The MICNP Podcast: Inspiring, Informing, and Advocating for Nurse Practitioners
Dive into the heart of Michigan’s NP community with thought-provoking conversations, expert insights, and powerful stories. From legislative updates to career growth tips, we’re your pulse on everything shaping the future of nurse practitioners.
The MICNP Podcast: Inspiring, Informing, and Advocating for Nurse Practitioners
Episode 3: The History of Transgender Medicine in the US--Editors Interviewed
This podcast episode features a discussion with experts in transgender medicine, focusing on the history, challenges, and future of transgender healthcare. The conversation highlights personal experiences, the importance of advocacy, and the evolving understanding of gender identity. The guests share insights on the medical treatment of transgender individuals, the cultural sensitivity required in healthcare, and the need for better training among healthcare providers. The episode concludes with a call to action for healthcare professionals to improve their understanding and support for transgender patients.
Takeaways
Transgender medicine has a rich history that is often overlooked.
Advocacy is crucial for improving healthcare for transgender individuals.
Personal experiences shape the understanding of transgender care.
Cultural sensitivity is essential in providing effective healthcare.
The evolution of gender identity understanding impacts treatment options.
Healthcare providers must be educated on transgender issues.
Diagnosis and treatment processes have changed over the years.
Transgender individuals often face systemic barriers in healthcare.
The importance of community input in shaping medical practices.
Future advancements in transgender medicine depend on ongoing advocacy and education.
Resources
Wolf-Gould, C., Denny, D., Green, J., Lynch, K. (2025). The History of Transgender Medicine in the United States: From Margins to Mainstream, SUNY Press, NY. ISBN-13: 979-8855801217
Theme music
- Keyboard, Bass: Clementine Kanfom
- Guitar: Tyler McDonald
- Drums: Andrew Padfield
- Mixed, Mastered: Andrew Padfield
Michigan Council of Nurse Practitioners (MICNP): Website
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Rachel Hetzner (00:01)
Welcome to the MICNP podcast. I'm Rachel Hetzner, your president-elect. Join us as we bring you the latest insights, discussions, and expert perspectives on the evolving role of nurse practitioners in Michigan and beyond.
Jen McConnell (00:16)
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Justin Hooks (01:46)
Welcome back to the My Camp podcast. We're so excited for this particular episode. We have the editors of the newly released book titled The History of Transgender Medicine in the United States, which was just released February 1st of 2025. Tonight with us is Dr. Wolf Gould, Dallas Denny, and Dr. Jamison Green. Welcome to our show, everyone.
Carolyn Wolf-Gould (01:49)
Thanks for having us.
Jamison Green (02:10)
Thank you, Justin.
Dallas Denny (02:11)
Thank you, yes.
Justin Hooks (02:13)
So I'm Justin, I'm a family nurse practitioner, HIV specialist, and problem member of MICNP. Rachel, our president-elect and co-host has a much deserved night off.
Jen McConnell (02:23)
Welcome back everyone. I am Jen McConnell, family and psychiatric nurse practitioner and proud member of MICNP We have so many good things to talk about tonight. So we're just going to jump right on in.
Justin Hooks (02:34)
I feel it's best for our experts on today's podcast to briefly introduce themselves and then we'll include on our show notes their professional links. So who would like to go first?
Carolyn Wolf-Gould (02:44)
Okay, I'll start. I'm Dr. Carolyn Wolf-Gould, and I'm a family practitioner. I have been practicing just general family medicine for about 30 years, and transgender health since 2007. I'm the founder of Bassett's Gender Wellness Center, which is an interdisciplinary center for transgender care in a rural town in upstate New York.
Jen McConnell (03:11)
Great, thank you.
Dallas Denny (03:13)
I'm Dallas Denny, I'm an applied behavior analyst, a writer and an editor. In the 90s, throughout the 90s, I ran an information clearing house back when there was almost no information about any kind of transgender issues.
Jamison Green (3:28)
And I'm Dr. Jamison Green. I am an independent legal scholar and a writer. And I led support groups for transgender people in the, starting in the early nineties. I've been an advocate for improved healthcare and legal rights for transgender people for about 35 years. And I'm a past president of the World Professional Association for Transgender Health.
Jen McConnell (03:54)
Wow, thank you all very much for being here. We really have some power players in the land of transgender medicine and transgender rights. So thank you very much for being here.
Justin Hooks (04:05)
So during the 2024 MICNP Annual Conference, I delivered a keynote talk called the Gender-Bred Person, and I kind of introduced LGBTQIA+ care. Now, transgender and gender diverse medicine is really important part of nurse practitioner practice. Whether you're an NP providing gender affirming care like myself, or you're just a nurse practitioner who has never treated or feels a little bit underprepared for treating transgender or gender diverse patients. This episode alone will inform you and educate you about the transgender community and the history of transgender medicine in the United States from some experts that have way more knowledge and experience than I do.
Jen McConnell (04:46)
So before we really get started on the book and all the awesome things that are in it, we always ask guests the same question. So if there was something you know now that you wished you would have known before you started either your practice in healthcare or your advocacy, what would you tell your person way back when? I know this was a tough question.
Carolyn Wolf-Gould (05:08)
So I'll start with that. As a doctor, I think I didn't really understand what the word privilege meant. When we join practices, when we join a hospital, we apply for privileges. And if we pass the hiring criteria, we're given permission to practice. And for years, I didn't really understand what that word privilege, why it was used for this hiring process. But now I do. It means that as clinicians, we're privileged by our bird's eye view into the lives of our patients. It's a real privilege to listen to their stories and especially in the treatment of transgender people to watch our patients courageously seek truth and authenticity. We bear witness to their journeys, their losses, their triumphs. And at the end of the day, as a provider for transgender people, I get to go home and ask myself, how am I doing with my authenticity? Am I living my truth? That is a true privilege.
Jen McConnell (06:02)
That's an awesome answer.
Dallas Denny (06:05)
I really beat myself up about this question a little bit because when I was in college, I was working in the mental health system in Tennessee in a psychiatric hospital as a psychiatric technician. And I had a strong sense of myself. And so I immediately began questioning what I saw as a very flawed and corrupt system. But I was scared and not sure of myself. So I would say trust yourself if something looks wrong, sounds wrong, smells wrong, it probably is wrong and question the system.
Justin Hooks (06:40)
That's a really good answer.
