June 29, 2025 • 35 mins
On this episode of Real Talk, Quincy invites Dr. Kristin Gianelis to talk about caring for the LGBTQ+ community. Dr. Gianelis is a Dual Board-Certified Women's Health Nurse Practitioner and Adult Nurse Practitioner with 20 years of experience. She and Quincy talk in depth about when and where to get care. ❤️
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Episode Transcript
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UNKNOWN (00:00):
🎵🎵
SPEAKER_01 (00:09):
Welcome back to Real Talk Community Health Care in
Action.
Today, I want to talk aboutcaring for our LGBTQ plus
community members.
Gender affirming care, asdefined by the World Health
Organization, encompasses arange of social, psychological,
behavioral, and medicalinterventions designed to
support and affirm anindividual's gender identity
(00:30):
when it conflicts with thegender they were assigned at
birth.
The interventions helpedtransgender people align various
aspects of their lives,emotional, interpersonal, and
biological, with their genderidentity.
The interventions fall along acontinuum as well, from
counseling to changes in socialexpression to medications such
as hormone therapy.
(00:52):
Joining me today is facultymember at Frontier Nursing
University, Dr.
Kristen Gianellis.
Dr.
Gianellis is a dual boardcertified women's health nurse
practitioner and adult nursepractitioner with over 20 years
of clinical experience.
She also holds certifications asa menopause society certified
practitioner, a certified nurseeducated, and she is certified
(01:16):
in perinatal mental health.
She received her MSN fromSimmons University in 2005 and a
post-master's DMP from FrontierNursing University in 2020.
Dr.
Gianellis has dedicated hercareer to providing equitable
person-centered women's andgender-related health care.
She has worked in varioussettings, both outpatient and
(01:36):
acute care, providingreproductive and sexual health
care to persons of all genders.
Dr.
Gianellis is passionate aboutadvancing the role of the
women's health nursepractitioner and incorporating
quality improvement practicesinto the role of the advanced
practice nurse.
Dr.
Jan Ellis currently owns andoperates a small volume
menopause and sexual medicineconsultant practice and lives in
(02:00):
Rhode Island with her husbandand two teenagers.
She's a lifelong learner andavid reader and a perpetual
student.
Dr.
Jan Ellis, thank you for joiningme.
SPEAKER_00 (02:09):
Thanks so much for having me.
I'm happy to be here.
SPEAKER_01 (02:14):
So during the month of June, we are celebrating
Pride, and we honor the livesand work of the LGBTQ plus
community and renew ourcommitment to equality for
people of genders and sexualorientation.
In healthcare, it's a time forus to reflect on health
disparities, specifically forthe LGBTQ individuals, and to
look for ways to improve carefor all patients.
(02:38):
Could you start by explaining toour listeners what we mean when
we talk about healthdisparities?
SPEAKER_00 (02:48):
Thank you so much for that question.
And I think this is a reallyfoundational piece that we need
to all be on the same page with.
Health disparities aredifferences in access to health
care or health outcomes.
so overall health, that arebased in systemic discrimination
(03:08):
and oppression.
But the most important part ofthis is that these outcomes are
preventable, meaning that theycould have happened differently
if the racism, sexism,heterosexism, classism, ableism
didn't exist.
And I need to clarify that thisisn't always just discrimination
(03:29):
that's happening today.
It's often rooted inlongstanding cultural inequities
that are built into our culturalnarrative.
And so again, we could be doingbetter,
SPEAKER_03 (03:42):
but
SPEAKER_00 (03:44):
these disparities exist.
So we know that LGBTQ peoplepersons as well as racial and
ethnic minorities and folks fromlower incomes, people with
disabilities, rural populations,women, I mean, I can go on all
day, typically have less accessto care and generally have more
(04:06):
health risks and worse healthoutcomes as a whole.
And each of these groups havedifferent health disparities and
nothing's ever across the board,but we know this to be true from
population data and healthcaredelivery.
And it's our job to be trying tonarrow these disparities.
SPEAKER_01 (04:31):
So specifically with the LGBTQ community, what are
the health disparities they'reencountering and then what are
their barriers to healthcare?
SPEAKER_00 (04:41):
Yes, so LGBTQ communities face really
significant disparities inhealthcare, most often related
to discrimination, stigma, bias.
And so these are all externallyimposed factors that are
creating a very real impact ontheir access to care and the
(05:03):
quality of care that theyreceive, and then their overall
health at the end of the day.
So we know that LGBTQ folkshave, they have higher rates of
unemployment or underemploymentwhich means they are not insured
at the same rates that straightand cisgender folks are.
And because of this alone, thisworkplace discrimination and
(05:28):
hiring discrimination, we knowthat one third of transgender
adults are living below thepoverty line in this country.
Sadly, these folks just can'tafford a healthcare.
We also know that more than halfof people who are LGBTQ report
at least one negative experiencein the healthcare setting in the
(05:51):
past year.
And this could be something assimple as misgendering as, and I
say simple, but it is real.
Misgendering, providers makingan unfair, like just assuming
something without asking tojust, we also see outright
(06:12):
refusal of care.
And with these staggeringstatistics, if you didn't have a
negative experience this year,you certainly know someone who
did have a negative experienceand they told you about it.
So that wouldn't make me want tocome to care at all.
SPEAKER_01 (06:30):
Right, right.
SPEAKER_00 (06:32):
And I think the outcome of that is that we see
delayed, or I know the outcomeof that is that we see delayed
or avoided care, especially whenit comes to wellness.
And so we don't see folks comingin for physicals or chronic
disease management, like fordiabetes or hypertension or
(06:53):
regular cancer screenings likePAPs and mammograms.
And we know that all of thesemeasures improve health
outcomes.
So if you have hypertension andyou're just not coming in for
care, again, I'm not gonna blameyou for not coming in for care
if you are discriminated againstevery single time you come in.
(07:13):
But certainly if we aren'ttaking care of that high blood
pressure, that is going to putyou at much higher risk.
I think the next place we needto look at when it comes to
these disparities is ourhealthcare workforce.
And so this is where we're partof the problem.
