Getting appropriate and compassionate healthcare can be a challenge for anyone in the current environment. For the LGBTQ+ community at large and especially for transgender people who have special and specific needs; getting appropriate, sensitive healthcare that acknowledges and respects their unique situations is critical—and unfortunately sometimes both difficult and demeaning.
But there’s another reality at Middlesex Health, and it’s a good one. Middlesex focuses on providing a complete array of care for the LGBTQ+ community and has a dedicated Center for Gender Medicine and Wellness. The Human Rights Campaign—the nation’s largest LGBTQ+ civil rights organization—has awarded Middlesex Health four consecutive “LGBTQ+ Healthcare Equality Leader” designations for their work with these communities.
In addition to medical expertise and specialists in these areas, providing outstanding care to the LGBTQ+ community is an inherent part of their approach. The health system continually trains staff – from receptionists to administrators, nurses to doctors – in the importance of supportive, thorough, respectful care.
Central to these efforts are the people on the front lines. Meet Medical Assistant Brandi Andres and Licensed Practical Nurse Candis Brooks. Their titles give you a good idea what they do, but their job descriptions could technically include “prizefighter.” Medical care? Yes, they provide that. But they also spend much of their time fighting on behalf of their patients.
“If we walk away with anything, it’s absolutely how important advocacy is for these patients, how important acceptance is for these patients, and to make them feel like, when they walk through our door, with the sticker that says Middlesex Health is a safe zone, that we absolutely deliver on that,” says Brooks.
“I’m also part of the community, so I have a lot of knowledge about it,” says Andres.
Brooks and Andres both work in endocrinology, and work with Middlesex Health’s full patient population, including those with diabetes, thyroid diseases and other endocrine issues. They also spend much of their time working with transgender patients on hormonal replacement therapy.
As an example of how the LGBTQ+ communities are under-addressed, Brooks says that before working at Middlesex, “I didn’t know gender care was part of endocrinology. It was not taught at all in nursing school.” She learned about hormone replacement therapy from Kathryn Tierney, medical director of the Middlesex Health Center for Gender Medicine and Wellness. Now Brooks teaches patients how to inject estrogen or testosterone.
“There is no place that does what we do when it comes to patient advocacy,” says Brooks.
Andres agrees. She says she battles with insurance companies to obtain medical insurance pre-approvals. She and Brooks frequently also spar with pharmacies. Often, pharmacists will supply only what they have on hand, rather than the specific injection supplies prescribed. The wrong equipment confuses patients, who have been taught to use different supplies, and, more dangerously, can lead to incorrect dosages.
Brooks says the northeast’s two biggest pharmacy chains are the biggest offenders. “They send patients on their way [with the wrong materials] and it’s: ‘You’re on your own.’”
Situations like these make both of them angry. “It’s frustrating to see how insensitively patients can be treated. You wouldn’t do that to anybody else. Why would you do it to this patient? I think 85 percent of it is bias. The rest is ignorance,” says Brooks.
Andres shakes her head in agreement and disgust. “Pharmacists call and ask if we’re aware we’re giving testosterone to a woman. I say, all you have to do is look at the diagnosis – it says gender dysphoria. Sometimes I’m not so nice.”
Sometimes pharmacies try to substitute a generic drug when it is imperative that the name-brand be prescribed, and Andres won’t have that. “I have to stand on their chest and say ‘You’ve gotta’ give them the name brand!’ You have to suck their air out of their chest to get them to listen.”
Says Brooks of Andres: “She doesn’t back down.”
“You’d think at this point in the game, there’d be some sensitivity training on how you handle this demographic of patient” within pharmacies, says Brooks.
It’s not the time-consuming part of dealing with pharmacies that bothers her, Brooks clarifies. It’s the lack of ethical treatment toward queer patients, “treating them as less-than.”
Non-Stop “Beast Mode”
There is no such thing as a typical day for them, the women say. “I have to flip the switch. I can talk to a gender patient, then a 9-year-old with diabetes, then I’m on the phone with an insurance company. I’m the go-to person for CGMs [continuous glucose monitors] and insulin pumps,” says Andres.
Days are similar for Brooks, who may be teaching a pregnant person how to use insulin, then responding to a call from the lab with a patient’s critical blood values, then teaching a trans patient how to inject hormones.
“You are in beast mode for every patient every day. It’s non-stop!” says Brooks. “As crazy as it gets, I still pretty much love every day.” Endocrinology was her favorite subject in nursing school, and she continues to learn something new every day.
One enjoyable part of her job is that it feels like a small, private-office, Brooks says, despite being a large facility. “There’s an individualized, hands-on approach.”
Chiefly, though, both say the impact they have on LGBTQ+ patients is what sustains them. The reaction from patients when you use their real name for what might be one of their first times is priceless to Andres. One patient in particular: “I called her name, and she was so excited she just ran to the door.”
One of Brooks’ most memorable patients was a visibly scared, young adult trans woman who lived with her overbearing and noticeably disapproving parents. Brooks reminded her she was an adult and able to make her own decisions and that Middlesex would advocate for her. “Next time we saw her, she had her own car and her own apartment.” She also had a new aura of calmness.
“I can identify with the gender patients, though I’m a native female and heterosexual,” says Brooks, who is biracial and has struggled with body image. She, too, has been asked by strangers to explain her identity. “If people don’t think you look like what you say you are, there’s a connotation that you’re lying.”
When Andres came out as gay, her then-young kids learned how to respond to taunts from other kids with “Yep, I’ve got two moms! What’ve you got?”
There are many issues that have made it difficult for LGBTQ+ people to find appropriate care. From practitioner biases, to misgendering of trans people, to individuals’ fears of disclosure, specifically among youth, finding the right care can be especially challenging for these people. The risk is that their needs may go unmet and their physical and mental health would suffer.
For the LGBTQ+ community, Middlesex Health offers a comprehensive range of care including primary care, hormonal therapy, behavioral health services, continence and pelvic health, gender transition surgery, physical rehabilitation, infectious disease testing and treatment, and voice therapy.
And having people like Brandi Andres and Candis Brooks always in their corner can make all the difference for our communities.
By Jane Latus