Jamison Green (06:42)
For me, I think what I've learned is not to be afraid to talk to doctors or nurses or healthcare providers, professionals in that system. I think a lot of transgender people are terrified of people in the medical system. And I've learned by actually stepping out and talking to them that they are human beings just like us. And that we all have things to share with each other, and we all have things to learn about life from each other. And I'm really happy that I've had the experiences that I've had and the privilege, if you will, to be part of improving the healthcare for transgender people with so many dedicated professionals.
Justin Hooks (07:33)
That's another great response.
Jen McConnell (07:35)
That is great. Just being your own advocate, for yourself. I tell my patients that all the time and as clients you are hiring the provider. They are your employee. So you really need to get what you need out of the appointment. And if it's not working for you, sometimes you just have to, you know, fire them and move on. So we don't want to be those nurse practitioners that get fired. We want to know what can we do to be better. So this is really important topic for us. So the next question I have for all of you is, how did you get interested and how have you been involved in the field of transgender medicine? I know this is a loaded question for some of you.
Justin Hooks (08:15)
Yeah.
Carolyn Wolf-Gould (08:16)
I think for me, I learned very early on taking care of transgender patients that it wasn't enough just to be a doctor, that you had to be a professional advocate as well as a doctor in order to break down some of the barriers that my patients were facing. And the more I became a professional advocate, the more I realized how painful the legacy was of history in this field.
And that really to break down the barriers, I had to understand the roots of those barriers, where it came from, and that involved learning about the history. So I was asked to write a piece for the Sage Encyclopedia. I volunteered and I said, write about the history of transgender medicine. I think I had nine pages to do it. I started to read and just was floored by what I started to learn about the field. And it really just made me so much more acutely aware of what my patients were facing.
I knew about Dallas who's a famous historian in the field. I heard her speak and asked her if she was interested and Kyan Lynch who's not with us tonight also joined the team and as did Jamison Green. I think we all have just a real passion for understanding this legacy.
Justin Hooks (09:20)
It's amazing. So Dallas, she mentioned you and your history. What motivated you to get into the work?
Dallas Denny (09:30)
Yes. Well, was from my college years, I was working in mental health care, mostly with adults with developmental disabilities, but also with people with various mental illnesses. And I'm trans and there was an absolute dearth of information. I could find no information. So I had a personal interest. And when I finally, after many years of searching, started to find some answers that helped me make sense of my life and what I wanted to do with it.
At the time, people like me were counseled to transition and then pretend it never happened and go off into the woodwork and disappear and have a wonderful life. And I didn't feel I could do that when so many people had to be like me, needing information and needing support so that they could make sense of their own lives. And so that's basically what I've done ever since.
Jamison Green (10:20)
And my experience is very parallel to Dallas's in that regard. Dallas was on the East Coast of this country. I was on the West Coast of this country. There was nothing basically in between. and we actually somehow met each other in the late 80s, early 90s and realized we were engaged similarly in trying to help people get good, reliable, accurate healthcare information.
There really was a dearth of it and both of us being writers, we were very much engaged in trying to expand that communication. And then I became involved with the Harry Benjamin International Gender Dysphoria Association because I thought that, well, they were the only organized medical association that actually was interested in research on this topic and filled with practitioners. And I thought they needed to do a little bit better job reaching the community. They made no attempt ultimately really to reach the community. They were trying to insulate themselves in some respects from the community in order to have their professional exchange. Well, that was fine. I understood that to an extent, but I think they needed a different perspective.
And so I got involved with them and ultimately became a member, was asked to become a member, and ultimately was asked to run for the board of directors and ultimately was elected president. And I spent 15 years on the board and another five years as a member prior to joining the board. And that organization, that is the organization that became the World Professional Association for Transgender Health.
Carolyn Wolf-Gould (12:13)
I'm just gonna jump in and get back to how asked how we created the book. And we started, I think, eight years ago. And we met and developed an outline for the book and then asked a number of people to contribute to the book who were experts in the field, who were transgender people who had expertise in the field, allies who had expertise in the field. And we met weekly over those six, eight years called the stories and edited the stories and put the book together. We faced a lot of editorial challenges while we created the book and we talk about them in the introduction, including questions like who should speak for trans people? I'm a cisgender doctor, should I speak for transgender people? Do I have that right? How do we approach the pathologizing or evolving terms used to describe gender diverse people throughout history?
Should we use the outdated terms like transsexual, transvestite? Is it appropriate to out someone after they die? And what pronouns do we use for somebody who never specified their pronouns or perhaps used a language that didn't have pronouns? So we talked about all of these things and fretted about them. And eventually we had two different focus groups with transgender individuals who helped us think about those questions.
And after extensive discussion, they reassured us that we would inevitably offend people no matter what we chose and said, just do it, just do it. So we did do that knowing that there could be some trauma in our choices, but hope that our choices will just enable other kinds of discussions for those scholars who come after us.
Justin Hooks (13:49)
I think that's why we, yeah, sorry, Jen. I think that's why we're gonna get into medicine to help people out and to kind of tell a story. And sometimes unfortunately, it can kind of come across as opposite, but we take an oath as a healthcare provider to serve every patient, regardless of anything they present, we take an oath to health.
Jen McConnell (14:12)
Yeah. And I think it's so great. In reading the introduction, I actually thought a lot about what you're saying now, Carolyn. And that is you just ask that community of people, what do you prefer? I think that's what we're missing a lot of times when we go to treat different members of the community. I felt the same way you did when you said I'm cisgender because I'm also cisgender and I'm in the mental health field and I'm trying to help patients.
I can't necessarily relate to every single thing that they go through. So is it okay for me? How do I best help them? And we do have a lot of patients that seek treatment from people who are more like them, and there's nothing wrong with that. We just have to, as providers, accept when this is gonna be a better relationship for us and the patient and what's gonna work best for them. So I think that's really important. But the fact that,
We are asking people from members of a certain community, what do you prefer to be called? What do you want? I think a lot of times in this day and age even we are missing that. And that's the big piece that I think we need to all realize moving forward as providers and as people.
Justin Hooks (15:29)
That's a really good point. And so people have said that gender identity is inborn and that some people say it's learned. This question is for Dr. Carolyn Wolf-Gould can you tell me a little bit about the research that you explored, the theory of nature versus nurture and how that applies?
