"I deserve to have gender affirming care..."



"My name is Shea Buckley, I use they/them pronouns, and I am a trans, gender non-conforming, queer medical student in my first year at New York Institute of Technology in their DO program. I don't exactly know what I want to go into, but I’ve been strongly considering OB/GYN with a focus on queer and trans sexual health, reproductive care, and birthing. I know that it needs to involve the LGBTQIA community because that is where my passions lie at the end of the day.


My coming-out happened in stages. The first stage, in regards to sexuality, was in which I was realizing, processing, keeping secrets, about who the people I actually had feelings for were. As a kid I had a place in my room where I wrote down the people I had a crush on, which was bold of me, and my sister found it! And she came to me and she said... we have the same secret, and it's okay, as long as we don't tell anybody.


And that was the first outing experience that I had. We went along with our lives for a good while, before coming out to anybody else. I grew up in a very conservative town, in a very religious, Roman-Catholic household. I always knew that queerness wasn't an option. It wasn't acceptable. I internalized that. For a while, I tried to pray the gay away, and that was very painful and scary. It really dissociated me from those identities that I was just trying to figure out… You know we're all trying to figure these identities out when we're teenagers. I ended up being outed to my parents as queer my freshman year of high school, which was a really traumatic experience. At the end of the day, it didn't turn out too terribly in terms of how they treated me. They came around to accepting it, and being okay with it. I was the first out gay person in my high school to go to a prom with their girlfriend, and we got a lot of crap for that.


That was all happening and I still didn't feel like I was who I was. I didn't have the words for, I didn't even conceptually know, what being non-binary or gender queer or even trans was. I didn't have the knowledge because it was not talked about as something that was a possibility. Fast forward a little bit, I came out in terms of my gender, as trans, when I went away to college.


I went to a women-centered university, which was very queer (which was amazing, and was one of the reasons that I went there). But it was a woman-centered institution, and I was there… wasn't I a woman? But there was a really lovely core group of trans and gender non-conforming people. I dove headfirst into that community and was able to really process my identities and come into myself. I ended up coming out to my family that first year of college – which turned out to be a very slow and painful process. The pronouns, the name, everything was very difficult for them. That was a very painful time in my life because there was so much uncertainty about how things would end up and if I would be accepted and all of that. My parents have really come around, my mom is my biggest support in standing up for me when her friends or people that we meet on the street misgender me – she's totally all there. And that has been so incredibly important, and having my sister as a queer ally. We call each other "quiblings", or queer-siblings! We've really pulled each other through. And that has been in the face of some familial tension. My brother is in seminary to become a catholic priest and does not accept who I am and does not accept who my sister is. And that has been full of a lot of pain.


But now I live my life as an out trans person. I find a lot of joy in knowing that most of the people in my life now just know me as Shea, with they/them pronouns. And that's how I introduce myself, and that's how they know me. And it's really great to not have the baggage of needing to come out every as different, you know, like, ask people to change their perceptions of me, as opposed to just enter into every interaction in any relationship with a baseline knowledge of who I am, and I have a really strong sense of self now that I never had before.

 

I think that every interaction that I had with healthcare providers growing up was reserved and entirely secretive. I didn't come out to any providers that I had until after I came to college, and was able to go to a specifically queer healthcare center. And that baseline

misunderstanding between me and my providers was a big wedge. I didn't feel safe with them. I didn't feel myself with them. And those are two of the most important things that I want to cultivate in my practice as a physician – the two most important things for me are to make my patients feel safe, and like they can be themselves. I never got that growing up. When I went to college, I was in Boston, and I was right down the street from Fenway Health which is a queer community health center. And, in my work as president of the trans org(anization) campus, I had pooled resources about different places that people could go for trans specific health care. And I knew that Fenway was there, but I still didn't go for a couple of years.


I was just like, ‘I can handle what my current situation is.' But then I realized that I didn't have to, and I could find someone who actually respected my identities, and to whom I can bring my whole self to the table. And so it wasn't until late in my college career that I decided to actually seek out a provider who was understanding and educated and willing to meet me where I was.


