to drink soy milk for fear of the effects it will have on their testosterone levels. 

Many of my patients are getting the majority of their information from the internet where anybody can go online, start a TikTok or Instagram account and call themselves a nutritionist, an unregulated credential in most of the United States.

I am usually the first person who has had any formal nutrition education or training that they have spoken to, and we spend many visits dispelling rumors and misinformation. For example, research does not show that soy milk intake effects testosterone levels in transgender or gender diverse youth. 

Parents and caregivers of my patients are often unaware of the signs of disordered eating including fasting, skipping meals (including breakfast), and eating very little.

Some disordered eating patterns like vomiting after eating or taking diet pills or laxatives are a bit more obvious; but even sudden changes in diet to Vegetarianism or Veganism with little explanation or beginning a new exercise regime that appears excessive can be a red flag that something more may be going on with that person.

Oftentimes what parents and caregivers tell me they see is their kids eating excessive amounts of food in the afternoon/evening not realizing that this may be the first or only meal their child has had that day.

Identifying the problem early on and getting help are the best actions to stop disordered eating from becoming an eating disorder. 

So what does getting help look like? Each person’s journey through recovery from disordered eating is different, so I will give you a guide on what has worked best for many of my patients.

Most critical is a good therapist/counselor/psychologist who is gender-affirming and able to discuss the relationship between food, mood, and body image; usually a gender-affirming dietitian is a good idea too, so they can discuss nutrition, food, and challenge any thoughts or beliefs that may have been learned from less desirable places, like social media or the internet; a medical provider who can manage any of the physical symptoms of disordered eating, of which there are many; and sometimes a psychiatrist or family therapist is necessary too. 

Unfortunately, like many things involving the transgender and gender diverse community, there is not enough research yet into disordered eating in the community and how treatment outcomes may differ from their cisgender peers.

There needs to be more clinicians who are able to discuss both disordered eating and the role gender identity may play in it. If you or a loved one is struggling with an eating disorder or disordered eating, please call the NEDA Helpline at 1-800-931-2237 where you can receive guidance and support. 

The Sun is Going to Shine

To distinguish from academic information regarding suicide, certain content has been ITALICIZED to indicate information about suicide more descriptive and personal in nature.

If you or someone you know needs support, please visit: https://www.outyouth.org/help for resources or contact the National Suicide Prevention Hotline at 1-800-273-8255

by John Oeffinger

The signs were there. Firemen milling in the front yard with no house fire to fight. Two police vehicles arriving shortly after – no lights or siren. Then the EMS ambulance arriving silently with no urgency to enter the home. Neighbors in their front yards watching and texting while the crime scene van pulls up. Wondering what could have happened in this quiet neighborhood. And yet, all of the signs were there. Almost exactly how they had played out in my mind too many times to count. I knew someone had just committed suicide. My heart tightened as I watched and heard the family try to make sense of this horrible event. Did they see the warning signs? What are the warning signs? Did the person reach out for help?

My suspicion, this person kept their thoughts compartmentalized like I did fifty-three years ago. I failed in my three attempts to kill myself in 1968. No one knew until forty-eight years later when my organization’s CEO, a social worker, made it safe for me to bare my thoughts over dinner — to give context for a new project’s importance. Thankfully, I had learned that the sun can shine the next day, and the next. The mental guardrails I developed over the years have kept this darkness at bay. Now, my ability to talk about suicide and suicide ideation helps as well. My hope is this blog post will assist at least one other person in working through that isolated, dark, and desperate place with no seeming way to escape. Suicide is not painless. Suicide does bring on many changes.

September is Suicide Prevention Awareness Month — a time to raise awareness on this stigmatized, and often taboo, topic. In addition to shifting public perception, the National Alliance on Mental Health uses this month to spread hope and vital information to people affected by suicide.

HuffPost published I was a gay boy who tried to kill myself. Now I know it wasn’t my fault written by my colleague and friend Dr. Phillip Schnarrs. Phillip describes a 2018 community assessment’s finding that 25% of LGBTQ+ adults thought about suicide at least one day during the previous week. One in four people. In the Austin area. 

The Trevor Project found 42% of their respondents “seriously considered” ending their life by suicide last year. More than half of the transgender and non-binary people considered suicide. “Crucially, the survey uncovered further disparities in mental health along racial lines. Twelve percent of white respondents said that they had attempted suicide in the past year, whereas Black and multiracial youth had both attempted suicide at nearly twice the rate — 21%. Furthermore, as many as 31% of ‘Native/Indigenous’ survey participants reported having attempted suicide in the last year. Finally, 18% of Latinx youth and 12% of ‘Asian/Pacific Islander’ youth reported having attempting suicide in the same time period.”

