S01_E19 - Gender-Affirming Care, and Why it Matters...

Speaker 1: 0:03

Welcome to the healthy matters podcast with Dr. David Hilton, primary care physician and acute care hospitalist at Hennepin healthcare in downtown Minneapolis, where we cover the latest in health healthcare, and what matters to you. And now here's your host, Dr. David Hilton.

Speaker 2: 0:20

Hey everybody. It's Dr. David Hilton, your host of the healthy matters podcast. This is episode 19 of the podcast, and I'm really excited to be talking about transgender health issues today with my colleague at Hennepin healthcare, Dr. Hailey Vizi, Dr. Vizi is in my opinion, a leading physician, not only in clinical cares, but in education about transgender healthcare and gender health in general. And that's what we're gonna talk about today. And I can't wait to get into the discussion Dr. VII. Thanks for being here.

Speaker 3: 0:49

Thanks Dr. Hilton. I'm really excited too.

Speaker 2: 0:51

It's great to have you here now for our listeners. Dr. VII literally has been the founder of some, uh, transformative healthcare at my organization, Hennepin healthcare in the areas of gender health. Tell us Hailey, why is this even a topic we're doing? Why is it important that we talk about gender health and transgender health

Speaker 3: 1:13

Specifically? Yeah, well, in, in one way, it's a little bit of a selfish topic for me, you know, I, as you know, and you remember when I started as a resident here, I looked a lot different and seemed a lot different. And of course, I came out of the closet as a trans woman during my intern year as a resident, as one of your pupils, as a resident here at Hennepin healthcare. And it was something that I was always interested in, and I just kept telling people, my attendings, your colleagues, our friends here, that I wanted to be able to do this sort of medicine someday, that I was interested in it. I was vested in it. I wanted to be able to provide care to trans patients in the future. And people just kept materializing out of nowhere that wanted to help me make it happen. And I assumed that the people here would help me get the training so that I could do it when I was done with residency. I never imagined that people would be so interested in helping me make this happen, that I would be able to start this clinic while I was a resident. And

Speaker 2: 2:09

Tell me about the clinic. Yeah. What clinic did you start then while you were still in training folks? Uh, Dr. VII did this while in training when the rest of us are trying to figure out how to write a Tylenol order.<laugh> she is developing a whole new clinical model. And I gotta say this isn't common in medical training.

Speaker 3: 2:26

Yeah, so I, during my second year of residency, I established the adult gender and sexual health clinic. And I say, I did it, but there were so many people again who were part of the organization that were really excited to help me make this happen, who really took steps and got me in meetings, got me in the room with the people to help make the decisions. And we started our first day of clinic in 2016 and started with one single patient showing up the first day. And since then, throughout the rest of my time as a resident, and now as a faculty for the last few years, we've got a, a full panel of patients and we're booking months out and are, have more work than we know what to do with. So, um, it's been a really great time of seeing what this institution was willing to do and, and back me, um, and doing so it's

Speaker 2: 3:12

Congratulations, congratulations, and Ali, congratulations. But thank you. Thank you for your work in setting up their clinic. Now, what kind of issues, what kind of, um, patient needs do you see in the adult sexual and gender health clinic?

Speaker 3: 3:27

Yeah, you know, I, I, I like to call it gender affirming medicine. What we do. We, we have patients that come to us for just regular primary care where, you know, they wanna have their blood pressure managed and blood sugar and lipids checked every year, but we specialize in gender affirming care. So we do gender affirming, hormone replacement therapy to help people align their physical body with their gender identity. We do referrals for gender affirming therapy, mental health. We do referrals for gender affirming surgeries. We help people with preexposure prophylaxis to try to prevent HIV and STI testing and treatment. And, uh, some limited family planning as well, as much as we can. It's a, it's a great place where people who are members of the LGBTQ community can come and get their normal primary care, but also take care of gender and sexual health as well.