And it was my senior year of college, when I was looking for an internship, that I started merging my queer identity with my career. Although...I was unsure of what my career was going to be. I hadn't even thought of crossing those two, you know, those two separate spheres of my life. On a whim, I reached out to Fenway and found out that they had a research institute focused on sexual health and HIV and reached out to the Simmons alum that was working there and got an internship. That's when my mind opened to: 'Oh, my God, these two things don't have to be separate, I don't have to hide this aspect of myself from what I want. I don't have to keep them as separate entities, I can do both. And I can be proud and out and working with people who are in the community, who can trust me as someone who can provide them with care that is educated and informed.'


That was a game changer for me, because before that point, I thought I was just going to be a provider who happened to be trans; I was going to be successful, and also be trans doing it.


At the time, that seemed like the ideal. I was thinking you don't see providers who are trans, or queer and successful in their field. And I wanted to do that, and be that. I was just going to do that and be representation for the next generation, but not necessarily interact with that next generation... Until I got to Fenway, I realized that I could be that successful person and also care for the community so that people don't have to go their whole lives without going to a health care provider who they can actually trust and feel safe with.

 

I was in college around people who talked about transition and who were going through transitioning medically, and I always kind of thought, 'Oh, no, I'm not trans enough for that. That's not really something I can do.' It took a while of internally really wanting these things, telling a couple of people here and there how ‘I really want my body to look different than it is.’ And ‘I really want my voice to sound different than it is.’ It took a lot of time before I realized that there was absolutely no reason that I couldn't get that. There was no reason that I didn't deserve that.


The hardest part of my transition was realizing that I deserved to have gender affirming care, and to have a body that felt like mine. That didn't happen for a long while...and then it all happened really quickly. Once I realized I could do this, I was like...I need this now. And I did end up going to Fenway for starting my testosterone. And I had a pretty good experience there with two separate providers who were both cis women, but who made me feel comfortable and were obviously very educated on hormones and prescribing for trans patients. I felt safe in that care.


One of the biggest hurdles, I guess I said this a little bit out of order. But when I told my parents that I wanted to physically transition, they got very upset. And they kicked me off the insurance, I think to try and deter me. It didn't deter me; I was very lucky at the time because I had a job and I could get insurance on my own. That disagreement is behind us. They have come around, but I had to do it all on my own. I had to figure out how to do it on my own. I was able to get insurance through my work and start testosterone like I wanted to. It did take a little bit longer than I wanted it to, but it ended up being pretty smooth sailing, it's just that I wanted to be 10 steps ahead of where I was at any given moment.


I also had gender affirming top surgery while I was still in Boston at Boston Children's. When I went to Boston Children's for my intake appointment, I came out of there feeling like that was the best thing that I've ever experienced! The way that they treated me was the best I've ever been treated. I came out of there so dumbfounded that it could be like that. And I was like, that's incredible. That was amazing. I want to be there. I want to be them when I grow up. They were so good about everything. There were a couple of times when they did use the wrong pronouns, like using he-series pronouns instead of they-series, which, of course, isn't ideal. But it was so much better than what I had gotten anywhere else. So I just was like, wow, this is brilliant.


Now that I am in a different state, I had to transfer my care to a New York State provider. I found another queer health center – Callen Lorde – in the city. And I ended up going there and I now have a non-binary provider who I've interacted with a number of times and they are my favorite. It has been so incredible. Their attentiveness and their empathy and their communication has been absolutely incredible.


They were able to educate me on things that I didn't know about my transition. They were able to answer questions that I didn't even realize that I didn't have the answers to. We talked about hormone levels and they were like, ‘well, you know, this is why we should do this and not higher, not lower,’ and ‘what are the effects that you're looking for? this is how we can get those for you.’ And it was just, you know, it was brilliant. I felt very supported through that. I'm so glad that I did that, because when I first moved here, I thought I would just go to the school health center, and get my PCP there with someone who probably would have been a member of the faculty teaching me.


I thought about doing that. But in my experience with NYIT, there was no evidence that would indicate people on faculty at NYIT know enough about trans healthcare to be supporting me through this. I was able to talk with some people in my support system who reminded me that I deserve great care. That just because I'm trans and need something different than a cisgender classmate who might be successful at the school health center, that's not something to be ashamed of. Seeking out providers that can actually see me as who I am and give me what I need, is so important. It was a moment of clarity of reminding myself that I deserved adequate and more than adequate care, I deserve great care.