2021 has also been the worst year for LGBTQ+ state legislative attacks across the country. In Texas, an unprecedented number of anti-LGBTQ+ bills, especially bills targeting transgender children, have been filed. “These bills represent a cruel effort to further stigmatize and discriminate against LGBTQ+ youth across the country,” states Equality Texas. Every time anti-LGBTQ+ bills are debated in Texas, we see spikes in kids in crisis. The Trevor Project has confirmed this spike in its crisis hotline from Texas area codes. Our LGBTQ+ youth, especially our transgender and gender diverse youth, are at serious risk of doing harm to themselves, or worse, thinking about suicide as an exit path.

There is hope.

The LGBTQ+ community, parents, and allies are rallying to support our youth. One example is TransFORWARD: Texas Transgender Health, a collaboration between Texas Health Institute and Equality Texas Foundation. TransFORWARD seeks to inform clinicians and policy makers on what competent and necessary healthcare looks like for transgender and gender diverse people. The collaboration was created to improve the lives of transgender and gender diverse people. The long-term goal is to reduce suicide attempts and suicide ideation. 

Improving the lives of transgender and gender diverse people using a patient-centered approach is a 3-step process. First, we must build research capacity for patient-centered outcomes research and comparative effectiveness research. Second, we need to do research that is patient driven and includes transgender and gender diverse stakeholders in leadership positions. Third, research results should be disseminated and applied to clinical practice and health policy.

Step 1 — Building Research Capacity

TransFORWARD: A Statewide Transgender-Powered Research Collaborative in Texas was recently completed. The thirty-five month project identified patient-centered outcomes research priorities and was funded by the Patient-Centered Outcomes Research Institute (PCORI EA #10671). Close to three hundred Texans were engaged in the research capacity-building effort. Transgender community members, physicians, clinicians, and researchers were engaged in eight regional summits to identify research priorities. Twenty Project ECHO virtual meetings started identifying how trans people are coping with the COVID-19 pandemic. Mental health, housing, and employment sessions surfaced emerging topics requiring research to better understand the long-term effects of COVID-19. These sessions also reinforced the value of personal narratives and speaking up to shine a light on important subjects. I truly admired the sharing of deeply personal information which inspired this post. 

TransFORWARD participated in a 2020 PCORI Virtual Annual Meeting Breakout Session Building Research Capacity to Address Disparities Faced by Transgender Individuals. PCORI recognizes that transgender individuals have a higher prevalence of HIV and STIs, violence victimization, mental health issues, suicidal ideation, and suicide than cisgender individuals do. TransFORWARD was one of three highlighted projects representing PCORI-funded engagement awards intended to address health disparities and build the capacity to promote comparative effectiveness studies with transgender populations. Each of the projects discussed the unique health disparities that transgender individuals face, shared lessons learned, and discussed future directions in transgender and health services research.

One of PCORI’s goals is to reduce the seventeen years it takes from a patient identifying a research topic to applying the evidence-based data through clinical application. The process begins with building a foundation or patient-centered outcomes research capacity. Creating a statewide transgender-powered research collaborative in Texas is TransFORWARD’s first step.

Step 2 — Creating Research Projects

The second step in the three-step process is creating research projects and developing evidence-based data. In this case, topics prioritized by transgender people. Suicide intervention is one of those crucial priorities for transgender and gender diverse people. Transgender and gender diverse young adults have higher rates of depression and stress and are at greater risk of suicide compared with other young people. These stigma-related stressors increase mental health risk factors, such as depression and anxiety, that heighten vulnerability to suicide attempts. TransFORWARD’s leadership team presented our work on the importance of addressing suicide attempts and ideation during a mini-symposia at the World Professional Association for Transgender Health (WPATH) 26th Scientific Symposium.

Suicide is also an important public health issue. The Centers for Disease Control and Prevention list three items as part of suicidal behavior. Suicidal ideation is thinking about ending one's life. A suicide attempt is a non-fatal suicidal behavior. A suicide ends one's life. Different communities are affected differently such as veterans and mothers during pregnancy and after childbirth. Part of public health’s broad view is an emphasis on population health—not just the health of individuals. While suicide is often thought of as an individual problem, it actually impacts families, communities, and society in general.

Suicide is the second leading cause of death in the United States among youth. PCORI’s Board of Governors recently approved four culturally adapted youth suicide intervention awards. Suicide attempts are much higher for LGBTQ+ young adults than non-LGBTQ+ peers. Preventing Suicide among Sexual and Gender Diverse Young Adults in Primary Care in Texas, was awarded to one of TransFORWARD’s partners, UT Southwestern Medical Center. The five-year effort capitalizes on the medical center’s experience and that of The University of Texas at Austin’s Dell Medical School and Steve Hicks School of Social Work. 

Asking about depression when they see a physician or other healthcare professional may help identify young adults who may have thoughts of suicide (suicidal ideation). There is little research indicating which intervention works best for the community. Currently, physicians and other healthcare professionals do not know which is the best intervention to use, especially in the primary care setting.