Carolyn Wolf-Gould (15:49)
Sure, I'm gonna tell you the story about Dr. John Money, who was a clinical psychologist, and he did a study that actually didn't involve transgender people at all. He was a clinical psychologist who did a lot of wonderful things in the field of sexology, but unfortunately, this very tragic story is what he is most known for now. So he believed that gender identity was learned, that we were born with a blank slate and taught to become masculine or feminine. And in the mid 1960s, he advanced this theory by describing the case of the Raymer twins and in the process became one of the most prominent sexologists in the world. David and Brian Raymer were identical twins, born to a middle-class family in Winnipeg, Canada. Brian's penis was destroyed during a botched circumcision when he was eight months old. His parents, desperate, didn't know what to do and brought him to John Hopkins, where Dr. Money advised them to surgically castrate their child and raise him as a girl.
So he insisted that they raise Brian according to very strict cultural expectations about gender roles. So Brian had to behave and was coached to behave in feminine ways. And everyone was completely secret about Brian's assigned gender at birth. So Brian didn't know that either. And for years, Dr. Money portrayed this twins experiment in the medical literature as a success and presented a very rosy image of two well-adjusted siblings living comfortably in their different genders. And this study made him famous and influenced public thought about the origins of gender identity for decades. His research also directed the surgical treatment of intersex children for years. And doctors sometimes still recommend surgically assigning a gender at birth for these infants. Even feminists backed his view that men and women were created equally and that gender identity was learned.
But as time went on, all was not well with David Raymer, who became increasingly distraught, depressed, and dysfunctional as he grew older. He couldn't really find words to express what was happening to him in his mind, with his body and his gender. He knew that he was very upset by visits to Dr. Money and even threatened suicide if he was forced to return to that office. At age 14, he told his local psychiatrist that he just didn't feel like a girl. And she insisted that he be told his story.
As he learned his history, he became angry, depressed, also had some very small relief because it kind of made sense what was happening to him. And he socially transitioned back to his birth gender of male, finding some comfort in that. But he continued to struggle with dark moods and explosive anger. He actually eventually married a woman, had two children and worked as a janitor in a slaughterhouse.
And in 1997, Dr. Milton Diamond, who was an academic sexologist who believed that gender identity was inborn and not acquired, found David and interviewed him and was shocked to hear his story. And when David discovered that Dr. Money's acclaim from the supposed success of his reassignment was used to legitimize infant sex reassignment for intersex and genitally injured babies, he was furious and he allowed Dr. Diamond to publish the true outcome of his study. So Dr. Diamond's theory that gender was learned was debunked. There was a whirlwind of controversy regarding Dr. Money's ethics, honesty, and research methods. And a few years later, David's brother, who had struggled with schizophrenia, died from a drug overdose, and David became increasingly depressed.
And in 2004, he took his own life shortly after his wife suggested the separation. So very tragic story. Very clearly showed that gender identity was not learned, not acquired, but inborn.
Justin Hooks (19:31)
It's interesting that you brought the twins as a point and example for that, because that's fantastic. I'm an identical twin, believe it or not, as well. And so my twin brother's a physician. People think the same thing being twins too. One turned out not heterosexual and one did in the same thing. Very interesting how it was recalling all that back in what we had experienced just between two different, two unique people, but two different identities, to say the least. And so that's a really good point, how there's differences.
Jamison Green (20:08)
And I know of several twin studies where the identical twins have one has transitioned and one has not. Fraternal twins where one has transitioned and one has not. And some where identical twins have both transitioned.
Justin Hooks (20:24)
And that twin bond is something that I can tell you is unique. So it breaks my heart to hear one twin being lost because twin bond is something that is so fascinating. And it's, it's something that I'm fortunate that my parents were able to have and create me.
So let's move a little bit forward we talked a little about the history of trans and transgender and identity, but transgender medicine has not. This is not a new thing. It kind of seems like a new thing, but this is really not a new issue. Can you explain, Dr. Green, why that is or a little about the history?
Jamison Green (21:06)
Well, I can say that, and we document this in the book, that transgender people have existed in every race, every class, every culture since the beginning of recorded history. It's just the vocabulary that has changed many times, but the medicine actually began in the late 1800s, early 20th century.
When in Germany, in Europe, and some other European countries too, there was little bits of this here and there. Denmark and some of the Slovakian countries had some people who were looking into the fact they were recognizing things about human sexuality and about theories about human beings that were coming to light and were starting to be explored in different ways. And there were some people who felt that these kinds of differences ought to be squashed. And some who felt that these kinds of differences ought to be acknowledged and explored because these were human beings and people been like this throughout history, we just haven't seen it always or recognized it for something that is unique and could matter. So Dr. Magnus Hirschfeld in Berlin was the most famous researcher who was doing work with trans people
He began to do some surgery. There were other kinds of endocrinological experiments that were going on by other doctors in other countries as well. But Hirschfeld had a center for studying human sexuality in Berlin, and he employed trans people in his clinic or in his research library.
And he worked extensively with the community on their legal access to society and on their medical affirmation of their gender identity. And so that means hormonal and surgical affirmation.
And then that transitioned to the United States through the person of Dr. Harry Benjamin who was an immigrant as a student, he came to New York to study tuberculosis. He was already a medical doctor, but he was still a young medical doctor before World War I. And he had worked with Harry Benjamin, he knew a lot about what had been done in Berlin, he was not happy with the state of research in the United States on tuberculosis. And so he wanted to go back to Germany because he thought things were better organized there. And then he got caught here between the two world wars and ended up ultimately emigrating to the United States.
And he also was connected with Dr. Alfred Kinsey and his sex research. And that communication helped to bring trans people into contact with each other. It's a very fascinating story, ultimately.
Dallas Denny (23:56)
Although the focus of our book is on trans history in the United States, we have a section on how that kind of vibrant medical scene in Germany particularly migrated across the ocean, including several people who migrated with it. And one of the things I learned
Jamison Green (24:10)
Yeah.
Dallas Denny (24:14)
I guess I already knew it, but it really hit home is that this medicine was really done in collaboration between cisgender sexologists and other medical professionals and transgender people, many of whom figured themselves out in an almost complete lack of information and then educated the doctors or went to doctors and convinced them to give them treatment. It was kind of remarkable. It takes a lot of self-knowledge and courage and wisdom to pull something like that off and many did.
Jamison Green (24:44)
And that cycle has repeated itself over and over and over throughout the last century on an individual basis, because people still to this day, in spite of all the communication, the internet, all the information that's potentially available, people still find themselves and think they're the only one who goes through this and have to reinvent this all and then make contact.
