Taking Charge: How transgender youth are trumping the medical system

Trans Youth - Stroger Hospital
Stroger Hospital, pictured above, is one of the only places in Chicago where trans youth can get assistance transitioning at an affordable cost as an alternative to self-medding. Photo courtesy of cookcountyhhs.org
**This article first appeared at chicago-bureau.org on Oct. 29, 2013**

For nearly two years Amelia, then 17, lived from package to package. They arrived, unlabeled, at friends’ houses, P.O. boxes and community resource centers, following her from city to city as she struggled to find permanent residence.

Each was small, containing only a few vials of pills, but their significance was monumental. Concealed within them were illegally purchased, non-prescription estrogen doses and androgen blockers — the magic ingredients that would give Amelia, a transgender woman whose real name is concealed here for legal reasons, the body she always wanted.

Do-it-yourself hormone treatment, or “self-medding,” as Amelia calls it, is an increasingly popular method by which transgender people acquire the hormones necessary for gender transition. It’s an alternative to professional medical care with its excessive expenses and deficiency of trans-knowledgeable providers. DIY, as many trans forums and online guidebooks see it, is the next-best solution despite associated health risks like blood clots, high blood pressure and liver damage.

Amelia, now 22 and living as a female trans activist in Chicago, called the self-medding issue a “big point of contention between the trans community and the medical community” because of a lack of understanding between the two groups.

“They don’t see all the hoops we’re forced to jump through as being really restrictive or bad things or in any way negatively impacting us,” she said. “So when they see us self-medding, they see it as us putting ourselves in unnecessary danger, when really it’s more like a response to inadequacies of the medical structure.”

Gatekeepers to Care

The sex hormones commonly used for transition, namely estrogen, testosterone and a variety of androgen blockers, are classified as prescription drugs by the U.S Food and Drug Administration. As such, acquiring them without a prescription from an online pharmacy or a street dealer is against the law, said Stephen King, FDA spokesperson.

Even so, transgender people sometimes pursue illegal hormones in lieu of accessible, affordable medical care.

A 2008 study in the American Journal of Public Health found that only 30 to 40 percent of transgender persons nationally utilize regular health care. When 100 trans subjects in New York City were asked why, they cited a lack of access to a provider with knowledge of trans issues (32 percent), followed by access to a transgender-friendly provider (30 percent), cost (29 percent) and access to a specialist (28 percent).

The study estimated the prevalence of unsupervised hormones to be more than 29 percent.

Trans Youth - Rob Garufolo, Director of Adolescent Health at the Robert and Anne Lurie Children's Hospital, gives a speech at the University of Minnesota about transgender health. He has worked with many self-medding adolescents to help them transition in a healthy way. Photo courtesy of the University of Minnesota.

Rob Garofalo, Director of Adolescent Health at the Robert and Anne Lurie Children’s Hospital, gives a speech at the University of Minnesota about transgender health. He has worked with many self-medding adolescents to help them transition in a healthy way. Photo courtesy of the University of Minnesota.

Dr. Rob Garofalo, director of the Center for Gender, Sexuality and HIV Prevention at the Ann & Robert H. Lurie Children’s Hospital of Chicago, often works with teens and young adults who formerly used non-prescription hormones. Although he discourages DIY and steers clients toward more thoroughly tested methods, he understands the demand for self medication given the gap in care.

“If I had to grade the medical system, I’d probably give it a C-minus in terms of its readiness to help the transgender community,” he said. “There are a lot of institutional barriers … a lack of scientific evidence to support the safety and the efficacy of what we’re doing, the general access things. The ball is rolling in the right direction, but it’s rolling slowly and it’s requiring a lot of pushing.”

For some, the ball isn’t rolling fast enough, especially when the prescriptions themselves are difficult to acquire.

The World Professional Association for Transgender Health (WPATH) Standards of Care  document states that hormone therapy generally requires one letter of approval from a mental health physician, and genital surgery requires two. Acquiring such letters is no easy task, according to many of the trans community.

Amelia remembers her college years in Philadelphia as a series of referrals from one therapist to another, having already experimented with hormones and not getting real satisfaction from any of the therpists in terms of the advice or care she was given. She ended up on a six-month waiting list for an endocrinologist who, she said, turned out to be largely in the dark about trans care.

