Month: June 2022

Keep the Government OUT of the Medical Office

/ Jame A. Agapoff, MD, MS (she/they) / 3 Comments

As a physician, yesterday’s news about the overturning of Roe v Wade came as a shock. Even though the decision had been leaked, a part of me could not believe it then or now. For a half a century, Roe v Wade protected a woman’s right to make a medically informed decision about her body. Now that right is gone.

The decision highlights the twisted hypocrisy among the far right and anti-abortion religious leaders, who claim to stand for limited government and individual liberty, while supporting decisions that take away individual liberty and place the government directly in the medical office.

The medical office is supposed to be a sacred place of choice. It is where some of the most difficult life decisions are made. Through the process of informed consent, a physician explains the benefits and risks of a treatment based on medical science and research, and then supports that patient’s choice. Sometimes, the scar of these decisions can last a lifetime, but they are made with the solidarity and belief in the personal freedom of each individual to make an informed decision about their medical care that supports their values and goals.

Today, in America, women have lost that right.

Overturning Roe v Wade is an ominous sign of what could come. Justice Clarence Thomas has already said that rulings protecting contraception, marriage equality, and privacy in the bedroom should be overturned. At risk are Americans’ fundamental privacy. It is not hard to imagine the same questionable arguments used in overturning Roe v Wade applied to these cases.

If SCOTUS and others truly wish to protect individual liberties and freedoms they should keep the government out of the medical office. The right to privacy is a fundamental right. Instead of impeding this right, the government and its branches should seek to safeguard the right to privacy at every turn. It is arrogant and misguided to think a woman, or any other person, lacks the capacity to make an informed medical decision with their physician. Sadly, that’s the America we wake up to today.

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Military Transgender Policy is Still Trapped in the Gender Binary

/ Jame A. Agapoff, MD, MS (she/they) / 4 Comments

Gay. Non-Binary. Psychiatrist. Military Officer. Wait, military officer?

In 2015, I commissioned as an officer in the U.S. Army Reserve. Last year, I was promoted to the rank of Major. This is a part of my life I rarely share on this blog; however, I think there are a few things I need to say about my service as someone who is gay and non-binary.

In 2010, I declined a military scholarship for medical school because of the ‘Don’t Ask Don’t Tell’ policy. A year later, this policy would be lifted, opening up the path for my future commission. For me, serving with honor and upholding the military code of ethics meant being able to express my sexuality.

In 2016, when President Obama lifted the transgender ban in the military, I was overjoyed. Even though the policy focused on individuals moving from one end of the gender binary to the next, the change opened the door for other forms of gender expression.

When the ban was reinstated in 2019, it felt like a step backwards for many non-binary service members. As I note in a previous post, the term transgender defines any person who identifies a gender not listed on their birth certificate. Thus, non-binary persons are transgender, but in terms of military policy, non-binary people don’t exist.

In 2021, the ban was lifted again, but the policy remained trapped in the gender binary, focusing on individuals wishing to transition completely from one sex to another. It did not address individuals with more neutral or androgenous forms of gender expression like myself.

There is some evidence this may be changing. According to Military.com, the “Institute of Defense Analyses, at the Pentagon’s request, is researching how nonbinary troops could be allowed to serve more openly.” Some branches like the Air Force are already ahead of the curve allowing service members to list their preferred pronouns on email chains.

In my opinion, clear policies recognizing non-binary persons are necessary to support and retain fighting strength. Non-binary persons fill critical needs specialities within the military that are essential for mission success. As definitions of gender move away from the binary, the military, as an all voluntary force, must also adapt and change.

I am proud to serve in the U.S. Army Reserve as an openly gay, non-binary soldier.

Happy Pride Month!

