An episode of “Changing the Conversation” podcast
Tucker Barker shares information on providing gender affirming care with host Ashley Stewart.
November 6, 2023
[Music]
Ashley Stewart, Host (00:05): Hello and welcome to Changing the Conversation. I’m your host, Dr. Ashley Stewart, Director of the Center for Health Equity at C4 Innovations. And today we have the wonderful opportunity to dive into a very, very important topic. We will be talking about gender-affirming care. My guest today is Tucker Barker, joining us from the one and only New Orleans. Tucker is the Center for Health Equity coordinator. And Tucker, I’m so excited to have this conversation with you today.
Tucker Barker, Guest (00:36): I am so excited to be here. Thank you for having me, Ashley.
Ashley (00:39): Thank you. Can you tell us a little bit about yourself and how your interests and passion as well as your work in gender-affirming care has been nurtured?
Tucker (00:49): I grew up here in New Orleans doing community organizing work as a young person after Katrina and was brought into organizing work by some incredible, beautiful people who are still making this city the magical place that it is. I would not be the person or organizer or the healthcare worker that I am without them, so I feel the need to mention that.
(01:12): But after college, I got into healthcare spaces, mostly, in the beginning, in the prevention space. So I was doing HIV and Hep C testing community-based events and working a syringe service program, so doing harm reduction work. And then eventually I got into gender-affirming care as a patient navigator in one of the largest gender-affirming care clinics in Louisiana and in the Gulf South generally. We served about 1,500 people of trans experience, including youth in a pediatric side of the clinic. And after being a navigator for a while, I became the lead patient navigator. So I got to lead the programming in that work, and it was a gift and an honor. And now here I am.
Ashley (01:56): Amazing. I know that gender-affirming care and thoughtfulness around inclusivity is something that is very much embedded in the work that you’re doing here. And I’m wondering if you could give us a little bit of history to gender-affirming care and for maybe some of our listeners who’s like, “Well, what is gender-affirming care?” can you give a little summary, a little basics?
Tucker (02:17): Here in the South, I have learned that a lot of folks know what gender-affirming care isn’t, but I don’t know that a lot of people know what gender-affirming care is. So I love to talk about this question, just getting down to some of the basics. Just overall, I would say that gender-affirming care is serving trans and gender non-conforming, gender diverse communities with dignity and respect and compassion. I believe that gender-affirming care includes everything from using the name and pronouns that our clients, our community members, actually use and move through the world with. It means helping to connect our clients to support systems and support groups. It means connecting people to therapeutic support.
(03:06): And then in the medical realm as well, things like access to hormones for young people, also puberty blockers when appropriate, as well as coordination and access to gender-affirming surgical care if that’s a part of someone’s goals and needs, right? And then beyond that, all the things that we think about when we think about healthcare also include gender-affirming care, right? So if we are working in a larger organization that has a dentist’s office or a case management program, it’s making sure that those programs are also accessible to queer and trans people and really all clients, right?
Ashley (03:44): I love that, and I love that you said it’s healthcare, it’s all forms of care. It’s about making sure that spaces are inclusive to people, and I think that that’s an important part of it that people like to skip over or look past in this conversation. You started it by saying that a lot of people know what it isn’t. What are some of those things that you hear people say, like what it isn’t?
Tucker (04:07): So gender-affirming care is not forcing hormones or surgery on anyone who doesn’t want them, right? I think that’s a really big kind of misconception that we see here in my community at least, especially when we’re talking about gender-affirming care for trans kids, because trans people exist, right? And so trans kids also exist. It’s a part of it. And appropriate care for trans youth is something that’s been really demonized and kind of weaponized in this country. So it’s something that I think we need to get really clear about as a larger community, especially a medical community.
(04:43): But I think just backing up too and thinking a little bit about the history, I like to name just a reminder for folks that the first gender-affirming care clinic opened in 1919 in Germany by a man named Magnus Hirschfeld. The first time he actually started performing gender-affirming surgical care was in 1930. We know that when World War II began, his clinic and his clients were targeted. So all of his research, all of his documentation of his clients’ care was systemically burned and erased by Nazis in Germany at the time.
