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Blog Out in Healthcare

Out in Healthcare: Hal Martin, OTD Student

Name: Hal Martin

Pronouns: They/Them

Identity: Non-binary Queer

Background: I’m a soon-to-be 31 year old, white, non-binary person born and with homebases that include Georgia (born and raised), Chicago, and now Philly (going on 6 years!). My undergraduate education was in the arts and I’m what some of my peers call a “nontraditional OT student.” With that said, I don’t see my trajectory into occupational therapy as a total 180 but instead heavily informed by the critical thinking and collaborative process-making of my undergraduate education!

Profession: OTD student

Area(s) of Practice or Interest: I’m ultimately interested in working in primary health care at a community-based setting / early intervention.

What does being ‘Out in Healthcare’ mean to you?: I believe being “out” is more complicated than the mainstream narrative you hear about being “out of the closet.” There is a decision whether or not to come out in every interaction, and in some instances, it isn’t a choice. When I choose to be out in healthcare, yes, I am choosing to affirm my gender in the moment, but I am also occasionally putting myself at risk or opening a conversation where I have to do a lot of education around my identity. I believe it is important for health practitioners to weigh each situation and, if they feel safe and have the energy, disclose their identity to their clients, employer, or coworkers. In healthcare, disclosing how you identify to patients and clients creates a reciprocal exchange where they may feel more comfortable talking about their gender and sexual orientation. Especially in the midst of the Supreme Court ruling in favor of healthcare discrimination against trans patients, knowing that a healthcare professional is able to verbally share that information with you and still able to practice indicates a culture of tolerance and safety for patients. I know from my own experiences navigating the healthcare system how interfacing with a healthcare professional who shares a common identity can alleviate the stress and anxiety of seeking services and increases the chances of me continuing treatment. Openly talking with others about my identity, sharing my pronouns, and correcting colleagues when I’m misgendered are ways to slowly change a culture that views hetero and cis identities as a default among working professionals. Being out in healthcare shows that despite stigma and discrimination that may exist, we operate as professionals and hold important lived experience that we view as a strength not a limitation. 

What is one thing everyone should know about your identity?: The language I use to identify myself is based on what feels affirming at any given moment. Right now, that means “queer” and “nonbinary.” They/them pronouns feel comfortable because they are neutral. My gender expression is expansive and does not operate in a binary way where I would describe myself as masculine or feminine. If I was to receive gender affirming surgeries or HRT it would not be to medically “transition” (as is commonly assumed about trans-identified people) from one end of the binary to another and I don’t believe my trans identity is dependent on whether I choose to change my body or not.    

How do you feel when your identity is included?: A huuuge sense of relief and perhaps pleasantly surprised because it doesn’t happen very often! In occupational therapy, we talk a lot about barriers in participation of meaningful occupations and when my identity is not included it is a MAJOR barrier. When it is included, I feel like I can fully show up as myself and participate! For example, I did not utilize my school gym for a long time because the gym lockers are in gendered spaces (with bathrooms) and to access them you have to check out a key. This required the person at the desk to either label me as a man or woman and grant me access accordingly. Every time I showed up, I was forced to pick one or the other label. In consequence, as you can imagine, I didn’t exercise as much!

What does “taking up space” mean to you?: I attended an adult rock camp (shout out to GRP!) once and we did a warm up where we very literally took up space with our bodies by extending our arms and legs full snowflake. In that moment, I realized how seldom I’ve allowed myself to take up space due to feeling like spaces are not meant for me. Taking up space in this very literal way is symbolic and serves as a reclamation of all the space that was denied to us, and that denial can take the form of systemic oppression on a macro level or through stigma on a micro level.  

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honor the identities of their patients?: Model what it looks like to share your identity. Say, “You can address me as…” or “My pronouns are…” or “You can just refer to me as ___.” If possible, on forms, leave open fields for people to self-identify rather than using checkboxes because self-identifying is empowering!

Has your identity influenced healthcare that you’ve received?: Yes, but moreso because I avoid seeking care in many situations due to feeling unsafe or unsupported.

Where can people find you?: nonyabuziness on IG. I also co-run a monthly Zoom meetup for trans and gender-nonconforming occupational therapy students and practitioners…If interested, you can email us at tgnc.ot@gmail.com.

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Inclusive Intake Forms

Inclusive Intake Forms

Imagine arriving to an office or facility for a medical or related appointment, interacting with the receptionist, receiving an intake form, and already having experienced more than one trauma based on the language used when referring to you or by the information on the paper in front of you. This is the tragic reality for LGBTQIA+ and transgender or gender non-conforming folx (TGNC) when accessing healthcare. When our gender identity, pronouns, and sexual orientation are assumed of us or left out of crucial paperwork, we have already been neglected by the systems we must access. 

