Queer Health Pod

Overview:

What is gender affirming surgery?

> A range of surgeries that includes the removal or addition of breast or chest tissue, creating a vagina and labia, creating penile tissue, or creating a penis. A gender affirming hysterectomy is also possible. Don’t forget facial surgeries!

> The most common ones are chest and facial surgeries, but given the difficulty in accessing genital surgeries we talk about those a little more here

Pre-surgery:

1. First up: information gather

> Online forums are great! But buyers beware...bias. It's still an online review forum, so now that its biased in who chooses to participate in online forums or share pictures there

> Surgeon’s website, realizing that they only choose the best photos, are also a good place

> Look for folks with similar bodies and skin colors to hear their stories

3. Find a good primary care doctor 

> Primary care providers will help navigate any possible changes in hormones post-op and be there to set you up with any resources for possible post-op stress or depression

> In addition: surgery stresses your body! A PCP can find ways to get your medical care in a good place before surgery to make the recovery process as smooth as possible

> E.g. having your blood pressure, cholesterol, and/or diabetes optimized

> Also, quitting smoking. Many surgeons will do a lab test to see if someone is smoking. Called cotinine testing, it's a breakdown product of nicotine and tells the health care provider if someone recently smoked nicotine. 

> FYI: there is some data that says folks who had access to primary care prior to beginning or completing puberty, including hormone blockers, are less likely to get surgery because the tissues they want surgically modified never developed

> For example, someone who took hormone blockers never developed breast tissue so never gets breast tissue removed surgically 

4. Find a surgeon

- Where to look?

>> For some folks, the internet is a great starting point

>> Others will be able to receive referrals from PCPs

- Some things to look for regardless of where you find your surgeon:

>> Make sure they are board certified

>> Someone with experience providing these procedures to trans individuals.

>> Do they take your insurance? 

5. Hair removal! If this is relevant to the surgery being planned.

- Get a head start - it often requires upwards of 10 sessions and takes about a year

- Look for folks who have experience in clients with your level of melanin

- What kind of hair removal? Laser hair removal or electrolysis (more about this in our full show notes on our website).

6. Getting mental health providers to provide a letter for your insurance clearance

- Let’s start out by saying: this is a controversial barrier to care that is often seen as a transphobic and discriminatory gate-keeping measure (almost no other surgery requires this step) ...but, if someone is making you see a mental health provider know that surgery is stressful and there are real resources a mental health provider can offer

- Heads up: this can take a while. And double heads up: if you are having bottom surgery you will almost certainly need TWO different mental health provider letters

7. Submit your mental health letters to your surgeon, who submits them to insurance. Cue the hours of hold music.

Post-surgery

- Set expectations

>> Post-op depression is common! It's not unusual that with big changes and the physical stress to experience changes in mood in unexpected ways

>> There is a healing process. It can take months, depending on which surgery you have

>> Your physical comfort and activity level will take time to return to baseline

- Seek out caregivers before hand to help you afterwards

- Dilation (this is relevant only to vaginoplasty)

>> Dilation is done to maintain depth and width in a newly constructed vagina

>> Expect to dilate weekly throughout your lifetime in order to have receptive vaginal intercourse 

>> To that point - not everyone will share a goal of keeping an open vaginal canal. If that’s the case for you, we encourage you to check in with your healthcare provider about what this means re:dilation

- Pelvic floor physical therapy 

>> Helps with healing, pain, urinary issues, dilation - a win!

>> Ask your surgeon for someone who has worked with people who have had your surgery before you, and who will be affirming!

- Sexual satisfaction

>> Is totally defined by the person experiencing it, and different folks will have different goals for their own sexual satisfaction

>> Lubrication may or may not happen, and may or may not be enough to make penetrative sex comfortable

>> Orgasming - can take time, practice, and getting to know your new body. Again - ask your surgeon honest questions!

>> If you use the body part for sex, get it tested for STIs

- Hormones may change - it really depends on the surgery, so talk to your provider

Some final context:

To quote our community voice: having surgery is not everyone’s end goal. Everyone’s journey with any gender affirming medical care is their own!

