These days, Dr. Jennifer Abbott is one of the leading physicians caring for transgender people in North Carolina. As a family physician at Western North Carolina Community Health Services (WNCCHS) in Asheville, she heads up the health center’s Transgender Health Program, staffed by experts who provide up-to-date, evidence-based care for trans patients.
But Dr. Abbott will be the first to admit that she wasn’t always an expert, and that she needed to learn best practices for treating trans folks.
“I had been a family physician for a few years at the clinic, and I had one of our therapists with one patient who came to me requesting testosterone therapy for gender transition,” Dr. Abbott said. “I hadn’t had any training in gender-affirming hormones or transgender care, and it gave me a little bit of pause. This patient had no insurance, but I agreed to meet with them, and they brought me a stack of handouts that was essentially a set of guidelines and standards of care for trans people. After meeting with this very nice patient, I decided to take a leap and go ahead and prescribe testosterone, and it turned out to be a very good experience for the patient – and for me.”
Learning Directly from Patients
It’s not uncommon for trans and nonbinary patients to be their own advocates for competent healthcare in the South, training their doctors on how best to treat them. For years transgender folks have been going online, doing the research, and identifying correct treatment protocols, then bringing that information to their care provider.
That was one of the takeaway lessons from the The Report of the 2018 Southern Trans Health Focus Group Project, published by the Campaign for Southern Equality and Western NC Community Health Services in December 2018. The report is a part of our collaborative Southern LGBTQ Health Initiative and is the result of a series of focus groups in six states. The focus groups helped to outline the many barriers to quality healthcare for trans and nonbinary Southerners – and how providers like Dr. Abbott are leading the way to better care.
After working with a trans patient for the first time, Dr. Abbot set off to learn more.
“There weren’t many resources available for providers who wanted to learn more,” she said. But ultimately, she learned, frequently with help from trans patients themselves. Eventually, resources were developed, including the World Professional Association for Transgender Health, or WPATH. “That’s an international organization, and they have standards of care available online,” Dr. Abbott said. “In the last decade there have been a lot of strides made in research and evidence in terms of the safety of gender-affirming hormones. I think now, new providers who are interested in learning have many good resources compared to what there were a decade ago.”
One that she recommends, on top of the WPATH, is a set of guidelines from the UCSF Center of Excellence and Transgender Health. “As a physician, we always like to see evidence,” Dr. Abbott said. “So it’s very helpful to have these guidelines available, to see research and studies that have been done to show the safety of hormones.”
Still, Dr. Abbott said, some of the best information she’s gathered is from the trans patients she sees and works with every week. “Most of the things I’ve learned have been from patients. Being willing to listen to patients and hear what they’re looking for from a health care provider – that’s where I’ve learned the most.”
Passing Knowledge On
Sometimes Dr. Abbott receives calls from other physicians with questions about treating trans or nonbinary patients. When she does, she tries her best to pass on what she’s learned.
She leads trainings in clinics throughout the South and is a champion for greater understanding of trans issues in medicine. After all, she’s seen the need for herself: More than 450 trans patients seek care from WNCCHS, and many of those folks come from outside of Buncombe County, where WNCCHS is based.
“One thing I really try to do if I get a call from a provider in an outlying community saying ‘Oh, I have this one transgender patient, can I refer them to you for care?’ I try to turn that around and say, ‘No, this is your patient. Let me mentor you and have you learn how to provide care for this patient, in their community, where they live.”
“One thing I really try to do if I get a call from a provider in an outlying community saying ‘Oh, I have this one transgender patient, can I refer them to you for care?,’ I try to turn that around and say, ‘No, this is your patient. Let me mentor you and have you learn how to provide care for this patient, in their community, where they live.”
At the Campaign for Southern Equality, we’re working to ensure that every LGBTQ person can receive quality health care without leaving their hometown. That’s a central part of our goal of building a South where LGBTQ people have both legal and lived equality. It’s why we do pop-up clinics in smaller cities and towns through our Community Health Program. It’s why we released and continue to update the Trans in the South guide, a directory of 400+ health and legal service providers in every Southern state. And it’s why we’re partnering with WNCCHS for the Southern LGBTQ Health Initiative.
The Future of Trans-Affirming Care
Dr. Abbott is seeing continually increasing interest within the field for understanding and appropriately caring for LGBTQ people.
“There’s a movement in medical training to provide trans-affirming, competent care for LGBTQ patients in general,” she said, pointing to medical schools and residency programs that are ramping up coursework and curriculum about the unique needs of LGBTQ patients.
Still, there are hurdles to overcome.
“For providers who are not trans-identified, it can be difficult to put yourselves in the shoes of transgender patients,” Dr. Abbott explained. “Being willing to have an imagination that gender is not just the binary that we’ve grown up with culturally is so important.”
The good news is that things are improving – and there is a roadmap for healthcare providers to be more inclusive, more affirming, and more skilled at delivering care to trans patients. Some of that roadmap is housed in The Report of the 2018 Southern Trans Health Focus Group Project, which found that so many trans people experience barriers in accessing basic services and in being treated with respect and dignity in medical settings. Factors including race, age, and living in a rural community increase the likelihood of hostility or other significant barriers to care.
“We are happy to partner in this important work with the goal of improving access to care and educating healthcare providers,” Dr. Abbott said on behalf of WNCCHS upon release of the Report. “I especially appreciate the ‘Recommendations for Southern Providers, Practices, and Health Care Systems” at the end, which provides very clear and concrete steps that clinics and providers can take to make their practices more gender affirming.”
The future of trans-affirming care in the South and beyond is bright – and that’s because of leaders like Dr. Jennifer Abbott and many other health care providers who care deeply about treating all patients with dignity and respect. We’re grateful for their work and commitment to constantly improving.
Are you looking for a trans-affirming health care provider in your community? Click here to see the Trans in the South guide and learn more.