Meanwhile, she was already self-medding. She said she saw the many steps of supervised transition not as precautionary measures, but as a form of discrimination and professional gatekeeping.

“It’s this really formalized process that ultimately is centered around not trusting trans people for transitioning,” she said. “There’s still this myth around trans people who transition and then regret it, which is such a tiny fraction of the population which is already tiny.”

A USA Today story estimated some 5 percent of people who make the change end up regretting it, but the numbers are tough to pin down.

Yet some trans-sensitive providers contend that the formalized process exists for good reason. Dr. Margot Bell, director of Adolescent Medicine at the John H. Stroger Hospital of Cook County and founder of the recently opened Same-Gender Loving (SGL) clinic, which was created to serve uninsured LGBT youth, said she won’t prescribe county-subsidized hormones from the hospital’s pharmacy until she is sure the client is ready to transition.

Trans Youth - Dr. Margot Bell is one of few physicians nationwide providing trans-sensitive medical care. She recently founded the Same Gender Loving (SGL) clinic in Stroger Hospital, where she can provide sex hormones for youth she feels are ready to transition. Photo courtesy of cookcountyhhs.org

Dr. Margot Bell is one of few physicians nationwide providing trans-sensitive medical care. She recently founded the Same Gender Loving (SGL) clinic in Stroger Hospital, where she can provide sex hormones for youth she feels are ready to transition. Photo courtesy of cookcountyhhs.org

Reaching a level of certainty, for Bell, entails evaluation of a patient’s medical and mental health history, a physical exam, as well as thorough inquiries into what the patient knows about transition, whether or not they’ve taken street hormones or other drugs, their sexual history and how they envision their post-transition body.

In her work, Bell said, she has had a few clients who transitioned and were unhappy with their new bodies, which is part of why she takes the process slowly, often over several months. She has worked with youth taking illegal hormones and said the pace and dosage of a physician-monitored prescription process may be contributing factors to the prevalence of self-medication.

“It happens very frequently,” Bell said. “Not necessarily because they can’t get care, but because they want more of the medication than the doctor will prescribe. Because they want to transition as fast as possible, they look for other ways to augment that transition.”

Though the current pace of treatment seems slow to some, it has come leaps and bounds in the past decade, said Emma Joy Jampole, a 57-year-old assistant professor at Northwestern University who first attempted transition in 1975. Jampole always knew she belonged in a female body, she said, but being trans was almost unheard of and therapists denied her hormones for so long that she eventually gave up.

“They thought I was trans, but they also thought I was attracted to women, and said ‘If we allow you to transition we’ll be taking you from being straight in some way to being gay, and we’re not in the business of making homosexuals.’”

After living in what she felt was the wrong body for three decades, Jampole finally underwent hormone therapy and so-called bottom surgery, which can include the changing of genitals or or other alterations, in 2009. Her long journey puts today’s “rolling ball” in perspective. But current DIY-ers, especially youth, are still not satisfied with the progress.

“Patience is not in rich supply for many of these young people,” Garofalo said. “They’ve been waiting their whole lives to be who they want to be, and to face any sort of obstacle is just so painful and it feels so oppressive. I feel like I’m an oppressor sometimes. I wish I could wave a magic wand and make it all better.”

High-Speed Delivery

The promotion of illegal hormones as the ‘magic wand’ for the new generation takes place mainly online, with all the virtual marketplace’s advantages of instant transactions, discreet delivery and anonymity of customer and vendor relations.

Anyone with a Yahoo! profile can join TsDoItYourself Hormones, a forum that currently serves more than 18,000 members worldwide. Within minutes of signing up, members receive one email containing the URLs for 24 different online pharmacies that moderators recommend for purchasing hormones, and a second listing six distributors of syringes and needles.Most pharmacies recommended on this forum distribute drugs that the FDA would consider illegal, and the backlash from officials may not be far off.

Participants also receive seven disclaimer emails stating that the group “does not promote or approve the personal exchange (buying, selling, trading) of any type of drug requiring a prescription or illegal drugs to any person whatsoever.” The same message appears in red on the forum’s homepage.

As some trans sites mention, online pharmaceutical consumers may be subject to fraud or may not always receive their packages, which can be stopped in, for example, U.S. Customs. The pharmacies referenced are largely based in Europe and the South Pacific.

