#14: The Not-So-Scarlet Letter
COMMUNITY VOICE: Elana Lancaster | HEALTHCARE EXPERTS: Sand Chang, MD; Ashley Florence, JD | COMMUNITY REVIEWER: Gaines Blasdel
SHOW NOTES
You’ve got (pathologizing) mail
Definitions
The “letter” refers to an actual letter of documentation from a health care provider that is often required by health insurance companies to access gender affirming surgery
They are also knows as letters of readiness.
Know that there is no standard template for these letters (we know, not ideal)
Some history
The WPATH Standards of Care 8 (published September 2022) recommend reducing the requirement from two letters to one, and expanding who can write the letter - from only mental health providers to anyone well-versed in gender affirming care
FYI, not sure when insurances will catch up to these new recommendations.
Wait – did you say “pathologizing”‘ earlier?
The fact that you need a letter to access gender affirming surgery is inconsistent with how other processes work within medicine.
Most surgeries only require “informed consent” - or, a discussion of risks and benefits (and time to make the patient make the decision)
Medicine very rarely makes engaging with mental health care compulsory - outside of the letter of readiness, the only other time is in the setting of mental illness, when someone is at risk of hurting themselves or others. The process itself implies that being trans is a mental illness (which, you know, to be clear - IT ISN’T)
The dynamics
Letters effectively require a provider to “sign off” on someone’s self-conception of trans.
This framing implies that healthcare providers are arbiters of who is or is not “trans enough” to access gender affirming care.
Conceptions of transness
For many letter writing providers, their understanding of transness is rooted in the gender binary and that trans folks always wanna move from one end to the other.
Many letter-seekers feel they have to conform to a particular script/story that emphasizes binary gender goals (think: “I want to look like a body builder”) with their letter-writer, to ensure they obtain their letter
How this impacts care
Letters create logistical barriers:
Time (more appointments)
Financial (more appointments, more money)
Not to mention folks often need letters before they can make consultation appointments with surgeons (not something recommended by the guidelines), leading to significant delays in care
But wait - there’s more (fraught-ness):
Making people feel stigmatized while discussing their transition goals makes them less likely to pursue care.
Bringing the letter writing dynamic (the inherent power imbalance, the feeling of needing to confirm to certain normative gender narratives to receive a letter ) can negatively impact a pre existing therapeutic relationship with a primary care or mental health provider.
Reforming the letter writing process
Folks like Dr. Sand and GALAP work to de-stigmatize the letter writing process by emphasizing transparency and centering the authenticity of the trans folks they help.
But as our community voice, Elana, points out, the full harm of these dynamics can’t be fully mitigated by even the most compassionate and affirming practices - the power dynamics are too integral to their premise
The ultimate way forward: shift towards a model that prioritizes informed consent and patient autonomy, without requiring letters or gatekeeping from healthcare providers.
TRANSCRIPT
Gaby: Hey – it's Gaby.
[MUSIC STARTS]
Gaby: So, usually our community voice kicks off our shows. But we're taking a second at the beginning of this one to acknowledge this political moment during which we're gonna be releasing this episode. The legislative attacks on trans healthcare throughout this country are jeopardizing people's ability to access gender affirming care – care like the surgeries that we're about to talk about for 30 minutes. And so because of that, everybody at QHP wants you to know one thing: gender affirming medicine is lifesaving and it is essential to the wellbeing of trans folks. As long as we've got microphones and a stable internet connection, we won't stop fighting for trans rights. And with that, let's get back to the episode that you came here for.
[MUSIC ENDS]
Elana: I ended up asking my therapist to write a letter because I was really worried that I wasn't going to end up with something remotely usable from this other person. It wasn't my rational self in that moment or in that room. It was that feeling of like – you are starving, and you can only get food if this person signs off, and you are just paralyzed with fear that somehow that is not going to pan out; that they're going to withhold that. That you're going to have to chew your own leg off in order to, you know, prove whatever you need to prove that you deserve to not starve.
