#7: Beyond the Binary
COMMUNITY VOICE: Kat | HEALTHCARE EXPERTS: Carl Drake MD MPH; Carl Streed MD MPH FACP | COMMUNITY REVIEWER: V. Greene
SOME RESOURCES
Got something useful that we didn’t list? Shoot us a message and we’d be glad to include it.
Safer Binding, from Callen Lorde Community Health Center
Safer Tucking, from Callen Lorde Community Health Center
SHOW NOTES
As always, some definitions up front.
Non-binary is a space that lives somewhere outside of male and female, or occupies both genders in varying degrees simultaneously.
For most folks, non binary falls under the identity umbrella of transgender, but as always, this is not universal.
Some sibling terms: gender queer or gender nonconforming
Why discuss non-binary care on its own?
We know that non-binary communities have a unique set of healthcare disparities and health care experiences.
We also know that non-binary individuals have different health outcomes, healthcare needs, and healthcare experiences when examed separately from the binary transgender umbrella.
Gender is a social construct. This matters to medicine because it impacts how we see non binary individuals and impacts their ability to navigate health care spaces
Non-pharmaceutical gender affirming steps
Stuffing: often rolled socks or a phallic shaped object in one's pants to present the image of a fuller package
Tucking - people with penises to tuck their testes into their groin and often tape their phallus to create a flatter appearance in their crotch
Check out some health tips at Callen Lorde’s Safer Tucking pamphlet
Binding - Wearing a special garment, cloth or other material to flatten chest tissue or contour one’s body
Some tips, consolidated from Callen Lorde’s Safer Binding pamphlet:
Max out your daily binder wearing around 8 to 12 hours a day
Avoid duct tape and ace bandages as these can cut into skin
Use undershirts or body powder to minimize the effects of sweating, like rashes and chafing
Hormones (specifically microdosing)
On the “micro” in microdosing:
It implies a binary as the “standard” size. We don’t love that implication, but it’s the word we heard from the community.
Other similar words we like more: “low dose”.
Our (improved) slogan: same hormones, different dosing
Misconceptions:
You can control the changes you going to get with a smaller dose
The effect size will be smaller (i.e. proportional to the dose)
Small doses mean non-permanent effects
General approach from a provider standpoint:
Go slowly and monitor effects
Expect a time frame of months to years to fully realize any changes
Constantly re-assess
Informed consent and microdosing.
Surgery, briefly.
It’s a la carte.
Any gender affirming surgery can be part of someone’s non binary affirming care.
Something we don’t love: to get a surgery approved by insurance, non-binary folks often have to resort to the binary - for example, someone may have to state they claim a male gender identity in order to receive the coverage for top surgery
Primary care for a non binary individual
Good gender-affirming care is grounded in good primary care!
Regardless of someone’s need for medically regulated medications (hormones) or procedure (surgeries) high quality primary care will include discussion of anatomy, gender identity, and sexual orientation.
For non binary folks, the binary expectations of a clinical space can be a barrier. From the paperwork to the social understanding of binary gender that health care workers bring with them to the clinical space - the reality of anticipated or experienced stigma is real.
Providers who are skilled in LGB health or transgender health may have shortcomings when it comes to understanding the goals and lived experience of non binary health care consumers.
TRANSCRIPT
Kat Griffin: When I say that I'm non binary, I guess I'm saying that I exist outside the binary of male and female. I'm, I'm saying that I'm transgender, but where some people transition in a more binary way, I transitioned in a non-binary way.
[QHP THEME MUSIC]
Gaby: Welcome to QHP. QHP is a podcast about queer health topics for sexual and gender minorities. My name is Gaby. I am a Cancer on the Leo cusp and I use she/her pronouns and I'm in primary care/internal medicine training in New York City.
Sam: My name's Sam. I use he/him pronouns. I'm a Gemini. My Patronus is a lox bagel talking like Fran Lebowitz. And as per usual, I have the same job title as Gaby.
