In recognition of Transgender Awareness Week 2021 from November 13 – 19, we spoke with PPMW’s KT Sylvia to learn a bit more about their background and how PPMW provides Gender Affirming Care at our DC and MD health centers.
PPMW: Tell us a little about yourself: your name, title, pronouns, and what you do at Planned Parenthood?
KT Sylvia: My name is Katie or KT Sylvia. I am a registered nurse at PPMW. I identify as queer and use they/them and she/her pronouns. I am the nurse coordinator for centralized follow-up so I follow up with lab results such as STIs, pap smears, breast cancer screening results, and Gender Affirming Care (GAC) hormone lab results. Also, I am available to patient's in regard to medications, referrals, and any questions and concerns.
PPMW: What was the path of your nursing career?
KT: I studied nursing at James Madison University in Harrisonburg, Virginia and started my nursing career as an emergency department nurse at a local Washington, DC hospital. I’ve always been interested in sexual and reproductive health, and I'm passionate about LGBTQ+ health care and access to such care. So, when I saw PPMW was going to start GAC services, I jumped at the opportunity to be part of the team.
PPMW: When going through academic training, how much does someone who's studying nursing learn about trans health care?
KT: I completed my nursing education within four years. We did touch on LGBTQ health in our community health course but didn’t really go into depth. I was involved with our LGBTQ student-led organization, so I spoke with my professors and I was suggested implementing panels. The panels would review basic LGBTQ terms, discuss our lived experiences, best practices in healthcare settings, and answer any questions students or professors. Truly, during college, I had to search for LGBTQ+ education and rely on our community for more information.
PPMW: Before you got to Planned Parenthood, did you encounter any trans folks in your medical career?
KT: When I started in the emergency department, I of course would see trans, and non-binary, and gender nonconforming people. Transgender people have the same health care needs as cisgender people, so they of course have emergencies. Accessing health care can be very challenging in the trans community, especially in the emergency department. The ER is a fast paced environment and it is a medical system that is ingrained with the binary so mistreatment and discrimination are ever present. I would witness patients being treated fairly but more often so I would witness some sort of discrimination and trans violence such as blantant misgendering of a patient or dead naming. This of course enraged me and I would always advocate for more education and resources, but as a queer nurse even if the mistreatment is not directed at me — it harms me too and made it more difficult for me to care for my patients.
PPMW: When someone comes into PPMW who is interested in exploring gender affirming care, what does that care look like?
KT: Gender-affirming care generally begins with a telehealth appointment at PPMW. There's always the option for the patient to come in person if they prefer but it's typically going to be over the phone and video. Patients must be 18 years of age or older to access these services. Our services are rendered through informed consent to reduce gate-keeping, which asks the patient to consider the expected benefits, risks, and the possible side effects of hormone therapy, so that the patient can decide with their medical provider if hormone therapy is right for them.
Over video with them, we go through an intake process. We ask the patient general questions about their past medical history, their lived experiences, how long they've identified as trans/non-binary/gender fluid, and what their goals are through GAC. We review benefits and adverse effects of hormone care, making sure the patient understands what’s going to happen or potentially could happen, the side effects and the timeline of treatment, potential risks, etc. It's all based on the individual patient and what their goals are. If you are assigned female at birth (AFAB) and desire more masculize features, typically we will prescribe a form of testosterone. If you are assigned male at birth (AMAB), and desire more feminine features then we usually will prescribe estrogen and an anti-androgen medication, which is medication that blocks testosterone. Like I said before, each plan is individualized so it does not always follow the above “formula.”
Usually, patients can start the medication the same day of their visit — occasionally there are delays due to insurance coverage but we have ways to work around this. Two weeks after starting the medications, patients will have their blood drawn to make sure the medication is not negatively affecting their body and then I or another provider will contact the patient through phone consultation to adjust the medication to ensure safe levels or tell the patient to continue on their medication as prescribed. Then there is a three month in-person follow-up for one year where we ensure patients are reaching their transition goals or have any concerns. We'll draw their blood and see how their hormones are. As long as labs are generally normal for that year, a patient will move to a six month follow up plan then eventually a one year follow up plan.
PPMW: What sorts of care and services does PPMW not provide?
KT: PPMW provides gender-affirming care by prescribing hormones, helping counsel patients, assisting with establishing an individuals’ goals, and providing referrals for other components of GAC. We can provide referrals for physical feminization or masculinization surgeries, electrolysis, voice-teaching, counseling, and even support local groups.
PPMW: The notion of trans health is kind of binary — transitioning from male to female, female to male — and that's not necessarily the case. Can you talk a little bit about that, and more broadly, how your own understanding about these ideas has changed?
KT: Initially, I think that's how I viewed transitioning in a very binary way, years ago. As I met more trans, non-binary, and gender fluid people, and I got more educated, it helped me understand the spectrum of gender. In understanding, I also learned more about myself and my identity as a gender queer. I think viewing trans health within a binary reinforces stigmas such as you need to be on some sort of medication or to be socially out to be valid in the community. That's not true. There are a variety of gender identities and all of these identities are valid even if you choose to embark in GAC or not. You don't need to be doing anything to your body to feel how you feel — and you don't always have to figure it completely out. It's okay to question, it's okay to look inside and see what you want. It's okay to change your mind. That is the beauty of the fluidity of gender.