And we see very mixed levels oflike knowledge and skills and
(07:38):
overall attitudes in ourhealthcare providers across the
country.
And certainly there arevariations by areas of the
country, but I will say that onaverage, it looks like providers
(08:03):
that are currently practicinghave received on average 4.5
hours or less of training inLGBTQ care in school.
That's not a lot.
And many of them are less.
And while a lot of thosehealthcare providers will say,
yes, I feel comfortable when itcomes down to it, they actually
(08:24):
don't feel comfortable talkingabout sexual orientation, gender
identity.
So they feel comfortable, butthen they don't feel
comfortable.
And their bias comes with theminto the exam room.
And if we don't think we haveany biases, then we're kidding
(08:45):
ourselves because we all havebiases.
So I think that, you know, whenwe think about access to care,
it's not as simple as, do youhave a clinic nearby?
But this really encompasseslike, first of all, can you
afford the care?
Are you comfortable getting carethere?
Are they going to respect you?
And will the provider even knowwhat type of care you need?
(09:09):
Will they know how to care foryou?
Will you have to teach them howto care for you?
You know, all of thosecontribute to health
disparities.
That's just scratching thesurface.
SPEAKER_01 (09:26):
Now we've talked a little bit about stigma and
bias.
So let's talk about mentalhealth and how the stigma and
the bias impacts mental healthfor the LGBTQ community.
SPEAKER_00 (09:44):
Yes.
Thank you for bringing that upbecause it's such an important
topic.
And I think that the experiencesthat LGBTQ people have in the
world absolutely affect mentalhealth and contribute to
(10:07):
significant mental healthdisparities compared to the
general population.
And I want to reiterate thatthis is not, this is like
related to minority stress andexperiences they have just
moving through the world.
This doesn't mean thathomosexuality or transgender
identity causes someone to bementally ill.
(10:30):
That is not at all related.
This means that it's theirexperience that puts them at
increased risk for havingdepression, anxiety.
We know that LGBTQ adults aretwice as likely to have
depression or anxiety.
They also have higher rates ofPTSD and trauma, higher rates of
(10:54):
sexual abuse in their childhood,eating disorders, intimate
partner violence, substanceabuse.
And again, this is not becauseof who they are, this is because
of what is surrounding themrelated to who they are and how
the world reacts to who theyare.
(11:16):
For youth, Stakes are evenhigher.
We know that LGBTQ youth aremore than four times more likely
than their peers to havesuicidal thoughts.
And up to 50% of transgenderyouth will have a suicide
(11:37):
attempt, which is really, it'shorrific.
We do know that one of theprotective factors for that is
having support of family andfriends.
And so I think that's reallyimportant to know is that that
risk goes down with even onesupportive adult in their life.
(11:58):
So yes, mental health is a hugearea of disparity and certainly
an area that we as healthcareproviders need to work on and
really support equity efforts.
SPEAKER_01 (12:13):
So switching gears a little bit, I mentioned
gender-affirming care earlier,you did, and that's, I feel like
a hot topic in the media thesedays.
So tell us what actually isgender-affirming care and why it
might be important.
SPEAKER_00 (12:35):
Yeah, so...
Within the LGBTQ community, thetrans community, that T in
there, is a community that'sreally at increased
vulnerability.
But let's just back up for asecond because, and I just want
to define gender identity for amoment, because I think people
who do not have a lot ofexperience with the trans
(12:59):
community, maybe they don't knowtrans individuals or they don't
know that they know transindividuals, have a little bit
of confusion or misunderstandingabout gender identity.
SPEAKER_01 (13:10):
Right.
SPEAKER_00 (13:12):
So first of all, we all have a gender identity.
A gender identity is how youfeel inside your internal sense
of what your gender is.
So a person's gender identitycan't be defined externally by
other people.
I can't determine what someone'sgender identity is.
(13:32):
It is their unique livedexperience and internal sense of
self.
And so for many of us, ourgender identity matches the sex
assigned at birth, which isbasically just what either the
midwife or the obstetrician sawfor genitals when we came out of
(13:52):
the uterus.
That's what we were assigned.
And for a lot of us, that's whatwe identify with.
But for trans folks, there's amismatch.
And that is a deep personalfeeling and experience.
And we really cannot refute thator deny it because that's their
internal experience.
(14:13):
I'll also say that gender existson a spectrum.
And so it's not just male andfemale.
And then when we havetransgender folks, they're
either trans male or transfemale.
There's lots of interesting anddifferent stuff in between and
so we have really put peopleinto this binary of male female
(14:40):
pink blue and really there's alot in between there and so many
people will identify asnon-binary meaning neither or a
combination of both and somepeople have identities that are
are very diverse and they may, Icould spend a whole podcast
talking about differentidentities along the gender
(15:01):
spectrum.
But again, that doesn't, that'snot something that I can, I can,
or you can define for them.
That is something they definefor themselves.
And we don't, necessarily haveto understand it.
That's the hard thing is thatsometimes they will talk about
(15:22):
something, like sometimes aperson will say something and I
don't quite understand theirexperience in the world, but I
don't have to because it's theirexperience.
I just have to listen andbelieve them that their
experience is real.
So coming back to genderaffirming care, Cause I think
(15:42):
that's what you asked about,correct?
SPEAKER_01 (15:44):
Yes.
SPEAKER_00 (15:45):
Okay.
I got off on a tangent
SPEAKER_01 (15:47):
there.
No, I think, I think all of thatis helpful to define because
again, it's, it's an internalthing and a lot of people just
see what's on the surface andthat is what it is.
And it can't be anythingdifferent, but exactly.
So
SPEAKER_00 (16:04):
coming back to that gender affirming care, this is
any care that affirms or,confirms, like helps a person
feel more comfortable with thegender that they feel on the
inside.
And so it may be a change intheir external physical
(16:26):
appearance.
It may be a change in the waythat they are presenting to the
world.
It may be a change in the waythat the names or the pronouns
that they use, and it may besomething medical as well.
So we've been doing genderaffirming care for a really long
(16:46):
time in regular practice.
So I think, first of all, wehave to remember that we all
have gender identities andanytime we are affirming a
person's gender, we are doinggender affirming care.
