Employee & Community Health

All genders are welcome

7/18/2019 by Drs. Cesar Gonzalez and Natalie Erbs

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At around week 20 of a woman's pregnancy, Dr. Natalie Erbs, Family Medicine, is often asked, "Am I having a boy or a girl?" This question has been passed down through generations to guide expectations of "what boys do" and "what girls do". It affects how individuals view themselves, others and their futures — as well as which colors or clothing they'll use, recreational activities they'll pursue, what occupations they'll be encouraged to follow, and even how much emotion is acceptable to express. But what happens when your sex assigned at birth is not aligned with who you are as an individual? 

Between the ages of two and four, most children will have already learned stereotypes of what boys do and what girls do and will have told their parents what gender they are. For most children, gender expectations based on sex characteristics informs their gender identity, defined as the internal sense of being a boy or girl. 

  • The term cisgender is used to describe individuals whose gender identity is in line with their sex assigned at birth. Most people are cisgender women or cisgender men. 
  • The term transgender is used to describe individuals who report that their gender identity is not aligned with their sex assigned at birth. 

Among transgender individuals, many report distress due to the difference between their sex characteristics and gender identity. This distress is called dysphoria; transgender people may or may not experience it. 

In a random selection of 100,000 adults living in the U.S., it's estimated that approximately 580 adults would identify as transgender. For adolescents (ages 13 to 17), the estimate is that for every 100,000 there are 730 adolescents that identify as transgender. 

Multiple studies have suggested that among transgender people, 40 to 50% have attempted suicide at least once in their lifetime. This is significantly higher than the estimated 3 to 5% of the general U.S. population. 

Minority stress linked to suicide attempts

Think about all of the stressors we have to deal with day in and day out. Now add the worry and focus of wondering if everyone you encounter is going to hurt or insult you just by being present. 

The constant worry and fear of being harassed and rejected, on top of daily stressors, is an example of minority stress. There's also the stress of being called the wrong name, wrong pronoun or being judged for using the bathroom. Multiple studies suggest that minority stress is a cause of the high rate of suicide attempts among transgender people. 

ECH promotes the health of all people

Employee and Community Health's (ECH) providers are committed to reducing minority stress by providing care that is aware of, and appropriate for, gender and sexually diverse individuals. 

We're aware of minority stress, and we counter it with simple behaviors that let our patients know we see them, respect them, and they don't have to fear coming into the clinic. In addition:

  • Our bathrooms are now labeled, "All Gender", rather than "male" or "female" so patients feel comfortable using the bathroom without judgment. 
  • For our electronic health record, we ask patients about their sex assigned at birth, how they self-identify their gender and what pronouns they use. We use this information to provide a welcoming environment to all patients. It also allows us to provide the correct health care for all of our patients. 
  • We want to send the following message: We accept you, no matter no matter who you are, and your visit to your clinic should feel safe — whether you are cisgender or not. 

Dr. Cesar Gonzalez is a consultant in ECH's Division of Integrated Behavioral Health (IBH) and serves as clinical director of the Transgender and Intersex Specialty Care Clinic at Mayo Clinic in Rochester. He also is the associate program director of the Family Medicine residency for Mayo Clinic. 

Dr. Natalie Erbs is a senior associate consultant in ECH's Division of Family Medicine at the Baldwin clinic in Rochester. As a family medicine physician and ally to the LGBTQIA community, she prioritizes creating a nonjudgmental space for all to feel welcome during their medical visits.