“I am Landon Casolari, I use he/him or they/them pronouns. I am currently studying to become a therapist. It is exciting but it is a lot! My queerness has really fluctuated over the years. I came out as bi to myself when I was 17, and shortly after that I realized Oh Gender, that’s a whole thing! And then I came out as non-binary to myself and my friends. As I got to college, I realized I was more transmasculine than neutral, and I was still identifying as bi at the time. I’m now realizing that I’m probably not attracted to women, which feels a little bit blasphemous!
Until recently, I would only really bring up my queerness in therapy. It was one of those things that I never really shared with my primary care doctor. I thought they would think it was irrelevant, which obviously is not true. But that was how I felt about it. I had experienced people minimizing my queerness by saying ‘Why are you talking about that, it doesn't matter’. So, I felt like that would happen if I were to talk to my doctor about being queer. In therapy, however, I would talk about it, but it was very… Well, I feel like my therapist’s understanding of queerness was very 90’s, if that makes sense. It was a little outdated and wasn't super helpful. My therapist was accepting. There was never a rude tone or anything like that, but I don't think she had a good sense of how to help me through that process. So, a lot of my experiences of queerness in healthcare was me being really nervous about bringing it up. Then when I did bring it up, people didn't know how to discuss it in a helpful way.
A few months ago, I was going to a primary care physician who also saw my parents. So, I just didn't bring up anything. The doctor didn't know I was trans. I think they were aware that there was something a little bit gay going on, but I didn’t know if they knew the genre of gay.
I just didn't trust that medical professionals would be able to respect my identity, and it would be more painful to outright ask them to respect me. My thought process was, if they don't know and then they disrespect me and misgender, then that’s one thing. That will hurt, but only so much. On the other hand, if they are aware of my queerness and trans-ness, and they misgender and disrespect me anyway, that's gonna hurt a lot worse. So, I just didn't bring it up.
Then, I started going to Fenway Health (an LGBTQ+ focused health center), and that has been a much better experience. When I eventually came out as trans to my therapist in undergrad, she wasn't super clear on how to help me. But, she was aware of Fenway Health. She said ‘Those people can help you. I don’t know how to help you, but they can’. And, Fenway has been really, really great.
It is interesting that I am doing this interview because I have a really severe phobia of doctors, for many reasons. I really hate going to the doctor. I avoid it at all costs because of things related to lots of my identities. But there at Fenway Health, I haven’t had any bad experiences, and my current provider has been really helpful. Everyone there seems to be very understanding, they are willing to help me, and they don't say things that are triggering. Which, I know that this may be a low bar, but that is the bar that I have right now. I feel like I can actually bring every part of myself into the room. I don't feel like I have to leave my queerness at the door to get health care.
In my experience, Fenway is generally more understanding, even with things outside of queerness which is really important. My past interactions have been a lot of confusion [from health care providers and within the health care system]. There was one time, when I was at Planned Parenthood to receive an IUD, and they were really confused about what was going on. I was like Oh I’m Trans and were like Okaaay...what? This was in a very suburban area where I don’t think they experience a lot of queer folks, so I dont think it was necessarily done out of malice. I think that they just straight up had never helped a trans person there before.
This is not necessarily related to my queerness, but because of the fact that I am fat, health care providers have kind of been just the worst. They have been really triggering. A lot of my experiences have often been people blaming all my healthcare problems on me being fat.
At Fenway, my provider seems very conscious of the factors that I struggle with and is overall very thoughtful of what she says. She doesn't just blame everything on my weight or anything like that. She is very affirming in how she acknowledges those things. In saying ‘this must be really hard for you’ it almost feels a little bit like therapy. She is more compassionate than what I have experienced before in health care, to the point where it almost throws me off a little bit!
I kind of put medical transition off the table because I am worried about how my family will perceive me. I know it’s something I want to do and it is something I can access currently, but I am so afraid to just go for it. In terms of legal things, I honestly don't even know. It really stresses me out. Trying to change my name on official documentation and all that kind of stuff is going to be something that I put off until that last minute. Up until I think okay, this is just getting ridiculous and I just need to change it. I think that the most relevant part of my transition for me right now is the social transition.
I am just now starting to bring my actual self into health care settings. I went to urgent care a couple weeks ago, and for the first time I provided my legal name, and then said ‘this is my preferred name, if you could call me that’. It went really well. I am just getting used to acknowledging that I’m allowed to be who I am in healthcare settings, which is really sad honestly, because that's not how it should be. I also just started with a new therapist, who has been really great about understanding my gender, and, most importantly, is really willing to learn. That is a big thing: some people say ‘I don't understand this and that’s where I'm gonna stay’. It is really important to me that my providers are able to grow with me.
I would say, something I want providers to know, is [how helpful it would be] to acknowledge the power dynamic that is present. If you’re a physician and you're meeting with a patient, you have a lot more power than they have. The patient may be really anxious around you or they might not be sure if you're going to be accepting. Being aware of the power that you hold [will help you] recognize that how you react to them, is going to make a big difference in their comfort level going forward. Even if it is something that you are really confused about, that is okay, but just be upfront with it. [Addressing it with words like], Oh I don’t have a lot of experience working with trans people, but I'm really willing to learn so if there is anything that you feel like I don’t really understand, please let me know, and I’ll do this research on my own. Something like that would be really helpful, because a lot of times I don't really think that providers are aware of the fact that they hold a lot of power in that relationship.
