Promoting gender-affirming care

Shea Nagle
Shea Nagle

Shea Nagle, MPH ’20, wants to improve health care for transgender patients

March 17, 2020 – A visit to the emergency room or a new doctor can make anyone feel vulnerable, but transgender people face a unique set of concerns. Even when it’s for a problem unrelated to their gender identity—say, a broken ankle—they may be asked invasive questions about their transition, or they may even face harassment or denial of care. As a result, according to a 2017 poll conducted by National Public Radio, the Robert Wood Johnson Foundation, and Harvard T.H. Chan School of Public Health, 22% say that they have avoided seeking health care.

Shea Nagle, MPH ’20, wants to help ensure that no transgender person has to make that choice. Attending the School through a prestigious award from the Harvard Presidential Scholarship Fund, she’s taking a year away from her medical studies at the University of Rochester to build her research skills in population health as a Women, Gender, and Health concentrator in the Department of Social and Behavioral Sciences. She hopes to contribute to the body of evidence on improving health outcomes for transgender people—and on how to train physicians to do a better job caring for this vulnerable population.

Very few medical schools have formal curricula around LGBTQ care, especially transgender care, according to Nagle. “Transgender people can feel very dehumanized in clinical settings when they receive care that isn’t gender-affirming and respectful to their identity,” she said. “By improving education, we could ultimately make a difference for these patients.”

Creating supportive environments

Raised in Dolgeville, New York, a small rural town in the central part of the state, Nagle was the first in her family to go to college.  An undergraduate workshop on promoting inclusivity for transgender students planted the seed for a new focus to her career.

The workshop raised questions for Nagle about how the concepts she was learning could be applied in a health care setting. She sought out opportunities to learn more, and as a medical student began caring for transgender patients.

A recurring story she’s heard from them is that providers who are unaccustomed to caring for transgender patients can be prone to asking questions that go beyond what’s needed for a diagnosis. Although the instinct to gather thorough information is well-intentioned, Nagle said, it can make clinical encounters difficult for transgender patients.

“There’s a difference between asking about hormones as part of someone’s medication list versus asking whether they’ve had a particular surgery in their transition,” Nagle said. “It can be traumatic for patients to have to educate every provider they encounter.”

Nagle would like to see more providers gain competency in the basics of gender-affirming care for transgender patients, including calling them by their correct pronouns, being able to provide hormones or refer patients for surgical procedures for their transitions, and working with families.

Creating supportive environments at home and in the community is particularly important for transgender adolescents, Nagle noted. A 2018 study in Pediatrics found that roughly half of transmasculine teens, 30% of transfeminine teens, and 42% of those who don’t identify exclusively as male or female, had attempted suicide at least once. In contrast, among teens who are cisgender (meaning that their gender identity matches what it says on their birth certificate), 10% of males and 18% of females have attempted suicide.

For her MPH practicum project, Nagle is working on data analysis for the Trans Teen and Family Narratives Project, a community-based research study at Boston Children’s Hospital. Nagle’s focus is on fertility desires and family building methods, looking at how trans teens are thinking about future fertility as they consider options such as puberty blockers and hormone therapy.

“Shea is incredibly organized, and passionate about improving the health and care of transgender and nonbinary individuals,” said Nagle’s practicum advisor and the study’s principal investigator Sabra Katz-Wise, an assistant professor at Boston Children’s Hospital, Harvard Medical School, and Harvard Chan School. “She regularly checks her own biases and assumptions about the transgender community and encourages others to do the same. I have no doubt that she will move the field forward.”

After graduation, Nagle plans to continue working to improve transgender patients’ health outcomes as both a researcher and physician. While she hopes that more providers become trained in gender-affirming care, she said that the most important concept can be applied right away: “You don’t need to know everything in order to take care of someone and treat them like a person.”

Amy Roeder

Photo: Kent Dayton