History of the Blood Ban: A summary timeline

1981: first patients with HIV described in the medical literature

1983: Test for HIV arrives; 1986: FDA institutes blood donation ban for gay and bisexual men

1997: FDA changes langage from lifetime ban to “indefinitely deferred” (we’re underwhelmed by that too…)

2014: FDA changed the policies to a 12 month deferral, which is an actual deferral. So no sex for one year to give blood.The FDA’s reasoning here.

You’re talking about blood but you keep saying plasma?

Fair point. Blood has two main components. Plasma is the watery part that also has some blood borne diseases and carries antibodies. This information applies to any type of blood or plasma donation.

What’s scientifically based vs discirimation?

Advocacy orgs: like behavior should be treated alike

Meaning: those screening for blood borne illnesses should use individualized risk assessment on questionnaires 

Meaning: don’t equate gay and bisexual men and “risky sex”, anyone who has penetrative rectal intercourse (ie the behavior) should be asked about it

Meaning: identity is not a scientific substitute for health behaviors, thinking so sets you up for discrimination and stigma

Public service announcement: oral sex, aka blow jobs, aka head - very low risk for HIV (<1% per the CDC, “theoretical” to others) - should not be considered a behavior for which to defer blood donation 

What’s the risk of getting HIV from a blood transfusion?

Same risk as getting into a plane (that crashes) or getting hit by lightning in a thunderstorm (stay inside folks!)

Some numbers: risk estimates range from:

1 in 2,135,000 (the higher estimate)

1 in 909,000 – 5,500,000 (the lower estimate)

Advocates want a three month deferral for gay and bisexual men - where does that number come from?

Window period! AKA the amount of time it takes for the test to be able to detect the virus once it's inside someone's body.

Explain! There is a lag time between when the virus enters someone's blood to when it has copied itself enough to be detected by medical testing.

The most up to date testing can see HIV in someone’s blood 5 to 11 days after acquisition. 

Q: So….why three months if the test works in about a week?

A: HIV isn't the only thing we test for. And testing exactly at the threshold of our best test is cutting it too close for the regulatory agencies.

Reminder: U=U applies to sexual practices - not to blood donations.

Questioning Questionnaires

It is discriminatory that the questionnaire considers an identity the same thing as a behavior. It sees gay and bisexual identity as the same thing as engaging in anal intercourse. (Just ask high school Sam - not true!)

Another nuance: many gay and bisexual men who don't have anal sex (again, see Sam in high school) and are at less risk than their heterosexual colleagues when giving blood.

What's going on about this: The FDA is (slowly) studying implementing a questionnaire that includes individualized risk assessment and making sure this keeps the blood supply safe.

HURRY UP FDA! Well, Dr. Anani said it best: “It's not their job to consider the feelings of others. It's their job to protect the blood supply. So from their perspective, to hell with the feelings.”

For now...#FeelingsHurt, the future goal being to ask specific questions respectfully to make blood donation and transfusion safe, less biased and less discriminatory.

So is the blood bank going to start calling me when this is all changed?

Not anytime soon. The FDA doesn't make changes without the data behind it and studying this data, studying how well screening questions that ask about specific individual sexual behaviors work is going to take a really long time.

Oh and this: blood centers don't want to scare away straight donors with invasive questions about butt sex. 

Q: Is that a discriminatoy dobule standard that favors straigh people at the risk of stigmatizing queer people donating blood? 

A: YES!

A non-discriminatory future of blood donation is likely a three month deferral period. Meaning - anyone who has anal intercourse would have to wait three months from that to give blood.

This accounts for emerging new diseases that could get into the blood supply that we may not know about.

We test for more than HIV - so just going by HIV’s best test doesn’t cut it.

The FDA wants to make sure asking about butt sex rather than identities associated with it doesn’t scare donors away.

Getting the lingo down

Note: tons of great content similar to this can be found via InterAct.

Intersex: term used for a variety of conditions in which someone is born with urologic, reproductive or sexual anatomy that doesn't fit the binary definitions of female or male. 