So menopause hormone therapy,when women lose their natural
hormones at menopause and wegive them hormones back, That is
(17:07):
gender affirming hormone.
That's gender affirming care.
Same thing for men.
When we see signs ofhypogonadism and they lose their
testosterone and we give themsome back, same thing.
That's gender affirming care.
We're affirming their malenessat that point in time.
(17:29):
Breast reconstructive surgeryafter a mastectomy for breast
cancer.
That's standard of care.
That is like, everyone sayslike, yes, let's do that.
That is gender affirming care.
So for trans and non-binaryindividuals, it's the same.
(17:51):
We just have to listen to whatthey want first.
We can't assume it, which Ithink it's silly that we assumed
it in the first place, but itcan take many forms.
So we need to respect that.
people's, what they're saying tous.
So a lot of times it starts withusing correct pronouns and their
(18:12):
chosen name.
And I say correct pronounsrather than preferred pronouns
because this is one of my littlepet peeves here.
And it's not a preference.
It's their pronouns.
So we can't refute it.
We can't say it doesn't exist.
Those are their pronouns and wehave to use them.
(18:35):
And just using pronouns, havingforms that allow for different,
you know, pronouns, differentgender identities, different
experiences in our office isaffirmation to start with.
From a medical perspective,gender affirming care is often
(18:59):
things we're very comfortabledoing already.
Like we routinely suppressmenstrual cycles for cisgender
women who just either havehorrible menstrual cycles or
don't want periods.
Transgender men and non-binaryindividuals usually don't want
(19:23):
periods.
I shouldn't say usually, Ishould say many of them do not
want periods because of coursewe cannot generalize.
And so- Suppressing menses,regardless of what the gender
identity is exactly the same,you know, exactly.
If you're a GYN provider,whether midwife or women's
health nurse practitioner, youknow how to do that.
(19:44):
And so that is gender affirmingcare and you should not hesitate
to do that.
SPEAKER_01 (19:51):
Because that's what you've already been doing.
SPEAKER_00 (19:54):
It's what we already do.
Like we're listening to ourpatients.
SPEAKER_01 (19:57):
And it's, is it fair to say that gender affirming
care is is primary care
SPEAKER_00 (20:05):
yes and it can't be care that is special or
different or outside the boxlike we can't send people to
special care or like this isn'tspecialty care because we all
have a gender identity and so Weall fit in primary care, which
(20:29):
means that we all need our caretaken care of in primary care.
So it does mean that we need toget comfortable with all aspects
of taking care of all of ourpatients.
When it comes to gender-forminghormone therapy, I think that's
(20:51):
really beyond the scope of thispodcast.
However, I'm happy to talk aboutit at any time.
I really want clinicians to knowthat all of the medications we
use are medications that youhave seen, probably prescribed
(21:11):
before, definitely prescribedbefore a lot of times, They have
been used for years and yearsand years.
These are not new medications.
Totally.
We know the side effects.
We know the risks.
We know the benefits.
We know how to counsel people onthem.
So we can't be afraid of givingmedications that we know how to
(21:34):
use.
Estrogen, testosterone,spironolactone.
We know how to use these things.
So why are we afraid?
And yes, it is a new indication.
It is a different indication,different dose, all of that.
And so we look to the guidelinesfor that.
(21:54):
But we have been doing that alot.
I mean, we all the time usedrugs for new and different
reasons.
I often think about the factthat we use Propanolol, which is
a hypertensive drug for stagefright.
You know, like for publicspeaking, that wasn't the
(22:19):
intended effect to begin with.
But we had to learn how to dothat by going to a guideline,
right?
And the dose of that is not thesame as the dose of trying to
control someone's blood pressurethat way.
So just because you didn't learnit in school doesn't mean that
(22:40):
you can't learn it now.
SPEAKER_03 (22:42):
And
SPEAKER_00 (22:43):
I will say what I learned in school 22 years ago,
very little of that is actuallyrelevant to current practice
today.
A lot has changed in medicine intwo decades.
It makes me feel like adinosaur, but at the same time,
if we were still doing care likewe did it 20 years ago, we'd be
(23:07):
in big trouble.
So We are supposed to come outof school with the basic minimum
competency and the ability tolook at guidelines and look at
new situations and meet theneeds of our patients.
And so this is just one morearea of that where we
SPEAKER_01 (23:27):
have to do this.
I'll go back to your bio to belifelong learners and perpetual
students, right?
SPEAKER_00 (23:36):
Yes, yes.
That's key.
It is key, and I think that alot of us, we all do some
continuing education every year,or we should, but we need it for
certifications.
A lot of us tend to do ourcontinuing education in areas
that we're comfortable withbecause it's fun, because we
(23:59):
want to learn more.
We want to see our friends atthese conferences.
I want to encourage everyone togo outside their comfort zone
and learn something they don'tknow about, because I think
that's what continuing educationactually is about.
It's very easy to learnsomething new about something
(24:20):
you're passionate about.
It's harder.
It takes a lot more effort tolearn something that you aren't
sure about.
That's where you need to go tothe conference or get the CE
credits for.
That's part of that lifelonglearning is saying like, I don't
know, but I'm gonna find outnow.
SPEAKER_01 (24:41):
Right.
So going back earlier, youmentioned the importance of
having a support person or asupportive family or friend.
So how can we be supportive?
SPEAKER_00 (24:57):
Yeah.
So I think, you know, in thecommunity, I think I mentioned
this with the youth.
We do know that, especially withkids and teenagers, having a
supportive adult, a singlesupportive adult, it does not
have to be a parent, although itwould be lovely if it's their
(25:18):
parents, but a single supportiveadult in their life is
protective against suicide.
And so that to me, is like weall have to be that single
supportive adult.
Hopefully we can all be morethan one single supportive
adult, but we all have to bethat supportive adult.
(25:40):
And so if you know a kid,support that kid 110%.
If you don't know how to supportthem, figure it out.
In this month of Pride, I thinkwe kind of get excited about
doing some allyship and wearingrainbow colors and getting
(26:01):
excited and going to parades andstuff.