Carolyn Wolf-Gould (25:09)
In many ways, I think you could say that Christine Jorgensen is responsible for Harry Benjamin. She figured out that she needed treatment, couldn't get it in the US, and went to Europe where she did receive treatment, experimental treatment at the time, and then came back home and was immediately this media sensation. People were just fascinated by her story, and she needed a doctor, and Harry Benjamin became her doctor.
And don't know, what do you think Jamison? I think that's why he became famous is he became her doctor and then there suddenly the trans population in the US had an icon to look for and started to demand treatment.
Dallas Denny (25:47)
I wrote in the 90s in a book chapter that she was the engineer of her own social experiment. You know, she made it all happen. She convinced the doctors in Denmark to treat her. She, you know, she worked with Harry Benjamin and
She was under the media spotlight for the rest of her life, which made life very difficult in some ways, especially romantic. You could never really have a partner because it was immediately all over the headlines.
Jamison Green (26:11)
Right, well I think too that, she went to Denmark because they had already done this before. You know, she went to Denmark because there were people who knew how to deal with the hormones. And
But I think that it still was an object of curiosity and there was a magazine called, what was it? Was it popular sexology? It was sort of like the popular mechanics of sexology. But they published for a long, time and there was a doctor, Dr. David Caldwell, David O. Caldwell, who wrote about strange sexual phenomena in every issue. He wrote lots and lots of articles and he wrote a very scathing article in 1948, I believe, which was described a transsexual person. That's the term that was used at the time and described them as pathological, having pathological psychology and not being a very stable person. And, and basically said it was because they came from a wealthy family that poor people were not capable of experiencing this kind of psychosis about their sexuality because they were too busy trying to survive. And that simply is not true.
Jen McConnell (27:33)
Yeah. And I will say that working in the mental health field, we have the DSM five right now and there are still diagnoses in there that I think as we learn and we become providers and we look to treat people, we struggle with diagnoses because how do we get reimbursed? How do we
How do we put a label on things so that people will get treated? I've actually talked to Justin about this before because he provides gender affirming care. He prescribes hormones. He helps people with their transitions. And I said, as a psychiatric provider, do I need to diagnose somebody in order for them to be covered by a family nurse practitioner or a primary care provider if they're going to seek hormones. So it becomes this thing like we have to educate ourselves. And then what happens when this information gets on their records and now it's permanent part of their records and is there going to be a backlash now? Is it outing them somehow? there's so many facets of being a provider and having that trust and going, okay, what's my responsibility and how do I do what's best for my patients?
So I think this is a good way as we move forward, even with the psychiatric world making these different diagnoses and going, okay, what do we need in this book and why is it there? You know, it can help people, but can also hurt them quite a bit. I've talked to other psychiatric providers that say, no, I just put the diagnosis down as depression. The reason for the depression doesn't need to be diagnosed in their formal diagnoses, but this is what's happening, you know, in and then the anxiety and the paranoia and the other things like this can be a part of their depression. So it's really important that we educate ourselves and as we move through and become more, educated providers and we get more experience that we start to understand how this affects people and just their general well-being.
Carolyn Wolf-Gould (29:26)
The whole world of diagnosing and the labels used to diagnose people have really changed over the years. We used to call it gender identity disorder, and the word disorder implies that someone is ill somehow, is unstable or whatever, disordered. And I think it was 2013. I'm trying to remember when it was. 2013, yeah, 2013, the diagnosis was changed to.
Jamison Green (29:49)
2013.
Carolyn Wolf-Gould (29:54)
a gender dysphoria and the thought being that gender diversity was normal, a normal thing, but dysphoria or the discomfort or distress between ones internally experience gender and their sex assigned at birth, that that was what we were treating. But now the language is further evolving and many of our patients aren't dysphoric at all. And we, in our clinic, we use the term gender incongruence, which is further depathologizing, our patients and their experience.
But you're right, we do have to give a code to give treatment. like a little.
Jamison Green (30:23)
Well, gender incongruence is part of the ICD, but it's not yet part of the DSM. I don't know, I'm not sure whether the ICD-11 has not been formally accepted by the United States yet. And that's why those new codes have not been incorporated. It took the United States 10 years to incorporate ICD-10 after it was launched.
So ICD-9 was accepted by the World Health Organization and all of its members in 2019. So we have probably at least until 2029 or 2030 before it's going to get integrated into practice in the United States. Gender incongruence was removed or the related conditions removed from a sexual perversion kind of psychosis chapter, removed from mental health and put into physical conditions of human sexuality in the same chapter as pregnancy, for example.
Justin Hooks (31:36)
That's sad, but things are changing and we have individuals like Dallas to be an advocate, not only have lived experience, but to write about it, especially with the books. So my next question was, Dallas, if you don't mind sharing, how was care that was provided for you when you started the process to where it is now. Have we made progress?
Dallas Denny (31:59)
Let me say, when you're trans, think the first thing, once you start processing it, think the first thing you do is like, no, this can't be happening to me. the, you know, I'm like every boy or every girl and you don't want to disappoint your family. You don't want to disappoint society. You don't want to be singled out and harassed or killed.
And you seek treatment. And after Benjamin's book popularized the term transsexual in a very binary society, gender clinics popped up. First at Johns Hopkins, and there were more than 40 that ran through the end of the 1970s. And after looking here and there for help, not finding many places to even look for help,
I went to the gender clinic at Vanderbilt University where I was later a doctoral student and paid money to take a battery of psychological tests I'd been trained to administer in grad school. And they told me that they would not offer me feminizing treatment. And the reason was because
I did not fit their clinical expectation of transsexuals. And that meant that I had a mental illness, that I had a character disorder, that I had a personality disorder, that I had histories of run-ins with the law, that I had a histrionic personality. It goes on and on. And in other words, I wasn't screwed up enough to be transsexual. And that's one event in my life that politicized me. I went right across the quad to the medical library and read everything there over the next couple of months and everything there absolutely agreed with them. because they were producing that same literature, which was based upon their beliefs and they let the people in the clinics in based upon their perceived view of how pathological that person was. after initially questioning, well, if I'm not transsexual, what am I?
I realized that the literature was like a snake eating its own tail, self-perpetuating. And that really politicized me. And that's when I went out and forged a prescription for estrogen at age 29. Changed my life. I don't regret it, but I regret that I had to do it.