Differences of sex development or DSD: 

The medical community’s umbrella term for a handfull of medical diagnosis where a biological characteristic or anatomical structure does not meet binary definitions of male or female.

Not all folks with a DSD diagnosis claim intersex as an identity!

One last point: who does and doesn't identify as intersex is always political. It's often based on how people receive the medical framing of the diagnosis. Some intersex advocates expect that in a few years' time, calling intersex a DSD condition will sound like calling someone's gender identity or sexual orientation, a psychological condition. 

Anatomic variations: a big-picture view

The overall incidence of any variant of sex development is estimated to be as high as 1.7% of the population (others make lower estimates). This is as common as folks with naturally red hair.

These variations can show up on a few different biologic levels

Genetic: e.g. Kleinfelter syndrome and Turner syndrome

Hormonal: e.g. congenital adrenal hyperplasia or androgen insensitivity syndrome

Because we talk a lot about AIS in this episode, here’s some more detail: it's a condition where individuals have XY chromosomes. But the receptor for testosterone has a slightly different shape, so testosterone doesn’t dock at the receptor. So the organs and structures formed by testosterone signaling are not there. 

Anatomic: e.g. gonadal dysgenesis (the gonads - or testes or ovary precursors don’t form) 

Variations can be discovered at different time points throughout someone’s life

Genetic screening or fetal ultrasound

Time of birth

Childhood, often while investigating a hernia or abdominal mass

During unrelated abdominal surgery, where sometimes undeveloped gonads are found

As part of the medical workup when someone who expects to get pregnant cannot

The role of hormones within intersex care

The biology of hormones

Body shape, voice, hair growth and distribution, bone strength, muscle development - these all depend on hormones (like testosterone and estrogen) 

In binary individuals, these hormones appear around age 5 or 6 and increase around puberty. 

How does this relate to healthcare for intersex individuals?

TL;DR: it depends on the individual. There is no set regimen or hormone therapy for someone based on a particular DSD variation.

Some individuals with an intersex condition identify as a gender other than that assigned to them by the time of puberty. Hormone therapy can help alleviate the distress which some folks may feel about their body, and help them achieve their desired form of gender expression.

As a reminder: just because someone is intersex doesn’t mean they are transgender.

Hot take: having the correct amount of hormones for the gender and body that you wish to have is very important.

Shifting paradigms of clinical care for intersex folks

For many years, the medical community routinely practiced non-disclosure with intersex patients

The basic idea behind non-disclosure: clinicians purposefully choose to NOT tell an intersex individual about their variation. The person in question will instead be socialized as either male or female (based on whichever gender “made more sense” given their anatomy).

The ideology supporting the practice of nondisclosure goes back to the 1950s, when a psychiatrist named John Money at Johns Hopkins said nurture would always override nature.

Why we don’t like it: 

Non-disclosure forces intersex individuals to conform to rigid societal standards, compared with the driving principles of medicine, which are beneficence, autonomy, and justice.

Also, clinicians should avoid lying to their patients and should instead tell them the entire truth about their body

Non-disclosure is (thankfully) falling out of favor, instead replaced by the notion of shared decision making when it comes to clinical care for people with intersex traits or DSD 

In 2006, a consensus statement came out saying that patients with DSD variations and their families should be told the full truth.  This was affirmed again in 2016 update.

Though as Dr. Dalke points out, this movement away from non-disclosure is itself a relatively recent and, frankly, radical evolution in care 

Care for intersex folks: areas for improvement

The language and framework that clinicians use when talking about anatomic variations

Medical language can (and should) present the specific biology of intersex folks in a way that isn't pathologizing

For example, DSDs can be framed as variations - just like red hair vs. blond or brown. (Can you tell we are obsessed with red hair?) 

Clinicians can partner with their patients to help them find whatever language feels most affirming to them

The assumptions made by the healthcare system about people’s bodies, anatomy, sex, and gender 

Some examples: health forms that only list binary gender options, clinicians that assume a female-presenting individual can become pregnant

An aside to say that these assumptions are damaging for others, too – people who are trans and non-binary and people who have had organs like their breasts, uterus, or testicles removed because of cancer

The physical exam

A person’s body and biology aren’t a spectator sport

Please, kick trainees out of the room!