Under certain circumstances, one’s legal name may be required on intake forms or during the intake process for insurance or legal reasons. Though this may be necessary, it can still be traumatic and invalidating for members of the LGBTQIA+, especially TGNC folx. Often times one’s “legal name” is considered a “deadname”, a name that is no longer used by the individual in order to reclaim their identity, as a part of their personal transition, or for various other reasons. It is best to simply require one’s chosen name on an intake form, but if a legal name is required, then also leave another line to include their chosen name – the name they should be referred to as. 

Though some healthcare facilities are beginning to include pronouns on intake forms, there is still necessity for widespread use, inclusion, and normalization of pronouns. Language is a powerful tool in creating a safe space for our clients, including who they are as a whole person, and starting off on the right foot for establishing a strong and trusting therapeutic relationship. Misuse of pronouns can contribute to layers of trauma and can be perceived as direct trauma, which fractures the relationship that one has with the specific healthcare environment and can decrease the likelihood that one may access healthcare environments in general. Some common pronouns include: he/him/his, she/her/hers, and they/them/theirs, though there are other options pronouns as well. When creating an inclusive intake form, you could include check boxes for pronouns with a “fill in the blank option,” as well for an individual to list their pronouns that weren’t listed above or note that they are not comfortable sharing their pronouns. It is best and easiest for all to leave a blank line to fill in when prompted for inclusion of pronouns. 

With good intention, some healthcare environments have included the “other” option when providing options for identity on intake forms. The intention is to move beyond the binary of man/woman or male/female, however the term “other” ultimately furthers alienation of members of the community. Sit with yourself for a few minutes and empathize with what it feels like to be “other”. If you don’t feel anything, take some more time. I, a non-binary and gay person, am not “other”. I am human and my identity is valid, it is not “other”.

There are numerous simple ways to create inclusive intake forms, just by changing the language and/or formatting options. One of the easiest ways to do so is to completely remove all check boxes, including the binary options, and to leave a blank space for one to self-identify. With this example, make sure to note before the prompt that it is equally as valid to state, “I’d rather not say.” 

An inclusive intake form may look like this:


Chosen Name:________________________________________________________________________
Legal Name (if necessary):_______________________________________________________________
Pronouns:____________________________________________________________________________
Gender Identity:_______________________________________________________________________
Sexual Orientation:____________________________________________________________________
Address:_____________________________________________________________________________
(Insert any other necessary intake information)

For me, this intake form would look like:

Chosen Name: Dev Neu
Legal Name (if necessary): Devlynn Neu
Pronouns: They/Them, He/Him
Gender Identity: Non-binary
Sexual Orientation: Gay
Address: 123 Urbane Scrubs Ln, Scrub City, NY
(Insert any other necessary intake information)

It is our job as healthcare professionals to advocate for what is best for our clients. This includes honoring our patients for who they are – their identity and making sure the language we use mirrors what is best for them. Names and pronouns are not preferred nor up for interpretation, they are fact. Note that pronouns and one’s identity can shift over time and that does not invalidate who they were or give less value to who they are. The burden of communication of identity often falls to those within the LGBTQIA+ community, especially those that identity as TGNC. We as healthcare professionals can be the agents of change in the battle for recognition and inclusion. We can advocate for change of the intake forms at our places of work, so that at the first encounter a person in seen. 

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Blog Out in Healthcare

Out in Healthcare: Madison Kirkpatrick, SPT, M.S, CSCS, LSVT BIG

Name: Madison Kirkpatrick

Pronouns: She/Her/Hers

Identity: Pansexual and asexual cisgender female

Background: I was born and raised in Eureka, CA. I grew up in an extremely conservative household that made me feel unsafe and forced me to repress my emotions and my identity. I completed my B.S. in Kinesiology: Pre-Physical Therapy with a Health Education minor in three years and then earned my M.S. in Kinesiology: Exercise Science in one year, after which I published my thesis research. I was accepted into the Doctor of Physical Therapy program at the University of St. Augustine for Health Sciences- Austin, TX campus. I will graduate with my DPT at the end of November 2020. I met my now wife during my M.S. and we got married in 2019. In my free time I enjoy spending time outdoors with my wife and our two puppies.

Profession: Physical Therapist

Area(s) of Practice or Interest: Pelvic floor PT with an emphasis on the LGBTQ+ population and outpatient orthopedics so I can treat other types of impairments beyond the pelvic floor.

What does being ‘Out in Healthcare’ mean to you?: Being out in healthcare means being visible to others so the future generations have the representation I did not have growing up, and it means fighting for health equity, justice,  and healthcare inclusion for all marginalized communities. As someone that understands what it is like to have to deal with healthcare disparities simply based on my identity, being out in healthcare is taking on the system full force to improve the lives of my community and the lives of all marginalized communities.