Speaker 2: 4:17

Wonderful. You've used some words there that, that I I've become familiar with, but only because I think I hang around you and, and, and colleagues and I, and I get to work at an institution that, um, is welcoming and, and provides a full range of healthcare services, but maybe not everybody knows those terms. What is gender and how is it different than the sex you were assigned at birth? Or are, are they different?

Speaker 3: 4:39

Yeah, they're very different. It's, it's kind of like talking about a house and, you know, a house has plumbing and electricity and sometimes, and they're, they're separate systems, but they're still part of the same house. And when we talk about sex assigned at birth, that's the physical structures that we can observe with our eyes that tell us that a person has more masculine or feminine physical structures to their body. And there's a huge range of that. That's one part of someone's identity and, and personhood. And that's an example of extreme diversity in the human species. And it's like everything in nature. There's, it's not a binary. There's not just black and white X and Y it's a huge range from the most maleness that a body can have to the most femaleness that a body can have. And it's completely separate from someone's gender identity. So someone's inner concept of themselves on that scale of maleness to femaleness. And sometimes they don't align. So if somebody's physical body, their primary and secondary sexual characteristics, so the parts that they were born with and the parts that changed throughout life and become more or less masculine or feminine, those things are separate from their gender identity. And if they don't align, if someone's sex that they were assigned at birth, doesn't align with their gender identity, their innermost concept of themselves, we call that person transgender. And that means that that's a huge umbrella, right? It's not just that someone goes from,

Speaker 2: 6:05

It's not one thing or the other, there seems like there's a, a diversity of what it means to be transgender then, right?

Speaker 3: 6:11

Yeah. And if someone's gender identity is absolutely anything on earth, other than the sex they were assigned at birth, they fit in that big umbrella. So you don't have to say there are only trans women and trans men. You can only go from one end to the other. It's not like that. It's a, a huge, diverse community and a huge, diverse umbrella to be under. And it can be anything from somebody who just doesn't feel like their sex assigned at birth fits them. And they wanna present a little bit more androgynous or feel like they're non-binary, they don't fit within the male, female binary or somebody who does say, you know, I was assigned female at birth, but I know I'm a man and that's who I am, and that's how I'm gonna present myself. And I'm gonna seek different treatments and therapies to help me align how people see me with my gender identity.

Speaker 2: 7:00

But Dr. Vizi, it is one or the other, and I'm being facetious here.<laugh>. So how do you respond to this? Uh, yes, there are there's X chromosomes and there's Y chromosomes there's male and female. That's what it is. And, and I'm trying to say that with a little tone of voice to say that I don't believe this, but I, but how do you respond to that? Where someone says, you're a boy,<laugh>, that's what you are. Yeah. Not, you know, you know, we can, I want to get into later about how harmful those thoughts, like those statements really are. Yeah. But how, but on the face of it, how do you respond to

Speaker 3: 7:31

Those? You know, it's really basic biology. When we go back to it, there aren't binaries in biology. It's not just black and white. All of the biology that we observe in nature exists on spectrums and exist in massive diversity. So when you look at chromosomes, most of us don't know what our chromosomes are. You know, I, I had a biochemistry degree in undergrad, so I, you know, did my own PCR testing and, and whatnot in undergrad. So I kind of know where my chromosome at

Speaker 2: 7:58

Seriously, you did your own PCL on your DNA.

Speaker 3: 8:00

It was, well, we did test,

Speaker 2: 8:02

Not that you're a nerd looked

Speaker 3: 8:04

For bar bodies and that sort of thing. So some people who go through that sort of training, know what their chromosomes look like, but the vast majority of us don't, and there are people walking amongst us who have different chromosomes in their body. People who appear to have two X chromosomes on testing, but appear physically masculine because of various mutations. It just takes certain presence of certain hormones during a few key time periods during a production of an embryo for someone's outward sexual characteristics to appear one way or another. So it's not just about hormones, it's not just about chromosomes. It's not even just about hormone receptors or the sensitivity and strength, uh, for each one of those things. And every one of those little factors that goes into making someone physically appear masculine or feminine exists on a spectrum, mm-hmm,<affirmative>, someone can have a whole lot of one type and a whole lot of another type and everything in between X and Y. And that's just the physical part of it. When we start talking about gender identity and the mental part of it, you know, someone's gendered brain, that's a whole other spectrum. So you can imagine just like any combination of, you know, dozens of variables that produces massive diversity of gender, gender, identity, sexual, uh, sex assigned at birth and sexual characteristics. It's really interesting. You know, when you think about basic biology that really points us away from a binary, there is no just black and white. There is there isn't extensive diversity in, in the existence of biology and nature. So