Dr. Elizabeth Arnold will lead the project whose aim is to reduce suicide among LGBTQ+ young adults. Two current “emergency room” interventions will be culturally adapted for the primary care settings. The first phase will collect information on the needs of LGBTQ+ young adults regarding suicide prevention and mental health. A pilot project then a larger study will be collected in different primary care settings. The goal is to see which intervention works best to decrease thoughts about suicide and other factors related to suicide. 

Dr. Phillip Schnarrs, at The University of Texas at Austin’s Dell Medical School serves as co-principal investigator. Dr. Lauren Gulbas at the The University of Texas at Austin Steve Hicks School of Social Work is a Co-Investigator. TransFORWARD’s partner Out Youth will provide MSW Interns to help with the project in the Austin area. TransFORWARD will assist with the patient-engagement plan. 

I am personally very excited about this research project. The $5.4 million award over 5 years can break new ground in LGBTQ+ suicide intervention. My personal belief is peers, quite possibly peers who have attempted suicide or have suicide ideation, are more likely to recognize signs and may be a “trusted friend” capable of intervening. This project includes “Youth-Nominated Support Team for Suicidal Adolescents.”

This gives me hope that we may be able to advance to Step 3 and apply the evidence-based data to clinical practice and health policy sometime in the future.

The Institute of Medicine states it takes 17 years from when a patient identifies a research idea or topic to move evidence-based research data into practice. This month we celebrate our 3rd year in taking these three steps as we help enter Step 2 with this important suicide intervention award.

One of my siblings said, “John, I never knew” when I told him about my failed attempts a half-century ago. My response was, “you were never supposed to know.” Not because I was ashamed, I was, but because I didn’t want family to intervene. I didn’t want family and friends to become concerned about my mental health. I still don’t for the most part. That said, I have learned to lean on or listen to four people (K, A, S, and P). Taking their thoughts together I have changed the way I think about suicide. I realize I have more to live for than the alternative. Intuitively, I knew this standing on that rickety chair in the woods so very long ago. The mental picture of my mother having to deal with my death helped me loosen the rope, step down, and realize I could have a future. My mother, who I still dearly miss, was 16 when her father committed suicide. I didn’t want to put her through that again when I was 16.

Watching the crime scene unit pull away from the curb reinforced something I think about often. It’s on my mind as I try and put these words to paper. It’s family members, especially immediate family members, and friends who are left to wonder why. Writing a note does not explain the desperation. The isolation. The mask over not letting anyone know what is racing through your mind. I felt pain and grief watching as a bystander. For the family now trying to understand. For the person who took the action to end their life. Reflecting on this has reinforced why the work we do try to improve transgender and gender diverse lives, the LGTQ+ community, and people and their families dealing with suicide or suicide attempts is important. I do have hope. I do know that the sun will rise tomorrow. And the next day. My hope is this suicide intervention project will help LGBTQ+ youth see that the sun is going to shine if they take that step into the light.

If you or someone you know needs support, please visit: https://www.outyouth.org/help for resources or contact the National Suicide Prevention Hotline at 1-800-273-8255

Acceptance

by Marcy Keefe, FNP

“Just because you don’t understand doesn’t mean it isn’t so” ~Lemony Snicket, The Blank Book

I grew up on a farm in a small town of fewer than 3,000 people in rural Wisconsin in a family riddled with mental health afflictions. I have always felt like I am awash in a sea of emotions and struggle to find the best words for this, maybe because I was essentially alone for the majority of my formative years. I felt scared, vulnerable and yearned for a safe haven that would protect me from an abusive father and a neglectful mother.

I feel this same yearning from many of my patients as they, too, seek a safe place and have the simple wish to be heard and validated. In preparation for writing this blog I read over the previous posts. It’s no wonder our gender-diverse clients feel a profound lack of safety. We have clearly documented the harsh political climate and lack of equity in healthcare as it pertains to transgender people, particularly trans people of color.

My patients are often scared, isolated and families are lost. Thich Nhat Hanh says “Deep listening is the kind of listening that can relieve the suffering of another.” I have the privilege and honor to create a space that is safe where authenticity is valued and I believe it in these moments that healing takes place.

I am hopeful that our individual voices in those sacred moments in exam rooms combined with those of strong collective supportive organizations such as the ACLU, TENT, Equality Texas, and various medical organizations can begin to make a wave of change. Nobody should feel alone or scared to simply be themselves.

“Politics has no place here. Transgender children, like all children, just want to belong. We will fight state by state, in the courts and on the national stage to make sure they know they do.” ~ Statement from the American Academy of Pediatrics, March 29, 2021.

What's In A Name? Respect and Identity In Transgender Care

Please note this post has been revised to include more affirming language, thanks to feedback from the community, for which we are grateful. We apologize for any harm this may have caused.

by Aliza Norwood, MD

Although the transgender community has received more societal awareness in recent years they have still not achieved equity in healthcare, as demonstrated by well-documented health disparities between cis and transgender patients.