But gay and trans people existall year round.
And so we need to carry thisthroughout the entire year.
I think our support is more thanjust a statement on Instagram or
Facebook.
Our support needs to be in ouractions, in our votes, in how we
(26:30):
show up for people.
And we need to explore our ownbiases.
Like I said before, we all havethem.
SPEAKER_03 (26:40):
Right.
SPEAKER_00 (26:41):
And you may not know what they are.
And so explore them.
And that's part of Lifelinelearning is learning who you are
and how you were formed andlearning to be a better version
of yourself.
And I will never be done lookingat myself and looking to improve
myself.
(27:03):
So, you know, in our, ashealthcare providers, we need to
create gender affirming,policies in our offices.
We need to make sure our forms,like our intake forms look good
and they have like, they're notjust centered on, you know,
heterosexual, cisgender people.
(27:23):
We can't have all thedecorations in, you know, in a
women's health practice.
Be all, you know, pink and allcentered around what we think is
a typical family.
Cause I'll just tell you, that'snot like, what is typical
anymore?
I don't even know.
(27:43):
We need to work on making surethat we have gender inclusive
bathrooms for people.
Just because they could go in abathroom that is labeled for
something that is not theirgender does not mean they feel
comfortable going in a bathroom.
And how like that is basic,basic human needs there.
(28:07):
We also need to make sure thatour staff around us is trained
as well.
And that will take someintention and some effort.
And sometimes we have to leadthe charge on that.
As educators, because of courseI am an educator, that's my
(28:27):
first role here.
This has to be part of oureducation.
And it has to be a big part ofour education.
I said before, you know, likenationwide, people say they have
less than, you know, four and ahalf hours of education in their
whole training.
In a study just last year putout by the American Journal of,
(28:51):
the Journal of AmericanAssociation of Nurse
Practitioners, they found that78% of nurse practitioner
students 78% who were gettingclose to graduation, I think
they were in the last term ortwo, had not received any
LGBTQ-specific training.
(29:11):
Now, I would like to say, Idon't think that these are
frontier students, because I dothink we are talking about this.
We can talk more, for sure.
We absolutely need to talk more.
But that...
is horrific.
We as a profession need to dobetter.
(29:31):
And so we need to increase oureducation.
We need to increase our ownpersonal continuing education.
We need to look at our ownbiases.
We need to like really recognizethat this is the population.
I will tell you when you look atgender, like gender and
(29:55):
sexuality statistics, and youlook at the way that generations
are moving.
When you look at the currentgeneration right now, who's in
like grade school and middleschool, when that generation
gets to our offices, as like ourprimary care offices and our
(30:18):
women's health offices, it willbe close to one in four of them
will be LGBTQ.
That's not specialty care.
That's everybody care.
You can't send a quarter of thepopulation to specialty care.
SPEAKER_01 (30:36):
Right,
SPEAKER_00 (30:39):
right.
So we better be ready becausethey're knocking on the door
right now.
And those of you who work inpediatrics, you already know
they're here.
So If we're not ready for them,we have to get ready.
And it's not like the quarter ofthe population just gets here in
(31:00):
the next 10 years.
It's gradually going up.
And I'm sure you're seeing thatin your offices.
And if you aren't seeing that,then you're not asking the
questions.
When we know better, we dobetter.
SPEAKER_01 (31:21):
And I think this podcast is a good start if you
are unaware or if you need acheck on where you're standing,
especially within your office orwithin your community or family.
So we're wrapping up on time.
What key takeaways or anythingelse that we need to add?
How about, what are some goodresources for LGBTQ folks and
(31:47):
their families for healthcareand advocacy?
SPEAKER_00 (31:50):
So for people who identify as LGBTQ, if you're
looking for care, findingsomeone who is well-trained and
really good person for you tosee can be challenging.
Sometimes it is word of mouthand that is hard, especially
when you're in a rural area.
(32:12):
I will say that there are somenational directories.
There's a national directorythrough GLAMA, which is the
Health Professionals forAdvancing LGBTQ And we'll put
their website in our notes.
(32:33):
There's also the National Queerand Trans Therapists of Color
Network.
And there's the National LGBTQCancer Network, which is a
provider directory.
And OutCare is another list.
It's actually a global list ofLGBTQ therapists.
(32:54):
affirming providers, and theyhave a lot of telehealth options
on there with lots of differentspecialties.
I will always recommend theHuman Rights Campaign as a great
place to get benchmarkinformation, to know what your
rights are, and to know whatquestions to ask when you go
(33:17):
into new places.
And and to know how to advocatefor yourself.
I will also say, bring someonewith you because it's important
to have an ally with you inthese appointments to really be
your voice when maybe you don'thave a voice.
SPEAKER_01 (33:42):
It would be good for them to do this research as well
and to do some grading upbeforehand so they know to speak
up and they can speak up.
SPEAKER_00 (33:52):
Exactly.
For providers, we really need tomake sure we know who our local
community providers are.
And because we can't bereferring people to specialists
who are not affirming, thatwould be a really bad thing.
(34:12):
So we want to know who thosespecialists are.
We want to make sure that we arereferring to specialists who are
affirming.
We want to know what theirinsurance acceptance is.
We want to know what theiravailability is.
So connect with these people inyour community But also, you
know, we also need to do sometraining ourselves and maybe
(34:34):
training our staff.
And one of the great places toget that training, the LGBTQ
Health Education Center, whichis through the Fenway Center in
Boston, they have a wonderfulrepository of toolkits and
webinars that go through a lotof training for healthcare
(34:55):
professionals and their staffson care.
how to be more affirming and howto provide care that's really,
really good for this population.
SPEAKER_01 (35:05):
Well, thank you so much for joining me today.
SPEAKER_00 (35:08):
It's been a pleasure.
I've enjoyed this conversationand I hope to come back and talk
about other things.
SPEAKER_01 (35:15):
Yeah, this was very informative and helpful to bring
awareness to gender-affirmingcare and the needs of our
community.
SPEAKER_00 (35:25):
Yes.
And we need to remember, it'snot just June.
It happens all year long.
So we want to support people allyear long.
