Opinion | ‘Trans Elders’ in Medicine Matter to Our Patients

Early in my third-year clerkships, one of my peers presented on a young nonbinary patient who had attempted suicide. My heart sank. I am a novice in understanding the medical complexities and details that accompany such a patient, but as a transgender medical student, I have extensive experience with a transgender person’s potential for suicide. Approximately 40% of transgender people report suicide attempts in their lives — nearly nine times the suicide attempt rate of the U.S. population — often related to their experience of hostility in what should be an accepting society. It is likely rare to be transgender and not know another transgender person who has attempted or completed suicide.

After my supervising resident cleared it with their supervising doctor, I went to offer my support to this patient as another transgender person. I knocked on the patient’s door and introduced myself.

“Hi, my name is Garrett and I’m a medical student. I use he and they pronouns. I wanted to check in to see how you’re recovering. What name and pronouns would you like me to use?” As soon as I outed myself to this transgender person, their face relaxed and they started crying.

“I can’t believe I’m meeting another transgender person in the hospital. I’m so exhausted from being misgendered constantly,” they said. With their permission, I sat down to talk with them, not sure what I had to offer, but wanting to help however I could.

The patient had just come out to themselves and their friends. Their parents didn’t know, and their terror at being outed in the hospital was increasing their anxiety. They had no access to information about gender-affirming care but had so many questions about it and didn’t know where to find answers. I was the first older transgender person they’d ever met.

After speaking for a few minutes about what it means to be transgender in our world, I listened to their anxiety about the onslaught of anti-transgender bills throughout the U.S. specifically targeting transfeminine folx, and with the majority of the scrutiny and oppression coming down on trans people of color. After listening to their hopes for the future, they reiterated their disbelief and said, “I don’t think you understand — you literally saved my life by coming to talk to me.” Choking back tears, I responded with gratitude that I could help.

Before I left, they asked me what advice I had. “It’s going to be hard,” I said, after thinking about what I wished others told me early in my own transition. “The world wasn’t built to support transgender people.” This is especially true for non-binary and transfeminine folx, and trans people of color. “There will to be times where you’re going to reach the end of your rope and feel so dysphoric and depressed. Like there’s no future for you. When that happens, try to find someone who has gone through it before. I leaned on my friends who transitioned before me for support — without them, I wouldn’t be here — do your best to do the same.”

They thanked me for my advice and said, “I’m so lucky that you came to talk to me. I never thought I would meet another transgender person, never mind a trans elder who is a medical student.”

Representation in Medicine Saves Lives

It was my honor to be the first older transgender person they’d met, and yet, being called a “trans elder” caught me off-guard. I didn’t think my age qualified me as such, but as I began to think about it, I realized my lived experiences do. The patient was able to see that someone like them made it through medical trauma and gender affirmation to a place where, while my gender identity and history continue to inform my choices and course in life, they are no longer holding me back. Ultimately, coming out to this patient, even as a support person, made a major difference. They told me that my presence was therapeutic, my lived experience gave them comfort, and my visibility gave them hope.

But most trans patients don’t experience positive interactions with providers — never mind those who understand a trans person’s unique situation. What does this say about medicine and medical education? Modern medicine was built upon the same racist, sexist, homophobic, and transphobic foundation as the rest of the world. It may not be medicine’s fault, but the responsibility to change the system lies with those in the profession, including both new and seasoned professionals of any identity.

A legacy of poor education and treating gender identity and sexual orientation as pathology instead of a spectrum of normalcy continues to impact the environment we learn and train in. Additionally, legalized discrimination and medical trauma perpetuate a system where most transgender patients are, at worst, actively, and at best, passively, traumatized. At its foundation, medical education, like most education, was designed to include rich cisgender straight white men at the exclusion of all others. Only the fierce advocacy of those brave enough to fight through the racism, sexism, homophobia, transphobia, classism, ableism, and other institutionalized systems of oppression have enabled others with those identities to be here. It’s a constant battle — one that often ends in defeat — but seeing those who have overcome those barriers is incredibly powerful.

By being out and visible, by promoting inclusion behind-the-scenes, advocate physicians can set the wheels of change in motion. The system only shifts when those within it deliberately decide to make that change. By increasing the visibility, presence, and representation of transgender and gender-diverse clinicians, we are showing others (both cisgender and transgender) that our identities are not an antithesis to being medical professionals — that our lived experience is an asset and can help us provide more comprehensive care to patients, especially those who share our identities. We must advocate for more representation and training of transgender and gender-diverse healthcare professionals — it quite literally saves lives.

Garrett Garborcauskas (he/him/his) is a third-year medical student at the Frank H. Netter MD School of Medicine at Quinnipiac University.