Keep in mind that you're allowed to bring all of yourself into appointments with your providers. If you are meeting with someone that you don't feel like you're able to be yourself with, then that is probably not the provider for you. This is easier for me to say than it is to do. Now, obviously, not everyone has the luxury of shopping for doctors, but it is important to advocate for yourself, and let them know what you need. It is being mindful of [the potential to be] in a situation where you can’t be yourself in healthcare settings or in general, and to be aware of how that is going to impact you. Even if it is something that you're getting used to--not really being yourself--it is going to impact you and your mental health. It is really important to be compassionate and find an outlet where you can fully be yourself. It is so hard to be closetted in any setting, but a lot of people don't have the luxury of being themselves. So, it is really important that if you can't always be yourself, you find an outlet so that you can at least acknowledge all of you, somewhere.
My outlet, for a long time, was really only Landon with friends. In class, with parents, in healthcare settings, in therapy: I was my birth name. Regardless of what name I [would] go by, a lot of my stuff that I would talk about was the same, but there was also a really big part of myself that I could only talk about with friends. And so, that really turned into spending a lot of time with my friends and having them remind me that it is okay to be trans, it is ok to be Landon, and it is okay to be myself, basically. And for a long time, probably a couple years, the only way that I could really be myself was in those moments with my friends. Until I was able to slowly expand the spaces where I was Landon, it was very much compartmentalizing my life. And I am just now starting to break down those barriers and allow myself to be who I actually am in all areas of my life. It is definitely a work in progress, but I started separately by almost living two lives: one with my family and one with my friend. And I am starting to take down those barriers, where now it is more that I have a seperate part of my life where that is my birth name and in the rest of my life I am Landon. So, it is almost swapped now, which is great. I would like to be just fully myself everywhere, but ya know, that is gonna take a while.
With these topics, I honestly don’t know how I am coping with it. It is one of those things that I try as much as possible not to think about because it is just one of those things that makes me really overwhelmed. Which as a future therapist, that is probably not the best way to cope with things, but ya know what, it is what it is, haha! It is always funny to me that I tell my clients one thing, you should cope with this actively instead of just letting this go, and then, in my personal life, I do exactly what they do!
I think one way of coping with it is making your gender presentation as close to your ideal as you can in the meantime. For some people that may be dressing in a certain way or wearing makeup or using a bander or a gaff or whatever that might look like for you. Try to adjust your clothes and stuff like that, so you feel more comfortable in the meantime, while acknowledging that you're not going to feel perfectly comfortable. Another really helpful thing is reminding yourself that this isn't permanent. At least for people in my situation, where you cannot medically transition right now, but there likely will be a day when you can. Or, you can work towards feeling more comfortable in your skin at some point. Another thing I like to do to cope is to plan outfits. For me, I really want to get top surgery, really badly. So, I like to plan outfits for when I have top surgery. I think, I'm going to wear this and I'm going to wear this outrageous outfit!
Acknowledging that it does negatively impact your mental health is helpful. I think a lot of times people feel like Oh well that’s just how it is! So I shouldn't have any feelings about it; it is what it is; whatever. Which is a great defense mechanism, but is not really accurate to peoples’ experiences. If you're not able to look how you want and you’re not able to present how you want, it can be really detrimental. So, be really mindful of the fact that you're struggling with something, and you might need extra self care or you might need extra time to yourself, or things like that.
I would say, overall, it is really just important for you to acknowledge your queerness and try your best to find a place where you can be authentically yourself in healthcare settings. Because for me, I think I minimize that part of myself as not really relevant, but that's not true! It is relevant! And so, if anyone else struggles with that, just know that you're not alone. Your queerness or whatever identity that you're struggling with is important and should be affirmed by your health care providers. So if you are not being affirmed in these spaces, at the minimum be aware that they should be able to do that. If you can find a different provider who is able to affirm all of you, that is important.
It is interesting because I don't necessary think of myself as being in health care, but I am becoming a therapist, and a lot of my training is around cultural competence: being aware of areas of privilege, areas of marginalization, ways in which we hold power as therapists over our clients, and acknowledging this action if it occurs. We have whole classes on acknowledging our privilege and how to work through that and how to work with clients who have certain marginalized identities. I don't know if that is true for other health care providers. I would imagine, not really. So, do that work on your own. If it is not provided in your training, it doesn't mean it's not important. It is really important to be aware of all different types of identities and how that impacts people’s experience in healthcare.
A lot of times, for queer folks, we think Oh I understand what that is like [to be in amarginalized identity]. But there are lots of other marginalized identities that are impacted in healthcare. Be aware that your race is really relevant to how you are able to provide for your patients, or if youre skinny, be aware that your plus sized clients are going to have a lot of trauma to unpack, or if your cis- be aware of the ares where you hold privlaged. Because even if you hold one or more marginalized identities, it does not mean that you're going to be super aware of how to help people of all marginalized communities.
For a long time, as a white queer person, I thought I understood marginalization and how this impacts people in healthcare settings, and to some extend I do understand that from being a queer person and fat person. But, I don't know what it is like to be a person of color, and that is really relevant, and that is something I need to work on. So just being aware that yes, I understand this, but I don't understand everything. And that is okay, and I am going to learn.
I would be remiss if I didn't say something vaguely therapeutic! Do something kind for yourself, and try to do it every day. If that is reminding yourself of positive characteristics about yourself, or doing deep breathing, or taking a break when you need one, it is really important that you do that. Because anyone in the world right now is experiencing a lot and is going through a lot, so it is really important to be self compassionate and give yourself those breaks when you need them." -Landon C., Southern California (he/they)