Gender Pronouns:  It’s good to ask.

Gender Pronouns: It’s good to ask.

What are your preferred gender pronouns?

As a gender therapist, I am aware that use of gender pronouns (he, him, her, she, his, hers, etc.) are critically important all of us, not just gender variant folks.  If you are reading this, and you identify as a male and look like a male, would you be uncomfortable if I referred to you as “ma’am,” or “miss?”  Say for example, I’m working at the local Starbucks and you are next in line, but you are not paying attention, and I start saying “miss,” “excuse me ma’am,” louder and louder, asking the person next to you, “can you let her know she’s next?” – and then you are tapped on the shoulder by a stranger, who is looking you in the eye and says to you, “ma’am, she’s ready for your order,” – and everyone around is observing this.  How would you feel?

Typically, it is an embarrassing thing to get gender pronouns wrong, for both the person being misgendered, as well as the person who is doing the misgendering. It is awkward and uncomfortable. The same is true for folks with gender dysphoria who are not yet at a point in their lives where their gender presentation matches their gender identity. Now, imagine a female-identified person who was born male, who is 6’5,” and is who is struggling to feminize her appearance in a way that the world can immediately associate as “female.”  In her mind, no matter how she looks, she will feel no different than the man in line at the local coffee shop, if she is misgendered.

Our mind identifies our gender in such a way that it is an uncomfortable experience for many transgender persons to be referred to with incorrect gender pronouns (misgendered) even when they are not out to the world, and they are not asking for or expecting correct pronouns.  Their discomfort is simply private; no one knows – except the female-identified person inside the male body who cringes with embarrassment with each misgendering. While she may not be ready to expose her true gender to the world yet (likely for fear of rejection and disconnection from loved ones and associations), she still suffers the pain of misgendering.

What can we do to help her, and other’s like her?  We can work to make our world a more gender-friendly place.

Advocating with Gender Pronouns

It’s uncomfortable to not know what a person’s gender is.  What do you do when you don’t know which gender pronouns to use?  If in doubt, don’t use a gender.  If in doubt, and you feel brave, or interested in participating in making the world a more gender-friendly place, the kindest thing, believe it or not, is to ask, “Which pronouns do you prefer?”

There is a common belief that it is rude to ask someone a question like this. However, if you are a person that embraces the diversity in the world, and you have a non-judgmental acceptance of the answer, it is actually quite kind to not assume that you know.  For example, I would never be offended if someone asked me, “Do you prefer men or women (gay or heterosexual)?”  The question itself suggests the the one asking realizes that not everyone is heterosexual!  What a concept!  To think it’s offensive to ask this question suggests that you consider it someone offense to be gay (or to be heterosexual, though I’m doubting that’s the case).  If you are comfortable asking someone if they are married, what is the difference between a question like that, and a question like, “are you bisexual, gay or heterosexual?”

Ask:  “Which gender pronouns do you prefer?”

Inquiring about a person’s gender is the same.  If you are comfortable and confident in your gender, having someone ask you which pronouns you prefer is not likely to offend you; you’re more likely to be curious about the question.  If you are uncomfortable with your gender, perhaps the question will bring you comfort – having the opportunity to clarify.

If you operate a business, or work with people on a regular basis – particularly those of us in “helping professions,” you can actually get into the habit of asking the question, “which pronouns do you prefer,” to everyone, so that it becomes common-place.

Gender pronouns on Email Signature Line

Another way to help make our world a more gender-friendly place is with your signature line on emails. On the signature line of my email, I not only include my name, address, website information and phone number, I also have a very simple line that says:  “she/her pronouns.”  I recommend you do the same, particularly if you are in the human service industry.  Some people will ask you about this.  You can educate.  Others will be comforted, and they will know you are a gender-safe person for them to be honest with.  This is a simple way to extend greater support, acceptance, and advocacy for non-binary, gender fluid, and transgender folks. I learned this from Dr. Gallagher’s Transgender Surgical Program Advocate, Nicole Jackson, who said she learned it from someone else… so see how this works… pass it along.

Gender Friendly Office Environments

A final strategy I’ll share about how to make your office a more gender friendly space comes from a fellow sexologist in one of my professional news lists.  He shared that his office is posting this information for all to see:

Our office is attempting to be more gender inclusive.

The staff will be asking about your pronoun preferences (Male, Female, Gender Neutral).

You may also hear us call patients Mx. (pronounced Mix) rather than Mr., Mrs., Miss, or Ms.
Of course, we will refer to you however your prefer.

This is a work in progress, please excuse our errors.

If you intend to be inclusive, kind and compassionate to all, regardless of their gender presentation and gender identity, these are ways to bring your intentions to life.

What are some other ways to be more gender friendly – please share in the comments.