Speaker 2: 9:35

Is gender a cultural

Speaker 3: 9:36

Construct? You know, there's definitely aspects of gender that are culturally constructed. There's aspects of gender expression that are varied from culture to culture and gender roles that vary from culture to culture. There's also some biology and neurobiology that goes into it. All that said it. I don't think that we need to put a lot of stock into what part of human's brains are gendered one way or another. We're not gonna put everybody who comes to our clinic in a functional MRI to see, you know, where their gender comes from in their brain. And there there's some fascinating studies into it that I might give credit to our really interesting, you know, there are sexually dimorphic parts of the brain parts of the human brain that seem to cluster in one area or another, and seem to correlate with sex assigned at birth. And some of those structures seem to correlate with gender identity rather than just sex assigned at birth. So, um, there's this bed nucleus of this dry, a termin in the brain, which is part of the limit.

Speaker 2: 10:35

Oh yeah. I know all about that.

Speaker 3: 10:36

<laugh> of course we all do.

Speaker 2: 10:38

Oh yeah, I remember it. Well,

Speaker 3: 10:39

Super familiar<laugh> but, um, there's some fascinating studies on that, that show that the, the sexual dimorphism seems to align with gender identity rather than someone sex assigned at birth, regardless of treatment for gender transition, uh, treatment. So there are some interesting points to make about there are there, there seems to be things that correlate with someone's gender identity, but I don't ever test anybody. I don't ever try to make someone prove that don't they're trans

Speaker 2: 11:08

Enough. You don't, you don't need to do that to yeah, I like that. Yeah. Or I think that that's a, an interesting point. Say that again, you don't need to,

Speaker 3: 11:14

I don't need anybody to prove to me that they're trans enough to be trans. I just trust that they are who they say they are.

Speaker 2: 11:21

God, that's great.<laugh> Neely. That's really good. I, I've not heard it said like that before. I absolutely love what you've just said. Now you're using trans as an adjective. Is that what it is?

Speaker 3: 11:31

Yeah. Yeah. An adjective, not a noun. So folks will sometimes, um, incorrectly say that someone is a transgender or, uh, also someone is transgendered. Um, that's not technically grammatically correct. So we typically use it as an adjective to describe someone as a trans person or a transgender person or trans man or a trans woman. Um, and I, I, I, I think that's the correct way of using it now, but I give a caveat with all definitions and terms in this because what's acceptable and, um, not offensive today might be wildly offensive in 10 years. So my big thing, when it comes to language is be nimble and be willing to change. Cause there are people who've been absolute pioneers in trans medicine from the seventies and eighties who just don't have modern language and it can come across, um, a, a little offensive sometimes. So be willing to change your language as time goes on and

Speaker 2: 12:24

Maybe just go naturally, admit you were wrong. Don't if, if you get corrected about what you've used it, language incorrectly, uh it's uh, admit it. Oh, I, I shouldn't do that. I've learned now and do better next time, but yeah. Give yourself, give everybody a little grace there. I want, before we move on, I wanna talk a little bit about, well, I wanna talk about a lot of things. I wanna talk about the significance of pronouns. Yeah. I wanna talk about mental health for, uh, transgender people. I want to talk about the healthcare system in general. So I have a lot to talk about before I get to that, before we get away from exact terminology, you and I went to chemistry class. A lot of people did. A lot of us looked at molecules and, and I'm still, my brain is still swimming about what trans CIS meant in chemistry. But how does the word cisgender, what does, what do those pronouns mean? Um, in, in this topic? Yeah. What does CIS gender person?