(05:23): So it’s hard because I think a lot of folks I’ve heard in my larger community, people coming to the table and saying, “Well, I didn’t know trans people when I was growing up, so what the heck? Right? Where’d y’all all come from?” when in actuality we’ve always been here, right? That’s the truth of it. So I just like to remind people that queer and trans folks have always existed, we will continue to exist, and appropriate and loving compassionate care for our communities will always be necessary.
Ashley (05:55): Yeah, that’s so important, particularly as we’re talking about the history of it, right? Different cultures where gender is not binary, where there’s different fluidity, spectrums of gender identity, spectrums of sex that are part of, inherent in folks’ culture, in the cultures, particularly I’m thinking about different aboriginal and indigenous communities. Is that something that is ever part of the conversation when folks are talking about the history or really the colonization of ideologies?
Tucker (06:27): Absolutely, Ashley. One of the main things that I know so many indigenous and Native people in my life like to remind folks as we’re coming to these conversations is that trans and queer people existed in many different Native communities in a documented way before colonization of this land specifically. So you might have heard the term two-spirit. That’s from a specific tribe. There has been a much more fluid understanding of gender, gender expression, the way that we move through the world and are perceived through the world than the Western settler ideologies that were brought to this land. It’s a deeply important thing that we need to talk about. Colonization really affected how we understand gender in this society and culture.
(07:22): I think another piece I would like to just add to that too is that when I was growing up, I remember hearing the term intersex, but I didn’t know what that meant. So I think it’s just important to name for a lot of people who might not know that intersex is a very large umbrella of different ways that all of the different things that we think of as sex and what our bodies are understood as and categorized as comes in many different shapes and forms. So hormones, chromosomes, genitalia, internal and external reproductive systems come in many different shapes and sizes, right? And so our really binary understanding, binary meaning two, by our understanding of men and women, is actually a lot more complex when we’re looking at the broad spectrum of how sex shows up in the world, and then from that, how gender actually works and shows up in the world for ourselves and our communities. So yeah, great question, and there’s always so much more to talk about there.
Ashley (08:20): It is so much to talk about there. I think about in honor of some of the work and the studying that I did in the pre-colonial history of Hawaii and Māhū, and really the healing role that the third gender and pre-colonial Hawaiian culture played, a really important role in the community. And so when we’re thinking and having these conversations, history does matter. Understanding the context is essential as part of the conversation, and so we can’t have it without cultural context. So as this conversation is happening and maybe not happening in a lot of different spaces, I know many organizations are starting to process through what systemic shifts and changes could look like at the organizational level. What are some of the things that you’re seeing done well, and maybe some opportunities?
Tucker (09:17): There is so much to say about different ways that organizations, healthcare specifically especially, but ways that different organizations and collectives in our communities can be better serving queer and trans people. One of the biggest things that I’ve been seeing in the healthcare context is trying to just, first of all, bring more queer and trans people into the decision-making tables at the organizations that we work for.
(09:46): The past organization that I worked at had a trans advisory committee, so a group of trans people who worked at the organization being able to come together and plan events for our community but also affect the programming, affect the systems. A group where people, the higher up positions in the organization, could bring the forms, for example, our new patient forms and have actual queer and trans people look at them and say, “This would not feel good to fill out,” or, “We could phrase this differently,” or making sure that our data collection is actually using accurate language that people are actually using to describe themselves, right? That’s such a big ongoing conversation in so many different contexts. Whether we’re talking about gender or race or sexual orientation, making sure that our forms and our data collection is actually affirming for our clients is a really big deal.
(10:34): And then beyond that, training for staff, right? If one area of your clinic, for example, is serving queer and trans people really well, but the front desk staff don’t know anything about how to serve someone with compassion who is a person of trans experience, that’s a systemic problem, right? That’s not that worker’s fault. That’s because they deserve more access to training and information. And we’re seeing more and more that when you provide workers with that support, they’re grateful for it, right? People want to know how to do this work well because they come to care work, again, wanting to care. We’re here because we want to be. So giving people the tools to do that well is a really important thing.