Justin Hooks (34:34)
Wow.
Jen McConnell (34:36)
That's really powerful. It really is. One of the things that I noticed too in the book is and throughout just like history and cultures of transgender people that they've been both vilified and celebrated. You notice this in the pre-colonial times when you talk about that at the beginning and then as you move through, you know, you have transgender people that are doing blessings and ceremonies for newlywed
people and to bless your child. And I mean, it's amazing. And then you turn around and we're in 2025. And, it's almost like the cyclic thing is happening with transgender people. can you explain why you guys think this is and, how it's affected transgender and non-binary people's ability to obtain medical care?
This is a tough one.
Dallas Denny (35:29)
I think when fascist movements begin to develop and thrive, they have to find a victim and they look for the easiest people to demonize. And we're up in this country right now in 2025. And it's very bad. are losing, many people are living in fear of their lives, problems with getting documentation, it's gonna be problems with medical care. And I'm anticipating increased violence because it's gonna be all right to do things to us in ways that it has been okay to do things to other people victimized in earlier decades. So it's a bad time. Try not to be political here, but it's a bad time.
Justin Hooks (36:16)
Do you, no, no, it's really hard to say too. And so I wanted to go back and when you talk about accessing the gender clinics, do you still go to a gender specific clinic or do you get the care from your primary care provider? And what do you see about that?
Dallas Denny (36:35)
Well, it was many years before I was able to actually get competent trans care. And now all I really need is just maintenance dosage of estrogen. And I get that from my endocrinologist, who knows enough about trans people to feel comfortable. I've run into some issues at my age, I'm 75, getting hormones, but she is willing to prescribe. I had to go through four endos to get to her, but... You know, I'm convinced it's kept me healthy mentally and physically to be on estrogen since I was age 29.
Justin Hooks (37:07)
Wow.
Jamison Green (37:09)
And I get care from my primary care provider.
Jen McConnell (37:14)
Yeah. And that's really what I think a lot of us as nurse practitioners and providers want to have that message out there that you don't necessarily have to be an endocrinologist to gain the expertise because we need more people that can provide gender affirming care. Justin does that in his clinic now. And he has also, been an advocate for you don't have to be specialized in a certain field to do this. We just need more people out there willing to be educated and willing to take that leap and go, hey, I have enough people in my area who can't find competent care and either I need to find them somebody that they can see regularly or I have to be that person that can provide that care. And I know Justin can speak a little more.
Justin Hooks (38:00)
So I usually, Dr. Wolf will like this one. I tell everyone, everyone asks me when they come, when they have a transgender patient, I'm usually the phone-a-friend that they call in and ask, how do I treat this person? And so I usually tell them if you can pronounce amiodarone or if you can pronounce or spell appropriately epinephrine, you can prescribe gender affirming care and you can do it without any problems. Cause we're doing it kind of already with OCPs.
And so we provide hormones in a different way. so Dr. Gould, this is your work that you do. And I don't want to cut you off Dr. Green either, but getting the care that you provide, your clinic is very unique because the research, what I found during my doctorate degree is nurses only received 2.12 hours of LGBTQ education. And then physicians in med school are allowed four hours of training. Do you really think that's enough? think everyone can agree it's not. But what are, can you talk a little bit about what you do and kind of a little bit about if you have to do the thing. Like I'd say if you do the violence epinephrine or spell it correctly, then you can provide gender and care.
Dallas Denny (39:15)
Let me just say before you start Carolyn, if they're sick that day, they get none.
You know, they missed us for hours, but had zero.
Carolyn Wolf-Gould (39:24)
Exactly. But that's for all of LGBT health, which is ridiculous. I guess I don't completely agree with you, Justin. I think it's important to be trained well in this. And like we learn how to take care of all manner of human conditions, it's important to get the right training. So it's more than just kind of knowing how to pronounce amiodarone it's knowing about what gender dysphoria is. If you're taking care of youth, knowing about the stages of development, knowing about the hormones, knowing about what barriers to care our patients face. But I think it's very possible to get that training as a primary care physician. There's all kinds of opportunities to get that training now through WPATH, through CMEs at all kinds of places, through mentoring. But I do think it's important to get extra training in the field to do it well.
Jamison Green (40:14)
It is an interdisciplinary field. And to understand really what your patient may need, you need to have a broad scope of understanding. what I was gonna say earlier was 30 years ago, I knew a primary care doc from San Francisco General Hospital who used to say, this is not rocket science.
It is not that complicated. If you have a medical education, you can learn this easily. You just have to pay attention. And what WPATH offers in terms of CMEs is the basic foundations courses two and a half days. And it's interdisciplinary and it really gives you a broad perspective of what trans people need and how care is administered.
Justin Hooks (41:06)
Yeah, I do have to say it is a lot more than just pronouncing epinephrine or amiodarone And I kind of say that in the sense of a lot of people are afraid as healthcare providers. And they reach out to me and say, I have a trans, especially people that are specialists, for example, because I provide gender affirming care to just through the primary care, I work different in a Medicaid, Medicare clinic and uninsured nonprofit organization. And so the work that I do is pretty big for a small team. But what a lot of my colleagues that are specialists or that are in specialty areas, and they say, I have this transgender patient, and they're on estrogen, or they're on testosterone, what do I do? And the answer is that you don't treat them any differently there's no difference It's the same
The point that I try to make is the same side effects that you would have of any medication. There's same side effects as someone that is going to be on that medication. We don't do things any differently. Now it's more specialized with blood work and we know how to prescribe a little bit differently, but as far as being afraid of taking care of someone that is transgender and on gender affirming care should be no different.
Carolyn Wolf-Gould (42:16)
People are afraid of what they don't know and don't understand. And that doesn't just go for trans people, but race, ability, disability, ethnicity, all those things, people are afraid of what they don't know. And I guess I think a real important part of being a gender-affirming provider is understanding the culture and understanding the subcultures. It's very different for someone who's 70, their experience has been very different than someone who's 14. They've lived in different cultures. To have some appreciation of that is important too.
Jen McConnell (42:49)
And I think you guys respected that a lot in your book when you were talking about the different language that you're going to see throughout the book. certain years, like you said, the words transvestite, transsexualism, that all comes up in words that, kids and teens are hearing now and using were maybe offensive, you know, 20 years ago. that happens in a lot of subcultures and different communities.