SPEAKER_01 (35:33):
Thank you.
And thank you for joining ustoday.
We'll see you next time.
This podcast is brought to youby Frontier Nursing University
and the Woodford County Chamberof Commerce.
🎵🎵
SPEAKER_01 (00:09):
Welcome back to Real Talk Community Health Care in
Action.
Today, I want to talk aboutcaring for our LGBTQ plus
community members.
Gender affirming care, asdefined by the World Health
Organization, encompasses arange of social, psychological,
behavioral, and medicalinterventions designed to
support and affirm anindividual's gender identity
(00:30):
when it conflicts with thegender they were assigned at
birth.
The interventions helpedtransgender people align various
aspects of their lives,emotional, interpersonal, and
biological, with their genderidentity.
The interventions fall along acontinuum as well, from
counseling to changes in socialexpression to medications such
as hormone therapy.
(00:52):
Joining me today is facultymember at Frontier Nursing
University, Dr.
Kristen Gianellis.
Dr.
Gianellis is a dual boardcertified women's health nurse
practitioner and adult nursepractitioner with over 20 years
of clinical experience.
She also holds certifications asa menopause society certified
practitioner, a certified nurseeducated, and she is certified
(01:16):
in perinatal mental health.
She received her MSN fromSimmons University in 2005 and a
post-master's DMP from FrontierNursing University in 2020.
Dr.
Gianellis has dedicated hercareer to providing equitable
person-centered women's andgender-related health care.
She has worked in varioussettings, both outpatient and
(01:36):
acute care, providingreproductive and sexual health
care to persons of all genders.
Dr.
Gianellis is passionate aboutadvancing the role of the
women's health nursepractitioner and incorporating
quality improvement practicesinto the role of the advanced
practice nurse.
Dr.
Jan Ellis currently owns andoperates a small volume
menopause and sexual medicineconsultant practice and lives in
(02:00):
Rhode Island with her husbandand two teenagers.
She's a lifelong learner andavid reader and a perpetual
student.
Dr.
Jan Ellis, thank you for joiningme.
SPEAKER_00 (02:09):
Thanks so much for having me.
I'm happy to be here.
SPEAKER_01 (02:14):
So during the month of June, we are celebrating
Pride, and we honor the livesand work of the LGBTQ plus
community and renew ourcommitment to equality for
people of genders and sexualorientation.
In healthcare, it's a time forus to reflect on health
disparities, specifically forthe LGBTQ individuals, and to
look for ways to improve carefor all patients.
(02:38):
Could you start by explaining toour listeners what we mean when
we talk about healthdisparities?
SPEAKER_00 (02:48):
Thank you so much for that question.
And I think this is a reallyfoundational piece that we need
to all be on the same page with.
Health disparities aredifferences in access to health
care or health outcomes.
so overall health, that arebased in systemic discrimination
(03:08):
and oppression.
But the most important part ofthis is that these outcomes are
preventable, meaning that theycould have happened differently
if the racism, sexism,heterosexism, classism, ableism
didn't exist.
And I need to clarify that thisisn't always just discrimination
(03:29):
that's happening today.
It's often rooted inlongstanding cultural inequities
that are built into our culturalnarrative.
And so again, we could be doingbetter,
SPEAKER_03 (03:42):
but
SPEAKER_00 (03:44):
these disparities exist.
So we know that LGBTQ peoplepersons as well as racial and
ethnic minorities and folks fromlower incomes, people with
disabilities, rural populations,women, I mean, I can go on all
day, typically have less accessto care and generally have more
(04:06):
health risks and worse healthoutcomes as a whole.
And each of these groups havedifferent health disparities and
nothing's ever across the board,but we know this to be true from
population data and healthcaredelivery.
And it's our job to be trying tonarrow these disparities.
SPEAKER_01 (04:31):
So specifically with the LGBTQ community, what are
the health disparities they'reencountering and then what are
their barriers to healthcare?
SPEAKER_00 (04:41):
Yes, so LGBTQ communities face really
significant disparities inhealthcare, most often related
to discrimination, stigma, bias.
And so these are all externallyimposed factors that are
creating a very real impact ontheir access to care and the
(05:03):
quality of care that theyreceive, and then their overall
health at the end of the day.
So we know that LGBTQ folkshave, they have higher rates of
unemployment or underemploymentwhich means they are not insured
at the same rates that straightand cisgender folks are.
And because of this alone, thisworkplace discrimination and
(05:28):
hiring discrimination, we knowthat one third of transgender
adults are living below thepoverty line in this country.
Sadly, these folks just can'tafford a healthcare.
We also know that more than halfof people who are LGBTQ report
at least one negative experiencein the healthcare setting in the
(05:51):
past year.
And this could be something assimple as misgendering as, and I
say simple, but it is real.
Misgendering, providers makingan unfair, like just assuming
something without asking tojust, we also see outright
(06:12):
refusal of care.
And with these staggeringstatistics, if you didn't have a
negative experience this year,you certainly know someone who
did have a negative experienceand they told you about it.
So that wouldn't make me want tocome to care at all.
SPEAKER_01 (06:30):
Right, right.
SPEAKER_00 (06:32):
And I think the outcome of that is that we see
delayed, or I know the outcomeof that is that we see delayed
or avoided care, especially whenit comes to wellness.
And so we don't see folks comingin for physicals or chronic
disease management, like fordiabetes or hypertension or
(06:53):
regular cancer screenings likePAPs and mammograms.
And we know that all of thesemeasures improve health
outcomes.
So if you have hypertension andyou're just not coming in for
care, again, I'm not gonna blameyou for not coming in for care
if you are discriminated againstevery single time you come in.
(07:13):
But certainly if we aren'ttaking care of that high blood
pressure, that is going to putyou at much higher risk.
I think the next place we needto look at when it comes to
these disparities is ourhealthcare workforce.
And so this is where we're partof the problem.
And we see very mixed levels oflike knowledge and skills and
(07:38):
overall attitudes in ourhealthcare providers across the
country.
And certainly there arevariations by areas of the
country, but I will say that onaverage, it looks like providers
(08:03):
that are currently practicinghave received on average 4.5
hours or less of training inLGBTQ care in school.