(11:14): And then the last couple of things I would say about that too, coming especially from a gender-affirming care background, vetting your referrals, so knowing where you’re sending your clients and if it’s going to be an affirming place is a really big part of trying to do wraparound supportive work well. So calling a place before you send someone there, making sure that they know, for example, “This person’s name is this on their insurance, but this is the actual name they use.”
(11:40): Things like that are a really big part of how we make sure that the referral process is successful and that queer and trans people aren’t falling out of care, because that’s a really consistent experience. Even with folks who are incredible at advocating for themselves, they end up falling out because we have bad experiences in healthcare a lot. I’m not going to go through the statistics, but I could, right? It’s a hard time to be a queer or trans person moving through healthcare. So everything from supporting workers, to making forms and data collection that is affirming, to training your staff well, to vetting your referrals and making sure that wraparound support is accessible and done well, all of these things are really important.
Ashley (12:22): And the work that we do, I love that you centered, we’ve come to this work with intentionality, to care, to reduce harm, right? And so making and navigating from that central assumption that this is something that we’re here to do. This is something that I’m sure folks listening to this is close to them. And then I’d imagine that there’s some folks who this might be close to them because it’s personal, because it’s related to a loved one. Maybe they’re working with someone in a nonmedical space but really wanting to think about ways to be more inclusive, to be a better advocate, a better ally, or just have an increased critical awareness of the experiences of their loved ones or folks who they are working closely with. What kind of shifts have you seen be helpful or things that folks are doing to be more thoughtful, to be more intentional in their day-to-day lives and with their loved ones?
Tucker (13:11): Yes, yes. I love starting from that place of knowing that so many people want to support the queer and trans people in their lives. And again, we need the tools to do that well. So one of the things I would say is that a lot of times when I used to tell people that I was working in a gender-affirming care clinic that served youth, one of the main questions I would get is like, “Well, how do you navigate the parents?” And it’s interesting, yes, I will be super clear, there were a number of young people who did not have supportive family systems coming to those spaces, especially we had people coming from across the Gulf South, so people coming from Florida and people coming from Tennessee and people coming from Texas, and that struggle is very real. And finding other supports for those clients is a really big part of doing the work holistically.
(13:58): So queer and trans-led organizations, building relationships with those nonprofits, with those collectives to make sure that you can actually send someone to a resource that is existing, and having that relationship is very helpful. But I think beyond that, it was amazing how many young people we had who did have supportive parents, the number of people who would come to the first appointment, for example, the number of people who… Something that we ended up doing was sometimes if we would have clients with parents who wanted to be supportive but were struggling with that process, going to therapy sessions together, having a mediated kind of a third party who can help facilitate the conversation. And as a patient navigator, sometimes that looked like…
(14:43): One of my favorite parts of my last job was texting with the moms of queer and trans kids, right? People reaching out to me to be like, “Hey, I heard about this really cool chest binder, for example. Is this safe for my newly out trans son to use?” Being able to have those conversations and knowing that there are support systems out there, even online, y’all. There are so many parents out there who are trying to support their kids well and the young adults in their lives, that the resources exist, and we need to make that process accessible so that parents can be supporting other parents as well. Family support is a whole other podcast topic we could do, but yes, yes.
Ashley (15:26): It is, and we definitely should. I don’t even know if you knew this, but in my work as a clinician, a big part of it was helping family members and loved ones reduce or assess their bias, particularly those with queer and trans family members, as well as maybe folks who are in interracial kind of relationships. A big part of it was creating a safe space for people to process through their bias so that they could show up more for their loved ones. And so that family component of it is so, so important and essential.
Tucker (16:01): And people deserve those spaces. Just want to say that. It shouldn’t be all on that one family member, or I just don’t ever want the families of queer and trans people to feel alone in that process because they’re not. You’re not, right?
Ashley (16:14): Yep. Yep, absolutely. We both come to this context from the Center for Health Equity, and we talk about equity a lot. What are the different things related to intersectionality that you see show up? Or what does intersectionality look like in this context of our conversation today?