But you're right. And this is why, Justin and I are doing this podcast and trying to just say, Hey, even if you know something about, the trans community, there's something you can learn here. There's a lot you can learn here. And, know, you need to get the whole idea when you're treating transgender people. it's not like we sign up for certain types of people when we are providers, we take who comes in and we want to do the best of our ability. So.
I think this includes this extensive history that you guys are writing on and it's so fascinating. I know there's one particular topic that I know is interesting and I'm not sure who wants to speak on this, but what is transgender broken arm syndrome and how does it apply to nurse practitioners?
Jamison Green (43:55)
I really want to talk about that. Trans broken arm syndrome is shorthand from within the community in terms of explaining to medical providers and insurance carriers, insurance companies, and administrators of clinics and things. What does it mean? We had exclusions back in the
Justin Hooks (43:59)
Hehehehe.
Jamison Green (44:21)
80s, starting in the 80s, exclusions started being written into healthcare plans where right off the bat, any kind of treatment provided for transition or transsexualism or anything using that kind of language was excluded from coverage. Those exclusionary clauses were written so broadly that they gave permission to people to just say, nope, don't treat people like you. We don't treat you. And so the big story that created trans broken arm syndrome was a trans woman who had been paying into her healthcare plan without, you know, paying for her insurance coverage for years was riding her bicycle.
slipped on some gravel, broke her arm, went to the emergency room, she was treated very well, and then a few months later, she gets this whopping bill. And she called them up and took them the hospital and said, what, why am I getting this bill? And they said, well, because we looked into your medical record and realized you're transsexual and we don't treat transsexual people.
What what I had a broken arm and you're not giving me a sex change I had a broken arm She's they said well your arm is transsexual
Jen McConnell (45:44)
⁓ gosh.
Justin Hooks (45:45)
my gosh.
Jamison Green (45:47)
and we don't treat transsexuals.
Dallas Denny (45:49)
And worse, she could have been turned away with a broken arm, unsaid.
Jamison Green (45:53)
Many people were turned away from emergency rooms bleeding because they were trans.
Justin Hooks (46:00)
Wow.
Jen McConnell (46:03)
Unbelievable.
Justin Hooks (43:03)
That's really interesting. so from all the research that I'm doing, that I've done already with my doctorate, when I teach healthcare providers about transgender health, there's different stages as far as transitioning. There's usually the social change first, and then there actually is more invasive, such as medication therapy, and then surgical procedures. So I wanted to go back and just kind of highlight. I'll start with Dallas and kind of share with us kind of your transition story and how did how did you start if don't mind.
Dallas Denny (46:37)
Let me say that not all trans people, and of course there are non-binary people, seek to change their bodies. It's more of a social thing with some people, but for some people they have a need to change their bodies, and that was my case. So I remember being age 14, my mother decided to be an Avon sales lady, and she had a jar of hormone cream that I would rub onto my nipples in quantities calculated for her not to notice the level going down. But I figured out about hormones in my early 20s and after being turned down by Vanderbilt, as I indicated, I forged a prescription. And the most potent estrogen from my reading of the literature seemed to be diethylstilbestrol. And I took that for some years until it was discovered that it had adverse effects. And then I changed my forged prescription to estradiol. But it made huge differences in the way I look now to the way I would have looked had I not been taking estrogen all those years. It made me much more at ease with my body, much more than surgery did. And so it's essential for many trans people and it's just, you know.
People are taking pills for antidepressant, they're taking pills for appetite control. This is just a pill to provide some psychic relief and change the direction your body is going.
Carolyn Wolf-Gould (48:02)
And I'll just add that we provide gender affirming care to cisgender people as well. give women birth control pills. We give men testosterone who need it for whatever reason. So we're always providing gender affirming care to people. And for transgender people, is in the form of estradiol, which now comes, historically, people took whatever they could get, like Dallas, right? They took birth control pills. They took their sister's, contraceptives or whatever they could get. I think Christine Jorgensen, I think she worked in a vet's office or something. I can't remember the details, but people just get whatever they can. But now we use estradiol. We don't use birth control pills because it's for transgender people because there's a high risk of blood clots. And estrogen comes in a topical form or a pill form or an intramuscular injectable form. And testosterone comes in a number of different forms.
We usually use injectable or topical, but now there's actually a pill form. There are implantable forms of testosterone as well. So there's a whole number of ways we can prescribe.
Justin Hooks (49:02)
That's amazing. Dallas was it always pills for you or did it change?
Dallas Denny (49:05)
I actually went to the one doctor I could find out about and the first time he injected me with estrogen, huge bore needle and immediately seeped right out. And the second visit he came back with a vial of testosterone and I decamped. Otherwise it's always been pills for me.
Justin Hooks (49:25)
Dr. Wolf, do you see most of your patients? Do they opt as far as going from male to female and doing estrogen? What is the most common route that you see in practice?
Carolyn Wolf-Gould (49:39)
It kind of depends on the age and the risk factors. So we do a careful assessment and determine what would work best. So some people find the pills are easier because they just can take them in the morning. It's easy. It's a daily thing. Other people really would prefer just to do an injection once or twice a week. Once a week or every two weeks or a couple times a week.
The patches are really easy for some people, but others are in the swimming pool all the time and they come off. If someone is more likely to have, or if someone has had blood clots, we tend to use the patches instead of the other forms, which avoids the first pass through the liver and less likely to have blood clots. So it really depends on patient's wishes, patient's preference, and what works best given the patient's history.
Justin Hooks (50:22)
And also insurance too, because we have to add that in. Unfortunately, it's kind of a burden what is covered by insurance. Now, Dr. Green, is your story similar to Dallas's or do you mind sharing your story?
Jamison Green (50:35)
Well, no, not exactly the same in terms of I never prescribed anything for myself. And I struggled longer with it. I I knew by the time I was 18 that I I called myself cross gender. I didn't know any language. I didn't know anybody else like myself, but I was terrified of doing something about it. And the only examples of people who transitioned were male to female. I'd never seen or heard of the fact that it could be possible for someone to transition from female to male. So that held me off until my late 30s.
And then I found out about a sex reassignment program at Stanford University. I'm out on the West Coast. I applied. actually, I asked for the application. I got it in the mail. It was 12 pages long. And I looked at it, and I went, my gosh, and threw it in my desk drawer for two years. It stayed there. Well, I continued to do a little bit of periodic research, looking for
Justin Hooks (51:47)
Wow.
