Author: Dr Clara Soo
Known for her dedication to the LGBTIQ+ community, Dr Clara Soo has the rare experience of providing gender-affirming care to her patients but has also gone through the process of gender affirmation herself.
Now living her life as a transgender woman, she can identify with the issues that transgender people have in terms of accessing medical care.
“What we’re seeing now is a gradual change in social attitude, laws, and legislation about access to gender-affirming care, and I think it’s really important for patients seeking this to get all the support and advice they need from doctors,” explains Dr Soo.
Discomfort in providing gender-affirming care
“I get the impression that a lot of doctors who don't specialise in this area feel very uncomfortable when they have a patient coming to see them saying they are transgender, identify as transgender, or want help with gender-affirming care,” says Dr Soo.
Dr Soo surmises that doctors worry that providing gender affirming care may potentially expose them to legal risk. But her experience tells her that all patients want is for their doctor to have a non-judgmental attitude towards it.
“Like anything that I don’t know the answers to, I tell them that I’m happy to go away and do the research and come back later to discuss it further. This is something every doctor can do, regarding any topic,” explains Dr Soo.
Gender affirming care is about listening to your patient, understanding how they see their gender, and then using your medical knowledge to see if that's something that you can apply to help the patient. It does not necessarily mean prescribing anything, because some patients may not want to have any medical intervention.
“Some patients may only want a social transition and some may, after a period of time, change their minds and identify with a different gender altogether,” explains Dr Soo.
“I would say gender affirming care is really all about patient-centered care. After all, isn't that what we are all trained to do?”
A safe and inclusive environment
In terms of creating a judgment-free zone for patients, it can be as simple as asking what pronouns they use and what their preferred names are.
“This sends the signal that you’re listening and you can work with them on this. You can certainly ask them how they see their gender identity, which gives an opening for them to talk more about how they’ve arrived here,” says Dr Soo.
While there are no right or wrong answers, people from all walks of life come into their gender identities in different ways. Whereas one person may have always been transgender but depending on the environment they were brought up in, they may not have been able to accept or understand their gender identity until much later.
Conversely, there are common stories about patients identifying with their transgender identity since they were children, or around the time of puberty.
“By the time this patient has come to you for your help means they’ve probably spent a long time thinking about it themselves. Coming to see a doctor and disclosing to a person of authority in society that they’re transgender is not an easy thing for most people to do,” says Dr Soo.
Witnessing the evolution in a patient’s journey
Upon reflecting on her 30 years of providing gender-affirming care, Dr Soo says one of the biggest differences is seeing more younger patients presenting.
“Looking back in the past 10-20 years, I don’t think I ever saw anyone under the age of 18 years old,” says Dr Soo. “I think the social attitude was that it was a lot more difficult back then to transition, so it took people much longer to make that decision. There was also a lot less knowledge about it.”
With more discussion about gender identity in the media, it has certainly made the topic less taboo. Gender dysphoria, which is a term used to describe people who have suffered psychological or mental distress as a result of how they see their gender identity and the sex they were born into, is less common than it was before.
“'I’m seeing some younger people who have very supportive parents and an environment where they've been able to live in a preferred gender from a young age,” summarises Dr Soo.
“They’ve grown up being exposed to very little or no gender discrimination, and therefore, don't actually have any internalised mental distress as a result of their transgender status. I think it's a wonderful thing to see.”
Dr Clara Meng Tuck Soo is a Canberra-based general practitioner, has been practising for more than 30 years and is a member of Medical Indemnity Protection Society (MIPS).
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