The American Academy of Pediatrics found that 30% of transgender adolescent girls and 50% of transgender boys report having attempted suicide. As adults, transgender patients are less likely than cisgender patients to have routine care and have higher rates of cardiovascular disease, psychiatric disorders, substance abuse, and suicide[i],[ii].

These disparities are worsened by transphobic systems and providers. A 2012 study revealed that one in five transgender people postponed or did not try to get healthcare because of fear of discrimination[iii]. In contrast, transgender patients report positive healthcare experiences when their providers create an inclusive, safe space[iv].

This article will highlight an example of how a simple patient-centered intervention strengthened the therapeutic alliance between a transgender patient and his provider and provide tips to increase trust in this underserved community.

The following story is about a young transgender man named Ilan, and his account of a particularly meaningful moment he had with his provider. Ilan was assigned female at birth but suffered from intensely painful gender dysphoria and depression from a young age.

With each step of his medical transition that dysphoria seemed to lighten, like a cloud lifting. He first started testosterone which gave him secondary sex characteristics that eased his transition including bulk, a beard, and male-pattern baldness.

He had a mastectomy, relieving him of the daily task of tightly binding his breasts which had caused back spasms and breathing problems. These changes made him feel more normal, more like himself.

He decided to have a hysterectomy which required that he go to frequent gynecology visits. He told me about the experience of being a man sitting in a gynecology waiting room, surrounded by staring women. He brought his wife along for support and to deflect those stares.

During these visits, he had to talk about personal body parts which triggered his gender dysphoria in a very intense way. These visits were extremely uncomfortable for him, so one day his wife had a strange but thoughtful idea.

She renamed his feminine parts with masculine names. Instead of talking about his uterus, she referred to his duderus. His fallopian tubes were fellow-pian tubes, ovaries became bro-varies, and his cervix was a Sir-vix.

It was ridiculous but it was a way to inject humor into a painful situation and it did make him feel better. Ilan and his wife joked about this during a gynecology appointment, and he told me that the doctor did something in that moment that completely changed the dynamic of their visits. She looked at him and asked, “Would you like me to refer to them with those names?”

When Ilan reached this part of his story I could see in his eyes that this simple act changed the way he saw his doctor. It showed a level of respect and a willingness to adapt in order to make him as comfortable as possible. And it worked. He felt more cared for, and he trusted her in a deeper way.

On the surface, this story is about a provider who listened to her patient and offered a simple concession. But on a deeper level, she recognized these names were part of a new identity, and that they made Ilan feel safe and in control.

This story also reminds me of watershed moments I’ve had with my own primary care patients. Those moments have invariably occurred when I’ve taken the time to ask some version of ‘What is important to you?’

As the medical community embraces patient-centered care, we should strive to apply that focus to our interactions with patients from historically underserved communities, including transgender patients.

Medical providers have a certain amount of authority both in the clinic and in society. We can use that power to not only affirm a patient’s gender but to affirm that they are worth our respect. The positive ripples from that kind of interaction can travel beyond the clinical space and provide another layer of strength and protection to transgender people.

In clinical practice, providing patient-centered care for transgender patients referred to as gender-affirming care means creating safe and inclusive spaces for patients. A few specific examples of how to create an inclusive space include providing gender-neutral bathrooms in the clinic, creating medical records that record gender-affirming names and pronouns, dedicated training for staff and providers, and universally asking patients what name we should use for them.

Cisgender patients may not understand the question, “what are your pronouns”, but asking the question “what name should I use for you” to all patients is a way to universal screen for gender identity and is a clear opportunity for transgender individuals to provide correct name and pronouns.

Regarding staff training, evidence shows that holding open forums with staff to discuss transgender biases can allow for targeted education[v]. There are high-quality free resources available to help with provider and staff education.

The UCSF Center of Excellence for Transgender Health has an online Transgender Health Learning Center with helpful resources for healthcare providers, researchers, and the public. Fenway Health also has a thorough website with helpful information on gender-affirming care and support resources.

At an academic level, medical students and residents should receive training so that more providers are willing and able to provide quality gender-affirming care, easing transgender patients’ burden of teaching their providers.

Finally, physician advocacy regarding discriminatory policies such as the military transgender ban and anti-transgender bathroom bills can help highlight how such policies create structural barriers to well-being for transgender people.

As medical providers, we took an oath to serve all patients to the best of our ability and to do no harm. Just as we practice universal precautions for infection control, so should we practice universal respect.

One of the simplest things we can ask a patient is, ‘What name should I use for you?’. When we ask patients what their pronouns are it isn’t a silly exercise in semantics.

A name is an identity. It carries with it a personal story, self-worth, and, in this case, a commitment to live an authentic life despite real risks of danger and bigotry. Ilan’s story is a reminder of how providers can empower their patients and create safe spaces by listening and asking, ‘What is important to you?’

---

[i] The National Center for Transgender Equality. The Report of the 2015 US Transgender Survey. http://www.transequality.org/sites/default/files/docs/USTS-Executive-Summary-FINAL.PDF. Published December 2016. Accessed February 9, 2019.

