"Life really does work out in the end..."


"Hello! My name is Minh (he/him). I am currently a fourth-year pharmacy student at the University of Maryland School of Pharmacy. I just finished my last clinical rotation a few months ago, so now I’m just waiting to graduate in May. I also just turned 27 – the big two-seven – a couple weeks ago and I’m not sure who needs to hear this, but: I apologize not only for being an Aquarius, but for being an Aquarius man. I just finished applying to pharmacy residencies and I'm waiting to hear back for some interviews. (Hopefully I get some by the time you read this!)

 

I started questioning my sexuality around middle school. I used to get really nervous in the locker rooms where we would have to change for gym class. Eventually, I was like... 'maybe I don't like girls!' And honestly, it was really towards the end of high school when I really accepted my sexuality, and that's when I first started coming out to my friends as a gay person. I spent a lot of my college career coming out to my friends, slowly. Coming out was really hard for me, but eventually it just became very natural to assimilate my sexual identity into who I am. I remember seeing those ‘it gets easier’ commercials on TV growing up, but I’d never expect that it would happen to me. I grew up in a very conservative area with very traditional parents, so I feel like that contributed to my hesitation to about coming out, especially (what I feel like) was rather late in my life. Now, I'd say I’m about…95% out, and the only people left are my parents. All my friends know by now and I even have a pride flag enamel pin that I wear on my white coat! I was very nervous putting the pin on for the first time, but one day I got over my nerves and it’s been on my white coat’s lapel for 2 years now! I get a lot of compliments on it, but I always take it off when I go home, just in case... although I'm sure my mom has a feeling.

 

Honestly, I haven't had that many experiences as a queer person in healthcare, and I really don't remember my first experience. The only thing that comes to mind... because I’m a first-generation American living in a conservative area, growing up I didn't personally know of anyone in healthcare or anyone queer, let alone anyone queer in healthcare. My only exposure to queerness intersection healthcare, really, was through media, like Grey's Anatomy, Nip/Tuck, and House, but it still felt taboo back then.


As a patient, I feel completely comfortable, until I get asked if I'm sexually active. I'll say 'Yes', and then follow up with ‘'Are your partners male or female?' And 11 times out of 10, I always hesitate before saying ‘Male’. I don’t know how to explain it, but for whatever reason, no matter how comfortable I am with my sexuality, part of me feels the need to hide my sexuality from my healthcare providers. I know I really shouldn’t feel that way, but it's almost like a defense mechanism to me. And then there’s, donating blood and bone marrow. The moral dilemma I get placed in when I get asked 'have you had sex with another male in the past 5 years?' Do I tell the truth and get reject? Or do I lie and potentially save someone’s life but then live with the fact that I had to lie to get what I want (I don’t like to lie). It's unfortunate but it is what it is.


When my experiences as a LGBTQ+ person come up, normally, providers are very neutral. I really try not to generalize, but there's more hesitation when the provider is an older, white, cis male. But overall, it's been a very neutral experience. The providers I’ve seen have at least done the bare minimum of not judging, or if they are [judging] I don't sense that thankfully. One time, a provider asked if I had interest in PrEP, because I have sex with male partners. At the time I just said, 'Oh, no I'm not interested.' but I thought it was pretty cool.

 

Being a first-generation person in healthcare is pretty tough! As a kid, I was learning English alongside my parents, and before the golden age of the internet, it was hard to find opportunities to get my foot in the door because my parents didn’t know anyone in healthcare. I remember I was so happy to find out about a children's volunteering opportunity at a local hospital when I was around 7 or 8, but I remember I struggled so much when it came to the application and interview. My parents don’t have resumés, at the time their American work experiences were either in the service industry or local nail salons, neither of which they mentioned required a formal job application process. And because they were working 7 days a week, they really discouraged me from pursuing extracurriculars in school, because they were always too busy at work to pick me up after school. Growing up was a lot of learning by myself and I really didn't have anyone I could lean on.

 

In pharmacy school, I'm still coming out to people. Honestly, I was a little nervous coming out to people in school. I know I shouldn’t be because, I mean, they're all my age, give or take 5 years, and (for the most part, love you Josh if you’re reading this) they’re all generally liberal and open-minded. So it's really not that big of a deal, although I'm still nervous about it.


