AUGUSTA, Ga. (WJBF)– We’re talking today with a doctor from the Equality Clinic at AU Health. It’s filling a need in the LGBTQ community, and they’re one of a few such clinics in the country.
In a 2010 study, 70% of transgender patients reported that they have been refused care blamed for their health status, physically or verbally abused when seeking healthcare, or that medical staff refused to touch them. 56% of gay, lesbian, and bisexual patients reported the same things. Augusta University Health’s Equality Clinic is trying to provide quality health care to members of the LGBTQ community.
One client says, “It’s nice to have conversations with the med students and know, ‘Okay, well this is who’s going out in the medical workforce.’ And they’re actually gonna, you know, maybe, they can change some things.”
Another issue facing gay and bisexual men is restrictions when donating blood, despite advancements in blood screening technology. For decades, the U.S. and many other countries banned donations from gay and bisexual men due to the risk of spreading HIV through the blood supply.
In 2015, the FDA moved from a total ban to a one-year abstinence period. In 2020, that was reduced to three months in the U.S. with Israel and the UK following by lifting some restrictions. Now, a nationwide study is underway in the U.S. to determine whether a restriction is needed at all.
The study will be able to help the FDA determine if an individual risk-based approach could be adopted to select individuals, obviously based on their answers that they provide, rather than a blanket deferral for three months.
Dr. Soren Estvold is a Family and LGBTQ Medicine doctor at Augusta University Health. He specializes in Transgender Medicine.
JENNIE: Dr. Estvold I wanna thank you so much, first of all, for being with us today, for giving us your time. And we’re gonna talk about Transgender Medicine in just a moment, but first I wanna go back to what we just heard about the blood situation and the banning and, you know, are we gonna loosen up these restrictions now? I’ve heard other doctors say that’s such an outdated practice.
DR. ESTVOLD: “It is a very antiquated practice, stemming from the 1980s when we had the big HIV epidemic, that then extended on into the 1990s. So what that was is there was so many gay men who were HIV positive that were afraid to get anywhere near their blood. And so as doctors, we said, ‘You cannot absolutely under any circumstances donate blood anymore.’ But that was what? 30 years ago? 20 years ago? Tere’s much safer practices out there. Many people who are positive with HIV are at an undetectable status and ‘undetectable’ means ‘untransmissable.’ So, they’re very safe if their blood were to become in contact with somebody else’s. So, this is really an old ordinance that just needs to be repealed, but unfortunately there’s so much stigmas surrounding HIV right now that no one’s willing to put forth the legislature to remove any of that.”
JENNIE: That leads us into LGBTQ Medicine. And what, you know, why is that a specialty? I hadn’t really thought about it before.
DR. ESTVOLD: “It is actually a very brand new specialty. Currently in the U.S. there’s maybe four or five fellowships in it. You can become a LGBTQ doctor. If you’re a Family Medicine doctor, an Internal Medicine doctor and get into a fellowship that way, and the reason why I bring that up is because it’s so novel. We’re now realizing that this population has its own set of things that you need to keep in mind when treating this patient and things that is different for them, culturally, that we need to keep in mind when we treat this patient population…. so, you’re going to get better care from someone who is like you.”
JENNIE: The physicians or in the LGBTQ community as well?
DR. ESTVOLD: “Most of them are, but not everyone. It’s not an exclusive community. We’re open to everyone, but you will receive better care from your physician who is, if they have a similar background as you do… It makes it much easier to be open with your physician. And that’s the basis of any patient-physician relationship. If you can feel free to talk to your physician and express exactly what’s going on in your mind and not have to hide anything from them, we can then treat you better and more accurately.”
JENNIE: I saw a statistic that really floored me. And that was that the suicide rate in the LGBTQ community is about five times the rate in the heterosexual community. And when you look at a staggering number like that, I think that’s where the clinic would come in, too, to at least provide resources for people who are uninsured. And maybe a safe space for them to talk.
DR. ESTVOLD: “That’s one of the great things that we do at Equality Clinic. So, apart from the ‘medicine’ medicine, because with a lot of their hormone-transitioning medicine, which we can get into later, there’s a huge component. About half of what we do is behavioral health. And so, we screen everyone for depression. We give them a PHQ-9, which is our official screening tool, to see how at risk they are for depression. And then if we need to get them in contact with another provider, or if we need to start them on medication to help get their depression and anxiety under better control.”
JENNIE: I don’t mean to be offensive, I don’t mean to be ignorant, but there are more letters besides LGBTQ? I’m seeing IA a lot right now. What does that mean? What, what do they mean?
DR. ESTVOLD: “So it’s an alphabet soup. That is correct. Okay, soup And that’s okay to acknowledge that. The, “I” means “Intersex”, okay? And that’s somebody who doesn’t quite identify as male or female, but somewhere in between. And then “A”, “Ally”, “A” also stands for “Asexual”. There’s “Q”, there’s two Qs. One is for “Queer” and that’s okay to say, it’s a reclaimed word. And then the other “Q” can also stand for “Questioning”. Another one I wanna inform you on is called 2S.’
JENNIE: Two, like the numeral 2?
DR. ESTAVOLD: “The number 2. And that stands for “Two-Spirit.” That’s actually a really old ancient theory that is more akin to like the ancient Hawaiians or Native Americans. And that’s saying that there weren’t always just two sexes. There were multiple sexes. And throughout that culture, that was a norm for them. And then when White American culture came to be and colonization happened, we did away with that. And the that’s when a lot of the Western theory of two genders was established. And so, that’s why Two-Spirit is very new, but it’s a very old concept in Native American culture.”
DR. ESTVOLD: “And then there’s P for Pansexual. And that’s, that one’s harder for me to describe, but you are more attracted to somebody as a person versus attracted to them as a gender. Are we missing other ones?”
JENNIE: Well, we, the other thing I hear people say sometimes is Cisgender.
DR. ESTVOLD: “So, cisgender and transgender, we can go over. Those are two terms that I like to explore with people ’cause actually, Latin words. So ‘cis’ meaning the same. So, if you identify as the same gender that you were born with, you’re termed cisgender. And if you identify with a gender that you’re not, or the opposite gender that you’re born with, that is where transgender comes into play. So ‘trans’ meaning ‘different or other.’
JENNIE: When I think about if you felt like you’re in the wrong body, that to me would be like the ultimate claustrophobia. It must feel like, “I’ve gotta get out of this. I’ve gotta get out of this.”
DR. ESTVOLD: “Yes. And that actually leads into what’s called gender dysphoria. That’s a depression, a very internalized depression that is linked to you becoming sad because you don’t feel like you’re the right gender. And that often stems from childhood in these patients. And so, oftentimes when I see these new patients and they wanna start hormone therapy, I ask them, you know, ‘Paint the picture for me. Why do you wanna transition?’ I’m not a guardian for transitioning. I’m not the one who says, ‘No’ or ‘This is bad for you.’ Or ‘We’re gonna have to talk about the morals of it.’ I wanna know why you wanna start this journey because I can help you with it. And often, they describe it from childhood, they just felt off or they felt they can see themselves turning into a different person from the person that they want to be.”
JENNIE: How does it make you feel when you see someone become the person they’ve always wanted to be?
DR. ESTVOLD: “I mean, me personally, it feels great to see them successfully start their transition, but to see their happiness on their face, three months in, a year in, three years in, when they walk through my door, and they’re now smiling. And they’re now glowing and they’re now happy, and comfortable with the person that they are versus the person that walked through my door originally. That’s such, that’s what makes me do my work better, longer, more accurately, that’s what really drives me and is part of my passion for medicine.”