Richard: I'm Richard. I use he/him pronouns and I'm a Gemini. I'm a pop culture enthusiast and the medical director of the pride health center at Bellevue hospital in New York city.
Sam: You're listening to QHP Episode Six: Primary Care for Non-Binary People.
Gaby: At the start of the episode we heard from Kat Griffin, this episode’s community voice.
Kat Griffin: Hello, my name is Kat Griffin. I am a New York-based actor and photographer. I am non-binary and I use they/them pronouns.
Gaby: Let's do some definitions. When we and Kat say binary, we are referring to our postmodern Western middle and upper class, mostly white race infused notions of gender. This strictly delineates two gender identities, masculine and feminine.
Richard: In contrast, non-binary is a space that lives somewhere outside of male and female, or occupies both genders in varying degrees simultaneously. For most folks, non binary falls under the identity umbrella of transgender, but as always, this is not universal.
Gaby: And non-binary has some sibling terms that folks may also identify with or prefer. Those are gender queer or gender nonconforming. And some may simply identify as queer, which has become sort of a respectful and reclaimed umbrella term for people who fall outside of sex and gender stereotypes.
Richard: The reason we're spending so much time on definitions is because the understanding of gender as more than just male or female is the hurdle that Kat and many in the non-binary community find themselves jumping in healthcare spaces.
Sam: For this season's most obvious understatement award we have the following nominee: gender is complicated.
Richard: Let's round out some more vocab. When we say trans masculine, we're referring to a transgender person who identifies as masculine or with masculine gender identity traits. Same for trans feminine and identifying as feminine or with feminine identity traits.
Sam: We hold these truths to be self-evident - regardless of someone's anatomy.
Richard: We've chosen to discuss non-binary care as its own topic for a few reasons. One big one is that we know folks who identify as non binary have health outcomes and access that looks different from folks who identify as binary.
Gaby: Trans health is too seldom examined separately from LGBTQ health. And non-binary health even more rarely gets separated out from trans health.
Sam: This episode will touch on a few important elements of non-binary health care. Many of these concepts are applicable to broader trans and queer health, but our hope is that by speaking to non-binary or healthcare on its own, we give folks a vocab for their health care experience and start to identify some ways to navigate healthcare spaces as non-binary.
[TRANSITION MUSIC]
Kat Griffin: I have this specific experience of where, had I transitioned in a more binary way, I could have identified as a trans man. And I think I know that I'm not a man right now, and that's just not my truth. And of course there are so many different ways that people express their gender.
Sam: Kat spoke about the ways a nonbinary identity fits their own gender experience, but remains this spacious term.
Kat Griffin: When I switched to just they/them pronouns, I thought about switching to they/he pronouns because I am a more masculine presenting person and I've had top surgery and I definitely align with that side of the spectrum. And of course it's not to say that some people who use she and he pronouns can't be non binary. Some people can be non-binary people can not change a single thing about the way they present themselves and be non binary. But for me, it manifests in a more transmasculine way. But I'm not a boy and I'm not a girl. So my definition of non-binary is more so just kind of like, look at me! I exist! And therefore I am this label because that's what I've decided.
Gaby: The definition of non-binary is personal and what makes it feel comfortable as a gender identity label will always be unique to how it fits each person's self-understanding.
Sam: To learn more about how someone's self-understanding impacts how they engage with medical providers, we spoke to Dr. Carl Drake.
Dr. Drake: My name's Carolyn Drake, all my friends call me Carl. Pronouns for me: she/her, or they/them are fine. In terms of introductions, I am newly on faculty at NYU School of Medicine, and I work as an attending physician at Bellevue Hospital.
Sam: Dr. Drake spoke to how our understandings of gender are specific to our historical moment and the society we live in.
Dr. Drake: I think gender non-binary people - it's people who don't identify their gender as fitting completely within a binary gender narrative, which is something that I think it's important to note as a social construct, right? Like those contexts of being male and female are things that we've come up with in history and society. And so there are a lot of people in current culture and many historical cultures as well, who just don't feel that they fit within that narrative.
