ACOFP Blog

By Rachel Nixon, DO

I cannot tell you the number of times I have heard the question, “Are you sure?” over the last 10 months. Truth be told, I am not sure of many things in life. Being a parent in today’s world is hard, and the last few years have made it even harder. Are we ever really “sure” of much? Should I send my kids to public school? Should I let my kids eat sugar? Should I allow my kids on social media?

There are so many more questions that we as parents can only really make our best guess as to how to answer them. There is, however, one thing I am very sure of as a parent, and that is that I love my kids. No matter who or what they are—I love them. With June being Pride Month, I took some time to reflect on the last year as I became more involved in the LGBTQ+ community after my 14-year-old came out as transgender. While I’m not “sure” about where this path leads yet, I have learned some things I hope will be useful if and when you work with kids and parents dealing with issues of gender, sexuality and identity.

I was raised in a very liberal family. We were taught throughout life that the golden rule always applies: Treat others as you wish to be treated. I saw my mother accept and love people without care of their color, religion, sexuality, cultural beliefs, etc. And so, as an adult I have prided (no pun intended) myself on being equally as accepting. I have always felt that I was truly an ally to minority communities and was pretty well informed. It wasn’t until my child came out that I really learned how little I knew, specifically about the LGBTQI+ community. As I was navigating care for my child, I realized how poorly informed I was on the issues, concerns, and care of individuals in this community.

As a physician, we go through a lot of training—years of developing medical knowledge, procedural skills and patient care expertise. We’re often told, “What you don’t know, you can look up.” I have told the residents in our program this same thing. Unfortunately, knowledge doesn’t always translate into understanding. I could find all the information I needed on what the definition of being transgender is, what gender dysphoria means, how individuals go through transition, what dose of androgen blockers were used or what the side effects of testosterone therapy might be and more.

But I couldn’t look up how to help my own child come out to conservative friends and family, what questions to ask when seeking gender affirming care, how to navigate insurance policies, how to help my husband (and myself) support our child while still grieving the loss of who our child once was. This was not a topic covered much in my medical training as a family physician. Honestly, I felt like I was drowning in those first few months.

Nothing really prepares you for the heartbreak you may experience when your child says they no longer want to go by their birth name. No one really talks about the loss a parent feels when realizing the life they envisioned for their child no longer exists. While I am and have always been fully supportive and accepting of my child, I’d be lying if I said that this acceptance was instantaneous. It is a process and one I was challenged by, especially with no one to truly guide me. So I decided to become my own guide.

I spent months constantly reading and reaching out to colleagues asking for guidance and resources only to hit barrier after barrier at times. I remember one instance where a very kind woman working for the insurance company told me that my child’s voice therapy was deemed “not medically necessary.” I thanked her for her time, hung up and cried. How could I help my kid when there were so many barriers? Why was it so hard to get the help my child needed? Being type A (and a very stubborn mother), I did not relent, and I was able to find our way through. We found a great counselor, some amazing support groups, and a great medical program at a gender clinic for youth nearby.

As I look back on our journey this year, I think to myself now—people who aren’t physicians must struggle even more to help their kids and families. They have even greater difficulty finding the care and resources their kids need. Ten months ago, if an LGBTQI+ person had come to me as a primary care physician, I would have been very ill equipped to help them. I am now “sure” I can do better, and I am “sure” can be a better resource for my patients and their families. I know that my child’s story is a meaningful one and that there are many out there without the support they need to flourish, so I have made it my goal to be this support for others.

While the PFLAG website is a great place to start, here some steps I’ve taken that may be helpful to others who also want to want to become more competent in helping (and demonstrating inclusivity) for this population of patients:

• Implement inclusive language in patient forms and EMRs
• Discuss and develop approaches on how to talk to patients about gender and sexuality in history gathering and physical examination
• Review and have available resources for patients and families who are going through these experiences

While my kid came out officially this last year, I have known for years that they were gender non-conforming (although I didn’t know that specific term until more recently). Over the previous three years, my child and I have had many conversations about their gender identity and how they were feeling and why and what that meant to them. I remember asking them several times, “Are you sure?” And every time I did, they would frown and say “I don’t know.” In September of this last year, a breakthrough occurred for me when my child said to me, “Every time you ask me that, I question myself again, but whenever I talk to my friends or I think about it alone—I’m sure. I know who I am.”

Looking back, I cringe that I said those words to my child. I realize now that asking them that question was probably incredibly frustrating and disheartening to them. I realize that I wasn’t being the best advocate for them or their needs as they were questioning, and I regret that. Now when someone asks me, “Are you sure they know? Are you sure this is the right thing to do? Are you sure they won’t change their mind?” I respond, “Well, I am often not even sure I should have this second cup of coffee. I know it will taste good, but am I sure it won’t make me jittery or upset my stomach? Nope. So, no I am not really SURE about any of those things.”

In fact, I am often terrified that I am making the wrong decisions somehow. I have had many sleepless nights pondering how to know what is best for my beautiful human. Truthfully, as you are reading this right now, I am probably having another mini meltdown or overthinking something about a decision I have made regarding one of my kids. I have come to realize I will probably never have all the answers or know what is best.

But there are things I am “sure” of. I am “sure” that there is nothing like seeing your kid smile when you use their preferred pronouns for the first time or seeing the tears of joy in their eyes when you had grandma make them a new Christmas stocking with their new name on it. And I am absolutely “sure” that no matter what the future holds, this is the journey that was meant for my child and our family and I am “sure” that they will always know they are loved and supported and affirmed at home. I am “sure” that I will always love my kid.

No matter how you think politically, religiously, socially or morally—if you realize these challenges and journeys do exist and need to be experienced, then be “sure” that your approach is one of love, acceptance and understanding. That should be something we can all agree upon.

Now as we go through Pride Month, I encourage you to remember it’s a time to reflect on how we can show love, demonstrate acceptance, work at understanding and celebrate the LGBTQI+ community. It’s a great opportunity to consider that maybe instead of the “Golden Rule” we should all move toward applying the “Platinum Rule,” which says “treat others as they wish to be treated.”