Focusing on Transgender Healthcare

In life, the paths we choose are influenced by our day-today experiences and the people we meet. Career choices are no different. As a pediatrician and academic, I am not infrequently asked how I became interested in working with the transgender community and doing academic work with this population. An openly gay man, many wrongfully assume that my interest and devotion stem from an identity as a sexual minority, but let us be honest that the lesbian, gay, and bisexual community has not always stood (as they should) in support and solidarity for transgender people, so quite honestly, my identity as a gay man has not been at the core of my commitment to transgender people or my interest in transgender health. My typical answer to that question credits my parents and my upbringing. My parents were middle school and high school educators teaching in inner city public high schools. They led by example and so rather naturally I developed an interest in caring for the underserved. For far too long, transgender people and transgender health have been footnotes in the fields of academic medicine and public health. Healthcare is a fundamental right of every human being; however, transgender people have often been overlooked in their pursuit of the highest quality healthcare, in part, because they face significant barriers when it comes to basic needs, including social support, education, housing, employment, and access to medical and mental health services. Among the many disparities facing transgender people are extreme levels of violence and harassment, and experiences of discrimination in the healthcare environment. Transgender people, particularly transgender women from communities of color, are the highest risk demographic group in the United States for the acquisition of HIV. Transgender people are also at increased risk for mental health and substance use issues, including higher risk for depression, post-traumatic stress, and attempted suicide. However, transgender health and the disparities-affected transgender people are woefully under-represented in the peer-reviewed academic literature. And as a good friend of mine once said, ‘‘in order to count, you need to be counted.’’ As I assume the role of Editor-in-Chief of Transgender Health, it is the intent to both shine a light through academic work on the already mentioned disparities and, more importantly, to be part of steps to help eliminate them. Assuming this role is a distinct honor for me and has given me the opportunity to reflect back on the roots of my personal interest in transgender health. Wedded in caring for the underserved as many of us who do this work, it has been four seminal life experiences that led me down the path of academic and clinical work caring for children and adolescents who are gender nonconforming or who identify as transgender. In 1990, I met Marsha P. Johnson, the gay liberation and AIDS activist, at a community event in New York City while attending medical school. I love pointing out to people that the ‘‘P’’ was her trademark and it stood for ‘‘pay it no mind’’ as I think that positive spirit of defiance is something I have always admired and respected and something that over the years has served the transgender civil rights and health movement well. To my knowledge, Ms. Johnson was the first transgender person I had ever met. To put it rather bluntly, I was mesmerized by her. I was a meek, nerdy cis-gender white man and she was this tall, powerful black drag queen. She talked about her life’s work and activism helping young drag queens and other homeless youth get food and clothing. I sat there in awe. Marsha and I were never friends; in fact we never met again. But I never forgot her. Shortly after graduation I read in horror and disbelief about her death in 1992; she was found