Dr. Gallagher’s: gender reassignment, consultation, gender pronouns

Dr. Gallagher’s: gender reassignment, consultation, gender pronouns

Gender Reassignment Access: insurance, consultation, gender pronouns, and more

Dr. Gallagher's: gender reassignment, consultation, gender pronouns

Nicole Jackson, Transgender Surgical Program Coordinator

In today’s post, I will discuss the steps involved in getting from inquiry to gender reassignment surgery with Dr. Gallagher.

The first person you’ll meet when you begin to to explore your options with Dr. Gallagher is Nicole Jackson.  Nicole is the Transgender Surgical Program Coordinator.   She will help you with insurance and scheduling, among other things.

Upon my visit to meet Dr. Gallagher, meeting Nicole was my first stop.  I found her to be not only helpful, she was informative and easy to talk to. One of my first impressions of Nicole came from the tagline in her email to me.  Under her name and contact information, she listed her preferred gender pronouns “she/her pronouns.”  This may not seem like a big deal, but how many professionals have you interacted with that have done this.  I’m going to guess none. This simple tag-line with her preferred pronouns underscores that none of us should assume another’s preferred pronouns, even if it seems obvious.

For a cis-gender female to note her preferred pronouns is a strong statement of understanding for gender variance. I now include my gender pronouns in my tag line because of her email.  (I encourage you to, also!).

One of the biggest obstacles to gender reassignment is finances.  Fortunately, more and more insurance plans are covering gender-related care, including gender surgeries.  Therefore, a big part of choosing a surgeon for GRS, SRS, chest surgery, and orchiectomy, revolves around insurance coverage and copay.

When considering Dr. Gallagher for your gender care, there are a few important steps you will need to initiate through Nicole first.

STEP ONE:  Email Nicole Jackson

Contact the office here.  Email is the quickest, most efficient way to explore costs for self-pay, or to learn your insurance coverage, if applicable.

To receive the quickest response, be preparted to provide the following information in this initial email:

  • Your name (both legal and preferred, if different)
  • Date of birth
  • Preferred gender pronouns
  • Copy of front and back of your insurance card (if applicable)
  • Indicate your desired type of gender reassignment surgery
  • Describe your current transition status:  length of time on HRT, dates of legal name change, gender marker change and FT living start date as well as any prior procedures, if you have a letter(s) of referral (necessary for surgery but not for inquiry and consult)

STEP TWO: Receive surgery cost quote

Wait patiently for your response.

They will determine your benefits and coverage.  Then she will respond by email with details about your out-of-pocket responsibility for the desired surgery.

STEP THREE:  Scheduling Consult

Once the financials are established, Nicole will schedule a consult for you to meet with Dr. Gallagher.  Not surprisingly, scheduling with Dr. Gallagher is taking longer as her schedule is rapidly filling.  Scheduling a new consultation is currently up to two to three months wait.  Scheduling is expected to eventually become a three to five month wait before long.

STEP FOUR:  Consultation

Consultation Fee

If you are using insurance, your insurance will be billed for the cost of the consultation.  You may be responsible for the copay at the time of your visit.  This can be clarified with Nicole prior to your consultation.  If you are self-pay (no insurance coverage), Nicole can also inform you directly of the fee for this consultation.

Consultation Length

Consultations for top surgery are 30 minutes.  For GRS, consultations are 45 minutes. You will see a presentation covering the surgery process, and you will  meet with Dr. Gallagher and Nicole both separately.

STEP FIVE:  Pre Determination Request

Using Insurance

After your consult, Nicole will submit your Pre Determination request to your insurance.  This is necessary for approval and pre-authorization of your surgery. This can take 30 to 60 days. Once an authorization/approval is received, surgery can be scheduled. Dr. Gallagher is currently scheduling 1 to 2 months out for surgery.

Self-pay

If paying out-of-pocket, Nicole will discuss forms, amounts and process for scheduling. Self-pay surgeries are also booked 1-2 months out. Payments must be made in full two weeks prior to surgery date. There are no payment arrangements or financing within IU Health or Plastic Surgery.  Any loans, credit lines or payment arrangements will need to be made outside of IU Health.

STEP SIX:  Gender Surgery

Location

Surgery locations vary based on insurance parameters, availability of scheduling and the selected surgery.  Currently, all vaginoplasty surgeries are done at Eskenazi. Top surgery and orchiectomies are typically performed at Senate Street Surgery Center, IU Health West Hospital and Eskenazi Hospital. Other IU Health locations are also used in certain circumstances.

IMPORTANT NOTE:  No smoking for 6 weeks before surgery. You will be nicotine tested and surgery will be cancelled if you fail the test.

Dr. Gallagher's: gender reassignment, consultation, gender pronouns - Michele O'Mara

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