Changing Minds
Episode 6: Embracing Identities: A Focus on Gender-Affirming Care
You're listening to Changing Minds, Transformative Toms for Healthcare Improvement. Grab a coffee or tea and join our team as we chat with leaders in the academic detailing space. For more information on academic detailing, visit us at narcad.org. Welcome back to our podcast Changing Minds. I'm your host Anna Morgan-Barsamian, the Senior Manager of Training and Education at Narcad. Today, we are joined by a special guest, Ryan Anderson, who is a detailer in Arizona. Ryan, welcome to our podcast. How are you today? Thank you so much. I am good. How are you? I'm doing well. I'm excited to dive into this content with you. I know that we just came off of a presentation at the AD Summit a couple of weeks ago, where we heard you chatting with us about gender-affirming care, and people we're really interested to hear more. So, looking forward to doing this podcast today. Thank you so much, and I'm very excited that people are excited about this topic. Yes. Yeah. Thank you, Ryan. All right. Let's dive in. So, our first question. Can you start by defining what gender-affirming care is and why it's so important? Additionally, gender-affirming care is a form of healthcare that consists of medical, surgical, and mental health services. An example of gender-affirming care is gender-affirming hormone therapy. So, this is going to be the use of testosterone or estrogen to achieve a congruence between physical attributes and gender identity. However, in terms of academic detailing, I like to use a broader definition and in turn a broader approach for gender-affirming care. At its core, gender-affirming care is simply the act of respecting and nurturing someone's gender identity and gender expression. The goal of DISHAZ, detailing for improved sexual health in Arizona, is to enable providers to respectfully and in an affirming manner, work, and care for gender-expansive patients regardless of the reason the patient is seeking care. So, let's say gender-affirming hormone therapy is out of the scope of the provider's practice. They can still practice care that affirms who the patient is. This can be done by using the correct pronouns and the correct name, creating a safe and welcoming environment and maintaining a patient-centered lens. Thanks, Ryan. That was really helpful to hear more about gender-affirming care and the overlap with academic detailing and how academic detailing can promote gender-affirming care and make clinicians more comfortable with the topic that I'm sure gets some objections when you bring up gender-affirming care. Is that right? At times, it's not a full objection. It's usually bits and pieces. The biggest concern that providers bring up to us is how other patients are going to perceive the gender-affirming care. So a big part of our academic detailing work is promoting the creation of a safe and welcoming environment, and oftentimes that entails visible materials, right? So it could be things like pride flags. It could be things like pronouns stickers. And oftentimes, providers will share concerns that they are unsure how the rest of their patient population will respond to these affirming materials. Did you say that that's the most common misconception about gender-affirming care that you encounter that is one of the ones. There's a second one, which is people often confuse the idea of gender identity versus gender expression. So gender identity is going to be this internal idea, this internal feeling of what our gender is. It's a very internal experience and can also be a very private experience, whereas gender expression is going to be this external representation, presentation of somebody's gender. So sometimes I encounter providers who are confused and at times frustrated because they see their patients' gender expression may not look like society's expectation of a gender identity. So let's say someone has a gender identity of transmasculine. So they identify much more with the masculine side of things. However, their presentation might be what society considers more feminine, but that does not negate their gender identity of feeling more masculine. Ryan, can you share a personal story or experience that highlights the impact of gender affirming care? Absolutely. So earlier this year, I had some medical issues pop up that led me to the emergency department. And as always, I embraced myself for dead naming, misgendering, and just general disrespect based off of my gender identity and the fact that my body looks different than a cis-man's. So usually the dead naming begins at the front desk and continues all the way throughout the visit until I walk out the door. As I'm sure you can imagine, this adds a lot of stress on top of an already stressful emergency situation. And in the first couple of years of my transition, I had to go to the emergency department and was consistently dead named, misgendered, and called the free. And this was a little less than 10 years ago, so not too long ago. So this time around this year, I braced myself for a very similar experience. However, from the moment I signed in at the front desk, I was pleasantly surprised. The correct name and the correct pronouns were used throughout the entire visit. I did not have to advocate for myself when it came to my gender identity at all. That allowed me to focus on the reason for the visit to the emergency department and allowed me to focus on healing. And at its very core, that is gender affirming care. Thank you for sharing that, Ryan, what an impactful story. Do you have any sense of why 10 years later, it was just such a striking difference? Because people are out there doing the work, talking about gender affirming care and not being pushed to the side any longer. We gender expansive folks are becoming much more vocal. Allies are becoming much more vocal, pushing for high quality care and just pushing for general respect in a health care setting. Yeah, so important. What you mentioned are alluded to this a little bit, but what are some of the biggest challenges or barriers to accessing gender affirming care and how can ED help overcome these barriers? The biggest barrier I see to gender affirming care right now is the accessibility factor. So for many folks who are gender expansive, who also happen to live in urban areas, there are clinics that are specialty clinics that focus on LGBTQ+ healthcare and many gender expansive people utilize these clinics for gender affirming care, which is awesome. And I'm so grateful we have these clinics. However, many of these clinics are often only in urban areas. So that's going to leave folks who reside in more rural areas in a bind. Do you do any work, Ryan, in Arizona and rural areas for detailing? We absolutely do. We cover all of Arizona. We do work in two of our biggest counties. However, we do focus on other areas of the state. A lot of the gender affirming care AD actually comes to us. We get requests from folks that are in these areas, folks that are gender affirming care champions that actually seek us out and ask us for assistance with training and one-on-one sessions. Oh, that's awesome that people already know about dish Arizona and they can reach out to you for additional resources. Yep. We also, dish AZ, we also have a gender affirming care community of practice. So we've created this big network of providers within Arizona. So that's how many folks hear about this. A lot of it is word of mouth. And as soon as they hear gender affirming care, I get sent an email or I get called, which is amazing because my personal goal is