Speaker 3: 13:14

Yeah, so a cisgender person is somebody whose gender identity lines up with the sex they were assigned at birth. So when we were going through our organic chemistry classes in undergrad, we looked at these organic molecules that had two parts that were on the same side of a molecule. And we called that CYS. And when they were on opposite side, it would trans it was a trans molecule. Yeah. And it comes from a Latin prefix. It just means on the same side of, or on the opposite side of which is a, you know, a little bit misleading because like I mentioned earlier, someone can be trans and not be on the quote unquote opposite side of someone doesn't have to be on the other end of a spectrum to be trans. It just needs to be someone who isn't what they were assigned at birth. So a cisgender person just means someone's whose gender identity lines up with what they were assigned at birth

Speaker 2: 14:02

Really helpful. We're gonna take a short break. And when we come back, I do wanna talk a bit about those other things I mentioned. So let's talk about pronouns, this little, teeny little words, you know, now you see him and, and hers and why does that matter? Yeah. Cause it, because it does, we're gonna talk about that when we get back among other topics, we're talking with Dr. Haley, VIY a physician of both internal medicine and emergency medicine at Hennepin healthcare and the founder of the adult gender and sexual health clinic in Hennepin healthcare here in downtown Minneapolis, stay with us will be right back.

Speaker 1: 14:35

Your listening to the healthy matters podcast with Dr. David Hilton, have a question or a comment for the doctor become a part of our show by reaching out to us@healthymattersathcmed.org. Or give us a call at six one two eight seven three talk that's 6 1 2 8 7 3 8 2 5 5. And now let's get back to more healthy conversation.

Speaker 2: 14:59

And we're back. I'm Dr. David Hilden. You're host of the podcast talking to Dr. Haley. VIY an internal medicine and emergency medicine doctor. I'm not gonna get into that, but she's like trained in everything.<laugh> um, here with me at Hennepin healthcare, we're talking about gender health and gender affirming healthcare. Dr. Vizi talk about pronouns, if you could. Why is it, what, why does it matter?

Speaker 3: 15:20

Yeah, yeah. It's important. Um, you know, pronouns, at least when we're talking about the English language, which we're kind of English centric, a lot of times in this culture, um, they're the way that we refer to somebody using shorter nouns for them. You know, he, she, they, them other more creative pronouns that are, that exist today as well. And it's a show of respect that you see someone, you understand what they want you to call them. And you, you do that. You, you satisfy that request. So it's a, a simple matter of respect and, and honesty and kindness. I think that we owe one another in our society. And part of the reason it's so important to me is that a large number of trans people in large surveys throughout the years have indicated that they have delayed seeking medical care because they were worried about being mistreated in a medical system. And it's not that they thought that they were gonna be physically abused. When they went in to see their doctor, they, they felt like they were gonna be the victim of microaggressions, of those little jabs in the side that show you that this society, this institution, this infrastructure wasn't made with you in mind. And one of those things can be being misgendered. So being called by the wrong pronoun or the wrong honorific being called Mr. Or Mrs, when that doesn't fit with your gender identity. And it just reminds you that you weren't in mind when this society, this structure was created and it hurts a little bit so honoring that is important. And one of the most important things that I educate people about is how to figure out someone's pronouns. I think the best way of doing that.

Speaker 2: 16:57

I'm glad you're getting into that because how do you,

Speaker 3: 16:59

Yeah, I think the best way of figuring out someone's pronouns is first to tell them yours, to normalize that conversation and show them that by me telling you what my pronouns are, I'm communicating that. I know that you can't assume my pronouns, and if you do that, it normalizes them then telling you their pronouns. And the way I do that is, you know, when I go into a room with a new patient, I'll tell them, hi, you know, I'm Dr. Haley or Dr. Vizi, um, I'm a trans woman and my pronouns are she and her, what about you? And that's generally seen as a universal way of being respectful and asking someone's pronouns. And then the next, most important part is doing it and using those pronouns consistently. And we all make mistakes. You know, I, I do, I do too. But when you make a mistake, the biggest thing is not to Seinfeld it, not to just dig the whole deeper and just talk about how you're such a great person. And I never do this and I have trans friends and I would never miss any,

Speaker 2: 17:52

I know a trans person I'm, this is not who I am.