Ok, so what does it feel like when things are patient-centered?

Patients should feel as if they are in control of every decision that's made in their care. 

A provider who's really trauma informed is going to check to make sure that a person is giving consent to every aspect of a clinical encounter. 

A person should feel empowered to say no to something or anything at any point during a clinical encounter or clinical decision making and not feel as though they're doing something wrong or they're going to be punished by the healthcare provider for this.

Again, language matters: diagnosis and identity

Maria, our community voice, says it best: For most of my life it was a diagnosis and it felt like a diagnosis and I felt different. I just felt different. When I found out I had XY chromosomes, that kind of took me in a new direction - when at your core, you're like, am I a boy? What is a boy? It made me question everything about my identity. And I felt like I sort of started at the bottom to build back up what my identity looks like and where my gender and my sexual orientation, my gender identity, where that all fits in.

Some definitions

PrEP: pre-exposure prophylaxis - referring to a daily medication taken to prevent the acquisition of HIV

PEP: post-exposure prophylaxis - referring to a combination of medications taken after a potential exposure to HIV in order to reduce the likelihood of transmission

Who should take PrEP?

People who have condom-less anal sex

People who have sex partners they don't know very well or whose partners know they have HIV

People who come from communities that have a greater burden of HIV because of less access to care and other systemic barriers

Anyone who has had a bacterial sexually transmitted infection, like gonorrhea, chlamydia, or syphilis in the past six months

Why is PrEP special?

PrEP is a powerful form of prevention that allows people to have autonomy and make decisions about their own sexual health

PrEP is not only a medication that prevents HIV, but it's also a very emotionally significant drug for many. For those who feel the legacy of the AIDS crisis of the 1980s and 1990s, having an HIV prevention drug can provide agency and control 

It can serve as a gateway into lent-term primary care (which we here at QHP are big fans of!)

A brief PrEP timeline

In 2012, Truvada (otherwise known as tenofovir/emtricitabine/TDF) - a medication previously used to treat HIV - was approved by the FDA for PrEP, or to prevent HIV.

It became apparent that Truvada as PrEP worked. The first big study looking at Truvada showed that daily PrEP lowered the risk of getting HIV by 92% if exposed.

Slowly but surely, the queer community got on board (with the help of groups like PrEP Facts). More and more people began using PrEP to prevent HIV transmission.

2019: a scientific trial called the DISCOVER trial published preliminary data

It investigated the possibility of a second PrEP medication, another HIV medication called Descovy (otherwise known as tenofovir/emtricitabine/TAF)

It also suggested that Descovy may have a better side effect profile

Based on the preliminary data, the FDA approved Descovy as a second PrEP option. Some folks started getting switched from Truvada to Descovy (with or without their consent).

At which point many people started wondering: which PrEP medication to opt for? Which is the better option?

Truvada vs. Descovy: the scientific data

When Truvada came onto the scene as PrEP, it did so with multiple large studies of high quality evidence and in multiple populations

iPrEx: a study that put Truvada on the map. Studied side effects and efficacy at HIV prevention in men who have sex with men as well as transgender women.

Partners PrEP: showed that Truvada was effective at HIV prevention within heterosexual couples where one partner is HIV+

Descovy, in turn, so far has less scientific literature discussing its efficacy as PrEP in a variety of populations

Basically, all we have is the DISCOVER trial - which only looks at cisgender men and some trans women

And note: up until 2020 (a year after FDA approval) the DISCOVER trial had not officially released its data, just a preliminary abstract

It’s unusual that Descovy was such a popular and widely-used option before the data was officially published – before healthcare providers could read the data for themselves and help their patients make informed decisions

In addition to the above differences in how the drug came to the market, Truvada has an additional study (called IPERGAY - you can’t make this stuff up)

 This study demonstrates Truvada’s efficacy as PrEP “on demand” – meaning, taken in the days right before and right after a sexual encounter

Descovy, in turn, has no such data supporting its use as PrEP on demand

Truvada vs. Descovy: side effects

Truvada

Abdominal discomfort: observed in roughly 1 out of 5 people. Usually goes away on its own after two to six weeks on medication

Changes in kidney function (as measured via a substance called creatinine), largely reversible

Changes in bone density - also reversible once taken off the medication

Descovy

Based off of what we know about Descovy as HIV treatment, it can increase cholesterol, blood sugar levels, or weight gain, risk factors for the development of heart attack and stroke.