Jamison Green (51:54)
community-based publications or community-generated publications or people that I could actually talk to who had been through this. Eventually, I got enough information where I felt like, yeah, I think this would be the right thing for me and filled out the application, paid my evaluation fee and took the tests like Dallas took and all that stuff. And I was accepted immediately. The variation in how patients are processed has a lot to do with how the clinicians who are evaluating them view them. And I was viewed as a very stable person and very clear
And also people perceived me as male already, know, least 50 % of the time. I mean, I was already halfway there without any kind of transition related care or activities at all. One of the biggest things for me was taking myself to a barber shop and getting a male haircut. You know, that was like, whoa, the scary, can I do this? my God.
Justin Hooks (53:06)
Yeah.
Jamison Green (53:06)
It's not medical. But, you know, I mean, not like I had a very feminine haircut as it was, but, it wasn't emphasizing sideburns and things like that. you know, So learning all about all that, it's kind of interesting.
It was a very simple process for me. The whole thing went very, very smoothly. I didn't have any obstacles to speak of. I had a good job. I could afford to pay for the services. I did not have insurance because I noticed that there was an exclusion in my plan. And I thought, hmm. And so I began to work on that as a policy project. And I also was involved in writing
Justin Hooks (53:41)
Wow.
Jamison Green (53:47)
The first non-discrimination ordinance for the city of San Francisco that included the words gender identity and expression. And the Human Rights Commission asked me to sit down with the city attorneys and make sure the language in law was accurate.
And because what we're talking about is not transgender experience or transsexual experience. That kind of language is, we're still struggling to recognize transgender people as just human beings. And the fact is, gender identity and expression is something that all human beings have and no one should be penalized by judgment about their gender identity and expression, no matter who they are.
Jen McConnell (54:30)
So Jamison, you were president of the World Professional Association for Transgender Health. Were you the first transgender president of WPATH?
Jamison Green (54:42)
I wasn't the first trans person, I was the first American trans person to be president. But there was a lot of resistance to having me even be a member in WPATH because many people who were on the board wanted me to be a member very much because they realized I was very knowledgeable and very connected. And there were others who really did not want me to be a member, let alone be on the board because I was a very accomplished
Justin Hooks (54:47)
Okay, now.
Jamison Green (55:12)
activist and advocate and they didn't want the organization to be, you know, perceived as an advocacy organization. And I said, you know, you think the cancer, American Cancer Society is not an advocacy organization. Why don't you want to be an advocacy organization? You really are here to talk about transgender health. Why don't you want to talk about it? You know, so, so we had those kinds of
if you will, almost ideological debates. But I think there was a lot of fear that came from many, many years of the stigma of transgender people, that transgender people experience, spilled onto the professionals who worked with them.
and they suffered for it, many of them suffered tremendously with the stigma of actually working with trans people. Many early members of the Harry Benjamin organization, which by the way, Harry Benjamin was never a member of the organization himself. It was named in honor of him because he had done so much research and so much activism and advocacy.
people would write articles about their research in this population and then be shunned They publish in the professional journals and then be shunned by their colleagues and people would write letters into the professional organizations particularly surgical articles about surgical procedures this is in the 1960s and 70s
If an article was published, the next issue contained all these letters to the editor about how horrible it was that they published this, how disgusting it was that people were doing this. So this, you know, it's been hard for professionals to recognize that by holding themselves back from actually addressing the problems that this population experiences, they are holding themselves back from doing their own work.
They're holding themselves back from providing care.
Dallas Denny (57:14)
When it comes to surgery, it's a different thing than getting hormones. First, it's expensive and until recently was rarely covered by insurance. Second, it's not something everyone wants. But especially in the early days, getting a surgery like breast implants that any cisgender woman could get required special permission.
Jamison Green (57:29)
Right.
Dallas Denny (57:40)
authorization by medical professionals and genital surgery required two letters. Those could be hard to get and the clinics especially were really good with a carrot and stick approach where you would be promised something that never materialized. Made a lot of transgender people upset and angry and suicidal in some cases.
Jamison Green (58:04)
So one of the policy statements that I wrote in WPATH when I was on the board of WPATH was that no one, which the board approved and the organization issued, no one should be required to have any medical treatment in order to have their gender identity recognized legally and socially.
Justin Hooks (58:28)
So you guys brought up a really good point that the process that it took just for you guys to start gender affirming care. I was wondering with Dr. Wolf, how is that process for you as a provider? Is it quite as extensive as what Dallas and Dr. Green discussed or is it more easy now?
Carolyn Wolf-Gould (58:47)
All things have changed so much over the last decades. Jamison has been involved, believe, in writing the standards of care, and the standards of care have evolved as we became clearer and clearer about what gender identity is and that it's not a disorder, that it's normal. So, yeah, so now current recommendations are that you don't have to see a psychiatrist to get approval for hormones. You just come and see the doctor, and we have a talk about the history, and we do a comprehensive history the same way I do for any of my patients.
including a gender history, and then we prescribe the hormones. So there are very few things that, the history is clear, then you treat it. The insurance companies do still require letters for surgery, and the new standards of care have reduced the number of letters, but the insurance companies are behind. So even though now it says just one letter from a mental health provider, most of the insurance companies, at least in New York state, are still requiring two letters.
Over the last year, we're seeing more in requirements instead of less requirements for what we get in those letters, which is indicating another change in the political climate. But yes, much simpler now.
Jen McConnell (59:53)
Okay, all right. So a good question that we have for our current listeners is what can we do as nurse practitioners to make transgender patients feel more at ease and comfortable?
Dallas Denny (01:00:06)
The elephant in the room is often how do you want to be addressed? That's often obvious because of the way they are groomed and the presentation that they are making. But it's not impolite to ask. Occasionally someone might take offense, but usually people are glad to be asked and then you will have their pronouns and that will help.
That's one thing I think we should count off as we go. So Jamison, you have one?
Jamison Green (01:00:35)
I think in addition to just addressing people the way they want to be addressed is to keep communicating with them. Look them in the eye, treat them as a human being. Don't be afraid of who they are or how they might be responding if you make a mistake. Most trans people understand that people do make mistakes and that's okay as long as you
And you don't have to make a big deal about, gosh, I just made a mistake, I feel so horrible. Just say, I'm sorry, I'll try to do better and move on. Keep it focused on the business at hand, keep it focused on the fact that they're a human being and that you're wanting to provide care.