Richard: Like so many other social constructs that spill over into medical spaces or have been built into the structural framework of medical understanding, medicine is certainly not immune to the biases of understanding gender as a binary only.
Gaby: The concept of binary genders, like male and female lead to assumptions that we can predict things like what genitalia people have or what traits they may have based on gender stereotypes. But we know that all of these ideas are socially constructed.
Sam: And with all of that under our belts, this brings us back to Kat and how they arrived in a medical space.
Kat Griffin: The points of my transition that like obviously required healthcare were when I decided that I needed top surgery. And so like, I've lived in New York for almost five years now and I still don't have a primary care provider. Well, I had one for a while, but then I lost my family's insurance and so I couldn't, they didn't take my Medicaid and so I can't go to them anymore. And even when I was with them, I only went to them because I needed blood work for top surgery. And so I was like, oh, this seems like a good time to like, establish a relationship with, um, like a doctor.
Richard: Unfortunately, you can't see our collective faces contorting in horror at Kat's experience of first, not having a primary care provider and then losing their insurance.
Sam: Ugh, I think I'm getting crow's feet.
Gaby: Kat’s experience that seeking gender affirming surgery was the catalyst to find a primary care doctor is not uncommon. We couldn't find data to directly support that, but we could find a healthcare expert.
Dr. Streed: Dr. Streed, he/him/his, I’m an assistant professor at Boston University School of Medicine and their research lead for their Center for Trans Medicine.
Sam: Dr. Streed said that many non-binary patients in his primary care practice arrived there while pursuing some type of surgery.
Gaby: And especially because so many folks present to a primary care provider in pursuit of surgery, we asked Dr. Streed about ways to make your body feel more affirming, even without things like hormones or surgery. And that leads us to binding.
Richard: Bindiing refers to using a special garment, cloth or other material, and often to flatten chest tissue. For many, this will mean using something to push down their breast tissue and flatten it. Some other ways that people can augment their bodies and affirming ways without surgery or medications include stuffing, which involves putting - stuffing - often rolled socks or a phallic shaped object in one's pants to present the image of a fuller package. And then tucking, by contrast, is used by people with penises to literally tuck their testes into their groin and generally taping their phallus to create a flatter appearance in their crotch.
Sam: Dr. Streed pointed out that while these are not medications or surgical procedures, some of them, like binding, come with specific health risks.
Dr. Streed: I ask the vast majority of my patients about binding practices, just to remind them to not bind when they're sleeping. If they're coming in for procedures to make sure that they take their binder off during any, any time even brief anesthesia kind of situations. Just kind of giving them the, the quick details of how binding is important for their gender expression and their identity, but also to make sure that they're maintaining good health while doing it.
Richard: All kinds of things can be used to bind in any of them can be safe, as long as they're not compressing too much. People can use special athletic compression shirts or special binders or shapers that are like spanks for your upper body. Many of these are designed for post-surgical healing and even to ACE bandages. Every person chooses what they have access to that helps them have the desired result based on how their body is shaped, as long as they do it safely.
Gaby: The other big thing that our experts recommended was taking breaks from binding every so often.
Sam: Put the numbers to this folk should aim for at most eight to 12 hours of binding at a time, knowing that sleep is a good time to take a break and let their skin air out to avoid rashes, skin breakdown and shaping.
Gaby: And we'll link to some resources from UCSF and Callen Lorde in our show notes that if you want to learn more about binding, you can.
[TRANSITION MUSIC]
Sam: Okay, so let's move beyond the non-pharmaceutical things like binding and tucking and get into the medications available for gender affirming care.
Dr. Streed: So we have gender affirming hormone therapy as one of the main options. The main ones, of course, are masculinizing therapies with testosterone, or feminizing therapies with estrogens, progestins or antiandrogens. And there are many ways of mixing and matching this and honestly it comes down to having a very frank conversation with patients. I mean, that's the same for everybody, but like for, for my non-binary and gender nonconforming and gender queer folks is I really just wanna get an idea of what, what are they expecting, what are they hoping for in terms of a medical or surgical intervention. And then we, we talk about what can and cannot be done and what the timeline is for actually achieving any kind of change.