[ii] Gonzales G and Henning-Smith C. Barriers to Care Among Transgender and Gender Non-Conforming Adults. Milbank Q. December 2017;95(4):726-48.

[iii] The National Center for Transgender Equality, National Gay and Lesbian Task Force. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Transequality.org/PDFs/Executive_Summary.pdf. Accessed February 9, 2019.

[iv] Baldwin A, Dodge B, Schick VR, et al. Transgender and Genderqueer Individuals’ Experiences with Health Care Providers: What’s Working, What’s Not, and Where Do We Go from Here? J Health Care Poor Underserved. 2018;29(4):1300-18.

[v] Boskey E, Taghinia A, and Ganor O. Public Accommodation Laws and Gender Panic in Clinical Settings. AMA Journal of Ethics. November 2018; 20(11):E1067-74.

Back to Basics

by Cece Flores, LMSW

With less than a month left, dangerous anti-trans bills are advancing through the Texas legislature. As advocates, we tirelessly voice our concerns by sharing public testimonies, making calls, sending emails, organizing/attending rallies, and sharing content on social media. We worry about the impact these bills have on trans youth who are out and the children who fear coming out. We understand that the bills will further marginalize trans youth.

The political climate and hectic schedules impact our overall well-being. In COVID times, days, weeks, and months all seem to blend together. We are doing our very best. It is not uncommon to forget to practice self-care when caring/advocating for our loved ones. The term self-care is not a trendy catchphrase, but essential in recharging. By allowing time to pause, we shift to fresh perspectives. When self-care does drop to the bottom of the priority list, going back to the basics will help.

Getting enough sleep, drinking plenty of water, eating nutritious meals, and keeping up with doctor visits is necessary for longevity. Meeting our mental, health, social, and spiritual needs keep us energized to advocate on an ongoing basis. Fellow advocates become re-energized and inspire others to join the cause. Yes, meetings and deadlines make it difficult to practice self-care. In the short term, stepping outside for sunshine or five minutes of mindfulness meditation on a busy day can make a difference. Find your work, home, activism balance, and prioritize self-care. Ask for help, spend time with your loved ones, or spend time alone. Be mindful of where you put your energy. Do not feel guilty for setting boundaries and saying no. Take care of yourself so that you can take care of others.

Despair

by Kazia L. Parsons, MD

Noun de·​spair | \ di-ˈsper \

Definition of despair

1: utter loss of hope

2: a cause of hopelessness

We’re in a strange place right now aren’t we? With such a multitude of contradictory events it’s a wonder we can even feel at all.

Infuriated by the amount of people who put opinion over fact and refuse to vaccinate. And yet at the moment of writing this blog there have been 219 million people vaccinated in the US.

28 states are introducing or have introduced anti-transgender legislation. And yet a new poll conducted by PBS/NPR/Marist showed that two thirds of all Americans are AGAINST anti-transgender legislation.

I find it easy to get discouraged and feel like nothing can be changed. And yet…

Change for the better IS happening all around us. If I stop myself for a moment-- take my eyes off the news of the day and look at the big picture, there is an abundance of hope there.

I am awoken to this nearly every time I have my first follow up appointment with one of my patients after they have begun medical transition. Most often it’s like seeing a new human, a happier human, a more confident human. It is my privilege to help someone start to become who they are.

When despair creeps into my darkest recesses, this helps to banish it with light. I cling to this. A simple act of attempting to make the world a little better where you are. I’m fortunate enough to have found my way to contribute to the moving of the needle.

Caring for LGBTQIA2+ patients is my oasis of empathy and humanity. My protection from despair and indifference. My port in the storm. Have you found yours?

If not, step back and look around. You might find that it’s been right there the whole time. Embrace the joy and love where you can and remember, we’re all in this strange place together. And together we can make it a little better. 

Tips for how support your partner if they come out as transgender or non-binary

By Sarah Swofford

So your partner just came out to you as transgender or non-binary? Congratulations! This is a really wonderful moment full of lots of changes and probably some challenges too, but remember what a privilege it is that someone so close to you trusted you enough to tell you this information. 

I was, fortunately for me, the first person my husband came out to as trans, and I had the privilege of being by his side not only for his more public/social coming out, but also through his transition journey up to this point. 

Now I’m going through a bit of a “gender awakening”, as we’ve been calling it, of my own, and he’s been right there supporting me too. Don’t get me wrong, while it’s mostly been affirming and positive for us in many ways, there have been challenges too. 

We’ve both navigated a lot of huge feelings and have really stretched ourselves to our edges at times. We’ve dealt with lots of family drama, medical challenges, and social changes, and those things aren’t always simple to navigate. 

Every transgender and/or non-binary person and couple have a different story with their own challenges and obstacles and celebrations, so this list is not a one size fits all by any means. My spouse and I have experienced a lot of privilege and also, our stories are unique to us, just as every non-binary/trans person’s stories and experiences are. 