That's not a lot.
And many of them are less.
And while a lot of thosehealthcare providers will say,
yes, I feel comfortable when itcomes down to it, they actually
(08:24):
don't feel comfortable talkingabout sexual orientation, gender
identity.
So they feel comfortable, butthen they don't feel
comfortable.
And their bias comes with theminto the exam room.
And if we don't think we haveany biases, then we're kidding
(08:45):
ourselves because we all havebiases.
So I think that, you know, whenwe think about access to care,
it's not as simple as, do youhave a clinic nearby?
But this really encompasseslike, first of all, can you
afford the care?
Are you comfortable getting carethere?
Are they going to respect you?
And will the provider even knowwhat type of care you need?
(09:09):
Will they know how to care foryou?
Will you have to teach them howto care for you?
You know, all of thosecontribute to health
disparities.
That's just scratching thesurface.
SPEAKER_01 (09:26):
Now we've talked a little bit about stigma and
bias.
So let's talk about mentalhealth and how the stigma and
the bias impacts mental healthfor the LGBTQ community.
SPEAKER_00 (09:44):
Yes.
Thank you for bringing that upbecause it's such an important
topic.
And I think that the experiencesthat LGBTQ people have in the
world absolutely affect mentalhealth and contribute to
(10:07):
significant mental healthdisparities compared to the
general population.
And I want to reiterate thatthis is not, this is like
related to minority stress andexperiences they have just
moving through the world.
This doesn't mean thathomosexuality or transgender
identity causes someone to bementally ill.
(10:30):
That is not at all related.
This means that it's theirexperience that puts them at
increased risk for havingdepression, anxiety.
We know that LGBTQ adults aretwice as likely to have
depression or anxiety.
They also have higher rates ofPTSD and trauma, higher rates of
(10:54):
sexual abuse in their childhood,eating disorders, intimate
partner violence, substanceabuse.
And again, this is not becauseof who they are, this is because
of what is surrounding themrelated to who they are and how
the world reacts to who theyare.
(11:16):
For youth, Stakes are evenhigher.
We know that LGBTQ youth aremore than four times more likely
than their peers to havesuicidal thoughts.
And up to 50% of transgenderyouth will have a suicide
(11:37):
attempt, which is really, it'shorrific.
We do know that one of theprotective factors for that is
having support of family andfriends.
And so I think that's reallyimportant to know is that that
risk goes down with even onesupportive adult in their life.
(11:58):
So yes, mental health is a hugearea of disparity and certainly
an area that we as healthcareproviders need to work on and
really support equity efforts.
SPEAKER_01 (12:13):
So switching gears a little bit, I mentioned
gender-affirming care earlier,you did, and that's, I feel like
a hot topic in the media thesedays.
So tell us what actually isgender-affirming care and why it
might be important.
SPEAKER_00 (12:35):
Yeah, so...
Within the LGBTQ community, thetrans community, that T in
there, is a community that'sreally at increased
vulnerability.
But let's just back up for asecond because, and I just want
to define gender identity for amoment, because I think people
who do not have a lot ofexperience with the trans
(12:59):
community, maybe they don't knowtrans individuals or they don't
know that they know transindividuals, have a little bit
of confusion or misunderstandingabout gender identity.
SPEAKER_01 (13:10):
Right.
SPEAKER_00 (13:12):
So first of all, we all have a gender identity.
A gender identity is how youfeel inside your internal sense
of what your gender is.
So a person's gender identitycan't be defined externally by
other people.
I can't determine what someone'sgender identity is.
(13:32):
It is their unique livedexperience and internal sense of
self.
And so for many of us, ourgender identity matches the sex
assigned at birth, which isbasically just what either the
midwife or the obstetrician sawfor genitals when we came out of
(13:52):
the uterus.
That's what we were assigned.
And for a lot of us, that's whatwe identify with.
But for trans folks, there's amismatch.
And that is a deep personalfeeling and experience.
And we really cannot refute thator deny it because that's their
internal experience.
(14:13):
I'll also say that gender existson a spectrum.
And so it's not just male andfemale.
And then when we havetransgender folks, they're
either trans male or transfemale.
There's lots of interesting anddifferent stuff in between and
so we have really put peopleinto this binary of male female
(14:40):
pink blue and really there's alot in between there and so many
people will identify asnon-binary meaning neither or a
combination of both and somepeople have identities that are
are very diverse and they may, Icould spend a whole podcast
talking about differentidentities along the gender
(15:01):
spectrum.
But again, that doesn't, that'snot something that I can, I can,
or you can define for them.
That is something they definefor themselves.
And we don't, necessarily haveto understand it.
That's the hard thing is thatsometimes they will talk about
(15:22):
something, like sometimes aperson will say something and I
don't quite understand theirexperience in the world, but I
don't have to because it's theirexperience.
I just have to listen andbelieve them that their
experience is real.
So coming back to genderaffirming care, Cause I think
(15:42):
that's what you asked about,correct?
SPEAKER_01 (15:44):
Yes.
SPEAKER_00 (15:45):
Okay.
I got off on a tangent
SPEAKER_01 (15:47):
there.
No, I think, I think all of thatis helpful to define because
again, it's, it's an internalthing and a lot of people just
see what's on the surface andthat is what it is.
And it can't be anythingdifferent, but exactly.
So
SPEAKER_00 (16:04):
coming back to that gender affirming care, this is
any care that affirms or,confirms, like helps a person
feel more comfortable with thegender that they feel on the
inside.
And so it may be a change intheir external physical
(16:26):
appearance.
It may be a change in the waythat they are presenting to the
world.
It may be a change in the waythat the names or the pronouns
that they use, and it may besomething medical as well.
So we've been doing genderaffirming care for a really long
(16:46):
time in regular practice.
So I think, first of all, wehave to remember that we all
have gender identities andanytime we are affirming a
person's gender, we are doinggender affirming care.
So menopause hormone therapy,when women lose their natural
hormones at menopause and wegive them hormones back, That is
(17:07):
gender affirming hormone.
That's gender affirming care.