References:

https://www.military.com/daily-news/2022/01/18/pentagon-quietly-looking-how-nonbinary-troops-could-serve-openly.html

https://www.military.com/daily-news/2022/02/11/im-pretty-much-leading-double-life-nonbinary-troops-and-pentagons-next-frontier.html

Click to access ARN32878-ARMY_DIR_2021-22-000-WEB-1.pdf

Headwinds of Intolerance

/ Jame A. Agapoff, MD, MS (she/they) / Leave a comment

For many LGBTQ+ persons engaging in a gender transition, the headwinds of intolerance are a real obstacle. It can mean rejection from friends, family, and even community. All transgender persons struggle with this truth. For this reason, it takes courage to align one’s gender expression to their gender identity.

In my previous article, The LGBTQ Psychiatrist Educator (Article Available on Request), I discuss under what circumstances it may be appropriate to share one’s sexuality in the clinical learning environment. In a thoughtful follow-up Letter (also Available on Request), a “bisexual” medical student, and now doctor, noted that transgender persons who are expressing their gender identity don’t always have the luxury of selective disclosures. For this reason, transgender persons often face the greatest headwinds of intolerance.

She’s right!

Intolerance comes in many forms, both passive and active. The natural reaction to intolerance is to shirk away from it or to change one’s behavior to avoid it. For transgender persons, this could mean changing where they shop, moving to a different community, making a career shift, or even finding new friends. The most difficult choice faced by some transgender persons is whether to hide their gender expression, which could lead to significant dysphoria but protect them from threats of physical violence.

Transgender persons remain one of the most stigmatized, misunderstood, mislabeled, feared, and marginalized minority populations. As Dr. Benfield stated at the end of her letter, we “…should strive towards creating a safe, inclusive workplace for trans people, and commit to role modelling trans allyship in our professional and personal lives.”

Happy Pride Month!

References:

1. Agapoff JR. The LGBTQ psychiatrist educator. The clinical teacher. 2021;18(5):472-473. doi:10.1111/tct.13335

2. Benfield E. LGBTQ educators: an LGBTQ student’s response. The clinical teacher. 2021;18(3):314-314. doi:10.1111/tct.13349

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Be Yourself! LGBTQ+ Advocacy Through Self-Expression

/ Jame A. Agapoff, MD, MS (she/they) / 1 Comment

Be Yourself!

Sounds easy, right? It is more difficult than you think.

At forty, I am still striving to live openly. Even when the environment is right for transparency, there is always a risk.

In college, I had a job as a lab tech in the chemistry lab. Another technician, an older woman, quickly became a friend. At some point we were talking about relationships and I told her I was gay. I still remember the look on her face. Shock… perhaps fear as well. And, then she said, “I am a Christian.”

Rejection. I was speechless.

I remember smiling pensively and continuing about my work, but I realized then that there was a wall between us that my openness revealed. I say “revealed” because I did not create it. She did. I think this is an important point because this kind of rejection can be easily internalized and influence future openness.

Sadly, the first reaction many gay and transgender people experience when they share their sexuality and gender dysphoria with others is rejection. This is one reason why drug use, mental health problems, and suicide disproportionately impact LGBTQ+ persons.

My experience has shown me that it takes resilience to be openly gay and non-binary. Despite greater openness and acceptance in our societies, there remains significant stigma. In addition to my work as a psychiatrist, I am also a military officer. If a transgender ban were to be reinstated, I could be discharged. I accept that.

The truth is that if we aren’t open about who we are, someone else will decide for us. We owe it to ourselves and others to lead by example. Perhaps, if we do, we will live to see a time when our openness leads to opens doors rather than walls.

Happy Pride Month!

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Why Pronouns are Important

/ Jame A. Agapoff, MD, MS (she/they) / 9 Comments

For many transgender persons, pronouns are an important part of their gender transition and expression. As I describe in my previous post, gender expression is how a person chooses to project their gender identity, which is one’s inner perception of self such as male, female, something between, or something outside the male-female binary. Gender identity is different than sex, which is based on physiological characteristics such as genitalia as well as chromosomes.