to have as many clinics as possible of Arizona. I'm practicing gender affirming care. It sounds like there was a snowball effect, like some clinicians had a really great experience with your detailing team and just continued to spread the word and share about it. And that's what we love to see in the detailing world. So kudos to your team for that. How can academic detailing enhance the understanding and delivery of gender affirming care among health care providers? So detailers are in a unique position to be able to connect with providers. And this is done through one-on-one conversations and sharing lived experience. We have the ability to change minds and also to open hearts. We also have the ability to share many of our resources. When health care providers first start into gender affirming care, it can be very overwhelming, right? If you just type in gender affirming care and Google, you are going to get thousands of results, and I can't speak to the quality of all of those results. However, through doing gender affirming care academic detailing, we have compiled a list of resources and have vetted these resources. So we know we can do warm handoffs to providers and be very confident that we are sending them the correct and gender affirming resources. We are also in the position of creating connections and a network of providers who work in various aspects of gender affirming care. So let's say we have a therapist who is new and to gender affirming care, but they're very passionate and they're still working on building their repertoire of resources. So we can give them resources to providers who are skilled at gender affirming hormone therapy or even surgeons who are skilled in practicing gender affirming surgeries. That's great, Ryan. And I wonder, would it be possible if you could share some of the key messages that your team uses during your detailing visits? So we have four key messages we typically review with healthcare providers when we're out there doing gender affirming care academic detailing. So our first key message is create a safe and welcoming environment for gender expansive patients. The second key message is use a patient centered lens to identify health risks and needs with gender expansive patients. Number three, ask about sexual health needs at every appointment. And number four is offer services that address the intersectional complexity of full person gender affirming care. Awesome. Thanks for sharing those, Ryan. And I know that your team worked so hard to put those key messages together. And you have so many additional resources that I will link in the podcast notes of this episode so that folks can see the resources that materials that your team has created to go along with these key messages as well. Awesome. Thank you so much. Of course. What advancements or changes do you hope to see in the field of gender affirming care in the next five to 10 years? I love this question. I spend a lot of time thinking about this. So the first change I am hoping to see is that if not all most insurance companies cover gender affirming care, it can be very pricey to access hormone therapy, gender affirming surgeries and also just routine mental health services. So I would absolutely love to see more insurance companies cover gender affirming care. And then I would also love to see more providers practice gender affirming care. If they are not in a position to be prescribing gender affirming hormone therapy, they can still absolutely practice using the correct name, using the correct pronouns. And overall being respectful and being a place that folks who are gender expansive feel very comfortable going to. And then I would love to see more peer to peer mentorship in terms of gender affirming care. When I'm talking to providers, one of the things I hear most is I wish I had other providers to talk to about gender affirming care. So that's a big part of what we do with academic detailing is connect other providers together. But I would love this process to take a life of its own and really just become the new more. I am also hoping more academic detailing programs will adopt gender affirming care as one of their topics they review with providers. The Disney Z team, we cover Arizona, however, we have many other states that could use academic detailing for gender affirming care. The ability to access gender affirming care is very inconsistent throughout the US. And academic detailing has the potential to bridge that gap. You and your team are certainly pioneers in this work and I know that a lot of the academic detailing programs are on the country and throughout the world can look up to you and your team and your materials that you've created. So thank you for being such an integral part of our AG community. We appreciate it. Absolutely. And we are always open, more than happy to work with other AG programs and how to start up their gender affirming care ed. Thank you, Ryan. We appreciate that. Let's wrap up with a final question. What advice would you give to someone who is just beginning their journey with academic detailing for gender affirming care outside of what we just talked about, which was that they can connect with your team. What other advice would you give? Prepare to be busy. Many providers, practices and organizations have reached out for gender expansive academic detailing. And as more people come out as gender expansive, the need for gender affirming care has increased. So more providers are actively seeking out these resources. And then also seek out and track your local resources as often as possible. And then when it's possible, vet these resources. Folks often don't know where to start beginning their journey into gender affirming care. And resources are very gratefully accepted by providers that are just starting out. Make sure to take care of yourself, especially if you're speaking from a place of lived experience. Try to debrief with colleagues if you are able to after the A.D. sessions or after presentation. There's a huge benefit to sharing lived experience. And in the same breath, it can also be a very vulnerable experience. It is worthwhile to compile personal stories ahead of time before the session or before the presentation, and then discern which ones you are comfortable with sharing. And which ones make the most sense to share with that clinician, right, and in that certain situation? Correct. Absolutely. I wanted to pull out one thing that you mentioned earlier about having an updated list of resources. So you're saying like a curated list of resources that exist in that specific community that you're detailing in? Correct. So things like referrals to other providers who have other specialties or even support groups, gender expansive support groups. Mm-hmm. Okay. That's really helpful. And something that I think is important for any clinical topic that someone is detailing on as well. Is there anything else as we wrap up, Brian, that you'd like to share before we close out this podcast? I just want to encourage folks to keep talking about gender-affirming care, ask questions, read articles and books, and talk to folks in gender expansive communities, and let's normalize gender-affirming care. Thanks, Ryan. We so appreciate you joining us today on our podcast. Thank you for sharing your story, and the passion that you have for your work is very clear, and I can't wait to hear more from the Arizona team in the future at our future events to see how things are going and what you accomplish next. So thank you again, Ryan, for being here, and have a wonderful day. Thank you so much, you too. [MUSIC]