Carolyn Wolf-Gould (1:01:18)
I'll just add that I think as the provider, it's our responsibility to train our office staff and that one bad experience with one person in your office is going to set the tone for the whole visit. So your office staff needs to understand some of the nuances about asking people their names and pronouns, your forms, look at your forms and make sure your forms have different places for different kinds of gender identities. Look at the artwork in your office, you know, go around and look at it. We did that in our office and we realized none of us really cared about the art and there were all these pictures of white pilgrims in our office. And it was like, what is this? We didn't have any people of color. We didn't have any queer people. So we went and got artwork that reflected all different kinds of people.
Yeah, safety is another. Making sure your clinic is safe. We sadly do have locks on our doors in our clinic to make sure that people are safe. So bathrooms, do you have single stall bathrooms with gender neutral signs or do you have male and female bathrooms? All of those things are important in a clinic setting.
Dallas Denny (1:02:23)
It's amazing sometime how everyone in this office has to come by and find a reason to come into the room to see the transgender person. That happens in some practices and the trans person certainly knows why that's happening and it's really offensive. So staff education is a big thing and people sometimes have religious or political views that might make them uncomfortable, but that's their issue. It's not the trans person's
Carolyn Wolf-Gould (1:02:53)
Yeah, I think when you're choosing your office staff too, if you run a clinic for deaf people, you're going to make sure you have somebody who knows how to speak sign out there, right? So if you're going to run a clinic for trans people, your office staff needs to know the language. They need to know how to use pronouns. They need to know how to say they, them. And you need to make sure that they are affirming people for trans, that they don't harbor beliefs that would, you know, they have to be people who will feel that they can provide appropriate care. Very important.
Justin Hooks (1:03:25)
Dr. Green and Dallas, did you guys, Dr. Wolf kind of talked about the environment. So when you guys were seeking out care, there things such as like a pin that Jen and I wear on our ID badge and other providers in Michigan, we get safe, you you're safe with me pins Is that really important as someone with lived experience that you look for from a provider?
Jamison Green (1:03:51)
I think so, yes. I think it's very helpful for people. I mean, there was nothing like that when we were first engaged. I do think that people nowadays have that, they see that symbol and they feel a little bit better. They still may be scared because there's still a lot of power struggle between providers and patients, especially if patients don't have a lot of experience communicating with professionals.
But I do think it helps if you're sincere about it. And if you're not sincere about it, the problem is that people will eventually find out that that badge means nothing. And that's not good.
And that will spread. That information spreads.
Justin Hooks (1:04:39)
That's a really good point.
Very good point.
Jen McConnell (1:04:48)
So I love having you all here. I think there's amazing things that we talked about. And I also want to, before we sign off and let you go, even though we don't want to let you, is there anything that each of you would like to share about the book information or the process that we haven't covered that you'd like to kind of highlight for our listeners?
Dallas Denny (1:05:10)
Well, I would like to say the title of the book is the history of transgender medicine in the United States from margins to mainstream, and it really has moved from the margins to the mainstream. We have more than 40 contributors and we address all kinds of things from surgery to hormones to the history. And there's lots of profiles of individual transgender people, many of whom invented their own medical care. What little they got.
So it's a good read, and we appreciate it if you buy the copy.
Carolyn (1:05:41)
I'll just say what I really learned was that transgender people are the ones who drove this history. I think the impression is that doctors created it and doctors built it and doctors control it, but really courageous trans people over time spoke their truth, said what they needed, and people responded to them. So I think that's an important and essential truth about this history.
Jamison Green (1:06:05)
One of the most exciting things for me was first as a writer working with this team, it's just been an incredible process. mean, weekly meetings for an hour, sometimes two hours every week between the editors and talking about the chapters that we were getting in, or what if a writer failed in providing the kind of depth of chapter that we needed? How could we deal with that?
looking at the order of the chapters, and we revised the table of contents a number of times to structure it in a way that allow the knowledge that the reader would obtain the knowledge in a gradual kind of structured way that looking at had the complexity of the interdisciplinary aspect of this field.
how you put it all together, finally at the end, if you start from the beginning and go to the end, you eventually have a pretty good picture of where we've come from and why we're where we are.
we don't tell you what to think, we don't tell you how to feel about it, we don't tell you everything there is to know because we did have a 500 page maximum of our manuscript in our contract and we actually turned in a thousand pages at the end and they still published it because they realized that it where they felt it was a very important book and we were very honored.
I'm very honored to have been part of the editorial team as well as a contributing writer. And it's just amazing the amount of experience and knowledge that is reflected in this book that has been hidden from so many people for so long. And I hope a lot of people will read this book.
Jen McConnell (1:08:01)
in saying that, I want to know if you are all going to get back together because I feel like this story is going to have much more to say as we move through, first of all, the political climate that we're in now. obviously history is being written as we speak. And I think it's important that we have people like you who are not only lived experience advocates, care providers who really are passionate about this subject and in this community, we need people that are going to get out there and tell the story how it needs to be told by the people who it needs to be told. And I think that's really important. So I hope that they hooked you on for, you know, a continuing edition after this one.
Dallas Denny (1:08:43)
Neither we nor the State University of New York Press anticipated this book dropping at this moment in American political history. It's kind of amazing. And we were struggling because things were changing leading up to this. And we really struggled with where and how do we end. And we finally decided we just have to end it. And we did.
Jamison Green (1:09:08)
So I just wanted to say that no, SUNY Press has not engaged us for another volume of this book, but anything could happen. But I will say that I know that the three of us and the four of us, the one editor who's not with us today, all of us are committed to this care and to this history and to this community.
we're going to keep telling these stories one way or another. Dallas and I are working on another book with another group of authors, co-authors, that will be telling community stories and we're both committed writers. We're going to tell more stories forever. So, you know, you never know what might happen, but we're going to keep contributing to this history as well.
Jen McConnell (1:10:02)
love it. I love it. I love the dedication. love it. That's wonderful.
Justin Hooks (1:10:07)
Well, we could talk all day about this, but with all good things that must come to an end. So unfortunately, that's a wrap. I want to let our listeners know to stay tuned for more engaging topics and educational opportunities. Whether you're a student, a seasoned NP, or a healthcare leader, we're here to keep you informed, inspired, and connected. And this is just a first of the many opportunities that we are gonna provide to you through our podcast and through our education.
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