Unclear if these effects will be seen or will have impact on people’s health in the long-term when Descovy is used as PrEP given that the drug is dosed differently in this context.

The DISCOVER data also suggests that there  may be fewer kidney and bone side effects -

So who actually should be taking Descovy as PrEP?

As of right now, the medication is approved in cisgender men who have sex with men. It is not approved for folks with vaginas, since that group was not studied in the DISCOVER trial.

Ultimately, the decision is an individualized one that depends on personal medical history and preferences. For example: for folks with kidney disease, Descovy may be a better option. 

Long story short: it depends. Bring it up with your primary care provider! (And if you don’t feel comfortable bringing it up, we encourage you to find a care provider  with whom you do feel comfortable – all while acknowledging that this is likely far easier said than done.)

A generic PrEP option

Truvada’s patent expired in 2019, at which point it became generic. How does having two PrEP options – one brand name, one generic – change the HIV prevention landscape?

The good

On face value, having a generic PrEP option seems like a good thing since it will increase financial access. 

Additionally, having two options gives folks agency, which may increase PrEP uptake

However…

Having a fancy brand name option (Descovy) may stigmatize the generic option (Truvada). This is tricky for folks who only have generic options available to them.

One drawback is that the Gilead co-pay assistance programs will not pay co-pays so there may be some back and forth with providers, insurance and pharmacies as this transition occurs.  However, there should always be an option to have PrEP covered.

Definitions

Douching: technically refers to cleansing the vaginal canal with liquid

Enema: delivers water or a solution directly into the rectum to loosen fecal matter and stimulate a bowel movement (i.e. pooping). Can be done as a way of relieving constipation or as a way to “clean house” before anoreceptive sex

Ways to douche

1. Bulb enema: a common “over the counter” option you can find at drugstores. Includes a bulb (filled with fluid) attached to a nozzle which can be inserted into the rectum

Can buy reusable rubber enemas that you fill with tap water, or can buy brand names (such as Fleet enemas) that come pre-filled with solutions designed to help stimulate a bowel movement - more on these solutions later.

Bag enema: 

A rubber bag with a small tube attached. You fill the bag with water, lock the tube shut with a small plastic piece and insert the other end of the tubing into the anus

A great option for folks who need to be in certain positions while douching or have mobility differences 

Shower nozzle:

What it sounds like. Beware of the high velocity and large volumes that come with shower nozzle douching. These can be damaging to the rectum!

Best practices – or, how to ace your douching exam

1. Dietary fiber

What to buy: something with psyllium husk or high soluble fiber as the active ingredient. No need to buy brand names (all you’re paying for is the muscular torsos on the labels, which...fair)

The dose: scale up slowly (every other day) to avoid bloating, cramping and other side effects. Increase gradually, and goes best with water

2. The actual gymnastics – er, mechanics

Positioning: bent at the waist (this straightens the rectum, making it easier to get liquid where it needs to go)

Place lube on the tip of the device to prevent local trauma to the area

Insert the device into the rectum but not too far (otherwise water goes too far in and you pull down unformed stool into the very area you want to cleanse)

Hold a Coke can-volume of water for about a minute

Expel into the toilet

Myth-busting

“The harder and faster I douche, the better”

Douching at high volumes/speeds (e.g. with shower nozzles) can can physically damage the rectum 

Water can travel too far and risk pulling extra feces into the rectum

“I can douche as often as I’d like”

Aim to douche no more than 1x/day and 3x/week 

When we say once a day, we mean the entire process of clearing the rectum, knowing that you may need more than one rinse per sitting, so to speak

Some experts have pointed out that douching runs the risk of stripping the colon of its mucosal layer – which plays an important protective role