This is just a small list of some things we experienced or have found helpful in our journey, or advice friends have shared with us. 

I hope that if this is something happening in your life or household, somewhere in this list you find something that can help you and your partner or loved one. In the meantime, welcome! We’re so glad you’re here! 

1. Ask and affirm if they choose to go by new pronouns and/or a new name. 

 If your partner tells you they are transgender or non-binary, ask them if they want you to start using a different name for them or if they want to update their pronouns. It can take a little time to get used to a new name or pronouns, but as long as you are making a genuine effort, that’s what really counts. If you mess up, it’s okay, just correct yourself and move on! No need to make a big deal of it. 

Also, if your partner decides to use multiple pronouns, try to use both of them and not just one. For example, I recently started using she/they pronouns instead of using just she/her as I did before, and my partner has done an amazing job at using both of my pronouns interchangeably. Some people that use multiple pronouns prefer one pronoun over another, and some want all of their pronouns to be used interchangeably, so be sure to clarify with your partner what they would like. 

Ways to take this further: offer to help them figure out how to legally change their name. That could mean looking up lawyers or name change clinics that are sometimes hosted by local universities or advocacy groups. There’s a lot of paperwork that goes with the name change process so that’s another way to help them. 

When my husband decided to legally change his name, I helped him with the mountain of forms that came with changing everything from credit cards to passports and everything in between. Sometimes just picking up or printing out the forms for someone can make things just a little easier and help them feel more supported. 

2. Ask your partner how they want to be supported (this ties into the name and pronoun conversation).   

After you talk about any name or pronoun changes, ask them exactly how they’d most like to be supported. There are lots of things you CAN do to help or assist them in their transition, but you want to make sure it’s what they actually want first.

Maybe they want you to help them file name change paperwork or set up doctor’s appointments (more on that later) but maybe they just want you to listen while they vent or process things too. Have a conversation about what it looks like to support them as an individual so you can both be on the same page. 

3. Learn learn learn! Educate yourself as much as you can, without relying on your partner to be your only resource. 

Get connected to resources like groups for partners & spouses of trans/non-binary people to learn more about supporting your partner; often these can be found on Facebook groups. Contact local advocacy groups and ask them how you can learn more, or check out larger organizations like HRC or GLAAD for lots of helpful articles and info. Here’s a couple of my favorites: 

• https://www.glaad.org/transgender/transfaq 

• https://www.hrc.org/resources/coming-out?topic=transgender

Often local LGBTQ+ organizations, conferences, and festivals have networking events both online and in person. These can be a great way to meet more people and learn more about the entire community as well as the specific branches you and your partner might find yourselves on. 

Also, sometimes a partner coming out can bring up new questions for us about our own labels or identity. Don’t be afraid to investigate those questions and have plenty of self reflection time. And if it’s accessible to you, seeking out professional help like counseling can be really beneficial for individuals or the couple together. 

Therapists, counselors, and other mental health professionals experienced in working with the LGBTQIA2+ community can help you learn and navigate all the new information and individual feelings surrounding this time. 

4. If your partner tells you they want to pursue specific gender affirming healthcare like surgery or hormone replacement therapy (HRT) for example, offer to help them plan for that care.  

Offer to make phone calls and inquire about the policies and care for transgender & non-binary patients at different hospitals or medical facilities. Offer to make appointments for them. Sometimes making appointments can be stressful or intimidating, especially if you are feeling vulnerable, so offer to help your partner or spouse out by making an appointment for them so they can take that off of their to do list. 

I made an appointment for my husband to go talk to a doctor about top surgery, after we had spent many hours discussing what doctors and clinics he was interested in. I was able to confirm that they had affirming practices and policies before my husband even stepped foot in the door, and at the time that was really comforting for him. 

(Also, here is an important point- I got explicit permission to share aspects of my husband’s transition story for this article. Always check with your partner before sharing any sensitive or private information regarding their transition with anyone. We both openly talk about being in the LGBTQIA+ community on our YouTube channel SwirlBabyTV, but we still make a point to check in with one another before sharing aspects of our story in a different way.) 

5. Help raise funds for their gender affirming care. 

Unfortunately many healthcare plans do not cover gender affirming care. While more options are becoming available all the time, many states as well as insurance companies have a long way to go in providing comprehensive and accessible gender affirming care. If your partner is okay with it, you could try to assist in raising funds for their gender affirming care in a few ways. 

Setting up an online fundraiser is one of the most common ways people help cover the costs of their care; you could offer to set up a fundraiser for your partner with their permission. Another option is to look into what grants different advocacy groups and organizations might offer. Some orgs, groups, and even companies offer special grants or funds for trans & non-binary people seeking gender affirming care. 

Additionally, you could try getting a little creative. We hosted a combination bake sale/garage sale to raise funds for a gender affirming surgery. Many people with artistic talent sell a line of T-shirts or stickers as a fundraiser, and I’ve seen people sell homemade goods from pies to eco friendly dish soap as well! 