What is one thing everyone should know about your identity?: I don’t like labeling my identity. I label my identity for the people that “have” to know. I am asexual, an identity that doesn’t get a lot of attention, and where I am on the asexual scale personally is that I have never been attracted to anyone I have ever met other than my wife. I am theoretically attracted to all identities of humans, hence why I use pansexual, but in reality, my asexual identity and my lack of interest in the labels another person uses are more who I am at my core (I respect everyone’s labels, but that doesn’t influence whether I am attracted to them or not).

How do you feel when your identity is included?: I feel seen and respected when my identity is included. I feel like my identity is as valuable as the heterosexual identity has been systematically respected historically.

What does “taking up space” mean to you?: Taking up space means taking ownership of the space that has historically given to heterosexual people but denied to members of the LGBTQ+ community. It means demanding that my identity and needs get as much attention as anyone else and it means fighting for more and more space for those that come after me. It is advocacy, it is radical, and it is vital to equity and justice for the LGBTQ+ community.

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honor the identities of their patients?: Put the work in to find the answers to the questions they have about how to honor the identities of their patients. It is not the job of a marginalized community to educate the majority, but there are a number of people from marginalized communities that do fill the role of educator and their resources are plenty and widespread. All it takes is a little Google searching and/or social media perusing. Once they have answers to their questions, it is time to put in the work and put those answers into action. Once the action is being taken guess what? It’s time for more work. It is time to continue to learn and grow, and it is time to teach others and fight for the rights of their patients. The work never stops.

Has your identity influenced healthcare that you’ve received?:  My identity has caused me to deal with subpar care from my primary care provider who asked me about my sexual activity and then spent a lot of time asking if I could be pregnant (multiple questions about this, to which I answered no every time), didn’t ask me if I was using protection, and then was shocked when I told him I was in a relationship with a woman, which I only told him because he wouldn’t stop grilling me about pregnancy. The visit was really uncomfortable after that, and it felt like he was rushing to get my visit done as quickly as possible. Ultimately, I was not educated on STIs, asked if I felt safe in my relationship (thankfully my wife isn’t an abusive person), or anything else that would normally be routine.

Where can people find you?: I am on Instagram @lgbtqphysicaltherapists and my email is lgbtqphysicaltherapists@gmail.com.

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Out in Healthcare: Caroline Cuyler, LMSW

Name: Caroline Cuyler, LMSW

Pronouns: She/Her/Hers

Identity: Pansexual Cisgender Female

Background: I was born and raised in a suburb of Rochester, NY. I went to the University at Buffalo for my bachelors in psychology and did 1 year of my masters in social work at Hunter College in New York City and my 2nd year at the University at Buffalo. I now live in Rochester with my fiancé and our fur children. I have spent my career working with many different populations beginning with survivors of sexual assault and domestic violence.  I am newly out as of about 2 years ago and it was a rollercoaster ride of an experience but, overall, quite positive. In my free time I enjoy camping, traveling and playing video games.

Profession: Medical Social Worker

Area(s) of Practice or Interest: I pretty much do it all in the inpatient medical world. The main unit that I work on is an adult medicine unit that is staffed by resident medical teams.

What does being ‘Out in Healthcare’ mean to you?: Being out in healthcare for me is about visibility and representation. I wear a rainbow pin on my nametag every day as visibility but also to signal to other LGTBQ folks that this is a safe space. I also see LGBTQ folks in all different roles in the hospital and it really creates a culture of inclusivity.

What is one thing everyone should know about your identity?: When trying to find the “right” identity for me, bisexual never felt right because it excluded folks that didn’t fall into the gender binary. I felt pansexual really suited me and my attraction to people for who they are rather than based on their gender. My fiancé is non-binary and is starting the first steps with top surgery and low dose hormones. I am proud that she is becoming the person she always knew she was.

How do you feel when your identity is included?: When my identity is included I feel seen. There is nothing better than when your identity is not something you have to explain or review over and over with others. That is why I focus so much on educating staff on practices such as asking for preferred pronouns and not assuming a patient is in a heterosexual relationship.

What does “taking up space” mean to you?: Taking up space is really about being your most authentic self, whatever that means for each person. I think it can be easy to shrink down who you are to make a situation feel more “comfortable” for everyone but when you take up space it paves a path for others to be able to also take up space. It’s a form of activism and advocacy for others as well as yourself.

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honor the identities of their patients?: This is a part of my role every day as a social worker. Constantly educating staff about how to honor patient’s identities. My number one piece of advice is ASK QUESTIONS. Our patients are the experts on their own lives. You can never assume anything about anyone’s identity and just ignoring or not seeing parts of someone is not treating the whole patient. If you make a mistake about someone’s identity, apologize. We are all humans who make errors but it’s important to commit to correcting the mistake. I think it’s also important to take an intersectional approach to honoring our patient’s identities. Each person’s experience is unique and much of that has to do with how the different parts of our identity shape how we experience the world.