Speaker 3: 17:55

Yeah. The biggest thing is to just say, you're sorry, once, correct yourself and move on and don't do it anymore. If you can. I, I think that's the biggest thing.

Speaker 2: 18:02

So I'm on zoom calls all the time and you're starting, and this applies to cisgender people. That's kind of who we're talking to here and great deal. Those of us who, um, the system was maybe built with us in mind, you know, and, and we need to recognize that to normalize that conversation, we need to put our pronouns. Do you agree with that?

Speaker 3: 18:21

Yeah. I think that's a good, helpful way of communicating these things. And sometimes you're surprised, you know, another thing to, I remember is that someone's gender expression, the parts of their style, their mannerisms, their hair, their clothing might not line up with their gender identity and their pronouns.

Speaker 2: 18:38

I think that's a, a good take home point for all of us to keep in mind. And it's not about you, you know, I I've had people get really, like, I'm gonna not gonna call them by she that's a, he, is it really? That is it really, it's really not about you. That is it's about what that person, I like what you said. It's about respecting an individual.

Speaker 3: 18:56

Yeah. Yeah. I think that's what it all comes down to.

Speaker 2: 18:59

Let's shift to the healthcare of transgender people. In general, you mentioned something that was provocative to me. Many people feel like the healthcare system wasn't built with them in mind. So could you talk a little bit about where there's similarities and where there are unique healthcare needs for the trans community?

Speaker 3: 19:21

Yeah, it's, it's interesting. And I think one of the biggest markers for that is the fact that all of the data that I use when I talk to patients about the risks and benefits of hormone replacement therapy, for example, almost all of it is extrapolated from cisgender populations or populations that just really don't apply to this group. So I would love it if we had a, you know, 10 to 20 year longitudinal study on all of the effects and, and negative effects of hormone replacement therapy on transgender populations. But I don't have that because all of the data that we have is based on cisgender populations, for example, a lot of the risk that we quote people taking feminizing hormones is from things like the women's health initiative, hormone

Speaker 2: 20:05

Replacement therapy and menopausal women.

Speaker 3: 20:07

Yeah. Post menopausal, cisgender women,

Speaker 2: 20:09

Cisgender women.

Speaker 3: 20:11

Yeah. That's the biggest population study that we have on that specific treatment. And we don't have something equivalent in the trans population. So that's just one example of something that we cope with, uh, when we do gender affirming medicine, just the sheer lack of massive amounts of data to tell us what things do and don't happen while a trans person is taking these hormones

Speaker 2: 20:34

And being a scientifically based community in academic community. We like to do, we strive in all we do to provide scientifically sound care, but when you don't have the benefit of, of a population that has, has not been studied,

Speaker 3: 20:48

Yeah. We have to rely on informed consent based treatment in these situations, right. Talk

Speaker 2: 20:52

About access. So we're fortunate, uh, uh, um, in this community, we have you and your colleagues and the nurses and the community health workers in both for adolescents and adults. We have it right here in our downtown Minneapolis clinic in Hennepin healthcare, largely thanks to you and your team. I'm gonna guess that such an outstanding gender and sexual health clinic doesn't exist everywhere. That's true. What is access to healthcare like in this country? And people are listening to this podcast from all over, not just in Minnesota.

Speaker 3: 21:23

Yeah. That's, it's,

Speaker 2: 21:25

What's it like?

Speaker 3: 21:26

It, it, it's sad in some ways, the fact that I have patients that have to commute to come to their appointments with me for hours is a sign that they passed by hundreds of clinics on the way here. And they couldn't go to any of them to get this sort of care. And that's the way in a lot of different places. And you're right in the twin, cities were incredibly lucky here at Hennepin. There's my clinic. And there's a pediatric gender and sexual health clinic that was started by Dr. McGee, my counterpart in the pediatric realm.