Gaby: To recap, the same hormones used for any gender affirming care apply here. But it's all about having a conversation with your provider about expectations and what you want out of hormone therapy.
Sam: Which brings us back to hormones. Specifically, micro-dosing them.
Gaby: Most folks have heard of microdosing in the context of recreational drugs, like taking a substance to get a small effect rather than a full blown high.
Richard: Here, we're talking about reducing the quote-unquote “traditional” - meaning binary - doses of hormones, like estrogen or testosterone, to achieve more moderate effects on secondary sex characteristics.
Sam: The term microdosing to some may imply a binary endpoint itself. Like why is quote-unquote “micro” the description used if it's the full or end effect that someone's looking for?
Richard: Right. Because the effects themselves aren't really micro. There's a lot of misconceptions about micro dosing. One is that you can control the changes you're going to get with the dose. The second is that the effect size will be smaller.
Gaby: All right, well that begs the question. What's the point of microdosing in the first place?
Richard: The reason folks microdose is to go slowly and monitor the effects of the hormones that they're getting as they go.
Kat Griffin: The people that I've seen look into microdosing because it seems like, well, maybe this can be a way to kind of see like what happens. I, I really want to, like, I really want to appear more masculine, but like, I don't want these changes to happen quickly, or like I'm scared of what these are going to do to my voice. And so I think it's looked at as maybe like a way to sort of test the waters.
Sam: So admittedly, the term microdosing isn't perfect, but it's the term many use and it refers to smaller and slower steps.
Gaby: And putting the name aside, let's talk a little bit about the scientific evidence behind micro-dosing.
Richard: Well, we've got lots of studies looking at gender affirming hormones at quote unquote “full” doses - doses that help achieve a binary standard.
Gaby: And for microdosing, there is little to no data.
Sam: Get it together science!
Gaby: You had one job.
Richard: In general though, the effects differ based on genetics and other factors. And we know how these impact secondary sex characteristics, like the pitch of your voice, the way your body grows, hair, fat distribution, clitoral tissue and breast tissue growth. And even getting your periods or menstruation.
Gaby: And just to drive this point home, these are the changes that we know and expect with quote unquote “full” or higher doses of hormones, but we're not entirely sure how they play out on the individual level when we use lower doses or quote unquote “microdoses” of hormones. And so maybe with all that in mind, you might not be surprised to hear that within Kat’s non-binary social network microdosingisn't really prominently discussed.
Kat Griffin: I have a few acquaintances who are microdosing hormones, and I personally haven't done much research into it. I imagine it's a good way to like test drive taking hormones or like a good solution for someone who doesn't want, like all the characteristics that taking hormones can give. But I, I don't know much about it at all.
Richard: The community and healthcare providers are on the same page with this one. We're all operating with very little robust scientific information.
Gaby: And, shocker, medicine doesn't do well with this kind of uncertainty, but to Dr. Drake and also me, there's absolutely room in a clinic space to acknowledge this gray area, this knowledge deficit around microdosing when you're talking to your patients.
Dr. Drake: I would want a care provider to say, look, you know, this is something that is becoming an increasingly common practice, but we don't actually have the data to show what this might do to your body. Are you comfortable with that potential risk? Here's what we think might happen based on what we know about full dosing, if you will, of testosterone, like at higher levels. But some of the risk of consenting to and participating in this medical treatment is the risk of the unknown.
Richard: We need to be clear with our patients who are asking for hormones at whatever dose about what the implications could be. Like if your voice gets deeper, it will likely stay that way. And I won't be able to predict exactly when and in whom that will happen. Let alone how quickly. The person taking the hormones needs to be a bit adventurous in spirit about the range of possible effects they're going to get from their hormones,
Gaby: All right. So the scientific data, the hard data around timelines and effect sizes is a big question mark. But fortunately we do have some healthcare experts hanging out on this podcast episode who have clinical experience prescribing microdose hormones.
