LGBTQ+

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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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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