Has your identity influenced healthcare that you’ve received?: I have only been out for 2 years but even in that short amount of time some things have come up. Specifically around sexual health there is always the assumption that I am in a heterosexual relationship and constantly having to correct my providers can get a little exhausting.

Where can people find you?: I am on Instagram (private account) @cecuyler and if you are ever at Strong Memorial Hospital, I am sure you will see me floating around!

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Out in Healthcare: Enrique Puentes, OTS

Name: Enrique Puentes

Pronouns: He/Him/His

Identity: Gay

Background: Both of my parents immigrated from Colombia, and I was born in Washington, D.C. I grew up in Northern Virginia but have spent the last fourteen years living in Central Florida. I have spent the past eight years working in catastrophe property insurance but have always had a longing for wanting to be in a profession that helped others improve. I finally decided to make the career transition and now am in my second term of my master’s degree.

Profession: Occupational Therapy Student (MOT)

Area(s) of Practice or Interest: I have huge interests in both Mental Health and Inpatient Rehabilitation but am unsure of where I may ultimately end up.

What does being ‘Out in Healthcare’ mean to you?: For me, being out in healthcare for me means inviting people to see my truest self. Representation of LGBT people in healthcare is important because not only does it create safe spaces for clients to feel they are being advocated for, but it also can help demystify misunderstandings that non-queer people have of the very community that I am a part of. I see being out in healthcare as a form of activism for anyone who has ever felt either marginalized in a society that has long celebrated heteronormativity.  

What is one thing everyone should know about your identity?: I want people to know that I am embracing the best possible version of myself by being out as an individual in healthcare. It is important for me to not be ‘discrete’ about my sexuality, because by me fully loving all aspects of my identity, I can in turn emanate the same level of love and care for others. 

How do you feel when your identity is included?: When my identity is included as both brown and gay, I feel included and seen as an equal amongst a group.

What does “taking up space” mean to you?: Taking up space means feeling pride about my own visibility and feeling the confidence in the fact that my visibility matters. I unfortunately did not always think/feel this way, so it’s empowering for me to live in this truth.

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honor the identities of their patients?: I think with any profession that involves interacting with all kinds of people (with varying cultures, backgrounds, political and religious beliefs, sexual orientations or gender expressions), we will almost certainly at some point, come to meet someone that we lack the education on, on how to honor and respect these individuals. Maintaining a sense of humility when engaging in these interactions is key to posturing yourself in a manner that is receptive to learning from these interactions. For healthcare professions in particular, it would behoove the practitioner to educate themselves on available resources that speaks on best care practices. Remember the importance of being client-centered in your approach and advocating for the client’s desires and wishes. 

Has your identity influenced healthcare that you’ve received?: My identity has impacted the healthcare that I have received. I have encountered practicing physicians who have not been aware of pre-exposure prophylaxis medications. It’s an odd feeling having to educate your own doctor on what this is and why you are requesting a prescription for this. I have also had experiences where healthcare professionals made assumptions of my sexual orientation. I greatly see the need for education of healthcare professions in working with LGBTQ clients.

Where can people find you?: Follow me on Instagram! (@ProudOTStudent)

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Out in Healthcare: Emma Baldwin, OTS

Name: Emma Baldwin

Identity: Cisgender gay/lesbian woman, White, Anti-racist

Pronouns: She/her/hers

Background: I am a 23-year-old born and raised in Oak Park, Illinois (the first suburb West of Chicago). I have been in Indiana for my years in higher education and I am ready to take on a new place following graduation! I studied kinesiology and studio art in undergrad, and was a life-long student-athlete. I love hiking, making art, and traveling, but I am the most passionate about advocating and learning. 

Profession: I am currently a 3rd year Occupational Therapy Student (3rd year), and an artist on the side.

Area(s) of Practice or Interest: Pediatric or adult home health, early intervention, hospice home health, sexuality and mental health, neuro… primarily emerging practice areas and places where I can take on leadership roles.

What does being ‘Out in Healthcare’ mean to you?: To me so far (newbie to healthcare over here), it has meant learning how to advocate for myself and others in my school, on my fieldworks, and beyond. I found ways in my school to advocate for bias-free language, better LGBTQIA+ client education, and many more purposes, all by trying to foster inclusive conversations and providing resources. I recognize that I don’t have all the answers but I sure do have a lot of ideas, and being ‘out in healthcare’ or ‘out’ at my school allows me to advocate first-hand. Shoutout to the Coalition of Occupational Therapy Advocates for Diversity (COTAD) for helping support us students in doing so!

What is one thing everyone should know about your identity?: I think the interesting thing about my identity is that I can blend in. It can be a blessing at times and a curse in others, but it is definitely a privilege. It is challenging for me still to own who I am and vocally identify myself as queer in healthcare because no one asks. Sometimes breaking apart from the assumptions is more challenging than simply stating how I identify awkwardly off the bat… but it’s still a balancing game that I am working to figure out. 