[QHP THEME MUSIC STARTS[
Gaby: Welcome to Queer Health Podcast. QHP is a podcast about queer health topics for sexual and gender minorities.
Sam: My name is Sam. I use he/him pronouns and I'm a physician in training to be a primary care doctor.
Gaby: I'm Gaby, she/her pronouns, and ditto to Sam’s job title.
Richard: And I'm Richard. I use he and him pronouns and I'm the director of LGBTQ clinical services at Bellevue Hospital in New York City.
Gaby: You're listening to QHP Season two, episode four, letters of Readiness for Gender Affirming Surgery.
[QHP THEME MUSIC ENDS]
Gaby: At the beginning of this episode, you heard the voice of Elana Lancaster discussing the mental health letter requirement that's needed to access gender affirming care.
Sam: Almost all health insurance companies require letters for those who want a gender affirming surgery.
Richard: These letters, which are sometimes called “letters of readiness" by those who recommend them, places the onus on a trans person to prove to a mental health provider that they're not gonna regret their decision.
Gaby: But it's not just mental health providers anymore, right?
Richard: Yes. The landscape around this is changing. We'll talk about this more once we get into the episode, but: know that WPATH, the leading group that supports gender affirming care, has said that letters can be written by anyone who knows their way around gender affirming care, not just mental health providers.
Gaby: And just to be clear, insurance companies probably won't catch up to this requirement for a while, but I think it's important context to know that the best practice recommendations have changed.
Sam: In short, If someone wants their insurance company to pay for gender affirming surgery, they need a mental health provider to sign off on it.
Gaby: If that seems offensive, we agree.
Richard: If it seems out of line with how other parts of medicine work, we agree.
Sam: If that seems like it's worth a podcast episode, we also agree.
Gaby: Today we're mostly gonna spend time talking about the pitfalls of these letters, how they're an exception to standard practices within healthcare, the ways they create stigma and how they complicate relationships between trans people and their healthcare providers. We'll also touch upon the way forward from the current requirements, and think a little bit more about how to make the process of gender affirmation more - well, affirming.
Sam: We know you are sa-li-vating with intellectual anticipation, and frankly, that is kind of our kink. So, send pics. BUT before your drool hits the table, some brief podcast love.
Gaby: Please follow us on social media. The links and all the handles will be at the end of this podcast episode, and if you're listening to us on Apple or Spotify, please don't forget to subscribe. It really, really helps us out because we want to get this information out to more people. All right, cue the music.
[TRANSITION MUSIC]
Gaby: So why is the letter requirement for gender affirming surgery pathologizing? And, what do we even mean when we're throwing that term “pathologizing” around? In one loaded word: gatekeeping.
Elana: When I started thinking about surgery for myself, like knowing that there was a letter requirement, like, both felt like a really significant practical barrier and a big mental barrier of like, “I don't want anything to do with this.”
Richard: It isn't just the logistical process of obtaining the letter itself, but more on that later. It's how personal and revealing these letters can be.
Elana: So some places were asking for like a full, you know, a full bio-psycho-social evaluation and you know, developmental history. And like – they need to know if you were born by C-section or vaginally. And like – they needed to know, like (laughter) if you know, how many bathrooms are in your apartment building. That's very long and extensive, and, yeah, very personal to, like, fax to a whole bunch of randos who you don't even know if you're really interested in scheduling a consultation with yet.
Gaby: Keep in mind that all of this is happening before an appointment with a surgeon has even been scheduled.
Elana: The first thing that happened was that the office asked me for a letter in order to schedule the appointment. But in order to meet with them, I needed to, like, produce the end result of like a, this hellish, like fairytale quest or something like, you know, this fucking letter.
Richard: It really does feel a little “Alice in Wonderland.” Someone needs a letter of readiness to talk to the surgeons about a procedure, but how can you get the information about the procedure without being able to talk to the surgeon first?
