06/18/18  Portland, Ore.

Photo: Dr. Christina Milano talks with a group of students about transgender health care for Social Justice June (Amity Calvin, medical student).

Story originally written for Inside the SOM by Rosina Grove, a digital content / communications specialist in the School of Medicine.

"Do it because it's the right thing to do. Know what you believe, and act on your beliefs –then tell people that's why you're doing it." –Dr. Christina Milano

Social Justice June is a new lecture series organized by medical students in the family medicine interest group. The series is dedicated to addressing societal inequalities in health care, featuring speakers with a range of experience advocating for health equity – both inside and outside the clinic.

The first lecture was June 4 with Jennifer DeVoe, M.D., D.Phil., professor and chair of family medicine, OHSU School of Medicine, addressing health insurance.

The second lecture was June 11, with Christina Milano, M.D., associate professor of family medicine, OHSU School of Medicine, speaking about transgender health and advocacy.

Dr. Milano began by encouraging students and trainees to “be awake to everything around you” – as health care professionals at the beginning of your careers, you don’t know what’s going to speak to you.

She then touched on emerging neurobiologic research around gender identity. “Some individuals remain incredulous around this issue – but functional MRI reveals our brains to be complex mosaics in the regions that are responsive to sex hormones. The findings do not support a blunt, binary male/female distinction,” said Dr. Milano. “That said, there is no test for determining a patient’s gender identity, nor should there be – we support people with the information they tell us.”

Dr. Milano also addressed the distinction between identity and diagnosis, where understanding gender incongruence de-pathologizes the sense of something aberrant, as implied in the current diagnosis of gender dysphoria.

Transgender patients may need medical support for transition – such as medications or surgery – or they may need support in social transition. It’s important to recognize that “some people may never make a social transition. Support people in any state, for whatever ‘transition’ means to them, and make it what the patient needs it to be,” Dr. Milano advised.

"My perceptions or assumptions regarding how a person presents, should have no bearing on my acceptance of who they tell me they are." –Dr. Christina Milano

Dr. Milano then discussed the origins of the Transgender Health Program at OHSU. “We think things can be better for our patients here,” she said, and then observed that OHSU “started becoming a more affirming place for staff, as well. It’s not just about patients – everyone’s boat rose.”

Grassroots efforts built into a snowball effect, where interested clinicians unified around their advocacy efforts, and received institutional support for interdisciplinary initiatives. In addition to workplace trainings and patient support at OHSU, THP volunteers and providers travel around Oregon and beyond to ensure knowledge and skills are reaching as many communities as possible.

The final SJJ lecture of 2018 will be June 27, with Lyn Jacobs, M.D., on immigrant health and advocacy.