How do you feel when your identity is included?: I think that goofy smile, one that you couldn’t wipe off my face if you tried, says it all. There is really no feeling like it.

What does “taking up space” mean to you?: To me, taking up space means being visibly unapologetically who I am. It means paving the way for future generations of me’s & you’s who don’t see ourselves represented in our fieldwork educators, healthcare providers, clients, and professors (etc.) as often. To me it means constantly navigating how to come out, when to come out, and how to feel okay with how people view me… yet it seems like the big key to all of that, is feeling okay with how I view myself. Doing this interview is just one step towards me being sure that I show my true colors and be my true self in my future work settings, for myself and for others.

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honor the identities of their patients?: Simply asking questions and giving me the space to answer, before assuming literally ANYTHING. That is the difference between making me want to come back and avoiding it at all costs. It really is true that sometimes LGBTQIA+ individuals may not feel comfortable in receiving care from someone after assumptions are made. I recognize that healthcare is crucial and that seems crazy to say, but even knowing all of that, I have avoided seeing specific doctors or changed providers due to discomfort. To be as researched and well-informed as possible on how to make your LGBTQIA+ patients comfortable and feel included will go so far. There are so many resources out there.

Has your identity influenced healthcare that you’ve received?: Yes, and you don’t want to listen to the long uncomfortable stories. Simply asking questions at the very beginning (even on a form) could have prevented these unfortunate incidents.

Where can people find you?: You can email me at embaldwin00@gmail.com or follow me on instagram at @em.baldwin.00 & @emmabaldwindesigns. Really, feel free to reach out!!

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Blog Out in Healthcare

Out in Healthcare: Rhia Reed, OTS

Name: Rhia Reed

Pronouns: They/Them

Identity: I am a genderqueer, trans*, non-binary Korean-American with mixed heritage. I also identify as an anti-capitalist, intersectional feminist committed to the life-long work of anti-racism.

Background: My background has been primarily as a choreographer, dancer, and somatics practitioner. I am currently in school for Occupational Therapy.

Profession: Occupational Therapy

Area(s) of Practice or Interest: I’m most interested to work within the following areas of practice: mental health, neuro, palliative care, people experiencing homelessness, and currently/formerly incarcerated people.

What does being ‘Out in Healthcare’ mean to you?: Currently, I help organize a monthly zoom meeting for fellow trans/gender non-conforming (TGNC) occupational therapy students and practitioners; sign-up link below. On a more personal note, being out in healthcare means being a resource to colleagues, and one day as an advocate for my patients. I am the first trans* non-binary person that most of my classmates and professors have met, and I don’t take that lightly. I see these relationships as a huge opportunity to be a representative for the TGNC community. My hope is for my peers to feel comfortable to work through their questions and ignorance with me instead of with future TGNC patients. Once I become a clinician, I hope to create a safe space for all of my patients, especially those of trans experience. My long-term goal is to continue my work as an advocate for trans patients within the scope of occupational therapy and the greater healthcare field.

What is one thing everyone should know about your identity?: I love to laugh at myself as much as I take my identity seriously. Sometimes I joke that my gender identity is simply Tired. On other days it feels Expansive. Most days it feels Fluid.

How do you feel when your identity is included?: Whew, what a question! It is impactful to feel seen! Moments where I don’t have to direct effort to be visible or taken seriously, I feel like I can direct my energy toward all of the other things that I am passionate about. I don’t need others to validate my identity, but it’s definitely a nice surprise when the things that make me me are seen and valued. It makes me feel safer to be me.

What does “taking up space” mean to you?: First, I think of the word marginalized and what that means in a literal sense. If you’re running out of space when writing on lined paper, you end up writing in the margins. “Taking up space” means putting whatever has been relegated to the margins front and center. Pragmatically, this means reallocation of opportunities, attention, time, money, access, and resources. It’s worth mentioning that taking up space isn’t something to apologize for or feel bad about. I love to loudly celebrate members of the Queer, TGNC community.

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honor the identities of their patients?: Great question! Ask questions and be patient with yourself while you are learning something new. Practice compassion and release shame. When getting things wrong, we often feel ashamed, but everyone makes mistakes. Shame bends a person’s attention inward toward their shortcomings. Instead, compassion maintains attention outward at the person they are helping. Shame is just a story we tell ourselves about ourselves to keep us small: “I messed up and I’m terrible.” Self-compassion is a different narrative: “I messed up and I’m learning. I can try again.” Compassion and mindfulness propel us to say “I messed up, and I see how my actions caused harm. I want to center that person’s experience instead of focusing on my mistake.”