Sam: And this is really just the tip of the iceberg. We could go on about the fact that there's no template for what information the letter needs. Or no, you know, rubric for what degree of personal detail needs to be included. It's often very surgeon dependent; there's providers who are charging hundreds of dollars to write these letters. And there's some trans folks who've been required to undergo years of therapy just to get this letter.
Gaby: Suffice it to say there's a lot to unpack. Let's bring in our first healthcare expert of the episode to give us a hand.
Sand: My name is Dr. Sand Chang. My pronouns are they/them and I live on unseated Ohlone land, also known as Oakland, California. My work as a clinical psychologist and DEI consultant is focused on trans health and body liberation, including eating disorders and trauma work. I've been working in trans health basically since the time that I came into my own genderqueer identity in the early 2000s. So my commitment to the field is both personal and professional.
Richard: Dr. Sand Chang is one of the founders of a group called GALAP or the gender affirming letter access project.
Sand: I was finding myself increasingly enraged at mental health professionals, profiting from gatekeeping related to gender-affirming medical care. Specifically the requirement that trans and nonbinary people get letters from mental health providers. We came up with the idea of asking providers to pledge to the commitment of writing free letters for people seeking gender affirming care.
Sam: So where did that process originate from?
Sand: So there is a really long history of requiring people who are seeking gender affirming medical interventions to get approval from a mental health provider. And this is related to the WPATH standards of care, a document that really lays out the standards that medical and mental health professionals go by when deciding whether someone is appropriate for some kind of gender affirming medical intervention – so hormones or surgery.
Richard: Like we mentioned earlier on, WPATH has come out with version eight of their Standards of Care.
Gaby: Consider this “standards of care” thing like a national expert reviewed benchmark for how trans care should be provided across the country.
Richard: Yes, and version eight changed the letter requirement no longer requiring the writer of the letter to be a mental health professional, but instead anyone who is well versed in gender affirming care. Also, the requirement for letters dropped from two letters to one letters in the standards of care eight. The reason for this is that they looked at the literature and found that virtually never did the two letters disagree with each other, and so making people get two letters was absolutely a simple barrier to care, but not something that was effective in helping the person make decisions.
Gaby: Okay, so this letter writing requirement is – at least in part – grounded in recommendations and evidence from a whole body of medical providers who specialize in gender affirming care. But; if the cynical side of your brain is wondering if some of the requirement comes from insurance, well, Elana wouldn't disagree with you.
Elana: My theory on what has happened in some places is that they have taken on board every wacky off the wall things that any insurance company ever required. And instead of being like, “Well, okay, yeah. Insurance companies are strange and unpredictable and the pox on our houses, and we need to make sure we know specifically what the requirements are for an individual person's insurance, blah, blah, blah, whatever.” They've created this unholy franken- requirement, – like, conglomerated from all of the worst things that insurance companies have ever asked them for. And I don't think that actually serves anyone well, cause I think if I had sent my insurance company, like pharmacy records, they would have been like, “What are you doing? We’re denying it because of the number of papers that are here.”
Gaby: Whether insurance companies like these letters because of liability, or they just have to pay less, or they're just transphobic, who knows?
Sam: Probably all three.
Gaby: Whatever the reason it's definitely atypical.
Richard: It's pretty clear that the people in the room were not necessarily trans themselves.
Elana: So many places with these requirements that you really see where they came from, that they did not come from a good place. They did not come from, you know…people have done a lot of work over the years to try to mitigate the harm and improve the systems. These systems don't come from a place of support or centering trans people's needs. They come from a place of prove to us that you are, who you say you are prove to us that you meet our standards, prove to us that you didn't forge this letter.
Sam: To hear more about this, we looped in Florence Ashley, a lawyer and bioethicist who writes about trans autonomy, the legal system, and medical science.
Florence: The pathologization in trans healthcare is quite specifically a form of psychopathologization. So it's really about intimating that being trans is a mental illness. This whole process of defining trans ness through diagnosis...it's not clear that it serves any genuine purpose other than maintaining medical authority over defining who gets to be trans and thus who gets to transition.
