Don’t just remember us: The loss of trans lives is preventable (part one)

In this first installment of a two-part series in connection with Transgender Day of Remembrance on Nov. 20, HIVMA Board member Catherine Grace Bielick, MD, MSc, MSc, highlights the life-threatening disparities that transgender people face and shares her own experience.

It’s often hard to know where I fit in as a trans woman, physician, data scientist, survivor, Christian and political advocate. I found my people in the infectious diseases field, where we have a week-long conference dedicated to advancing ourselves clinically, emotionally, technologically, ethically, politically, spiritually, epidemiologically and equitably. We embody the paragon of physicians of old, who join all of these areas to create a singular outspoken authority that does not leave behind love for the least of humanity for the sake of higher salary or acclaim. As we approach Transgender Day of Remembrance, I find myself remembering the words of Mark Dybul, MD, from the closing plenary of this year’s IDWeek: “You can’t fight HIV if you don’t support the LGBT community.”

The ID community may be more familiar than others with the 2015 U.S. Transgender Survey Report, from which many chilling statistics have become well known. There were 40% of us who reported a suicide attempt in our lifetime (nine times the 4.6% background rate of the U.S. population), including 7% who made the attempt in the past year. Among all trans women, 3.4% reported living with HIV, of whom 19% were Black trans women (or up to 57.6% of transgender Ryan White patients in 2017). There were 30% who reported experiencing homelessness in their lifetime, 15% were unemployed (compared with the overall U.S. unemployment rate of 5% at the time), and 29% were living in poverty (compared with 12% overall). Seventeen percent left K-12 school because of mistreatment, and over half (55%) of those who sought insurance coverage for gender-affirming hormones or surgeries were denied. Accordingly, 23% of the sample did not seek health care when indicated for fear of mistreatment.

I did not escape these statistics. And for health care professionals to most effectively remember any group, it is important for you to become familiar with what your affected patients and colleagues have experienced. How else can you stop us from dying if you don’t know what’s killing us? You must be able to form a differential diagnosis for any element of a person’s suffering if you endeavor to alleviate it. Gender dysphoria began for me in childhood, but I didn’t realize what it was until after college. By then, I had found and immersed myself in numerous distractions from reality that kept me from thinking about the future or my own health.

I worked two to three jobs through college and graduated with a purposeless bachelor’s degree in psychology and a minor in marketing, and the real world ultimately found me anyway, as it inevitably does. I couldn’t find a job after graduating, and I hadn’t thought about my career as anything more than a fantasy that I might one day accidentally self-actualize. I was homeless for a month, living in my friend’s parents’ living room, but in the throes of poverty myself, I remembered a saccharine dream from my adolescence. I devoted myself fully to becoming a physician to fight disease and poverty through the betterment and development of individuals and communities in the most need.

I was still living as a man, though. I didn’t recognize that as a source of ongoing pain until I had finished two more years of post-baccalaureate medical school prerequisites, another year of minimum wage employment and two additional years of graduate school. I was dating a woman who I had every intention of marrying and she of me. One day, without any warning, I was at a Brandon Sanderson book signing event with my closest friend when 26 years of memories coalesced into an asphyxiating realization that I was a woman. In 2012, I had never heard of what it meant to be transgender, or transsexual or any variation of terms you might imagine. That night and the entire following month, I insatiably pored over the stories of other trans women online. You could just take a pill and make your body be the way you have felt like it should be your entire life?

It wasn’t that simple. It should have been, but it wasn’t. I did love my partner at the time from the bottom of my heart. I agonized and procrastinated but eventually sat down with her at a brewery in Raleigh one night after church and ripped off the Band-Aid. Her first words were, “I’m still here, and I’m not going anywhere.” I was clear about what I wanted and so was she. I wanted to transition to being a woman and to stay with her. She wanted to be with me and for me to live as a man. For a variety of reasons, I chose the latter scenario.

We got married, I was accepted to medical school, and before matriculation, I decided to put my best foot forward into conversion therapy. It did not go well. I can give testimony to the report to the United Nations from Victor Madrigal-Borloz: “It is generally unethical for health care professionals to purport to treat anything that is not a disorder, and they are compelled by the ‘do no harm’ principle not to offer treatments that are recognized as ineffective or purport to achieve unattainable results. For those and other reasons, the Independent Forensic Expert Group of the International Rehabilitation Council for Torture Victims, a group of preeminent international medico-legal specialists from 23 countries, has declared that offering ‘conversion therapy’ is a form of deception, false advertising and fraud.”

Don't miss the next post in this series, in which Dr. Bielick shares more of her story and underscores the important role of physicians in providing and protecting gender-affirming medical care.