Something as simple as scheduling a visit to a doctor is a privilege in and of itself. Navigating language or financial barriers can prevent some people from seeing a healthcare provider. But for the portion of the population that are transgender, seeking medical care can be limited for a variety of reasons — lack of access or availability, lack of knowledge, or straight-up fear and ignorance. Some of the most vulnerable members of the trans population are transgender children and young adults.
Thankfully here in Richmond, parents and family members of transgender youth don’t have to look very far. The Children’s Hospital of Richmond at VCU (CHoR) has two physicians who specialize in the care and treatment of transgender youth and adolescents. If you go to the CHoR website and type in the term “transgender,” you come to the page for Transgender Care. Services are offered, literature and resources are listed, and there’s a Meet the Team page. This is where you’ll find Susan Jones, MD, a child and adolescent psychiatrist; and Mansi Kanhere, MD, a child endocrinologist.
Trans youth face extra challenges since society often tells them they are too young to question their gender identity. “Cisgender kids, whose gender identity and body match up, typically know their gender identity between ages two to four — and no one says ‘Well, how do they know? They’re too young to know,’” said Jones.
Jones said the Children’s Hospital team builds their clinic and services around gender affirmation, assertion of one’s gender through social interactions. And to Jones, the affirmative environment is the most important aspect of her work. “Sometimes, we’re the only source of emotional support and affirmation,” she said. “Frequently, we have to be that child’s advocate with their families.”
Jones knows all too well that interacting with a child’s parents is really the only way she can maintain contact with the patients who need her most. “If you don’t try to meet the family, you’re never going to see that kid again,” she said. But Jones emphasizes to the parents that they themselves are the most crucial aspect of their child’s transition.
“One of the most important things for families to know is that family acceptance protects against suicidal thoughts, suicide attempts, self harm, depression, anxiety, substance abuse, and risky sexual behavior. Family acceptance makes a difference in all of those areas,” she said. “That’s often an argument that will really sway parents. I also try to get parents, if they can’t be accepting, [to] at least be neutral and not rejecting.”
Scott Krell is very familiar with Dr. Jones, her colleagues, and the services at CHoR. His 11 year old daughter, Hazel, is trans. “At the end of second grade, she came to us and said pretty much that she felt that she was a girl and that she would prefer to be called by a girl’s name,” he said.
After hearing about a support group at Side by Side through some folks at their church, Krell met Dr. Melinda Penn, the former child endocrinologist at CHoR. He met with her and Jones in order to provide supportive and comprehensive care for his young daughter. “I want what’s best for my daughter. I want her to be happy and comfortable and live the life that fits her body, that fits her mind, that fits how she feels,” he said.
Overall, he is extraordinarily pleased with the team at CHoR. “I recognize how very lucky we are,” he said. Working with support groups for parents of transgender children, he’s seen the struggles those who don’t have such resources close at hand have to go through. “Some people have to travel many, many miles to just meet with an endocrinologist.”
Krell explained that the physicians are incredibly communicative, understanding, and patient with his questions. “It’s been an exceptionally easy and pleasurable experience. I am truly grateful and thankful that we have such an opportunity here in Richmond.”
Kids like Hazel don’t stay young forever, though, and eventually must seek adult healthcare providers. When asked where she points when her patients age out of her field of care, Jones advises them towards either VCU Health or private practice specialists. However, the private practice option offers reasons for hesitation. “I’ve talked to a private adult endocrinologist who said they were afraid if they put their name out there, working with transgender adults, that’s all they would see, that they would be swamped,” said Jones. “They didn’t want to limit themselves to one area.”
As there’s only an estimated 1.4 million transgender adults and 150,000 transgender young adults ages 13-17 years old in the United States, a belief that any healthcare provider offering care for transgender patients would be inundated with trans patients may seem naive to us. But perhaps there’s more to investigate within that problem.
Meanwhile, if you search the website of VCU Health, the adult equivalent to CHoR, for transgender health services, nothing comes up. Steve Crossman, MD, a family medicine physician for VCU Health, believes that for both VCU Health’s physicians and for physicians in private practice, it comes down to comfort in expertise. “Not all of our physicians are fully comfortable in terms of the provision of specific clinical services.” said Crossman. “However, all of our physicians are open, and desire to be good medical doctors, for all of our patients. Most of us have done official Safe Zone training. Others have trained at programs that had larger LGBT populations.”
Crossman acknowledges the absent categorization on his bio, as well as that of his colleagues. “It is certainly not from an exclusionary perspective,” he said, stressing that VCU Health is not trying to turn trans patients away. “What it does do is remind me that it probably is worth addressing.” However, Crossman worries that, if he listed his availability for transgender health services, it would affect his non-trans patients.
“I can only speak for myself. I can’t speak for VCU,” he said. However, he continued, “I think the potential for harm that I see is that if I put myself out there too much, that I may make other patients uncomfortable coming to see me.” VCU Health sees a substantial amount of metropolitan Richmond area patients, and Crossman understands that we live in a rather polarized world. “There’s a lot of ignorance and a lot of misunderstanding about what it is to be trans,” he said.
In addition to seeing patients, Crossman gives VCU medical school students a yearly lecture on LGBTQ patients. While he acknowledged that he cannot teach about every single culture and subculture who might have specific needs when seeking a healthcare provider, he highlights the importance of a physician being open to diversity in their patient population. “Our general approach in teaching medical students about cultural competency has been we want to make sure that we have students and physicians who are trained, competent, caring, and compassionate, to care for the diversity of patients that we will see.”
Crossman recognized another hesitation for physicians might also lie in fear of lack of knowledge. His advice for physicians concerned that they don’t know enough to provide transgender health care: “Don’t try to be an expert in trans care. Present yourself as a physician who’s open to learning from patients,” he said.
As for transgender patients who may feel nervous about seeking out a full-time healthcare provider, he said, “I realize that there are institutional structural discriminatory practices that exist against folks who are different. Use the resources that are out there. The vast majority of family doctors that I know want to take care of all people well.” One of many assets, he said, is the Gay and Lesbian Medical Association (GLMA), which has a list of subscribed physicians across the nation who see LGBTQ patients; Crossman is on that list.
Although we could find no concrete answer to the question of why VCU Health doesn’t have an organized page or even doctors who list “transgender” under their variety of services the way CHoR does, one thing is for sure: resources are out there. Planned Parenthood, Health Brigade, and any of the healthcare providers listed on the GLMA website are all available in the Richmond area. Crossman firmly believes that seeking out good medical providers is important. “You deserve healthcare that is compassionate, and understanding, and quality. Don’t settle for less than that.”
Top Photo: Scott Krell and his daughter Hazel. Photo courtesy of Children’s Hospital of Richmond