Most of us have gotten into the habit of assuming pronouns based on a person’s gender expression. This assumes that a person’s physical appearance matches their gender identity, which is not always the case. Even people who are cis-gender (a person whose gender identity and sex align) may have many kinds of gender expression. To be more affirming, all of us should try to get out of the habit of assuming pronouns.

Often an easy way to know someone’s pronouns is to introduce yourself with yours. For example, “I am Dr. Agapoff. I use he/him/they/them pronouns. It is nice to meet you.” This creates a safe and open space for the other person to share their gender identity if they choose. Research shows that using someone’s correct pronouns has a positive impact on their mental health and wellbeing. Let’s all work together to create a more inclusive and respectful world.

Happy Pride Month!

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A Quick Guide to Sex, Gender Identity, & Gender Expression

/ Jame A. Agapoff, MD, MS (she/they) / 2 Comments

June is LGBTQ+ pride month. Happy Pride Month! In support of LGBTQ+ persons, all blog posts this month will have an LGBTQ+ theme. Today, I’ll familiarize everyone with the differences between sex, gender identity, and gender expression.

We often conflate sex and gender, but they are different. Sex or “natal sex” is what is written on a person’s birth certificate. A person’s sex is based on physiological characteristics such as genitalia as well as chromosomes. Male, female, and intersex are examples of sex.

Gender or gender identity describe one’s inner perception of self such as male, female, something between, or something outside the male-female binary. When a person’s sex and gender align, they are considered cis-gender, when they do not align, they are transgender. Thus, non-binary persons are transgender by definition.

Gender expression is how someone chooses to express their gender identity. Examples of gender expression include names, pronouns, clothing, haircuts, behaviors, voice, body characteristics, and more. The process of aligning one’s gender expression to their gender identity is called a transition. Transgender individuals can transition using a combination of personal (name, pronouns, dress), legal (changing sex on legal documents, name change), or medical means (surgeries, hormone therapies). Transitions often help ease gender dysphoria, which is the clinically significant distress a person experiences when their natal sex does not align with their gender identity.

I hope this quick guide helps you understand the differences between sex, gender identity, and gender expression. May it help you be an ally for the transgender community!

Happy LGTBQ+ Pride Month – Growing up Gay and Genderqueer in the 90s

/ Jame A. Agapoff, MD, MS (she/they) / Leave a comment

In celebration of LGBTQ+ Pride month, all June posts will have an LGBTQ+ theme. 🙂

Pride month has become an important time in my life and for many other persons who identify as LGBTQ+. Being gay and non-binary comes with many challenges in today’s culture. Great strides have been made to improve LGBTQ+ rights and inclusion since I “came out” over twenty years ago. Even so, these rights and freedoms are not guaranteed, and for many of us, the shadow of prejudice looms large in our psyche.

Growing up as a gay and non-binary teenager in the 90s was very difficult. Like many others, I chose to hide my sexual orientation out of fear of being bullied or shunned. In my small high school, there was only one student who was “out,” and his courage did not come without social shunning and isolation.

Being non-binary as well as gay came with other challenges. Puberty meant differentiation along the gender binary. To me, “transgender” meant a move from one end of the binary to the other, rather than being somewhere in the middle or completely outside of the binary. As you can imagine, being unable to express myself as gay and genderqueer came with a lot of dysphoria, which led me to act out at home and in school.

It wasn’t until I graduated high school and left my small town that I gained the courage to express myself. Even among my close friends who knew I was gay, I did not have the language to describe what it meant to be genderqueer and non-binary. This has come slowly and with time. Changing my dress, physical appearance, and pronouns (he/him/they/them) has given me a sense of wholeness I did not know was possible when I was a teenager. In truth, I am still transitioning, but with each step outside of the gender binary, I take one step closer to who I am, and in this I am proud.

Happy LGBTQ+ Pride Month!

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