Finally, here’s a link to an article that goes into more detail about other financial options like lines of credit or personal loans: https://www.nerdwallet.com/blog/guide-paying-transgender-surgeries/

6. Offer to help them come out to family and friends. 

This can mean physically being with them when they make a phone call or go to meet up with their family, or it can mean telling some people for them if that’s what they want. My spouse asked me to tell a couple of our friends so he didn’t have to be the one to bring it up first.

Sometimes it can get tiring figuring out exactly how and when to tell every person in your life this huge important news, and sometimes there are moments that you can let someone else handle that for you. If your partner asks for this kind of support, make sure you are both clear on what exactly they want you to share so you can help them most effectively. 

7. Tell them you love them. 

Coming out can be scary, exciting, nerve-wracking, exhilarating, and so many other things, but it’s usually a vulnerable and emotional moment. Show your partner that you appreciate them sharing something so important with you. Tell them you are glad that they feel safe telling you and you will support them in their transition. 

Full disclosure, the night I finally decided to tell my partner I wanted to change my pronouns I got super nervous and even hid in our bathroom for over an hour after I told him because I felt so overwhelmed! Once I finally emerged he gave me a huge hug and told me he fully supported me. Even though I knew he’d react that way, in the moment fear and anxiety just won out and all I could do was run and hide for a minute. 

Sometimes telling your truth is scary, even if you know you have a supportive partner waiting for you. Be patient with each other and yourselves, just continue to try to approach your partner with love and kindness. 

8. Give them an affirming gift. 

If you have a little bit of spare time or money, you could make or purchase a small gift to celebrate your partner or loved one coming out. Make them a congratulatory card, get them a trans or non-binary flag, bake some cupcakes in trans/non-binary flag colors, give them some flowers, or offer to help them get some new gender affirming items for their wardrobe. 

9. Celebrate! 

This kind of goes hand in hand with the affirming gift, but There are lots of ways to celebrate this happy news if physical gifts aren’t you or your partner’s thing.  

My partner and I celebrate the day he started HRT by having a “T” party every year, complete with hot tea, scones, and sandwiches, the full afternoon tea setup. We know other people who have a birthday party to celebrate coming out milestones, and some who plan a day of their favorite things to commemorate a special day. 

Celebrate however you can or however you want to, just have some fun together! Celebrating life’s milestones helps us feel connected and bonded, and it’s fun to find reasons to make lots of different life events into celebratory ones. 

10. Stand up for them. 

It would be so great if we lived in a world where every time someone came out, their friends and family rejoiced and were nothing but supportive and said only the right things. But that isn’t the reality of it for many people who come out. 

Sometimes it’s really hard to constantly fight a barrage of invalidation or even straight up abuse like intentional misgendering or dead naming, so if you see an opportunity to support your partner by standing up for them or enforcing a boundary, do it. 

Of course you have to think about everyone’s safety in the situation, but if you think the situation allows, make it clear that you won’t tolerate listening to anyone misgender or mis-name or verbally harass/abuse your partner or loved one. 

Help your partner enforce a boundary by offering to leave the situation with them. Let them know that you’ve got their back, no matter what, even when it comes to the tough moments. 

Again, this list is just a small fraction of possibilities and ideas. Focusing on expressing your love, encouragement, and support is the best thing you can do, and any gesture in that direction will not go unnoticed by your partner. Life is full of adventures, and this is just another opportunity to go on one together!

Seeing Myself Reflected Back

by Jessica Soukoup

My phone rang.  It was an endocrinologist's office calling to set up a time for me to come in.  

Confused, I logged into the health portal for my primary care doctor’s office.  I knew I had a series of tests the previous week. However, she never called and so I assumed nothing was wrong.

My heart leapt as I read the message from my doctor. The note said I had osteoporosis and everything suddenly fell into place.

I had gone to a health and wellness fair and while there, some salesperson had tested my bone density on my ankle with a device.  The device said I had osteopenia, the precursor for osteoporosis but I didn’t lend it much credence as I assumed it was part of the sales tool.  After all, my testosterone level was 650 - high normal for my age and biology.  I had a lifetime of workouts and fitness and healthy eating. I was not at risk for osteoporosis.  Nevertheless, I mentioned it to my doctor when I saw her and she scheduled me for a bone density scan. I did so at the same time as another test.

This meant that I could go to the endocrinologist and receive estrogen - Hormone Replacement Therapy (HRT) - as treatment for my osteoporosis. This avoided an insurance exclusion designed to block the transition of transgender people.

Now with that obstacle overcome, I had to figure out if this endocrinologist was affirming of transgender people. A quick facebook post solved that problem. In addition to reports from several of my trans friends who received HRT through this office, one of my cisgender best friends had followed my request a few years earlier and asked their doctor if they were trans affirming. I had made this request in an effort to encourage doctors to get necessary training as there is such a shortage of trained doctors. The doctor I was referred to happened to be the doctor she was seeing. So, in addition to the information from facebook, I my friend had a personal conversation with the doctor to fall back on.

