Societies have traditionally divided people by male or female due to appearance. Everyone was assigned to one of these categories, and many societies considered the matter settled. Today, we cannot assume we understand someone’s sex and gender solely by their appearance, especially in the healthcare field — we need to check our assumptions. We need to realize that gender identity is more complicated than meets the eye.
At Mary’s Center, we want to welcome all patients, regardless of their sex or gender identity. People must have the space to express themselves without their actions being gendered. Our Gender-Affirming Care team helps patients with diverse gender identities navigate how to live more comfortably in their skin.
The truth is, that most people do not think about gender identification, which is why it has been a historically undiscussed issue. But for some, it is a very relevant topic because their gender identity does not align with their body, or they do not fit in the gender binary (the division of people into male and female), but instead identify somewhere between these two ideas, or completely outside those two concepts. Some gender-diverse people seek out medical care to help their bodies better match their identity.
For some patients who feel this way, their body might even be distressing to them because it appears and does things that are typical for one gender – but that does not match how they think of themselves. The self-awareness that someone is gender diverse may happen when they are a toddler or can emerge during puberty when they experience body changes that they are not comfortable with. For some, this realization occurs in adulthood.
Dr. Paul Doherty, a pediatrician at Mary’s Center, sees all kinds of children for their general medical care – physicals, vaccines, and asthma. If a child expresses gender concerns, he tries to help the child and family determine what may happen. Gathering information from parents and family is important, but asking the child to relate their experience is key. While some children do have a gender identity that is not aligned with their assigned sex, other children might have a “typical” gender identity while “coloring outside the lines” of what is expected behavior for males and females.
While most children have a gender identity that aligns with their body, or “assigned sex,” it is a normal part of general well care to check with patients around gender. These conversations may occur with the parents present in young children. Teens should always be able to talk to their medical provider alone – so they can ask about concerns without their parents present. Gender identity is one topic that might arise in such a conversation.
A small number of teens identify as “gender-diverse” and an even smaller number are seeking hormone care and other gender-affirming medical care. Medical care is not just about hormones and surgeries: it includes any medical treatment that helps people feel more comfortable in their bodies. For example, a trans man (a person assigned female at birth but who has a male gender identity) may not want to start testosterone treatment but may be distressed during his monthly menstrual period. Using medication to stop menstrual periods safely might help avoid distress in such a person. There is no one-size-fits-all or binary (male/female) in gender diversity. Everyone is different and has their own goals. Not every gender-diverse patient desires gender-affirming medical care. And medical care is only one part of gender-affirming care.
The most important part is listening to our patients to understand who they are and what they need. When a patient at Mary’s Center fills out intake forms, we ask about their gender identity. We check in to see if they have a chosen name and ask for their correct pronouns. These are added to their medical records if they prefer that. Our staff knows how to pause and introduce themselves and their pronouns. They know how to clarify when there is uncertainty around gender issues. And they know how to navigate these conversations in both English and Spanish. It is always better to ask and confirm than to assume. We have worked hard to improve our clinic systems to serve our diverse patients best. We do our best to treat people with respect and earn their trust.
Because of the long-standing taboo, many adults say they could not address their gender identity when they were young. The people around them were not open to these ideas, and the world was not welcoming. These reactions amplified their distress. However, in recent years we have seen that the taboo is slowly being lifted. We have more adult patients seeking gender-affirming care than ever before. The younger generation, Millennials, and Gen Z are even more apt to discuss and accept gender-diverse identities. Society has shifted to make space for that. Even in the 1980s and 1990s, many young people did not have the words to explain what they were experiencing and would have gotten a lot of negative responses for expressing their feelings. Today, there is a world on the internet where gender-diverse people can connect with others who are going through similar experiences.
Today, November 20th, is known as Transgender Day of Remembrance, an observance that recognizes the violence committed against transgender people just for being who they are. At Mary’s Center, we are committed to providing a safe space for everyone and the tools our participants need to accept each other and eliminate barriers to their well-being.
You can learn more about our Gender-Affirming Care services.