How many transgender dentists do you know? Is your answer greater than zero? My answer is exactly one and that person is myself. As a thought exercise, imagine you identify your dream career — and then consider what it would be like to pursue that same career without ever meeting any faculty, colleagues or mentors with similar lived experiences. This example highlights the importance of workforce representation, and it’s a struggle many minority groups know all too well.
It’s not as if there is a lack of transgender people in America. The Williams Institute estimates there are 1.4 million transgender adults in the country, or 0.6% of the U.S. adult population, and that number continues to rise every year with increasing societal acceptance. Per U.S. Bureau of Labor Statistics data, there are about as many transgender adults in this country as there are active elementary school teachers. So why, after two years of networking with dental students across the country, do I still struggle to meet someone who shares my identity?
The truth is that LGBTQ+ people — and trans people, in particular — face significant barriers in pursuing postsecondary education, barriers that originate from a lack of respect, understanding and, sometimes, outright bigotry. These factors make it difficult for queer and trans youth to excel academically: We suffer heightened rates of psychiatric disorders, violence, substance abuse, homelessness, bullying and suicidal thoughts, per HealthyPeople.gov. The 2015 U.S. Transgender Survey reported 40% of transgender respondents had attempted suicide in their lifetime.
June is LGBTQ+ Pride month, and Pride is about overcoming systemic oppression. Due to an increase in LGBTQ+ visibility over the last decade, many allies assume that we’ve “won,” but the truth is that queer and trans people have yet to realize the full spectrum of legally enforceable civil rights available to the broader cisgender, heterosexual public.
Just this month, our rights to non-discrimination protections in health care were threatened when the Trump administration announced it would be removing transgender identities from the protections secured in Section 1557 of the Affordable Care Act. Three days later, the Supreme Court decided for the first time in the history of this country that federal workplace non-discrimination protections include sexual orientation and gender identity. Statewide protections for LGBTQ+ individuals in health care, housing and the workforce are scattered and have led to a geographical distribution of civil rights that is unequal and unjust. The fight is far from over.
In the following paragraphs, I will leverage my identity and privilege as perhaps one of the only transgender dental students in the entire country to highlight a vision for transgender oral medicine that is rooted in justice, equity and empathy. When it comes to health care, being an “ally” to your patients can mean the difference between sickness and health, or even life and death.
In broad terms, our duty as allied health care providers is to create the safest environment possible for patients to discuss their health concerns and receive treatment recommendations. This includes abiding by the principles of non-maleficence, beneficence, justice and veracity outlined in ASDA’s Student Code of Ethics. We must start by recognizing the extent of discrimination against transgender patients: According to the aforementioned survey, 28% of respondents reported experiencing harassment in medical settings, while 19% reported being refused care outright due to their gender identity. It is vital that we as dental professionals leverage our power to reduce trauma to this vulnerable community.
To achieve this goal, we must educate ourselves on the fundamental aspects of transgender medicine. Transgender identities are diverse, valid and backed by science, and patients who pursue transition-related care will receive a diagnosis of “gender dysphoria/gender identity disorder.” With this in mind, we must then explore the most common treatment options, including any contraindications to dental treatment that may accompany them, while recognizing that no treatment is an acceptable and desirable treatment option for many trans individuals. In accordance with the justice principle, we should be as familiar with transgender hormone replacement therapy as we are with Atorvastatin, Metformin and Amlodipine.
The social aspect of trans health care is equally as important as the medical side. Our next job is to learn to speak with trans patients in a way that constantly affirms their identity, and this requires a level of cultural humility to which we may not be accustomed. Examples of ways to affirm transgender identities in your practice include adapting patient intake forms and EHR systems to allow for a variety of responses to questions about sex and gender identity as well as a space for pronouns. Every team member should be trained to offer their own pronouns before asking for those of the patient, and pronouns should be clearly displayed on every staff member’s name tag. This form of allyship designates the sharing of pronouns as a ritual that everyone can and should participate in. Finally, in terms of gathering information, we must ensure our inquiries are respectful, knowledge-based and relevant to the treatment at hand.
These recommendations are far from exhaustive, but they provide a foundation and concrete steps for leveraging spectatorship into active participation. Remember, Pride is only the most visible manifestation of a struggle that queer and trans individuals face in their personal lives on a daily basis. When LGBTQ+ Pride Month ends, the work continues. Educate yourselves, ask questions, stay humble and never forget that we as health care professionals took an oath to care for and protect even (especially) the most vulnerable among us.
~Bradley Morgan, San Francisco ’22