Has your identity influenced healthcare that you’ve received?: Yes…I’ll keep it brief by saying that sometimes I often allow myself to be misgendered and avoid disclosing my identity out of self-preservation.

Where can people find you?: mreed9@lsuhsc.edu, and here’s the sign-up sheet for the monthly TGNC OT meeting: Click here!

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OT and Transfeminine Equipment: Breast Forms, Gaffs, and Tucking Oh My!

Transfeminine equipment or equipment for those with feminine gender expression among people assigned a male sex at birth, particularly transgender and gender non-conforming individuals may include: prostheses, breast forms, gaff, tape, tucking, padding.

Padding: Padding refers to the use of undergarments to create the appearance of larger breasts, hips or buttocks. Padding may also assist in minimizing dysphoria.

            Some padding-specific garments include:

–       Padded undergarments: Typically, useful for facilitating appearance of wide hips or full buttocks

–       Bras with pockets: Also known as mastectomy bras, they are designed to accommodate breast forms and other associated prostheses

–       Padded bras: May be preferable if breast growth is present but not at the desired size.

Prostheses: An artificial body part(s), typically made from plastics, lightweight metals, or composites. May be formed to represent a breasts, penis, scrotum, or other anatomy.

Breast forms: Prostheses that have the appearance of breasts. Typically made of soft silicone gel and adhere to one’s body or are placed in a bra. Can be considered a form of padding.

Tucking: Tucking is the practice of arranging and supporting external genitals between the legs, including the penis, scrotum, and testicles so they are not visible in clothing. There are many ways to tuck, such as pushing the penis and other anatomy between your legs and then pulling on a pair of undergarments, to tucking the testicles inside of you. People tuck for many different reasons. One might tuck in order to feel more at ease in their body (minimize dysphoria), to feel more comfortable in their clothing, or to facilitate affirmation as one’s gender. There is minimal research on the safety of tucking.

Gaff: compression underwear that minimizes the appearance of a penis, scrotum, and testicles.

Tape: tape may be used with or instead of a gaff to “tuck” or minimize the appearance of the penis, scrotum, and testicles.

Important gaff considerations:

o Choosing the right size gaff is like choosing the right size underwear. One can also measure the circumference of their waist, just above the hips for correct sizing.

o Safe tucking/gaff techniques mirror those of binding:

o Minimize frequency of wearing, take breaks throughout the week (although it may not be ideal, it is particularly important for involved anatomical and physiological systems). Reducing the intensity of wearing (daytime donning) can also reduce risk of negative effects, though not as significantly as reducing the frequency.

o Minimize duration of wearing, as in reducing the wear time throughout the years. Bottom surgery is an alternate to tucking, however it is important to note that not every individual that tucks will want bottom surgery, nor will all individuals have access to the procedure (cost, access to healthcare, etc.)

o Unsafe tucking can affect the circulatory system, musculoskeletal anatomy, fertility issues, sex and intimacy, and skin integrity.

Gaff/ tucking garment maintenance: First and foremost, follow the washing/care instructions on the packaging/garment. In general, hand washing is the best. Avoid using bleach and/or a dryer as they accelerate material breakdown/ reduce integrity of the material. Pay special attention to skin folds, folding in the tucking garments (gaffs), bulging skin adjacent to the gaff or selected garment, redness, skin abnormalities, and prolonged indentations. Pay extra attention to the effects of the trans affirming/generally affirming care that you provide.  

The risks and contraindications are 𝕒𝕝𝕞𝕠𝕤𝕥 𝕒𝕝𝕨𝕒𝕪𝕤 𝕒 𝕣𝕖𝕤𝕦𝕝𝕥 𝕠𝕗 𝕦𝕟𝕤𝕒𝕗𝕖 𝕥𝕦𝕔𝕜𝕚𝕟𝕘 and 𝕒 𝕣𝕖𝕤𝕦𝕝𝕥 𝕠𝕗 𝕒 𝕙𝕖𝕒𝕝𝕥𝕙 𝕤𝕪𝕤𝕥𝕖𝕞 𝕥𝕙𝕒𝕥 𝕗𝕒𝕚𝕝𝕖𝕕 𝕒𝕥 𝕞𝕖𝕖𝕥𝕚𝕟𝕘 𝕒𝕟 𝕚𝕟𝕕𝕚𝕧𝕚𝕕𝕦𝕒𝕝𝕤 𝕟𝕖𝕖𝕕𝕤. We need to have the knowledge based to educate our clients on safe tucking practices as healthcare provides and 𝕖𝕤𝕡𝕖𝕔𝕚𝕒𝕝𝕝𝕪 as occupational therapists. HELLO!! ADLS!! DRESSING!! Anotha time for the people in the back: we alllll know that our professors/we talk about dressing all of the time throughout our programs and throughout providing care 𝕒𝕔𝕣𝕠𝕤𝕤 𝕥𝕙𝕖 𝕝𝕚𝕗𝕖𝕤𝕡𝕒𝕟. That’s right peds friends, I’m calling you in on this too. You may have a child, adolescent, or young adult that is going to need 𝕪𝕠𝕦 to educate them on safe tucking practices.

