Trans Bodies, Trans Selves: The Owner's Manual to Life, Health, and Self

Abstract

In this article, the author reviews Trans Bodies, Trans Selves as an educational and clinical resource from the perspective of an academic physician working with transgender and gender non-conforming patients.

Introduction

Laura Erickson-Schroth, ed. Trans Bodies, Trans Selves: A Resource for the Transgender Community. New York: Oxford University Press, 2014, 672 pp., $39.95.

The lead editor of Trans Bodies, Trans Selves: A Resource for the Transgender Community (TBTS), Laura Erickson-Schroth, MD, MA, states in the preface that her aim was to have a resource written by and for transgender and gender non-conforming people which shares trans health information and implores medical providers to educate themselves about trans bodies. She finishes the preface with the same words that were the last words of the text's inspiration, Our Bodies, Our Selves (OBOS): “Please share this book with others.” Whether you read this book cover-to-cover, thumb through it searching for specific information, or utilize it for its rich medical and health resources, you too will find that you will want to share this book with others.

As lead editor and chapter author, Erickson-Schroth has drawn from her many roles and experiences with lesbian, gay, bisexual, transgender, and queer (LGBTQ) people—as a psychiatrist working with LGBTQ people from New York City, as a board member of the Gay and Lesbian Medical Association (GLMA): Health Professionals Advancing LGBT Equality and the Association of Gay and Lesbian Psychiatrists—to paint in broad strokes the contemporary issues facing trans* people. (Trans* is an umbrella term that refers to all of the identities within the gender identity spectrum.)¹ TBTS is a 648-page book inspired by Our Bodies, Our Selves, and is a book of many diverse voices, each attesting to some facet of living as trans* people. It is a kaleidoscope of stories, resources, essays and poems from over 200 contributors, many coming from the ranks of a “Who's Who” list of leaders, writers and activists, as well as medical, surgical, and mental health experts. The soft cover text is organized into six sections which, in turn, are divided into 24 chapters, each providing a balance of personal stories, literature, ethnography, recommendations, and resources. Each chapter ends with additional references and readings from the primary medical, social and scientific literature. For novices to trans* identities, the A-to-Z glossary of terms provides definitions for common terms used by transgender people and those who care for them.

As a health professional who works with transgender, gender non-conforming, and what our health center considers “gender-awesome” adults and children, I was excited to read and utilize this resource. At first glance, TBTS has a bright cover and the makings of a coffee table book. However, upon reading through the table of contents, one finds the text organized into sections entitled, “Who We Are,” “Living As Ourselves,” “Health and Wellness,” “Our Relationships and Families,” “Life Stages,” and “Claiming Our Power,” which create a humanizing framework for the text. As I read on, I realized this was the book that I wished I had read to prepare me when I began my own career caring for trans* people.

Many readers of this book will be health professionals seeking to enhance their clinical and cultural competency in caring for transgender and gender non-conforming people. To be clear, TBTS was never intended to be a medical textbook or a health professional how-to guide. TBTS was written by the trans* community, for the trans* community. In order to use this resource effectively, health professionals and trainees will need to practice cultural humility and view life and health care through the lens of trans* people. The stories held within TBTS speak to the challenges of navigating the health care world, interacting with health professionals and providers, and owning one's health and body. With that said, there is an enormous amount of information which can improve the health care experience for trans* people, and we as health professionals deliver that care.

The Health and Wellness section is particularly useful for a practitioner of transgender health care, including cross- gender hormonal care. The chapter on General, Sexual, and Reproductive Health by Nick Gorton, MD, and Hilary Maia Grubb, MD, nicely presents a foundational review on the history of transgender health care, discrimination based on real/perceived gender identity and its impact on health care access, as well as health conditions of particular importance to transgender people. The chapter reviews approaches to examinations and procedures that are important in preventive health, including genital exams and anatomy-based cancer screening. There is additional information on both fertility preservation, as well as contraception for transgender people, a much less-discussed topic in most health care settings. In the next chapter, Maddie Deutsch, MD, takes the reader through a comprehensive review of transgender hormonal medical therapy and reviews the essentials of initiating cross-gender hormonal therapy, its side effects, and the important potential barriers to medication adherence, including insurance coverage for hormonal care and obtaining hormones from a reputable source. Deutsch references a number of seminal articles and resources including recommendations from “The Endocrine Society: Endocrine Care of Transsexual Persons” (Hembree, et al. 2009)² and an article from NEJM on the “Care of Transsexual Persons” (Gooren, 2011).³ Chapter 13 focuses on surgical transition and is very well written and organized. I found the writing on post-operative care particularly helpful for a provider counseling a patient on his or her new anatomy.

Section 5 will appeal to readers working with one or more age groups within trans* communities. The chapters on Children (Chapter 19), Youth (Chapter 20), and Aging (Chapter 21) each delve deeper into the medical, psychological and social implications of being transgender or gender non-conforming. The authors tackle issues ranging from exploring gender with gender non-conforming children, support for parents with transgender or gender non-conforming children, social transition, navigating gender-segregated spaces, disclosing one's gender identity, sexuality and dating, and aging. Of note, the authors also address legal issues important to those aging in place or in nursing care facilities. Advanced directive planning and funeral directives are also addressed. These are all important and practical issues facing trans* people daily, but go unaddressed often until it's too late.

TBTS is a virtual encyclopedia of nearly all things trans* and there were few omissions. Gaps within TBTS are explicitly stated by the authors as limitations in care recommendations supported by evidence-based outcomes research. In general, more detailed resource lists and suggestions on how to find more local/regional resources would strengthen this text. Many websites of organizations and agencies serving trans* people are referenced and in sidebars of the text, but not many URLs provided.

TBTS offers the reader a thorough review of fundamental constructs of sexuality and gender necessary for any health professional caring for transgender people. The text explores a thoughtful discussion about non-binary language and intersectionality (“Who We Are”) and diversity within the trans* community: Deaf, differently-abled, people of color, two-spirit, and Hijra, among others. With this said, Erickson-Schroth bravely lists the limitations of this book: “An effort was made to select short pieces, quotes, and art that represent the diversity of trans communities. We have inevitably failed at this goal. Most of the authors live in the United States or Canada. Many are middle- or upper-class, and many are white.” The first edition of any book is imperfect and has room for improvement. TBTS is no different, and the authors encourage others to contribute to share their stories in the next edition. What is clear is that TBTS, like its namesake, offers readers access to a world of trans* experiences and knowledge to educate and empower health professionals to be clinically and culturally competent trans* allies. In time, I have no doubt that TBTS will evolve to be considered a classic in its own right, like its inspiration, OBOS, while remaining universally accessible to health professionals and consumers alike.