Dr. Streed: In terms of expectations for changes, the cliche is like, we're talking about puberty. Remember how long that was. It still applies the same in terms of non binary or gender nonconforming or gender queer expectations in terms of your body takes time to change with whether it is quote unquote “low” dose hormone therapy or standard dose hormone therapy. And we will be monitoring that over a period of months to years.
Richard: And that's the power of informed consent with micro dosing. For folks to make changes to their bodies, evaluate them, and then move forward in the direction that they feel comfortable with. It's worth noting that your gender expression goals may change over months to years, which is another reason to keep checking in with your health care provider.
Sam: We followed up with Dr. Streed about what to expect when microdosing testosterone.
Dr. Streed: If they're looking for the full effect of testosterone, in terms of like more stereotypical masculine features, deeper voice, facial hair, more body hair, a physique that is more stereotypical stereotypically masculine. We talk about like microdosing really isn't going to achieve that. And certainly not on a timeline that people would normally desire. So again, it's more about understanding what somebody's goals are, setting expectations and going from there.
Gaby: While lower doses, these quote unquote “micro” doses, of testosterone might have a different or slower effect than a higher or quote unquote “full” dose, it is worth noting that when taking testosterone, there are some side effects that are permanent.
Sam: Voice deepening, changes in facial hair or body hair distribution, clitoral enlargement or growth, and quote unquote “male” pattern baldness.
Gaby: For people who are taking estrogen, just a reminder that it's more effective for folks who are also taking a testosterone blocker. But the effects that you can expect are smoothing of the skin, testicular atrophy if testicles are a part of your anatomy, decreased muscle mass, libido decrease, and decreased ability to have an erection if you have a penis. And it's also worth noting that estrogen will not make your facial hair fall out, but you may see some decrease in the overall growth of facial or body hair growth.
Richard: It also will not make your hair grow back if you've lost it.
Gaby: See, now you’re throwing in your own bald jokes, so this is really – (laughter)
Richard: No that one's true. My, my bald joke on that one is I can take as much estrogen as I want to, but I'm not getting this hair back. [ laughter ] It's not going to happen. The permanent changes from taking estrogen that people should be aware of are that certainly fertility can be impacted in the longterm, although that seems to be uncertain. And also any breast tissue that develops may be permanent.
Sam: So that just about wraps up hormones, but before we move on, we wanted to mention one other type of medical interventions, specifically surgery.
Gaby: So surgery is kind of offered as an a la carte option.Andwhat feels affirming to one individual is going to be really different than what feels affirming to another person. And that’s all going to depend on your own goals for your own body. And sometimes for some folks it’s going to include surgeries like hysterectomies, feminizing or masculinizing facial procedures, or even bottom surgery. And sometimes it won't involve any surgery at all. One thing that our community reviewer did point out is that sometimes in order to qualify from an insurance perspective for a surgery, for gender affirmation, non binary folks need to assume identities that they don't actually claim. Like for example, to get top surgery, someone might need to claim that they're living as a man or have a male gender identity.
Sam: And with that, let's wrap up by recapping what we've just gone over about microdosing. Mainly what we know and what we don't know about it.
Richard: What we know: what you and much of the healthcare community have heard about gender affirming hormones at the doses with well-documented data may or may not be applicable to micro dosing levels. This means variable changes, different time periods before some of these effects will appear
Sam: And we remain link obsessed. So check out our show notes for links to what we do know about taking gender affirming hormones at lower doses.
[TRANSITION MUSIC]
Sam: For our last section, we are going to hit on the barriers to accessing affirming care that come up for non-binary individuals more often.
Gaby: Let's start with Dr. Streed on what ideal gender affirming care feels like.
Dr. Streed: A lot of gender affirming care is really just standard, good primary care. Like what are people's goals? What tissues and anatomy do they have? And then we do what we can with the information we have.