Speaker 2: 21:53

Wonderful

Speaker 3: 21:53

Pediatrician. Yes. Wonderful. Um, and most of the major health systems in the twin cities have somebody that is doing this sort of healthcare, but a lot of states and a lot of cities and a lot of rural areas really don't have anybody who's willing to do this, which is a little frustrating because when I do lectures for our, our interns and residents in the internal medicine residency, I always quote that if you're able to do post menopausal hormone replacement therapy for cisgender woman, you can do it for a trans person. And if you can prescribe testosterone for cisgender, man, you can do it for a

Speaker 2: 22:25

Trans. I love it. You Don pull any punches. You look, you do do this to cisgender women. What, what, why can't you? Yeah, that's a really good point.

Speaker 3: 22:31

It's not super complicated in medicine. Um, it's, it's pretty logical once you get down to it and, and get past some of the hurdles and fears and misconceptions that go with it.

Speaker 2: 22:40

So what are the consequences of lack of access to, uh, healthcare that is intended? Yeah. Trans people and, and, you know, you know, what are the, what are the consequences of that?

Speaker 3: 22:50

I think some of the best data for why this is important as well, comes from studies in pediatric community. So there there's these large studies in the trans community that looks at health disparities. So things that the trans community communicates that they live with that the CIS community doesn't. So for example, the us trans survey, the most recent one from 2015 indicated that 40% of trans patients communicate that at one point in their life, they've attempted suicide. When you look at a similar

Speaker 2: 23:22

4, 0 4, 0, really half

Speaker 3: 23:23

40%

Speaker 2: 23:24

Astronomically high number. Yeah.

Speaker 3: 23:26

At least 10 times higher than the national average. When you look at the national population in general.

Speaker 2: 23:31

Yeah. To put that in context, that is 10 times higher.

Speaker 3: 23:34

Yeah. And when the

Speaker 2: 23:35

National population.

Speaker 3: 23:36

Yeah. And when you look at other social determinants of health and other health disparities, unemployment, homelessness, um, living in poverty, living with all the things that lead to poor outcomes and health, the trans community has a higher rate of all of those things than the national average. And a lot of those things are, are concomitant with mental health problems, you know, depression and, and anxiety and suicide attempts. All of those things are drastically worse for the trans population. However, when you take a subgroup of these trans people who throughout their life were supported in their identity by their family, their community, their doctors, their pediatricians, then their adult doctors, their family, their friends, those statistics go back to the national average. So the American academy of pediatrics, not to, I'm not a pediatrician, but I think they, they give us a lot of data on the fact that when a trans person is supported and allowed to be who they are and supported

Speaker 2: 24:34

By from an early age,

Speaker 3: 24:36

Yeah. From an early age, all of those risk factors go back to the normal national average. There's

Speaker 2: 24:41

Almost nothing more compelling than that statistic for me, at least that simply providing appropriate gender affirming care from an early age in children and young adults can reduce those horrible health outcomes. And, and for cisgender people out there, we should, all, in my opinion, just a little soapbox. We should all be concerned when whole communities of our neighbors and our friends and our fellow citizens when whole communities have health outcomes that are so, um, much worse and preventable.

Speaker 3: 25:14

Yeah. And we've seen that through time too, other, um, communities that were disparaged or, or treated poorly by society seemed to have worse health until there was more acceptance. So, um, in the, you know, cisgender gay community, we've seen incredible progress and less disparities over time as that community's been more supported, we're still not too equality or equity yet, but, um, we're we're but a little progress. Yeah. And you can see it over time. And it comes from the idea that, um, in gender affirming medicine, at least we, we realized that we're not treating someone's identity in medicine. We're treating the dysphoria that comes from how society treats us differently. What