But the heyday for online distributors may be waning. Just last October, the FDA joined Interpol’s Operation Pangea — a global effort to decrease the prevalence of illegal medical products — and with it shut down nearly 18,000 Internet pharmacies.

Ordering online exacerbates what was already a dangerous situation, Bell said. Even used under supervision, hormones can put users at higher risk for breast cancer and other serious illnesses. Acquiring the hormones from an outside source only amplifies those risks. Bell also warned against other DIY methods mentioned in online guidebooks, such as buying from hormone dealers on the street or getting drugs from Mexico.

“You really don’t know the trustworthiness of that company, so you don’t know what you’re getting,” Bell said. “That can certainly be a danger.”

Garofalo said he commonly sees transgender women who undergo fraudulent silicone injections only to have the treatments result in lesions, infections and, in rare cases, death. Additionally, online hormones typically come in oral forms, which are processed by the liver and can do damage to it. Most doctors prescribe patches or injections to prevent that damage.

Though many DIY-ers are aware of general health risks and most forums urge readers to seek medical care, self-medication remains the method of choice for some.

“The reason for taking this route is quite simple: it’s the only available path to transition,” said Sarah Gerace, a 48-year old transgender woman and moderator for the Yahoo! group.

She added, “For the vast majority, DIY is the preferred choice still, if not for the lack of a well-beaten path, certainly for the privacy and anonymity many feel compelled is absolutely essential in embarking on a course friends and family still see as unacceptable.”

Another Way

There is another way around the system. Some resource centers, notably the Howard Brown Center in Chicago, have launched hormone distribution programs based on informed consent, a process now acknowledged by the WPATH Standards of Care, through which clients can start hormone therapy without approval by a therapist so long as they are competent and at least 18 years old.

Redmond Lhota, a 20-year-old Northwestern student who started transitioning to male over a year ago, said he has heard about transitioning on DIY hormones but believes it to be too dangerous. He is currently receiving care through Howard Brown’s THInC (Transgender Hormone Informed Consent) program, where a healthcare professional provides him with a prescription for testosterone and monitors his hormone levels. Overall, Lhota, who studies engineering said he has been happy with his care, but emphasizes that transitions are difficult, even with medical supervision.

“When I was on a two-week cycle doing intramuscular injections, I had problems with a big spike at the beginning and a hard fall-off at the end,” he said. “These were accompanied by big mood swings. Because I was under medical care, my doctor was able to suggest that I switch to weekly subcutaneous injections, which work a lot better for me. Less swing and less scary needle.”

Baylie Roth, a trans patient navigator, or counselor, for THInC, said he would like to see the field of transgender medicine shift to a place of informed consent, where a client would drive the chronology for his or her own care.

“I’ve never encountered a trans person in my life who wanted hormones and wasn’t ready for them,” he said. “The dominant culture puts the idea of ‘being ready’ on trans people instead of letting them decide for themselves. My job is just to make them aware of the changes that might happen. We should shift the thinking away from when they’re ready to how we can help.”

More Competent Care

With more and more trans-positive clinics taking on the ‘informed consent’ model, the road to transition could be slightly less treacherous in the future, according to experts and trans interviewed for this story.

The key, according to Amelia, will be an increase in research on trans-medical issues and efforts to better inform healthcare providers about the population – which has been extremely difficult to gauge or count although NCTE estimates that between .25 percent and 1 percent of the U.S. population is transexual.

In the meantime, DIY-ers will likely continue to care for themselves.

“The trans community has compiled a lot of information about all of the medications we take,” Amelia said. “Usually trans people have to educate ourselves about the way everything works, and we end up having to educate our doctors about it, which has consistently been a frustrating thing.”

Ryan Sallans, a 34-year-old transgender speaker, consultant and author who presents his program “Scouting the Unknown” at universities and hospitals across the country, urges young adults to be patient and work with, not against, the medical system. He is currently working with Affiliate Risk Management Services, Inc (ARMS),  a New York-based nonprofit that creates LGBT-sensitive online courses and trainings for medical personnel.

“We always need to advocate for our own health,” he said. “If you are calling somewhere and they’re not giving you the right information or they say they can’t do it, do some research and get back at them. Don’t be scared to use your voice. When you do that, things happen.”


Students, staff push for full-time coordinator for LGBT Resource Center

**This article first appeared at dailynorthwestern.com on May 8th, 2011**

Students pushing for a full-time coordinator in the LGBT Resource Center recently gained the support of the Associated Student Government when Senate passed legislation in favor of their cause.