Richard: This point is important, so let's repeat it. The letter requirement gate keeps on a logistical and resource-based level –
Gaby: – because you know more appointments, more money, more time.
Richard: – and as Florence highlights, it very quickly bleeds into something much larger, a dynamic where institutions like medicine and mental health are somehow in charge of validating and giving permission for someone to be trans.
Sam: Which, FYI, is not the reason most, if any folks are presenting to mental healthcare.
Florence: People come seeking something specific. They come seeking transition-related care. They are not there to be like, “Please determine whether I'm trans or not." No – they're coming for a specific form of care because they want to self-actualize, self-determine through that medical care.
Gaby: And as a reminder that you probably don't even need: this whole idea that you have to prove your experience to a provider is pretty atypical within medicine. For example, we don't normally require mental health evaluations for pretty much any other surgery.
Sand: So when someone seeks out necessary medical care, they want to be believed and they don't want to be told to see a mental health provider who can basically attest to them not being mentally unstable. There are a few other kinds of surgeries that do require mental health evaluations. But for the most part, if you need a life saving or life affirming surgery, which I believe gender affirming surgeries are, then you only need to provide informed consent.
Gaby: The mental health screen alone isn't the only way these letters are exceptions. It's also the way the mental health evaluation is actually framed: as a test of sorts, a, a gauntlet to figure out if the symptoms described are, quote, legit enough to be considered trans.
Florence: We generally trust people when they are reporting things that are inner experiences And especially when it relates to something, as quite fundamental to who they are and how they feel about themselves in the world. Like the symptom, gender dysphoria is the thing, gender dysphoria. Whereas if I'm, you know, coming with depression, “I'm like, oh, I'm sad." And they're not gonna say no, you're not sad. They're just gonna try to figure out why I'm sad.
Sam: And this atypicalness this need to "prove" your own experience is in and of itself rooted in transphobia.
Florence: Letters of assessment or a starting from the get, go with the assumption that there's something suspicious about the very claim like "I am trans, I have gender dysphoria." Yet, my gender identity. And whether I have gender dysphoria is precisely the kind of, kind of core experience of myself and of the world that I would have the most authority over. And it would take an extremely strong reason for someone to go around and say, oh no, you're not, right? Because that's something so fundamental – they don't see inside of my brain! The problem with that is that, well, then you're doubting people like people's sense of self and that's without a strong reason other than "Hey, being trans looks weird. So we're going to have to double check that.” Which is fundamentally, dehumanizing by reason of prejudice against trans people.
Gaby: And the toughest part about this is that this pathologizing is baked into the letter writing dynamic. Even therapists who acknowledge this dynamic can't really do much to mitigate the damage that comes with inherently needing to quote, prove your transness.
Richard: Not to mention that many though, not all of the providers who write these letters have an understanding of transness that is, shall we say…
Gaby: …limited?
Sam: Un-nuanced restricted transphobic, outdated, ridiculous, offensive…
Sand: Usually, providers have a pretty limited view of trans experience based on a medicalized Western binary narrative. That really just doesn't fit for everyone. and all these models of what a real trans person is, is, based on white supremacists and colonialist, gender ideals. So, you know, there's a lot of confusion from providers that sounds like, “Wait, the person wants surgery, but not hormones” or "Wait, they haven't come out to their family yet,” or "What, they want phalloplasty without a vaginectomy?” So any presentation that challenges, the idea that trans people want to embody cis-het normativity is flagged and it's the traditional narrative by those who have, really, no imagination and can't step out of what they've deemed as the one right way to be a man or a woman or trans.
Gaby: And this binary view of transness is just not how transness works…period.
Sand: We need to move away from the idea that transness or any one gender identity equals a certain medical intervention. There are people who either choose not to or can't access medical interventions, and they are no less trans than people who can or do want to access these interventions. There are non-binary people who want medical interventions and there are binary people who don't. So we really need to eradicate the idea that one's gender justifies having a certain body.
