The doctor’s office, a place where needles in the arm and Popsicle sticks in the throat are commonplace, can be an uncomfortable setting for anyone.
But for those who feel misidentified, it's worse. "Trans folk are distrustful of the clinic setting," explains Adrien Lawyer, executive director of the Albuquerque-based Transgender Resource Center of New Mexico.
"Providers have refused to touch [transgender] bodies. People have been called by the wrong gender," he says.
Jess Clark, an education and prevention supervisor at Solace Crisis Treatment Center in Santa Fe, agrees and says oftentimes transgender people get "misgendered" at the doctor's office, "from someone calling you your birth-given name to a doctor not asking you the right questions about pregnancy, about what kind of partners or what kind of sex you're having."
Occurrences like these may explain why the transgender community is more likely to shy away from health care.
A 2010 study by the National Center for Transgender Equality and the National Gay and Lesbian Task Force found that nearly 30 percent of transgender individuals surveyed postpone seeking medical care when sick or injured because of discrimination.
But by all accounts, transgender people are in disproportionate need of health care. The same study found that nearly half of those questioned reported that they couldn't afford health care. Rates of HIV infection are four times higher in the transgender community compared to the national average. And perhaps most alarming is that 41 percent surveyed reported attempting suicide—much higher than the 1.6 percent in the general population.
Clark says fear of accessing health care is common in the transgender experience, explaining it further as the "fear of someone's biases getting in the way of correct treatment" and the "fear of people whispering beside you, 'Is it a boy or a girl?'" Kristine Parke, a family medical practice doctor at Christus St. Vincent DeVargas Health Center, says one of the biggest problems with transgender health care is the lack of training on the field.
Though she's been treating transgender patients in Santa Fe for the past decade, Parke says her training on the issue has been self taught mostly through reading manuals.
"Traditionally in medical school and residencies, there's zero training with that," Parke tells SFR.
“Transgender” itself is a broad term encompassing a wide range of people. The
says it’s used by, but not limited to “cross dressers (those who wear clothing of the other sex some of the time)” and “genderqueer people (those who feel they belong to either both genders or neither gender).”
Clark's personal story, he says, is pretty simple. He identifies as transmasculine, meaning he was assigned female at birth but identifies as male. He's been "out as trans for five years now," he says.
"I grew up in Santa Fe and always presented masculinity," Clark says. He maintains that for now, transgender-targeted health clinics are necessary until larger medical providers are trained to treat the transgender community. It's something that the Transgender Resource Center has been working on.
In the fall of 2012, the organization held its first ever "Pabst & Paps" pap clinic for transmasculine people who are fully or partially equipped with female body parts.
The idea behind the Pabst & Paps name was to create a masculine-sounding title (Pabst refers to the blue-collar beer, though Lawyer says the clinic doesn't serve alcohol) for a health care practice usually associated with women. But more serious is the attempt to get needed care to those who "don't want to come face-to-face with a part of their body that they have negative feelings about."
"We know this is a screen that people need," Lawyer says.
But expanding the clinic's services remains an issue.
In the past year and half, the Pabst & Paps clinic has operated a handful of times at Albuquerque's Midtown Public Health Office. Later this month, the Transgender Resource Center will hold free sexually transmitted infection tests at the same location.
So far, these clinics have been held in Albuquerque. Still, both Lawyer and Clark say that Santa Fe offers many good doctors and providers respectful of transgender patients. And Santa Fe's transgender community can take part in a support group that meets on the evenings of the second and fourth Wednesday of each month. More information on that can be obtained by contacting the Transgender Resource Center at (505) 200-9086.
This coming April, Parke says she plans to attend her first continuing medical education conference on transgender hormone therapy. Overall, a combination of caring, respect and compassion, Lawyer says, is key. To ensure comfort, the TRC recruits local nurse midwives who have "a willingness to maintain an open mind" by being respectful and not calling their patients by the wrong name and pronoun.
"As odd as it may seem, we have clinicians who call somebody 'sir' while they're looking at a cervix," Lawyer says.
What: Free gonorrhea, chlamydia, hepatitis and HPV testing for the transgender community
Where: Midtown Public Health Office. 2400 Wellesley Drive, NE Albuquerque
When: Friday, Feb. 28 from 7pm to 9pm