I remember sitting in the waiting room before my first meeting with her. My stomach was all in knots. I was so excited. I had been reading about HRT for years as I tried to navigate the systems in order to get it as well as evaluate my own personal needs and concerns.  

When I finally got in to see her. She was lovely.  She spent two hours with me going over my whole health history, options for treating my osteoporosis and very carefully reviewing the informed consent document for cross sex hormone replacement therapy.  She wrote me up prescriptions, I made my follow up appointment where she would train me to give myself the injections and I went on my way.  I was so happy.

That happiness did not last.  

I knew some pharmacists would refuse to write prescriptions. I had a 10 year relationship with mine and so I hoped it would be ok. Turns out she was willing to fill the prescription but she didn’t stock it and it was on backorder. She placed it on order but as the date of my appointment approached, there was no estrogen to be found.  She searched and searched and could not find a place to get some. The night before my appointment, I took matters into my own hands. I knew so many trans women in town. Somebody must know where to get it.

As I messaged around, I found that these shortages happen far too often and many trans women maintain a few extra vials in order to not go through menopause every time there is a shortage. I received multiple offers for a loner vial but we eventually located a CVS up in Austin that had a vial. I drove there from San Marcos after work and waited in line for more than 90 minutes to get it filled. In celebration, I went to my trans friend’s house and we had a celebratory glass of wine or two before I headed back home.

Off to the endocrinologist I went. I frankly didn’t need to go for this appointment.  She had asked me to come in so she could teach me how to do a shot. In addition to my pharmacist, who out of frustration for not being able to fill my estrogen order had carefully trained me what to do, I had already watched a number of YouTube video tutorials and read several articles on it all. Thank goodness I had. The syringes that were prescribed with the estrogen were too large for my dose and so I had to ask the pharmacist to get me smaller syringes.

Regardless, I showed up in my endocrinologists office and took my required training and gave myself my first injection.  As I sat there listening to the training and carefully reviewing with my doctor the procedure, I beamed. I can’t remember ever having been that happy. Finally, I would take the steps to bring my body into alignment with my internal vision of self. This step promised to allow me to look at the reflection in the mirror and instead of looking away and trying not to think about the reflection that stared back at me, but maybe, just maybe I would begin to see myself.

Alas, my journey was not over though. Weeks passed and injection after injection left me increasingly depressed.  

Every three months, I would meet with my endocrinologist and she would adjust my hormone levels. The problem was, she was limited by a hormone protocol developed using hormones derived from horse urine rather than the bio-identical ones of today.

After 9 months, I had enough. I complained on social media of my challenges and a doctor who I had become connected to via some trans related activism suggest I come and see her.  She made some minor changes to my protocol and it was like a light turned on inside me.

Not only did my depression clear but, it was like a heavy wet blanket that had been laying on top of my emotions for my entire life suddenly lifted.  I began to blush for the first time in my life and it was fascinating feeling my cheeks get hot.  I smiled.  I laughed.  I cried.  And, I loved it all.  It felt right. I felt right.

On top of that, my body responded.  For the first 9 months of HRT, I had no breast growth.  In the year since, I have gone from nothing to large C, small D breasts.   My skin is soft and sensitive. And, finally, for the first time in my life, as I look in the mirror, I have begun to see myself reflected back.  

Let's Find Love in a Hopeless Place

Sarah Kapostasy, MA, LPC

We found love in a hopeless place

We found love in a hopeless place

We found love in a hopeless place

We found love in a hopeless place

- Rhianna, We Found Love 

I don’t know about you, but hopelessness is more than reasonable right now. We are in the midst of the dual pandemics, COVID-19 and state sponsored violence against Black bodies. Our country is divided. We can’t agree on the truth. 

And yet. 

I was speaking with my colleague Wes Cowan about all the examples of empowerment and mutual aid we are seeing in the LGBTQIA2+ community right now. Particularly within the trans community, and specifically for trans people of color. For example, Black Trans Leadership of Austin, a new non-profit, is starting to distribute funds for those experiencing housing insecurity. 

BTLA was formed in 2020 by local queer Black activists and advocates who saw where other LGBTQIA2+ organizations did not have the lived experience and direct connection to Black and queer people. BTLA seeks to lead by example on how to support them. 

As a white cis woman, I’m struck by how I get bogged down in despair about the state of the world. Meanwhile, folks who are objectively more impacted by these forces than I am keep going. They find ways to support and love one another because they have to. 

Rather than feeling guilt, this motivates me and gives me hope. I hope to be the best co-conspirator I can in supporting these efforts. I invite you to consider a donation:  https://btla.squarespace.com/take-action 

And if you need more motivation, go listen to some classic Rhianna. And, I hope this blog continues to inspire us as we move through 2021 together. See you next month. 

Blog coming in 2021!

Stay tuned!