Dakota Keogh remembers that age when boys and girls start to go their separate ways, about four or five.
“I felt like I got caught in the wrong tide,” she says. “I wanted to be over there.”
Over there, with the girls. But she felt like she didn’t have a choice and kept those feelings to herself.
“That was the early '60s. I was in an Irish Catholic family with a former boxer for a dad. That just wasn’t going to fly.”
When it comes to transgender issues, the bathroom debate has been in the media spotlight. But the issue goes beyond that. When it comes to health care, there’s a void.
Over the years Keogh got married and started a family. Last year, at age 58, she came out as trans to her family and circle of friends. Earlier this year, she decided to start hormone therapy. At that time she was seeing a couple of specialists for an unrelated health issue.
“At that point, the estrogen showed up on my medical record. They asked, 'What’s that about?' 'Well, you’re the doctor, do you really have to ask me?' At that point, both of them sort of got stiff and their speaking became clipped and direct.”
Keogh sensed they were uncomfortable. After the hormone question came up, the specialists told Keogh they didn’t need to see her for a while.
For many transgender patients, interactions like this have been all too common. A 2014 report by the National Transgender Discrimination Survey shows that negative experiences can have profound health impacts on trans patients. Many postpone seeking medical care because they fear discrimination.
Now there’s a new toolkit to help providers. Clare Sherley is a nurse midwife. She co-developed the toolkit as part of her doctoral project.
“When I speak to providers, they want to be able to provide good care, but they don’t know how, and they don’t always know where to look,” Sherley says. “There’s a reflex response to refer that patient to someone who specializes.”
Sherley wanted to help trans health care. Her partner identifies as trans, so she has seen and heard about the challenges in accessing care. She created the toolkit so that providers don’t have to send patients to a specialist. All they have to do is go online and get the information they need, including articles, resources, and even training modules.
“We wanted to make that accessible to people who have never encountered a trans patient,” she says.
“The doctor in rural Wyoming who has a patient who walked into their office and says, 'This is who I am,' and the doctor is able to say, 'Oh, I need to learn about this so I can provide the best health care and there being a place to find that.'”
Take wellness exams, for example. On the one hand, these office visits focus on the whole person — their medical history, their lifestyles and relationships. But there are things specific to trans patients, says Sherley, like gender dysphoria, feeling distress with their born gender.
“For a lot of trans men, whenever they have their monthly cycles, that can cause gender dysphoria. When they have to go in for their pap smears, that can cause gender dysphoria … so things that remind them their body isn’t quite what they want it to be.”
Sherley says that knowledge can help providers find ways to help patients feel comfortable in their bodies. This summer, Cedar River Clinics launched the toolkit online, and will keep it updated.
Since coming out, Keogh’s experience in society has been uneven. But her family has been supportive in her transition.
On a recent Wednesday morning, Keogh sat in the dining room of her ex-wife Sara’s house. Her daughter Adrienne dabs on some foundation on her face and tries to blend it. But the sweat gets in the way.
“I’m going to ask that you try not to sweat,” Adrienne teases. Dakota replies, “I’m having an inner conversation with my pores.”
Amanda, Dakota’s other daughter, looks on as Dakota gets ready for a photo. It’s a family effort. “I’m really happy to help and try to be supportive,” Adrienne says.
Keogh hopes the toolkit will help create a safe environment for trans patients to open up about their needs and provide the health care community knowledge.
“Part of that I put on the trans community, because there has been a prevailing attitude of accept me, respect me, and don’t ask me questions,” she says. “That creates a bubble of ignorance and when there’s a bubble of ignorance, people tend to fill in the blanks badly. We need toolkits like this to undo that.”