“ASG Stands with the LGBT Resource Center” was authored by members of Rainbow Alliance, Hillel Leadership Council, In Technicolor and ASG in an effort to draw attention to the resource center’s need for more staffing. It passed April 27, opening the door to a lengthy process that, if implemented, would involve restructuring the staff of the Center for Student Involvement.

The LGBT Resource Center was founded in 2004 and is located on the third floor of Norris University Center. It aims to create a safe space for members of the LGBT community and its allies while providing education and training about LGBT issues for the entire University, said Doris Dirks, coordinator for the center.

Dirks said she currently spends half of her time working with the center and the other half with about 15 groups she advises as coordinator for Student Organizations for Social Justice. Dirks said with the University’s increasing demand for LGBT resources, the job can no longer be done satisfactorily by one person.

“People know. Everybody knows,” Dirks said. “And the message I’ve received is it’s worth working on, it’s in process. And it’s not about me. It needs to make a transition. We’re at a point where I used to say yes to everything, and I can’t do that anymore.”

The Resource Center is the only designated “safe space” on campus where students can go for help with LGBT issues, Dirks said. Additionally, the center is responsible for providing ally training to campus organizations, providing free HIV testing, co-sponsoring events and holding panels. Dirks said she was recently asked to provide training for the School of Law on the Chicago campus but had to decline due to lack of time and resources.

Dirks, as well as a member of the center’s student staff, voiced complaints that a lack of budget and a lack of physical space prevent the center from providing LGBT support for students, staff and faculty who need it. Their newest publicity campaign, displayed on posters and on a banner at Norris, states that though 10 percent of Northwestern students identify as LGBT, 100 percent are served by the LGBT Resource Center.

“If you asked most administrators, they’d say they were supportive of the LGBT community,” Dirks said. “But it’s one thing to say that, and it’s another to put your money where your mouth is. I think it’s an issue of institutional priorities. It seems to me that when the University deems something important, they somehow come up with the money, resources and staff.”

Creation and expansion of coordinator’s role

Though the resource center was founded in 2004, it did not have an official supervisor until 2006, when Dirks, who was already on the staff of the Center for Student Involvement, was asked to be the center’s part-time coordinator.

Natalie Furlett, assistant director for the Center for Student Involvement, said it was an experimental position created before the University knew what the resource center would become.

“I think the amount of work that has sprung out of having that person has created more than what we had budgeted for,” Furlett said. “It now seems like we could use someone who could do it full time.”

The resource center is not considered a student organization but an entity of CSI. Dirks compared it to being of similar function to the Women’s Center or the Multicultural Student Affairs office.

Cara Tuttle Bell, director of programs at the Women’s Center, said her office has five full-time staff members that enable it to serve faculty, staff and students on both campuses.

“I think they’re spread thin right now,” Tuttle Bell said of the LGBT Resource Center. “In terms of what we do, they could do a lot of the same things if they had staff and resources available.”

In order to allow Dirks to work with the LGBT Resource Center exclusively, CSI would have to redistribute the other 15 groups she advises to other members of CSI staff, Furlett said. This would mean putting organizations like College Feminists, College Republicans and College Greens under new leadership.

Furlett said she is in favor of the change, but it would have to be done with careful consideration for the groups in play. She said the process would start with a talk among CSI staff and then with Rick Thomas, executive director of Norris, but starting discussion would not be plausible until next year.

Thomas said the resource center is not unique in that it operates on limited resources, as many organizations could also use more space or staffing. He also said redistributing Dirks’ other responsibilities would be complicated, given that the other CSI staff members have equally demanding responsibilities.

He said the center is a clear priority of the University, which was why administration decreased the pool for student offices in 2003 to make space for it and why a part-time coordinator was put there in 2006. He said he can see a full-time position as a reality down the road and will bring it up at the fall budget meeting.

“We make decisions about what we’re able to do and what we’re not,” Thomas said. “If there is demand that is there, and a legitimate need that needs to be addressed, that’s part of the argument I use to justify more resources to be able to meet those needs.”

LGBT centers at other schools

The LGBT Resource Center has a library of books, magazines and DVDs relating to LGBT issues, but resource assistant Chris Garcia said no one knows about it.