Sources:

http://www.phsa.ca/transcarebc/care-support/transitioning/bind-pack-tuck-pad

https://www.gendergear.ca/pages/all-about-gaffs

Categories
Blog

OT and Transmasculine Equipment: Binders, Packers, and Prostheses Oh My!

Transmasculine equipment or equipment for those with masculine gender expression among people assigned a female sex at birth, particularly transgender and gender non-conforming individuals may include: binders, packers, prostheses, and bandaging.

Prostheses: An artificial body part(s), typically made from plastics, lightweight metals, or composites. May be formed to represent a penis, scrotum, testicles, or other anatomy.

            Packers: A prosthesis with the form a penis

Binders: commercially produced binders designed for binding. Other options (usually less safe options) are sports bra, neoprene/athletic compression garments, plastic wrap, duct tape, and more. The benefits of binding far outweigh the risks, however 𝕥𝕙𝕖 𝕣𝕚𝕤𝕜𝕤 𝕒𝕣𝕖 𝕥𝕠 𝕓𝕖 𝕥𝕒𝕜𝕖𝕟 𝕧𝕖𝕣𝕪 𝕤𝕖𝕣𝕚𝕠𝕦𝕤𝕝𝕪.

Binding: Binding involves wearing tight clothing, bandages, or compression garments to flatten out one’s chest and/or other anatomical features. 

Safe binding practices include:

  • Donning neoprene/athletic compression garments or commercial binders. The limited research supports using neoprene/athletic binders over commercial binders.
  • Minimize frequency of wearing, take breaks throughout the week (although it may not be ideal, it is particularly important for involved anatomical and physiological systems). Reducing the intensity of wearing (daytime donning) can also reduce risk of negative effects, though not as significantly as reducing the frequency.
  • Minimize duration of wearing, as in reducing the wear time throughout the years. Top surgery is an alternate to binding, however it is important to note that not every individual that binds will want top surgery, nor will all individuals have access to the procedure (cost, access to healthcare, etc.)

Binding maintenance: First and foremost, follow the washing/care instructions on the packaging/garment. In general, hand washing is the best. Avoid using bleach and/or a dryer as they accelerate material breakdown/ reduce integrity of the material. A binder should never be too tight. Pay special attention to skin folds, folding in binding material, bulging skin adjacent to the binder, redness, and prolonged indentations. Pay extra special attention to the effects of the trans affirming/ generally affirming care that you provide.

According to research, some benefits of binding include:

– Increased self-esteem, confidence, ability to go out safely in public, positive mood

– Decreased suicidality, anxiety, and dysphoria

The research also notes the following risks and contraindications:

– Pain related to the musculoskeletal system and at times internal systems

– Musculoskeletal system changes including bad posturing, shoulder joint ‘popping’, fractures, and muscle atrophy

– Neurological system changes like numbness, dizziness, and more.

– GI system changes, decreased motility, and more

– Respiratory changes like SOB, coughing, and more

– Skin and tissue change like skin breakdown, wounds, and infection

𝕃𝕖𝕥’𝕤 𝕓𝕖 𝕤𝕦𝕡𝕖𝕣 𝕔𝕝𝕖𝕒𝕣

The risks and contraindications are 𝕒𝕝𝕞𝕠𝕤𝕥 𝕒𝕝𝕨𝕒𝕪𝕤 𝕒 𝕣𝕖𝕤𝕦𝕝𝕥 𝕠𝕗 𝕦𝕟𝕤𝕒𝕗𝕖 𝕓𝕚𝕟𝕕𝕚𝕟𝕘 and 𝕒 𝕣𝕖𝕤𝕦𝕝𝕥 𝕠𝕗 𝕒 𝕙𝕖𝕒𝕝𝕥𝕙 𝕤𝕪𝕤𝕥𝕖𝕞 𝕥𝕙𝕒𝕥 𝕗𝕒𝕚𝕝𝕖𝕕 𝕒𝕥 𝕞𝕖𝕖𝕥𝕚𝕟𝕘 𝕒𝕟 𝕚𝕟𝕕𝕚𝕧𝕚𝕕𝕦𝕒𝕝𝕤 𝕟𝕖𝕖𝕕𝕤. We need to have the knowledge based to educate our clients on safe binding practices as healthcare provides and 𝕖𝕤𝕡𝕖𝕔𝕚𝕒𝕝𝕝𝕪 as occupational therapists. HELLO!! ADLS!! DRESSING!! I don’t want to hear any of that “we don’t have room in our curriculum for LGBTQIA+ topics” anymore. Sis, honey, darling, we alllll know that our professors/we talk about dressing all of the time throughout our programs and throughout providing care 𝕒𝕔𝕣𝕠𝕤𝕤 𝕥𝕙𝕖 𝕝𝕚𝕗𝕖𝕤𝕡𝕒𝕟. That’s right peds friends, I’m calling you in on this too. You may have a child, adolescent, or young adult that is going to need 𝕪𝕠𝕦 to educate them on safe binding practices.