“Douching with ~fancy~ commercial solutions is better than douching with plain water”

Douching with water - tap water - is preferable over other solutions (such as those found in brand-name enemas)

No need to look for “pH balanced” solutions – the anus is a neutral pH with the rest of the body

Moreover, some of these solutions are designed to irritate the colon/rectum to help you poop, which – while useful for constipation – should be avoided if you plan on inserting something else into your rectum shortly thereafter

“Using warmer water helps cleanse more effectively”

Remember: the tips of our fingers can handle water temperatures a lot higher than than what our insides can

Lukewarm water is the way to go (since cold water, while safe, is not terribly pleasant) 

“Douching after sex will help me avoid sexually transmitted infections”

In fact, the opposite may be true, as further local mucosal injury and introduction of pathogens may increase the risk of injury and/or acquiring an infection. 

Overall, douching after sex does not decrease the risk of getting a sexually transmitted ifnection and has no proven health benefit.

Douching and sexually transmitted infections

There’s very little scientific literature on this subject. However, the few studies we’ve found suggest that those who douche > 1x per week may have an increased association with getting an STI, such as chlamydia, gonorrhea, or HIV

The reasoning behind this: in those who douche, the outer protective layer of cells in the rectum can sometimes be removed. This means that bugs that cause STIs have increased access to their port of entry, so to speak.

For people who have sex without condoms, remember that part of being a responsible sex partner is getting screened for STIs in the sites you use for sex (including your butt and throat)

Is there anyone who should think carefully about douching?

Patients with high-inflammatory states affecting their rectum: 

Particularly underlying colitis, active rectal or anal infections, active HPV. 

In these cases, douching may exacerbate the underlying condition by further irritating the rectum.

Patients whose immune systems aren’t running at 100% (such as those with HIV and low CD4 counts): 

These folks can be susceptible to a greater number of infections. 

Important to make sure filtered or bottled water is being used

Patients with chronic kidney disease:

Folks with chronic kidney disease have a hard time clearing phosphate from their systems.

Here, the pro-tip is to avoid using phosphate solutions (such as those found in Fleet enemas) since this introduces extra phosphate to your retum which can then be absorbed into your body.

Who we are

Gaby (she/her), Sam (he/him) and Richard (he/him) - two doctors-in-training, one full-fledged physician. We all live in New York and specialize in primary care/internal medicine.

What this is

• A podcast by queer people, for queer people.

• Started because queer health is becoming a Thing (!!) – and we want to bring this knowledge directly to the community

Our format

• Episodes will be 30-40 minutes long.

• There will be music, there will be puns, there will be laughter!

• Each episode will center a member from the queer community (and their health story). We’ll then bring that to experts within the medical community. The final product will weave a narrative that answers health questions in the context of what science and clinical research actually knows about

• What’s more, we’ll acknowledge what we know when we know it. And what we don't know when we don't know.

What do you mean by queer health?

• Queer health is a broad term that encompasses a range of issues that impact how a queer individual might interact with the healthcare system. Whatever you think is relevant to your health as a queer person is queer health.

• And when we use the word queer, we use it inclusively. We feel that a spacious home for people's identities as sexual and gender minorities gives people the breathing room to be their fullest self. 

Slide into our DMs

• We’ve got Instagram and Twitter accounts as well as a handy-dandy contact page on our website.

• We want your ideas for what our next episode should be. We can’t wait to hear what you want us to podcast about!

Sam: Welcome to queer health podcast a podcast by queer people for queer people about - queer health.

Gaby: Cue the theme music!

[QHP THEME MUSIC]

Gaby: So let's get to introductions. I’m Dr. Gaby Mayer. I use she, her, pronouns and I’m a resident physician – which means I’m a physician in training in internal medicine/primary care. And I live in New York City.

Sam: I’m Sam Dubin. I use he him pronouns and I'm also an internal medicine resident physician in New York.

Richard: I'm Dr. Richard Greene. He him, his, an older queer doctor, director of the pride health center at Bellevue hospital.

Gaby: Sam, why are we here? 