Garcia, a Medill junior and co-author of the Senate legislation, said due to the center’s small physical space and location, it gets minimal traffic and does not fulfill its function as a safe space in which people can “hang out.”

“We need an office and position that can grow and can have a stable trajectory,” Garcia said. “We don’t have a good response for hate and bias incidents. We don’t have good resources for trans individuals. The resource center is so small, and for any practical purpose, it’s too small to be effective.”

At the University of Michigan, the LGBT Resource Center, now called the Spectrum Center, has just celebrated its 40-year anniversary. The center was the first of its kind in the U.S. when it was founded in 1971, and its assistant director William Sherry said it is still going strong, with four full-time staff members.

Sherry said the Spectrum Center is centrally located and equipped with computers, printers, a refrigerator, couches and bean bag chairs. He said having a full-time staff is an integral part of the center’s success.

“Having people students can develop relationships with makes all the difference,” Sherry said. “Having a full-time staffer makes students more comfortable. They know who they’re going to be talking to. It allows for safety and consistency.”

About two weeks ago, the dean of Harvard College announced it would hire a full-time director of LGBTQ student life, according to an article in the Harvard Crimson. The change was the result of an extensive administrative review of the LGBTQ experience at Harvard.

Garcia said he and the presidents of Rainbow Alliance are writing a long-term plan to address the needs of the NU LGBT community, but that the process should start with a full-time coordinator.

“For the University to prove that it cares about LGBT individuals, you need to have someone in the administration that has LGBT in their title and can commit themselves to working with sexual orientation and gender expression exclusively,” he said.

Gay youth struggle against schools’ ignorance and communities’ intolerance

**This article was first published at chicago-bureau.org on June 25, 2012**

As thousands in the LGBT community took the streets over the weekend in places such as Chicago, New York and San Francisco to parade pride before a nation that considers itself tolerant, research shows gay youth still grapple with painful issues during perhaps the most pivotal stages of their lives.

Take, for example, a recent report by the Human Rights Campaign, the nation’s largest gay-rights advocacy organization. The report stressed the prevalence of bullying and discrimination toward LGBT youth, a problem Chicago-area experts say is caused by intolerant and unsupportive systems in schools and communities.

HRC’s national survey of 10,000 LGBT-identified youth, called “Growing Up LGBT in America,” recently found 51 percent of participants had been verbally harassed at school, and 48 percent felt excluded by peers because of their sexual identity.

One seeming remedy is forming Gay-Straight Alliances – extracurricular organizations that aim to create a safe space for LGBT youth and their allies. However, few GSAs exist in Chicago-area schools. While 47 percent of students nationally reported having a GSA at school, only 41 of 158 Chicago public high schools are listed in the Illinois Safe Schools Alliance’s GSA directory, according to an analysis of Illinois Safe Schools Alliance data.

Alexis Wieselman, who has advised GSAs at both Eric Solorio Academy and Phillips High School, said running these clubs is particularly difficult without the support of administration and the surrounding community.

When she advised the club at Phillips two years ago, she said the administration “put up barriers whenever possible” by delaying the start of the club and subjecting them to additional paperwork.

“The problems that I have run into with GSA’s in inner city Chicago schools is that administration doesn’t have an understanding of the importance of visibility for LGBT youth,” said Wieselman, a science special education teacher. “They don’t view it as important that teachers be out and that there be communication in the handbook that LGBT students exist.”

A Gay-Straight Alliance, when permitted, can provide a place for students to speak openly about their identities, which may work to combat the rise in LGBT youth suicides that led to the viral “It Gets Better” campaign from 2010. But a recent report from the Suicide Prevention Resource Center indicates that it is not getting better. LGBT youth attempt suicide at a rate of two to four times higher than that of their heterosexual peers. They struggle to “cope with developing a sexual minority identity in the midst of negative comments, jokes, and often the threat of violence,” the report said.

Spencer, a 16-year-old attending a public high school in New York, was initially afraid to share his identity with friends, family or teachers. HRC reported that one-third of LGBT youth feel they do not have an adult to whom they can talk.

Spencer said his parents, who were unsure how to handle his questions, arranged for him to speak to a therapist about his identity. Through these sessions and a few friends, he learned to ignore people who probed him about his identity with malicious intent and brushed off “certain remarks, certain looks and just people being rude.”

