The Heartbreaking Question

The unspoken question looms. I might ask first, dropping a bomb that disrupts the medical visit. Or the patient asks at the appointment’s conclusion, when I query, “Anything else today?” Patient concerns brought up when their visit has ostensibly ended are dubbed “doorknob questions.” Previously, these were predictably about Viagra or vaginas. Since the November 2024 election results, my patients voice their terror that access to gender-affirming medical care will cease to exist.

As we discuss the facts and their fears, I note the desperation and vulnerability in their posture, voice and eyes. I try to meet them with kindness, advocacy and reassurance. I am fortunate to work at a mission-based organization that prioritizes gender-affirming health care. I share my center’s resources and connections and speak of my personal commitment to continuing their care. I hope this can inoculate them briefly against the hatred from our government.

Most of my patients have jumped over enormous hurdles to have arrived at where they are today. Children have changed schools to escape bullying. Teens made the untenable decision to have parents pay for their college if they didn’t take hormones. Chart review reveals histories of physical, sexual and emotional abuse, multiple suicide attempts, eating disorders, psychiatric hospitalizations, unsafe alcohol and substance use, and dissociation. My heart breaks anew for each patient. The trans or gender-diverse person sitting before me deserves the same love and compassion as the cis patient in the exam room. Trans folks want to learn and work, spend time with loved ones, and enjoy each day just like their cis counterparts.

My trans patients work tirelessly to build lives that allow them to be their authentic selves. I marvel at their determination and strength, for their journey at best is challenging, and at worst is grueling. Worrying that people will reject them and stop loving them when they come out as trans. Losing family support. Losing jobs resulting in financial woes. Navigating the pharmaceutical system to receive hormones. Binding and taping breasts. Surgeries with complex post-operative instructions and long healing times. Endless reams of paperwork to change names and gender markers. Misgendering by ignorant strangers, or worse by family members who prioritize their comfort over my patients’ safety. Families of trans youth making impossible decisions about relocating to keep their children safe.

I wrote this to honor and make visible some of the bravest people I know.

Pamela Adelstein
Newton, Massachusetts