Sam: Well, the reason we're here is to tell Richard that older doesn't really quite apply to him yet. 

Richard: Is that an expert opinion? 

Sam: Hmm. No comment, Dr. Greene. 

But the real reason we're here - and that we decided to start this podcast - is because so many queer people depend on their own experience or talking to their friends and network to know what works and what doesn't, when it comes to their health. And so many more don't even have access to the resources that they would need or want to make the most of their health. But there's a visible body of public health and clinical knowledge around many queer health topics. LGBTQ health exists. It may not be mainstream, but it's getting its critical mass. We want to share that knowledge that clinical and public health knowledge with others and this podcast is a way to do that using community storytelling to share the power that that health knowledge can provide people

Richard: So each of our episodes is going to center on an individual story and then some of the medical questions that come up as a result. So we're going to use experts from the community, from the medical community and weave a narrative to answer the questions in the context of what science and clinical research actually knows about. 

Gaby: In other words: if you want to learn about queer health, this is the podcast for you.

 Richard: And when we use the word queer, we use the word queer inclusively. Some people like that word, and some people don't like that word, but we're choosing to use that word because we feel like a spacious home for people's identities as sexual and gender minorities. It gives people the breathing room to be their fullest self. 

Gaby: Too often we sent her on just one part of our community, but on this podcast, we're going to be focusing on activities and things that involve everybody in the LGBTQ+ community. And that's our reasoning for using queer.  

Richard: And we want to make sure you know, this isn't for healthcare professionals. Although if you're a healthcare professional, we think you'll probably learn something too.

Sam: Okay. Now that we're talking about vocabulary, can someone explain what we mean when we say queer health and why we're not using LGBTQ or the phrase sexual and gender minority health instead?

Gaby: Queer health…it's a broad term that encompasses a range of issues that impact how a queer individual might interact with the healthcare system. It can be everything from walking into a waiting room and interacting with staff at the front desk. To talking about things like gender affirming, hormone therapy, or talking about fertility issues, if you're a queer couple. whatever you think is relevant to your health as a queer person is queer health. And that's the important thing. 

 Richard: What's our approach going to be, how are we going to handle this? 

Sam: So QHP understands that the queer community has  a diverse array of experiences and perspectives.  QHP is going to pursue our mission with evidence based medicine and expert advice. Acknowledging what we know when we know it. And what we don't know when we don't know

Gaby: Something we do know are the episodes that are going to be in our first season. Some of the topics you can expect include: douching, what you need to know about the two current options for preexposure prophylaxis for HIV, what nonbinary primary care looks like and how to access gender affirming surgery.

Richard: We'll also have episodes on the blood donation ban for men who have sex with men episodes on queer cisgender women's primary care and sexual health. And we'll also spend some time exploring intersex, community members, healthcare stories, and ongoing ethical controversies.

Gaby: I know, I know you probably want to hit next and listen to our first episode. And if it's Winter 2020, then you can - but otherwise hang on tight and tune in in December for episode number one.

Sam: In the meantime, you can follow us on social media @QueerHealthPod, both on Instagram and Twitter. 

Gaby: Yes. And if you're not a social media person, don't worry. We have a website too. It is www.queerhealthpod.com. You can go there for our episodes. We'll have show notes up there; we'll have resources that we talk about during our episodes. So bookmark it, make it your home page - aaaall that good stuff.

Richard: And though we are all doctors, I need to make it clear that we cannot give medical advice on this program. What we can do is talk about what we know in the literature. So please, if you have  concerns, go see your own healthcare professional, 

Gaby: BUT for everything else. Please slide your queer health questions into our DMs or inboxes. We would be glad to incorporate them into an episode.

[QHP THEME MUSIC]

 Sam: QHP’s mission is a power sharing project that puts community stories and conversation with health expertise to expand autonomy for sexual and gender minorities.

Gaby: We can’t wait to have you listen to our first season. You’re gonna love it!

Sam: Everyone feel free to be your bossiest bottom.

The QHP contact page (send us your thoughts for future episodes!)

Our Twitter account

Our Instagram account