Gaby: First off, generally speaking, it really, really sucks to have a mental health provider who doesn't have a fully realized understanding of your identity. Plain and simple. Then there's the second layer to this, which is that because these letter writers don't have a nuanced view of transness, surgery becomes the thing that folks use to benchmark who is "trans enough.” Which leads to the following mind bender.
Sam: You have to get yourself diagnosed to access surgery, but the surgery is the thing that makes you quote authentic enough for the diagnosis in the first place.
Gaby: It's frustrating, circular logic
Elana: So definitely, like, when I was first in trans community and then when I was first coming out as trans – anything that had to do with medical transition with very much still like “You're not real unless you, you know you're not, you know, you're not really trans unless you've done all these medical things. A nd you can't do these medical things, unless you can prove to us that you are sufficiently really actually super duper trans and this circular, like this, like prove yourself, you know, very, yes, very much very rigid.
Gaby: Super duper trans! I am pocketing that for some QHP merchandising.
Sam: But before Gaby finds it yet another excuse to buy herself more muscle tees let's summarize things. We've talked a lot about how the letter requirement process is a barrier to care in so many ways.
Gaby: The letter requirement sets up a power dynamic where trans folks have to quote, prove their transness.
Sam: This process is not centered on trans healthcare consumer needs, but rather asserting the power of pathologization onto experiences that many medicine providers don't understand.
[TRANSITION MUSIC STARTS]
Richard: Lastly, and perhaps most importantly, the letter requirement for trans folks is inconsistent with how the rest of medicine works!
[TRANSITION MUSIC ENDS]
Gaby: I wanna start this next section off by giving Elana some air time to tell his story about their experience getting their pre-surgery letter.
Elana: I was seeing a therapist at the time and, you know, that was totally fine. And I knew that it was something that person probably, you know, wouldn't bat an eye at writing, but I really didn't want to ask for it in the context of – basically, I was like, “I hate this. I hate this a lot. This feels demeaning and humiliating to have to ask for.” And I don't want that poisoning my relationship with my therapist. Like, I didn't want to invite that into the room and so I was like, "Okay. I'll go to someone else who can write this. This is pretty straightforward." I probably just sound like I'm really bitter about – it was kind of surreally bad though. It was like, they like rattled off a bunch of questions about like, “Oh, so like were you suicidal when you started puberty? What's your school history? What pets do you have?” (laughter) in a string where I was like, "Okay, hey, one of those things is not like the others" and B, like, you don't actually need any of those in order to fill these requirements and, you know, help me jump this hoop. The phrase that they kept on using was “I, I just want to give you an opportunity to tell your story.” And that drove me up the wall completely. I was like, “I have so many opportunities to tell my goddamn story if I want to, like people actually pay me to tell my story.” And then they wrote the letter and sent it and emailed it to me. And they had diagnosed me with gender identity dysphoria disorder, which is not a thing has never been a thing. It does not exist (laughter). I mean like, okay, welcome to the DSM 4-DSM 5 mashup edition. I mean, it was digital, but I felt like if I was reading it on paper, it would have been like, I don't know…either like a children's collage or like a ransom note. I was also like, “Oh my God, if I handed this to someone, they are definitely going to think that I wrote it myself!” Like I would never fuck up that badly in a million years. So I asked them to fix it. And that was a very long process during which I ended up asking my therapist to write a letter because I was really worried that I wasn't going to end up with something remotely usable from this other person. So, you know, in the end, I – I did end up with a correctly spelled letter that accurately reported my age.
Gaby: How strange that little things like getting someone's age right and bodily autonomy all add up when all is said and done. And for those of you who live outside of the metropolitan New York area, that's a sarcastic comment because this is obviously horrific.