Gaby: So high quality primary care is going to include discussing your anatomy, your gender identity and your sexual orientation, regardless if you need medically regulated things like hormones or surgery to realize your gender.
Richard: In other words, affirming care for non-binary people is all about letting go of assumptions about how gender and sex assigned at birth are linked.
Gaby: Kat talked about how some of their healthcare providers haven't been able to disconnect gender identity and anatomy.
Kat Griffin: After I told this person I was talking to on the phone that I had had top surgery and actually I use they/them pronouns. She was like, Oh, you should have told me that sooner before I asked you all the questions about pap smears, because now she was assuming I was a person who didn't need pap smears, that I was a trans woman. Um, And so then I had to be like, no, I have a uterus. Um, I have a vagina, like I do need, a gynecologist and I should be getting pap smears. It was frustrating, but also familiar because the like base knowledge just is not there.
Richard: What Kat's describing here, isn't unique to non-binary folks. Assumptions around gender, sex assigned at birth, and organs people have that need screening play out for many folks in clinical spaces.
Gaby: But for non-binary folks, this need to explain anatomy and gender identity is just an extra hurdle on top of what can be a baseline level of anxiety or apprehension when entering a healthcare space.
Dr. Drake: I think it's important to note also that for both non-binary and people who identify as transgender there may be parts of their body that they really don't feel represent who they are or that don't sort of feel congruous with their gender identity. So for anybody who perhaps, you know, wouldn't prefer to have a cervix, like it can be really difficult to know that you need to go get a pap smear, no matter how great your gynecologist might be.
Gaby: And Dr. Drake also pointed out that sometimes healthcare spaces that advertise themselves as LGBTQ affirming, aren't actually affirming for non-binary folks.
Dr. Drake: Many providers who believe that they're, you know, trained and more comfortable with providing LGBT care are really comfortable with sort of the basics of providing, you know, transgender gender affirming care. And that really, again, potentially reinforces a binary, right? That somebody who was assigned female sex at birth wants to become a masculine person. And historically the language was like F to M or M to F, which is not really a terminology that I think is appropriate to use anymore. But there's oftentimes an assumption in medical settings that if you are a gender nonconforming person or you sort of claim a gender queer space, that you are wanting to move from one side of a spectrum to another, in a way that can be really problematic and overlook a lot of, you know, somebodiy’s identity.
Richard: For healthcare spaces or providers to be truly queer affirming care, they cannot rely on or assume a binary conception of gender. Because while this may work for some trans folks, it won't be inclusive for all.
Kat Griffin: When someone comes in and they are like a mashup of different types of transness, there's like a lack, a lapse in competency where they're like, Oh, but I know like, I know what a trans woman is. I know what someone taking testosterone looks like, but like what's, you know, I don't know, like what is using they/them pronouns. That idea of transness definitely assumes that people are modeling their transitions after cis people and that looking or passing as cis gender is the goal, but that's definitely not the case for so many trans people. And everyone is just in pursuit of like the truest, most honest version of themselves.
Sam: For anyone whose gender identity is not legible, meaning understandable to a healthcare provider, they are at a higher risk of experiencing stigma.
Dr. Drake: For anybody feeling like somebody doesn't understand who you are right at the outset of a health encounter can be a really challenging place to start a vulnerable dialogue about your body and your identity.
Gaby: A handfull of studies have documented how non-binary individuals have worse health care outcomes. And they discussed this exact reason as one possible cause.
Richard: It's a system where trans men and trans women might be legible to a provider. Although, less often than we might like. But someone who is between or beyond binary gender altogether has no scaffold within the medical system on which to build.
Sam: Kat pointed out how this comes up all the time with our other favorite obsession here at QHP: paperwork.
Kat Griffin: In those, the forms that they give you, it's like, What is your gender? Male, female. And then I have to be like, are you asking for my biological sex? Are you at like, do you want to know what my gender identity is along with that? Like, is there a place where I can list my pronouns to kind of cue you in that something's happening here?