“During 8th grade I had identified myself as a homosexual, but never publically,” he said. “I never talked about it. People would always ask me and I would deny it, not because I wasn’t proud or I wasn’t comfortable. It’s just that I didn’t know what that meant. I wasn’t positive, I wasn’t sure. There were so many questions floating around. It was not a hard time but it was just confusing.”

And even with a supportive administration, a club’s success can hinge on the attitudes of the school’s neighbors. According to the HRC report, four in 10 LGBT youth say the community in which they live is not accepting of LGBT people.

Spencer, for example, said the community in which he grew up focused more on racial diversity than sexual diversity, and being gay was still a taboo subject, especially for his parents’ generation.

Emily Tongue, who advises the GSA at Collins Academy High School in North Lawndale, said establishing the club was easy; retaining membership proved more difficult because of the stigma surrounding it. Students sometimes referred to the organization as “that gay club,” and parents approached her insisting that their child remain uninvolved, she said.

“Commitment is really hard in high school in the first place, especially with something like a GSA,” said Tongue, who, like Wieselman, teaches science special education. “We’re [North Lawndale] a mostly African-American  area, drug ridden, low income, and very homophobic. So it’s big-time needed there. But it’s just a matter of students feeling comfortable enough to show up.”

Tongue said a few of her GSA seniors were victims of bullying last year, but chose to mediate the situations within the club rather than take it to administration. The club provided support for the targeted students but encouraged them to handle the situations on their own.

“This was their chance to start standing up and being the voice they needed for the rest of their lives,” she said. “We were lucky to have only a few bullying cases, but the students learned to know that the world was mean, and they would have to be bigger person and move on from it.”

Even when bullying cases are brought to authorities, the “three strikes you’re out” policy typically used in Chicago schools is not conducive to LGBT mediation, said Bonnie Wade, associate director of UCAN, a Chicago-based program for LGBT. The perpetrator gets a slap on the wrist and the victim gets set aside, without further effort to create a safe space, she said. Often, Wade said, the complaints of LGBT students are overlooked by teachers and administrators who blame the students for drawing in violence with their appearance and behavior.

“Our social structures are not set up to support gender variance or gender nonconforming young people.” she said.  “So when young people fall outside of the mainstream…that is seen as deviant or is stigmatized…It’s still pretty uncomfortable for people, especially when it comes to teenagers. Our schools, our community groups and churches, we’re in the process of catching up.”

Stroger Clinic Opens for LGBT Youth

**This article originally appeared on windycitymediagroup.com on May 7, 2013

John H. Stroger Jr. Hospital of Cook County is now home to an LGBT clinic.The Same-Gender Loving (SGL) Clinic at Stroger opened Feb. 1 and has been providing weekly care for uninsured and underinsured LGBT youth since.

SGL is one of three county-funded clinics serving teens ages 13-24, but it’s the first and only to cater specifically to the needs of the LGBT community.

At the clinic, which operates between 1-5 p.m. on Tuesdays, youth can drop in for general health services like those offered at the other two adolescent clinics. They can also meet with a physician or psychiatrist to receive counseling on sexuality, gender identity, hormone therapy, safer sex or a slew of other topics.

Dr. Margo Bell, a senior attending physician in the Division of Adolescent Medicine, who encountered many uninsured LGBT teens while doing outreach work on the South and West Sides, first conceived of the clinic.

With the help of colleague Dr. Lisa Henry-Reid, Bell got the pediatrics department chair to quickly approve the new clinic to supplement the general clinic and the HIV clinics that run on Wednesdays and Thursdays.

The new clinic is funded entirely by Cook County and is staffed by three rotating physicians as well as two psychologists and a health educator.

“We’re skilled in taking care of this population of adolescent young adults,” said Henry-Reid. “We provide very developmentally appropriate care, and we can do that in a setting where you’re not going to be judged. We’re all about making sure that you’re healthy and trying to promote that in whatever way we can—by the tests that we do, by the education we provide.”

An average of three youth visit the SGL clinic each Tuesday, said Bell. Most, who are over 18 or are with a consenting adult, are seeking mental health services and hormone treatment.

Charlie Person, a 16-year-old transgender female from the North Side, started visiting the clinic about six months ago to learn more about transitioning, which she had only read about on the Internet. A few weeks ago, Person brought her mom, Deborah Person, into the clinic to try to educate her on transgender issues and ask approval for hormone treatment.