Elana: I found this requirement really frustrating and humiliating and difficult. They didn't expect it to actually seem hard for me at all, which, from an outside perspective, I'm like, I get it. Like a lot of people can be pissed off about that situation and still kind of go in and like, you know, rattle off just like, you know, I don't know the trans equivalent of like name, rank and serial number. Just like here, you know, like, “Here's what I knew. Here's when I came out. Look at what a great surgical candidate I am, this is easy.” And my experience was more like... I felt like a trapped animal that was kind of being interrogated and did not feel like there was anything helpful to salvage out of this interaction, particularly.
Richard: This comment about name, rank, and serial number – it reflects a really prevalent feeling that there's a standard spiel or script that a patient must recite when they're having a conversation for a pre-surgical letter.
Sand: A lot of people seeking gender affirming medical interventions, know that they're supposed to say the right thing. They're kind of hip to this idea that they're supposed to spit out this medicalized narrative.
Sam: Because the whole encounter centers around a specific single product, which is the letter, there's a fear that the wrong thing is said, the letter won't materialize.
Elana: It wasn't my rational self in that moment or in that room. It was that feeling of like: you are starving and you can only get food if this person signs off and you are just paralyzed with fear that somehow that is not going to pan out that they're going to withhold that, that you're going to have to chew your own leg off in order to, you know, prove whatever you need to prove that you deserve to not starve.
Richard: And so, these letter writing mental health appointments don't intrinsically lend themselves to being forums for honest, authentic, and vulnerable exchanges.
Florence: So we see here an example of the fact that this sort of defensive mode that, people are being put on through gatekeeping is actually having the reverse effect because of course if you have to wait 26 months to get an appointment, and then the person is looking for any excuse to deny you care, the last thing you want to do is work through your doubts and your worries with them. Of course you don't want to do that. You don't want to do that self-introspection. There is far too much at stake.
Richard: This is especially true for trans non-binary folks who often have to retrofit their gender identity story to fit a binary because that's what the letter or the letter writer requires.
Sand: But unfortunately, so many people who don't fit binary narratives or who can't really prove that they meet criteria for mental health stability are asked to jump through more hoops to access care. And it's just unfortunate because people don't feel safe being themselves or being honest when the actual context of this whole thing is being able to be more authentic and more yourself in the world.
Richard: It was not uncommon for trans men that I knew to say that when they were going in to get their letter, they would tell a story that they wanted to look like Arnold Schwartzenegger in the 1980s when he was in his muscle body building phase, because that image of hypermasculinity was perceived to get you a letter faster than saying, like, I feel like a trans guy.
Sand: And a lot of us who are in the role of letter writing also feel like we are putting on this persona and I try to be transparent with people. And in the GALAP we really do encourage providers to be transparent and name things, like, talk about the gatekeeping power and make sure that we're not situating ourselves as the expert on someone else's lived experience.
Richard: But as Elana points out, even these strategies can't always make the experience completely better.
Elana: I do think that like a lot of therapists, you know, are like, "but I'm very approachable. And I'm just there as support. I'm not trying to make anyone prove that they're trans enough," being aware of how our dynamic doesn't make it go away. Doesn't erase it. Doesn't give someone basic bodily autonomy back. It's like people, you know, don't go into that work to feel like they're interrogating someone or because they love paperwork. You know, like, people want to turn this requirement into something helpful when they can. And I think that's admirable and also in some ways, not – not necessarily a great situation. Cause you can't really non-consensually support someone. It's not really – I mean, you could try it won't but my experience is that that doesn't really work very well.
Gaby: And for some people it's going to impact the ability to talk vulnerably and honestly going forward.
Elana: That power dynamic happening and that sense of powerlessness and that sense of just really primal fear that I'm not going to be able to get what I need. That made it hard. I mean, it made it hard for me to talk about surgery with my therapist, basically impossible for me to talk about surgery with my therapist, which sucked.
[TRANSITION MUSIC]
Richard: Some people defend the letter requirement by saying that it's a way to screen for those who might regret their choice later on. But I think it's clear the defensiveness is baked into these encounters that completely undermines the goal.
Florence: By creating gatekeeping, we're really setting up a scheme where we're hindering their ability to figure that out. And that's not the right way of doing things. So I think that's an important way in which these attempts to prevent regrets become quite counterproductive. Because then from there being you weaponized to promote approaches that end up actually creating regrets.