Sources and Citations:

http://www.phsa.ca/transcarebc/care-support/transitioning/bind-pack-tuck-pad

https://www.lgbtq-ot.com/terminology

Peitzmeier, S., Gardner, I., Weinand, J., Corbet, A., & Acevedo, K. (2017). Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study. Culture, Health & Sexuality, 19, 64-75. doi:10.1080/13691058.2016.1191675 

Categories
Blog Out in Healthcare

Out in Healthcare: Wade Robinson, OTD

Name: Wade Robinson

Pronouns: He/his

Identity: Gay man 

Background: While completing my undergraduate degree, I became passionate about the field of sexual wellness while working with various non-profit organizations that provided HIV-related services and raised scholarships for LGBTQ students. Those experiences emphasized the importance of education around sexuality, and after beginning graduate school I was delighted to discover that sexual activity is included in the domain of occupational therapy. I was able to bring OT and sexuality education together and collaborate with @sexintimacyOT for my doctoral capstone project to create a continuing education course on LGBTQ0-inclusive practice.

Profession: Occupational Therapy

Area(s) of Practice or Interest: Sexual activity and education, pediatrics, hand/orthopedics

What does being ‘Out in Healthcare’ mean to you?: I believe that generally people have many misconceptions about what it means to be LGBTQ until they know that they know LGBTQ people. In my day-to-day life, I live by the mantra of “advocacy through visibility”, and I try to do the same in a professional setting by being authentic about my own sexual identity. I think this normalizes conversations about sexuality, models to colleagues how to respond, and indicates a safe-space to clients.

What is one thing everyone should know about your identity?: Overall I think that LGBTQ visibility is a good thing, but I’ve noticed that a lot of the mainstream media highlighting LGBTQ people are pretty narrow in their scope. I just want people to check themselves for implicit biases that are easy to subscribe to and know that being gay does not mean being into interior design, subscribing to a particular style of drag, or being into drag at all for that matter. Part of allyship is celebrating LGBTQ people for their identities, so just recognize that there are countless ways for identities to differ and each is as valid as the next.

How do you feel when your identity is included?: We [LGBTQ people] have gone so long without seeing proper representation or inclusion that I definitely notice when we are included in policies and media, even with little things.

What does “taking up space” mean to you?: To me this goes back to the idea of advocacy through visibility. It’s not like I always talk about being gay, queer culture, or anything like that, but I do think it is important to share my sexual identity with the people around me. I think its personal relationships that create allies. It’s so obvious to LGBTQ people how cisnormative/heteronormative everything is by default, and that creates a lot of marginalization that the majority never considers. I think that we can use that lens for the better to recognize how other minority groups could be excluded and erased, then aim for more inclusive, mindful practice.

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honor the identities of their patients?: I know for OT in particular, there are not very many resources, which is why I created the LGBTQ-inclusive course for my capstone project. For healthcare professionals in general, I think the National LGBT Health Education Center is the best resource for practice guidelines. Time in the clinic is precious and the experience is often stressful for clients; it would be very unusual that that time would be best spent with the client educating the clinician about their sexuality. Being educated about sexuality before interacting with clients is best practice. If somebody finds themselves in a situation where they still are unsure, I think the most import thing they could do is approach the situation with humility. 

Has your identity influenced healthcare that you’ve received?: There are two instances that come to mind in which providers made assumptions about me after I disclosed that I am gay, and both instances were regarding sexual health interestingly enough. The first time I was just completing a routine check-up and getting some vaccinations to start graduate school, and the physician suggested that I complete a battery of STD tests. Even after I explained that I have worked in sexual health, am very aware of my relative risks, and was current on all my tests, the physician suggested that I at least get an HIV test. The second time, the nurse told me that they were going to ask me some questions about my sexual health, but once I said that I was gay, they moved on to ask me about other areas of health. Afterwards, without knowing any of my risk factors or sexual habits, they proceeded to try to administer a test that was completely inappropriate and did not apply to me at all. At this point, I said I would not be doing that test, explained that I previously worked in sexual health, and commented that I was surprised that they did not ask more questions to assess which tests were appropriate. The nurse brushed off my response and quickly said that there were more questions on the template but they were optional to ask and this was standard procedure. 

Where can people find you?: Hidden away studying for the NBCOT exam, hiking, or on Instagram at @Wad_the_robin