Speaker 2: 25:54

Does dysphoria

Speaker 3: 25:55

Mean? Gender dysphoria is the, the negative feelings that someone gets from that discordance in their gender identity and sex assigned at birth. And it's not always just from an internal source. It's not that it, it's not a dysphoria. That's always created internally by the person. Sometimes it's put on them by society. So in other cultures throughout history, where there have been third genders or accepted roles that weren't just X and Y male and female, a lot of people didn't have the same sort of experience there wasn't this gender dysphoria that society had to learn how to treat. So in a lot of first nation and, uh, indigenous cultures, there were third genders sometimes referred to as two-spirit people who were just an accepted normal part of that population. And in sometimes in some ways revered, um, and we don't see the same sort of phenomenon where like in Western cultures where things have been kind of created for a binary, you get more people who express that, oh, I'm dysphoric because of this incongruence. And we're realizing that it's just a matter of diversity rather than pathology. We're not treating their identity. We're helping them to not have the dysphoria that, that society has sometimes put on them.

Speaker 2: 27:06

That's wonderful. I'm gonna shift, I'm gonna shift a little bit, uh, and maybe I'm asking you to speculate here, but why, why do you think in our, both in interpersonal, um, relationships and in our community at large, the public discourse, why are people, and I am asking you to speculate, why do you think people are threatened by the whole topic, but even talking about this, why do you think, why do you think we're so, uh, we're so quick to judge other

Speaker 3: 27:35

People. You know, I, I think in some ways when people are stressed and trying to cope with the pains and the stresses of society, it's easy to find scapegoats. And the trans population is an easy one. We're small, you know, the, the estimates are, you know, maybe as low as 1% of the population is trans, but I suspect it's a lot higher and it, it's easy to point that out. And, and in a small group, you know, there's a lot of people who don't necessarily know if they know a trans person, even if they probably do, they just might not know it. Mm-hmm<affirmative>. Um, so if you don't know somebody in a community, it's a small community, it's becoming more visible. It's easy to point them out as a, a scapegoat and a reason for someone's stresses or ills. You know, if somebody's upset about how the television makes them feel, or, or the, the shows that are on at night, because it just makes them uncomfortable. It's easy to point to a group like ours and, and blame them. Yeah.

Speaker 2: 28:29

That's insightful. Are you, are you comfortable telling me how it was for you? Uh, uh, you were, you're a new doctor.<laugh> I remember, yeah. You showed up it's your intern year and, and not only were you learning to be a doctor, but you came out as a trans woman during that time. Are you comfortable giving us a little bit of how, how that went for

Speaker 3: 28:47

You? Yeah. You know, I'm, I'm not from Minnesota originally. I'm from New Mexico. I'm from Farmington New Mexico, which is in the four corners area. Yeah. In the Northwest part of the state.

Speaker 2: 28:56

Everybody knows four corners area.

Speaker 3: 28:57

Yeah. The only place in the country where four states touch.

Speaker 2: 29:00

Yeah. I've been in all four of'em at once. I've stood there.

Speaker 3: 29:02

I think that's probably a little off with, when you look at Google maps, the actual monuments that, oh,

Speaker 2: 29:07

Come on. You are bursting my bubble, Hailey I've stood in Utah, Colorado, New Mexico, and Arizona all at the same time.

Speaker 3: 29:13

It close enough. It's

Speaker 2: 29:15

Off. Okay. So you're from an area.

Speaker 3: 29:17

Yes. That's where I'm from. Um, and I went to the university of New Mexico for undergrad and med school. And then I came here and in the second half of my training in med school, I started transitioning. Um, and I wasn't outta the closet. I wasn't telling anybody yet. I was still kind of trying to figure that out. You know, it's that awkward time in a lot of trans people's lives, where figuring out when and where and how to communicate your identity outward is, is still ongoing. So that means that I started my intern year, which is one of the couple of years in a doctor's life that is most stressful.

Speaker 2: 29:51

Oh, there's almost no more intense, stressful life in a doctor than that intern year.

Speaker 3: 29:56

Yeah. Your first year as an intern. And I think your first year as an attending are both incredibly stressful years, so far as I've seen. Um, but I was going through that intern year and a second puberty, which it probably isn't the best time if you had to choose it. But, um,

Speaker 2: 30:10

The timing sucks.