For the past 8 or so months, I have been doing my clinical rotations. Since I've been wearing my pride pin on my white coat so everyone can see it. It's nice to see other doctors and nurses also wearing pride pins... it makes me feel like, 'Oh! I'm not the only queer person here.' In terms of seeing patients, I work at a grocery store pharmacy on the weekends, where people compliment my pin. And, my grocery store has partnered with a local hospital to do free HIV and STI testing twice a month. The people who ran it asked me where I got my pin and I said, 'Oh, my best friend got it for me.' Next month when I saw them, they showed me that I inspired them and they actually got the same exact pin for their backpack!

On the hospital side… When I was doing my ambulatory care rotation in an outpatient transplant clinic, and I went in to see my patient who had someone in the room with him, and after introducing myself, I said ‘Who do I have the pleasure of speaking with today?’ and he introduced the other person as his partner. At that same time, I noticed that they both looked at my pride pin, and I vividly remember seeing them both relax their bodies after that small interaction. The rest of check-up felt very casual and they seemed to open up to me a lot. I never expected to make such an impact on people when I first put on the pride pin on my white coat.

 

Because I'm in pharmacy school, there's a lot more of an emphasis on the medication. In our endocrine module, there was a section on hormones, for gender-affirmation and transitioning. So we did learn about that for a bit. But in the curriculum, that's really the only exposure to the LGBTQ+ population that I can think of. I don't know if this is appropriate, but in our cardiology unit, we do mention poppers (a drug that is inhaled and produces an instant high). You can't take that while you're on Viagra or Cialis due to their interacting mechanisms. I thought that was pretty funny.


One of the cool things that was recently started on my school’s campus, was a collaboration with the school of nursing, school of pharmacy, and school of medicine, to offer a week-long pilot course-study on providing interprofessional care for transgender pediatric and adolescent patients. I had the privilege of signing up for it and it was a really great experience. We were split into groups with at least one medical, nursing, and pharmacy student in each group. The really great part is that the professors brought in local transgender adolescents about their experiences in the healthcare system as a trans person and what they wished their providers did better, and offered insight on how we, as future providers, can improve care for trans people moving forward. It was a really rewarding experience, I hope that they offer it more in the future, since that was their first year trying to program.


I have also been able to sit in on a Continuing Education information session, about the controversies with gender hormone therapy – caring for transgender people, insights and points of controversy in medication therapy, and it was really interesting! It reinforced education we learned in our other module, including doses and drug target goals, and effects in gender affirming hormone therapy. But they also delved into more nuanced things, such as a study which supported subcutaneous testosterone injections compared to intramuscular. I also remember something about estrogen tablets, where it mentioned that guidelines say patients can take the tablet that sublingually (place under the tongue) rather than swallowing it to avoid something called first-pass metabolism, where the liver breaks down drugs before it reaches systemic circulation. Essentially the idea is that placing it under the tongue allows for better absorption, but the tablets aren’t formulated for sublingual absorption, so there needs to be more research on the efficacy of that.


I think pharmacists are one of, if not the most accessible healthcare provider. There's a CVS, Walgreens, or grocery store pharmacy everywhere. If there’s one thing that the COVID-19 pandemic taught us, it’s that community and retail pharmacists especially are an integral yet undervalued part of healthcare. I think that, should they choose to, that could have the biggest role for improving and advocating for LGBTQ+ healthcare,



I would hope to see the future of queer medicine as more being more... queer. I feel like as more and more queer people enter healthcare and we keep advocating for things like including pronouns on hospital pins and badges, we can make healthcare more comfortable for the LGBTQ+ community. Personally, I feel like some members of the LGBTQ+ community may have mistrust in the medical community. I would hope that we, as future queer providers can really do something to close that gap.


I would say for advice for any queer health providers future providers reading, to just keep taking opportunities that you can to advocate or learn more about providing care, and also to be the person you wish you had growing up. That's really cliché sorry... And then for the non-queer providers reading, to keep supporting your friends and family. Just having your pronouns visible helps show that you are an ally. And if you see an opportunity like I did with the pediatric and adolescent trans-care pilot course, from the pharmacy students I was the only queer person in my cohort of those pharmacy students (that I know of!). I was glad to see a lot of allies there too, it wasn't just queer people, so it was great to see that.

 

To my younger self: I know we don’t like that cliché saying, but life really does work out in the end, so try not to stress that much.. Also! Do not chase that one boy freshman year in college because he’s not worth it!! I hope he doesn't read that oops. You're not alone being queer and going into the healthcare field. And coming out really does get easier; you’ll surround yourself with people who will show you nothing but unconditional love and support." -Minh T., Baltimore, MD (he/him)



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