Recognizing and validating the diversity of gender identities and expressions positively affects the health of our patients and our communities.
Lifelong Learning in Clinical Excellence | January 6, 2020 | 2 min read
By Carl G. Streed Jr., MD, MPH, Boston Medical Center
For as long as I’ve known them, they have been an explosion of gender expression beyond the constraints of binary categories of “man” and “woman.” I was fortunate to get to know Jacob Tobia (they/them) in 2011 as a fellow Point Foundation scholar, before their current incarnation as a gender-queer star following the release of their memoir, “Sissy: A Coming of Gender Story.”
The first few pages of this poignant and precocious memoir dispel any notion of Jacob walking us through “Transgender 101,” and am eternally grateful to take a break from the basics of terminology and pronouns. What Jacob shares is the unique experience of an individual coming to terms with a gender that is not neatly confined to the binary categories we have been led to believe are our only options.
Throughout “Sissy,” we are asked to pause and consider our understanding of our gender and how we express it. While everyone has a gender identity, for persons who have gender identities that are beyond binary categories, they can experience some of the most pervasive forms of stigma and discrimination with measureable effects on health.
In my own research and advocacy, we find that gender non-conforming and non-binary adults in the US experience disparities in physical and mental health compared to not only cisgender peers but also transgender binary peers (i.e., transgneder men and transgender women). The observed disparities in physical and mental health outcomes persisted after adjustment for sociodemographic characteristics, healthcare access, health conditions, and alcohol and cigarette use, highlighting the need for further study to elucidate reasons for these disparities. Similar evidence is being found for youth as well.
As is evident in Jacob’s narrative, and the expanding research in Minority Stress, there is growing evidence that interpersonal and structural discrimination towards gender non-conformity results in stress that contributes to worse health outcomes.
Sissy as a badge rather than a slur
As they explore their remembrance of their gender and their community’s response, Jacob reveals the initial harm of being called a “sissy.” The self-doubt, the forced behaviors to conform, the very real effects on their self-worth. As they grow and find strength and accept their gender to be outside binary categories, Jacob reclaims Sissy. I, for one, look forward to seeing where Jacob and other folks expanding current gender categories take us. As physicians, we are natural advocates and must continue to be so for persons and communities of all genders.