I'm so grateful that I've made that decision to go out and travel to the city for my care because it's been the most incredible experience, I’ve even caught myself thinking: Is this how people feel? Is this how it feels to be respected and seen in society? Because outside of very niche groups of people, as a non-binary, genderqueer trans person, I have quite literally never been seen as who I am. It's always being assumed to be something different than who I am. When I was pre-transition, I was always assumed female, I was assumed to just be a queer woman. And that was really, really painful. Now that I am transitioning and trying to keep myself safe on Long Island, I express masculinely (growing out my stubble). I'm assumed to be a guy, sometimes a trans guy, but most of the time I just pass as a guy. And that's also painful. It's painful either way. There's no assumption that is correct about me, is what I've realized, because we live in a binary world. And so to walk into a doctor's office and to have someone first off, not make assumptions, and second off, see me and respect me in my identities, has been brilliant.

 

I came to NYIT from a series of two very queer bubbles. I was at Simmons, which was very queer. I was at Fenway, which was very queer. I came to New York Institute of Technology here on Long Island, and I was all of a sudden the only trans person. I knew it was going to be difficult. I was prepping myself for a lot of emotional energy that needed to be, you know, dedicated towards either handling and just taking being misgendered or actually standing up for myself; I wasn't sure which one I would end up doing more. But I knew that either way, it was going to take a lot of emotional energy. And it certainly has, it certainly has. I have tried to stand up for myself at different points with different people. And for the most part, it's been largely unsuccessful. And that's really sad, that it's pretty gut wrenching to be like: I have tried. And I've tried again. I don't necessarily have the energy to keep trying, at least in this specific setting. I am hopeful that because of my desire to work with and for the queer community, once I go to residency, and if I decide to go to fellowship or anything after that, that I can be within a practice that will be a little bit more like the environments I've been in in the past – where I don't have to try as hard. Hopefully it’ll just be a universal baseline that people respect my pronouns and don't ask ignorant questions and all of that.


But right now, I have three years left of getting through medical school. And that's not to say that I haven't tried or that I won't continue to try. I have made a couple of connections with people both in the community and allies who have been kind of beacons. I'll give you this little story... My school does something that they call clinical practice reflections (CPR). CPR is where they introduce the student body to various patient experiences and different determinants of health and disparities within healthcare. And they made an attempt to do one on trans identities. And they did so poorly. As the only out trans person in my class of 350 (in the school at large, I believe, which you know, is 350 times four), I reached out to one of my queer classmates and we are sitting down with the deans to discuss how that [activity] did more harm than good. I'm hoping to at least have my voice heard in that setting. It's really scary, because I know for a fact that there are faculty who don't respect trans identities because I've heard them misgender me constantly. I have heard them say problematic things. So, I know that I'm putting myself out on the line for this one, but I think it's worth it because even if it were just my class – that's 350 providers who know better how to treat a trans patient and that is worth it.


So, I am putting in the extra energy, facing the the fear of how I will be treated, to hopefully make an impact on the education of my peers in a positive way so that when they go out into the world and interact with trans people, because they will, and when they interact with queer people, because they will, no matter what they're doing, that they don't royally screw up. And because that is dangerous for our community. It's dangerous to open yourself up to a provider in that way and be treated poorly, either because of ignorance or because of malice. The community deserves more than that. You know, it's been hard, I have to seek my queer validation outside of school. So I do that. But I'm putting an effort where I can and conserving energy where I can. I'm hoping that once I'm able to be more selective about what it is that I'm doing, and where I'm doing it, that hopefully the environment that I'm in will hold space for me better.

 

If we're talking 'closeted-Shea' I would say, you are going to learn how to be proud and how to be bold. You are going to learn about yourself in ways that you can't even imagine right now. I urge you to let yourself do that, and let yourself have and experience that joy. Don't think of yourself as deserving any less because you deserve the queer joy, the trans joy, the joy... period.


For everybody who is going to be somehow involved in healthcare, so providers (whether they're within the community or not), I would encourage them to reflect on their education and on their knowledge. I urge them to be thorough and fearless in that reflection and to really take it upon themselves to educate and learn from the queer community about how best to care for the queer community. Because it is only through that expertise and experience that they will be able to better care for our community, and that's what is really lacking – listening to the people who are in need of care. So, for all the providers out there, just put in the work. It is so incredibly impactful, and you will not be sorry for how much of a positive impact you will have for the LGBTQ community through some real educated care." -Shea Buckley, Long Island, NY (they/them)




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