Deborah, who knew little about transgender issues before that visit, said the announcement was a little shock to her. It has been accompanied by some conflict over whether her child should be wearing female clothing.

But many conversations with Bell, have made her more sensitive to Charlie’s needs, and she will consider hormone therapy for the future.

“The clinic is very informative, very patient, giving you all kind of literature and information, opening questions,” said Deborah, who still uses male pronouns for Charlie. “My position is loving him unconditionally, letting him accept who he is and not letting society dictate to him who he is. And that he lives comfortable within himself as well as outside, and be productive in society as he does this transformation.”

Charlie is more at ease in the SGL clinic than at a standard clinic, she said.

“It’s important because a lot of people don’t have anywhere to go to take hormones, or a lot of people don’t feel comfortable going anywhere else,” said Charlie. “They treat you how you want to be treated and they comfort you and make you feel welcome more than any other clinic you go to.”

The only hurdle in running the clinic so far, said Bell, has been establishing a gender-neutral bathroom on the floor, which took a fair amount of paperwork and debate.

Future plans for the clinic include hiring a caseworker for visiting adolescents, which would require grant money. Plans also include further engagement with the lesbian community through a weekly lunchtime meeting.

Opening an LGBT clinic on the West Side was important, said Henry-Reid. Bigger LGBT centers like Howard Brown Health Center and the Center on Halstead (which does not provide medical services) can be geographically inconvenient for underprivileged youth in other parts of the city. Most youth travel to the clinic by public transport, she said, and some money is available to help them with travel if needed.

The clinic is also unique in its level of cultural competency and sensitivity toward LGBT issues. Henry-Reid and Bell have led trainings with nursing staff and residents on LGBT health issues, especially transgender issues.

Stroger LGBT Clinic to Serve Detained Youth

**This article originally appeared on windycitymediagroup.com on June 6, 2013

At the Cook County Juvenile Temporary Detention Center, gender matters. It determines where inmates sleep, where they take meals and what they do for gym class. Most importantly, it determines what kind of healthcare they receive while in confinement.

While this used to be problematic for LGBT residents, center officials say a new collaboration between the center and the pediatric department at Stroger Hospital could lead to more pointed and culturally competent care for incarcerated youth across the gender spectrum.

The Same-Gender Loving (SGL) Clinic at the John H. Stroger Jr. Hospital of Cook County opened Feb. 1, providing LGBTQ detained youth with access to affirming care.

This level cultural competency may not always be present in the Juvenile Detention Center, but the staff is becoming more educated all the time, said Dr. Ngozi Ezike, medical director for the center.

Over the past year, detention center staff have undergone hours of training to learn how to place transgender individuals in the way that will be most comfortable for them, rather than the “one-size-fits-all” policy that was in place before.

When youth arrive at the detention center, they receive a medical exam in their first two hours. For the rest of their time, which can be anywhere from a few days to a few years, they receive weekly care at the clinic, staffed by Bell and two other Stroger physicians.

Dr. Margot Bell a senior attending physician in the Division of Adolescent Medicine, conceived of the clinic.

If Bell or Ngozi sees that a youth has a problem that may be better suited for care at the SGL clinic, they can arrange for an appointment back at Stroger. There’s a precedent for that, Ngozi said, as inmates have been to the other adolescent clinics in the past. Though youth from the center have not yet been taken to the clinic, both physicians see it as a possibility for the future.

“Dr. Bell—she’s almost like a human conduit,” said Ezike. “It’s very seamless. They’ll easily give us an appointment to accommodate our kids from here. That’s a pretty strong and well-established connection.”

One of the biggest issues with caring for incarcerated transgender youth is sorting out their hormone treatment, said Ezike. The youth in the center are mostly under the age of 18, so they cannot receive hormones without parental consent. Some youth come in already on a hormone treatment that they bought on the street or on the internet, but Ezike cannot continue that treatment without getting guardian consent. If inmates can get parental consent, Ezike could bring them over to the SGL clinic to start or continue on hormones. Beyond hormones, Bell and Ried said they can help youth from the center with LGBT-specific mental health issues.

“Because we still have a presence there, we started having a conversation about partnering to make the whole of the county system more LGBT-friendly in terms of providing care for youth, and that’s how we got tied in together,” said Bell.