Same thing for men.
When we see signs ofhypogonadism and they lose their
testosterone and we give themsome back, same thing.
That's gender affirming care.
We're affirming their malenessat that point in time.
(17:29):
Breast reconstructive surgeryafter a mastectomy for breast
cancer.
That's standard of care.
That is like, everyone sayslike, yes, let's do that.
That is gender affirming care.
So for trans and non-binaryindividuals, it's the same.
(17:51):
We just have to listen to whatthey want first.
We can't assume it, which Ithink it's silly that we assumed
it in the first place, but itcan take many forms.
So we need to respect that.
people's, what they're saying tous.
So a lot of times it starts withusing correct pronouns and their
(18:12):
chosen name.
And I say correct pronounsrather than preferred pronouns
because this is one of my littlepet peeves here.
And it's not a preference.
It's their pronouns.
So we can't refute it.
We can't say it doesn't exist.
Those are their pronouns and wehave to use them.
(18:35):
And just using pronouns, havingforms that allow for different,
you know, pronouns, differentgender identities, different
experiences in our office isaffirmation to start with.
From a medical perspective,gender affirming care is often
(18:59):
things we're very comfortabledoing already.
Like we routinely suppressmenstrual cycles for cisgender
women who just either havehorrible menstrual cycles or
don't want periods.
Transgender men and non-binaryindividuals usually don't want
(19:23):
periods.
I shouldn't say usually, Ishould say many of them do not
want periods because of coursewe cannot generalize.
And so- Suppressing menses,regardless of what the gender
identity is exactly the same,you know, exactly.
If you're a GYN provider,whether midwife or women's
health nurse practitioner, youknow how to do that.
(19:44):
And so that is gender affirmingcare and you should not hesitate
to do that.
SPEAKER_01 (19:51):
Because that's what you've already been doing.
SPEAKER_00 (19:54):
It's what we already do.
Like we're listening to ourpatients.
SPEAKER_01 (19:57):
And it's, is it fair to say that gender affirming
care is is primary care
SPEAKER_00 (20:05):
yes and it can't be care that is special or
different or outside the boxlike we can't send people to
special care or like this isn'tspecialty care because we all
have a gender identity and so Weall fit in primary care, which
(20:29):
means that we all need our caretaken care of in primary care.
So it does mean that we need toget comfortable with all aspects
of taking care of all of ourpatients.
When it comes to gender-forminghormone therapy, I think that's
(20:51):
really beyond the scope of thispodcast.
However, I'm happy to talk aboutit at any time.
I really want clinicians to knowthat all of the medications we
use are medications that youhave seen, probably prescribed
(21:11):
before, definitely prescribedbefore a lot of times, They have
been used for years and yearsand years.
These are not new medications.
Totally.
We know the side effects.
We know the risks.
We know the benefits.
We know how to counsel people onthem.
So we can't be afraid of givingmedications that we know how to
(21:34):
use.
Estrogen, testosterone,spironolactone.
We know how to use these things.
So why are we afraid?
And yes, it is a new indication.
It is a different indication,different dose, all of that.
And so we look to the guidelinesfor that.
(21:54):
But we have been doing that alot.
I mean, we all the time usedrugs for new and different
reasons.
I often think about the factthat we use Propanolol, which is
a hypertensive drug for stagefright.
You know, like for publicspeaking, that wasn't the
(22:19):
intended effect to begin with.
But we had to learn how to dothat by going to a guideline,
right?
And the dose of that is not thesame as the dose of trying to
control someone's blood pressurethat way.
So just because you didn't learnit in school doesn't mean that
(22:40):
you can't learn it now.
SPEAKER_03 (22:42):
And
SPEAKER_00 (22:43):
I will say what I learned in school 22 years ago,
very little of that is actuallyrelevant to current practice
today.
A lot has changed in medicine intwo decades.
It makes me feel like adinosaur, but at the same time,
if we were still doing care likewe did it 20 years ago, we'd be
(23:07):
in big trouble.
So We are supposed to come outof school with the basic minimum
competency and the ability tolook at guidelines and look at
new situations and meet theneeds of our patients.
And so this is just one morearea of that where we
SPEAKER_01 (23:27):
have to do this.
I'll go back to your bio to belifelong learners and perpetual
students, right?
SPEAKER_00 (23:36):
Yes, yes.
That's key.
It is key, and I think that alot of us, we all do some
continuing education every year,or we should, but we need it for
certifications.
A lot of us tend to do ourcontinuing education in areas
that we're comfortable withbecause it's fun, because we
(23:59):
want to learn more.
We want to see our friends atthese conferences.
I want to encourage everyone togo outside their comfort zone
and learn something they don'tknow about, because I think
that's what continuing educationactually is about.
It's very easy to learnsomething new about something
(24:20):
you're passionate about.
It's harder.
It takes a lot more effort tolearn something that you aren't
sure about.
That's where you need to go tothe conference or get the CE
credits for.
That's part of that lifelonglearning is saying like, I don't
know, but I'm gonna find outnow.
SPEAKER_01 (24:41):
Right.
So going back earlier, youmentioned the importance of
having a support person or asupportive family or friend.
So how can we be supportive?
SPEAKER_00 (24:57):
Yeah.
So I think, you know, in thecommunity, I think I mentioned
this with the youth.
We do know that, especially withkids and teenagers, having a
supportive adult, a singlesupportive adult, it does not
have to be a parent, although itwould be lovely if it's their
(25:18):
parents, but a single supportiveadult in their life is
protective against suicide.
And so that to me, is like weall have to be that single
supportive adult.
Hopefully we can all be morethan one single supportive
adult, but we all have to bethat supportive adult.
(25:40):
And so if you know a kid,support that kid 110%.
If you don't know how to supportthem, figure it out.
In this month of Pride, I thinkwe kind of get excited about
doing some allyship and wearingrainbow colors and getting
(26:01):
excited and going to parades andstuff.
But gay and trans people existall year round.
And so we need to carry thisthroughout the entire year.
I think our support is more thanjust a statement on Instagram or
Facebook.
Our support needs to be in ouractions, in our votes, in how we
(26:30):
show up for people.