Speaker 3: 30:11

<laugh> yeah, it was not, not the best time to be going through that second puberty, but, um, it was, it was the right time for me. Um, and I found, um, as I was able to be myself more and felt comfortable here in Minneapolis, which that's one of the reasons I chose to come here. That that's one of the reasons that this was my number one choice on the RI it was because this place seemed safe and seemed comfortable for somebody like me to come out. Um, among the other things, you know, it's the best EMI in program in the country bar, none

Speaker 2: 30:39

Emergency medicine, internal medicine. Yeah.

Speaker 3: 30:41

Right. Um, but also Minneapolis and, and the system here seemed like a good place to do that. And I, uh, came here with that intention of eventually coming out of the closet and doing what I do someday. I just didn't know that I would be so supported and be able to do it as starting during my residency.

Speaker 2: 31:01

And then you are trained emergency medicine doctor. So, so throughout that training, you did this extraordinarily long training, and then it was our great fortune to hire you after you've finished. And now you're on staff here. And I just wanna say thank you for, um, a number of things actually, thank you for actually being on this podcast with me. I have learned a lot here, but thank you for being here among us. Thank you for, um, uh, promoting transgender health and gender firming care at this institution. It needs to happen throughout the country, I think. Is there hope for that? So thank you. I just wanna say thank you that, and I'm just thrilled that you're my colleague here. Um, you have enriched my life and the lives of so many people here. I don't even know if you know how much you've enriched our lives, but before we go, are you hopeful for healthcare issues in transgender, uh, communities?

Speaker 3: 31:49

I'm always hopeful. I'm, I'm skeptical at times mm-hmm<affirmative> and always worried about the backlash. You know, anytime a group becomes more visible and starts to take steps towards equality. Sometimes there's other forces that force another step or two backwards mm-hmm<affirmative>. Um, but with the affordable care act and the sections of the affordable care act that made it possible to make it illegal, to discriminate based on gender identity, that was a huge step forward. And in Minnesota, that's been interpreted to the point where I can usually get most treatment that I deem medically necessary for a patient covered. Um, as long as we're willing to fight for it. All right. So I'm hopeful for that. And I hope that that spreads and becomes the norm across our country, but I, I always worry, you know, I worry about those protections being taken away, but our institution, our state has been a great example of people willing to take steps forward. And we're not perfect. None of us are, none of our systems are, um, but we're, we're taking steps,

Speaker 2: 32:46

Dr. Hailey Vizi emergency medicine and internal medicine physician at Hennepin healthcare and the founder and current clinician at the adult gender and sexual health clinic. Thank you for being here on this episode.

Speaker 3: 32:57

Thanks Dr. Hillman. It's been an honor

Speaker 2: 32:59

Such great insights from Dr. Vizi and I hope this episode has got you thinking about some issues that maybe you hadn't considered before, particularly regarding gender affirming healthcare. I want to thank Dr. Vizi for being here. I want to ask all of you to go out and work towards justice in healthcare for all people, including those in the transgender community. Thank you for joining us. I hope you'll join us next time. And in the meantime, be healthy and be well.

Speaker 1: 33:25

Thanks for listening to the healthy matters podcast with Dr. David Hilton, to keep up to date with the latest in healthcare and your health, subscribe to this podcast, wherever you get your podcasts for more information on healthy matters, or to browse the archive, visit our website@healthymatters.org. And if you have a question or comment for the doctor, email us@healthymattersathcmed.org, or give us a call at six one two eight seven three. Talk to catch all the latest from Dr. Hilton and the healthy matters podcast. Follow us on Twitter at Dr. David Hilton. Finally, if you enjoyed this podcast and would like to support us, please leave us a review and share the healthy matters podcast with your friends and family. The healthy matters podcast is made possible by Hennepin healthcare in Minneapolis, Minnesota, and engineered by John Lucas at highball executive producers are Jonathan Camuto and Christine Hill. Please remember we can only give general medical advice during this program. And every case is unique. We urge you to consult with your personal physician, if you have more serious or pressing health concerns until next time, be healthy and be well.