Gaby: If you've listened to our gender affirming and intersex episodes, it may seem like paperwork is the root of all evil.
Richard: It is, sis, it is.
Gaby: True. But paperwork is also just a symptom of a larger healthcare system whose foundation is far too embedded in the binary.
Sam: And that doesn't just impact paperwork. That impacts how likely it is that healthcare providers will offer these gender affirming medical options to achieve a non-binary goal.
Kat Griffin: The like lack of knowledge and care that's gone into like making spaces and like trying to create opportunities for trans people when it's like, no, like that is not what my voice is going to sound like. And that is not what transitioning is going to bring for me.
Gaby: And when someone encounters these barriers over and over again at every doctor's appointment, well, that trauma adds up.
Kat Griffin: Even when people mean well, and they like do genuinely want to provide you like the best care. And they aren't, obviously they're not like transphobic evil people. They just don't, they just haven't had the proper training to interact with, um, with trans people. And so it just, it just is a familiar and frustrating interaction to like never receive the kind of care that you would like hope to get from someone and always kind of feel like a second class like person experiencing healthcare.
Richard: So don't feel gaslit if you feel tired or if your gender identity isn't understood. In our show notes, we have links to info you can share with your healthcare provider or from other healthcare professionals about non-binary healthcare. Better yet see if you can find somebody who has some experience with non-binary care.
Gaby: Because then you might get a doctor whose perspective is something like Dr. Streed’s.
Dr. Streed: It's my job as a clinician to be more expansive in order to meet the goals of people for whom the binary does not work. I think one of the main ways we do things a little differently for our non binary folks is sometimes the conversation's a little bit more involved in terms of trying to get an idea of what their goals are.
[TRANSITION MUSIC]
Gaby: This episode has gone into some of the specifics of topics relevant to primary care for non-binary folks.
Richard: We've talked about the importance of binding, tucking, and packing safely. And how microdosing comes with less data and maybe a different set of expectations for how bodies will change, and over what timeframe.
Sam: And in addition to specific medical interventions, we also talked about how the entire healthcare system, it's paperwork, and the expectations of some of our medications that we give are often structured around a binary system that may leave non-binary people out.
Gaby: Here's Kat with the last word – and it's not about paperwork.
Kat Griffin: Everyone's transition is continuous and our genders and personalities and the way we see ourselves evolve and grow as we grow older. So just because someone has ticked all the stereotypical boxes doesn't necessarily mean that they're done. So much of gender is like thinking in an emotional way and like thinking in intent, you know, it's not all about like surgeries and like the, my biological sex and what I'm doing with my body and what my hormone levels are. Like so much of it, is more of an intangible, emotional, saying that you can present in a variety of ways. And so for non binary people, you literally could look like anything. You could have any sort of, sexual reproductive organs and you still could identify in a very specific way that you can't know until you ask someone the right questions.
[QHP THEME MUSIC]
Richard: QHP is a power-sharing project that puts community stories in conversation with healthcare expertise to expand autonomy for sexual and gender minority folks.
Sam: And as always thank you to our community voices, Kat Griffin, and our healthcare experts Dr. Carl Streed, Jr. and Dr. Carl Drake.
Gaby: For information on the stuff we talked about in this episode, check out our website, www.queerhealthpod.com. It's going to have show notes, links to resources, and a lot more.
Sam: Help this information find a larger audience by leaving a review and subscribing to our feed on Spotify or Apple podcasts.
Gaby: And if you like what you heard, give us a follow on Twitter or Instagram. Our handles there are @QueerHealthPod, and you can let us know what experts you want us to bring on. We're planning season two.
Sam: And thank you to Lonnie Ginsberg who composed all the music heard throughout this episode.
Richard: And as always, opinions of this podcast are our own and do not represent the opinions of any of our affiliated institutions. And even though we're doctors, please don't use this podcast alone as medical advice, but instead consult with your own healthcare provider.