Gaby: There is a way out of this. An informed consent model would foster a process to ask questions and explore expectations, which would make sure that the outcome of hormones or surgery has more benefits than risks for someone or that the risks are worth it.
Sand: I want people who have concerns, fears, and questions to feel like they can ask them without that being like a ding. You know, like where they miss the, you know, they got th e wrong answer on the test.
Richard: So we give them the best information they have, and if they're able to make decisions for themselves, then we allow them to make those decisions.
Florence: Once you lower the stakes, once you become the ultimate determinant of whether you have access to medical transition and the person in front of you is only that to help you in whatever way you want. And you're the one who decides how that works and if you're not sure now then you can come back next month and you don't have that gigantic, like kind of timescale then you're going to be much more likely to, you know, really kind of explore how you feel.
Gaby: Letters of readiness are often the first step towards gender affirming surgery. They're a prerequisite before the first surgeon's appointment can even be made. Though who can write the letter is changing thanks to new trans health guidelines, many insurances still require the documentation to come from a mental health provider.
Richard: There's a widespread understanding that there's an ideal or right way to say things when getting assessed for the letter. Otherwise, you risk walking away without the letter.
Gaby: A risk that after months of waiting lots of office fees and the general transphobia of the healthcare system, doesn't make it worth it to gamble on.
Richard: This creates an environment where asking authentic questions or expressing fears becomes super high stakes enough so that most folks won't feel safe engaging in vulnerability or self exploration
Gaby: For those who already have an ongoing relationship with a therapist, the pre-surgery letter, this stigmatizing triggering letter can complicate or corrupt that mental health relationship.
Sam: As our experts pointed out, lowering the stakes of these letters or by getting rid of them together, could help promote a more honest, authentic exchange, which would allow people to explore their doubts and fears about the procedure they’re interested in pursuing.
Gaby: So if I had to pick a theme song for this episode, it would probably be “Isn’t It Ironic” by Alanis Morrisette.
Richard: Except that that song completely misinterprets the definition of irony. And I do love Alanis.
Gaby: All, right. All right. No more grammar lessons time for Elana to have the last word.
Elana: When it comes to pathologizing it and creating a system where you are non consensually requiring people to engage with a therapist even if you have super great intentions for how that's going to actually be really useful for them still not, it's not optional. To me, that's, that's the biggest impact of that pathologizing history and present. It’s created that power dynamic. It is baked into that system. It then makes it really hard to separate that power dynamic from the whole idea of therapy.
[QHP THEME MUSIC STARTS]
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: Thank you to our community voice, Elana Lancaster, and our healthcare experts, Florence Ashley and Dr. Sand Chang. We would also like to extend a big thank you to our community reviewer, Gaines Blasdel, who helped conceive of this episode and identify our excellent guests. conceive of this episode and identify our excellent
Gaby: For more information on this episode's topic, please check out our website, www.queerhealthpod.com. And despite Sam's best attempts to only write me handwritten letters. We are also on Twitter and Instagram. Our handle there is the same. It is @QueerHealthPod for both platforms. So please reach out to us.
Richard: Thank you to Lonnie Ginsburg who composed our theme music
Gaby: And big shout out to the Macy foundation who is providing some of the funding for the technology for this episode.
Sam: Opinions on this podcast are our own, and they do not represent the opinions of any of our affiliated institutions. Even though we are doctors do not use this podcast alone as medical advice instead consult with your own
[QHP THEME MUSIC ENDS]
Sam: Narrator: it was not straightforward. By like making the meme out loud - I'm like, am I gonna take the fall for something that I don't know is funny or not? (laughter)
Gaby: I think it'll work. I'm gonna run it by my sister later, but I think it'll work. The arbiter of pop culture.
Sam: I just don't know. So I'm like, I'm the – I'm the good one to say it. Cuz it's like, wah-wah.