Tucker (16:32): The most successful collective organizing that I see happening, at least here in New Orleans and in the Gulf South as far as I’ve experienced it, are collectives that are led by Black and Brown trans women. I feel like the vast majority of the work that’s happening down here that is successful is actually intersectional spaces. There’s one collective down here called LocALL. It’s half of an acronym, but it stands for Legislative Organizing Coalition for all LGBTQ Louisianans. And here in Louisiana, we’ve had some really horrific attacks on both gender-affirming care but also queer and trans students’ ability to be themselves in school. So things like a proposed bill this year for forced outing of kids, where if you’re a teacher and a young person comes and tells you something about themselves or their identity, you’re supposed to tell the parent. We’re seeing some really horrific, draconian, violent, oppressive things being presented in our communities right now.
(17:40): And this coalition, I think, is really impressive because it brings together… I think it asks that question of what already exists? Who is already at these tables trying to shift legislative policy? And how can we bring all of those different groups together? So, LocALL is a place where I see so many different organizers who are not just specifically focused on queer and trans issues at those tables. We have abolitionists at those tables. We have environmental justice folks at those tables. We have so many different people who are trying to make this state a better and livable place where we don’t have to leave and our families don’t have to leave, making that work as holistic as it possibly can be.
(18:23): But I think if I can just add quickly looking at healthcare organizations and how different orgs can be deepening their work in an intersectional way, building relationships across those sectors is a really big part of it. So if your organization is trying to connect with organizers who are doing work around abolition and police brutality, then the Black and Brown trans, queer people who are coming to your space know that it’s a space that actually values their humanity. So these are much bigger conversations than just, who’s here and who’s making the decisions? It’s like, how are we acting? How are we moving through the world with policy support and training? And I mean, I could go on, but yeah, there’s much to say in that context.
Ashley (19:16): Yes. There is so much, and I think about someone who’s listening to this and maybe definitely cares. They care. They’re wanting to do more. They’re listening with the intention of hoping to get something from this but recognize maybe that they have the privilege for things to be out of sight or out of mind. How do people know what’s happening today and get involved or increase their awareness? Because to some of the functionality of it, a lot of it isn’t making some of the headlines or people aren’t aware of the issues that folks in the community might be experiencing. So what would you say about how folks can be present in what’s happening today?
Tucker (20:02): Yes. I feel like there are so many different collectives in truly every community that are trying to do holistic, supportive work in a very real and tangible way. So a lot of times, at least down here, that looks like mutual aid work. So mutual aid, the idea that we are coming to a place of supporting one another from mutual support as opposed to charity, solidarity, not charity, this is a place where I see a lot of queer and trans people supporting each other and navigating things like recovering from a surgery, or making rent that month, or navigating if you get fired from your job because of transphobic experiences. The issues that I see queer and trans people having in my life are not just like, “I went to the doctor and had a bad experience.” It’s like every day systemic, “Where’s my next meal?”
(21:02): So those spaces are spaces that are hopefully, and at least from what I’ve seen, trying to support queer and trans folks really explicitly. So sometimes maybe that means Googling, “Mutual aid network in my city.” Or maybe that means reaching out to the queer and trans folks that you do know, the Black and brown organizers in your life who are doing liberatory work and asking, “Where can I plug in? How can I support?” That doesn’t always mean financially. Sometimes that means providing your services for free if you’re a body worker. Sometimes that means cooking a meal for someone who needs it. Sometimes that means literally just talking to the houseless people in your neighborhood and treating them as people and getting to know them. There are many ways that this works, and there’s no one-size-fits-all, but the more you ask the question, the more you’re going to get answers that are really actually beneficial to the people that we love and want to serve well.
Ashley (22:00): Tucker, I appreciate you so much for being here with me, having this conversation.
Tucker (22:04): Thank you so much, Ashley. It’s been a gift.
Ashley (22:07): And to our listeners, join us next time on Changing the Conversation.
Erika Simon, Producer (22:12): Visit c4innovates.com and follow us on Twitter, Facebook, LinkedIn, and YouTube for more resources to grow your impact. Thank you for joining us. This episode was produced by Erika Simon and Christina Murphy. Our theme song was written and performed by Peter Hanlon. Join us next time on Changing the Conversation.
[Music]
Access additional “Changing the Conversation” podcast episodes.