And we need to explore our ownbiases.
Like I said before, we all havethem.
SPEAKER_03 (26:40):
Right.
SPEAKER_00 (26:41):
And you may not know what they are.
And so explore them.
And that's part of Lifelinelearning is learning who you are
and how you were formed andlearning to be a better version
of yourself.
And I will never be done lookingat myself and looking to improve
myself.
(27:03):
So, you know, in our, ashealthcare providers, we need to
create gender affirming,policies in our offices.
We need to make sure our forms,like our intake forms look good
and they have like, they're notjust centered on, you know,
heterosexual, cisgender people.
(27:23):
We can't have all thedecorations in, you know, in a
women's health practice.
Be all, you know, pink and allcentered around what we think is
a typical family.
Cause I'll just tell you, that'snot like, what is typical
anymore?
I don't even know.
(27:43):
We need to work on making surethat we have gender inclusive
bathrooms for people.
Just because they could go in abathroom that is labeled for
something that is not theirgender does not mean they feel
comfortable going in a bathroom.
And how like that is basic,basic human needs there.
(28:07):
We also need to make sure thatour staff around us is trained
as well.
And that will take someintention and some effort.
And sometimes we have to leadthe charge on that.
As educators, because of courseI am an educator, that's my
(28:27):
first role here.
This has to be part of oureducation.
And it has to be a big part ofour education.
I said before, you know, likenationwide, people say they have
less than, you know, four and ahalf hours of education in their
whole training.
In a study just last year putout by the American Journal of,
(28:51):
the Journal of AmericanAssociation of Nurse
Practitioners, they found that78% of nurse practitioner
students 78% who were gettingclose to graduation, I think
they were in the last term ortwo, had not received any
LGBTQ-specific training.
(29:11):
Now, I would like to say, Idon't think that these are
frontier students, because I dothink we are talking about this.
We can talk more, for sure.
We absolutely need to talk more.
But that...
is horrific.
We as a profession need to dobetter.
(29:31):
And so we need to increase oureducation.
We need to increase our ownpersonal continuing education.
We need to look at our ownbiases.
We need to like really recognizethat this is the population.
I will tell you when you look atgender, like gender and
(29:55):
sexuality statistics, and youlook at the way that generations
are moving.
When you look at the currentgeneration right now, who's in
like grade school and middleschool, when that generation
gets to our offices, as like ourprimary care offices and our
(30:18):
women's health offices, it willbe close to one in four of them
will be LGBTQ.
That's not specialty care.
That's everybody care.
You can't send a quarter of thepopulation to specialty care.
SPEAKER_01 (30:36):
Right,
SPEAKER_00 (30:39):
right.
So we better be ready becausethey're knocking on the door
right now.
And those of you who work inpediatrics, you already know
they're here.
So If we're not ready for them,we have to get ready.
And it's not like the quarter ofthe population just gets here in
(31:00):
the next 10 years.
It's gradually going up.
And I'm sure you're seeing thatin your offices.
And if you aren't seeing that,then you're not asking the
questions.
When we know better, we dobetter.
SPEAKER_01 (31:21):
And I think this podcast is a good start if you
are unaware or if you need acheck on where you're standing,
especially within your office orwithin your community or family.
So we're wrapping up on time.
What key takeaways or anythingelse that we need to add?
How about, what are some goodresources for LGBTQ folks and
(31:47):
their families for healthcareand advocacy?
SPEAKER_00 (31:50):
So for people who identify as LGBTQ, if you're
looking for care, findingsomeone who is well-trained and
really good person for you tosee can be challenging.
Sometimes it is word of mouthand that is hard, especially
when you're in a rural area.
(32:12):
I will say that there are somenational directories.
There's a national directorythrough GLAMA, which is the
Health Professionals forAdvancing LGBTQ And we'll put
their website in our notes.
(32:33):
There's also the National Queerand Trans Therapists of Color
Network.
And there's the National LGBTQCancer Network, which is a
provider directory.
And OutCare is another list.
It's actually a global list ofLGBTQ therapists.
(32:54):
affirming providers, and theyhave a lot of telehealth options
on there with lots of differentspecialties.
I will always recommend theHuman Rights Campaign as a great
place to get benchmarkinformation, to know what your
rights are, and to know whatquestions to ask when you go
(33:17):
into new places.
And and to know how to advocatefor yourself.
I will also say, bring someonewith you because it's important
to have an ally with you inthese appointments to really be
your voice when maybe you don'thave a voice.
SPEAKER_01 (33:42):
It would be good for them to do this research as well
and to do some grading upbeforehand so they know to speak
up and they can speak up.
SPEAKER_00 (33:52):
Exactly.
For providers, we really need tomake sure we know who our local
community providers are.
And because we can't bereferring people to specialists
who are not affirming, thatwould be a really bad thing.
(34:12):
So we want to know who thosespecialists are.
We want to make sure that we arereferring to specialists who are
affirming.
We want to know what theirinsurance acceptance is.
We want to know what theiravailability is.
So connect with these people inyour community But also, you
know, we also need to do sometraining ourselves and maybe
(34:34):
training our staff.
And one of the great places toget that training, the LGBTQ
Health Education Center, whichis through the Fenway Center in
Boston, they have a wonderfulrepository of toolkits and
webinars that go through a lotof training for healthcare
(34:55):
professionals and their staffson care.
how to be more affirming and howto provide care that's really,
really good for this population.
SPEAKER_01 (35:05):
Well, thank you so much for joining me today.
SPEAKER_00 (35:08):
It's been a pleasure.
I've enjoyed this conversationand I hope to come back and talk
about other things.
SPEAKER_01 (35:15):
Yeah, this was very informative and helpful to bring
awareness to gender-affirmingcare and the needs of our
community.
SPEAKER_00 (35:25):
Yes.
And we need to remember, it'snot just June.
It happens all year long.
So we want to support people allyear long.
SPEAKER_01 (35:33):
Thank you.
And thank you for joining ustoday.
We'll see you next time.
This podcast is brought to youby Frontier Nursing University
and the Woodford County Chamberof Commerce.
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Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.