As a trans teenager, a lot of my experiences with trying to advocate for myself—which was often a necessity as I tried to access gender-affirming care—were difficult, and sometimes traumatic. I still remember how it felt not to be respected or believed by providers I relied on for care, and those experiences have left me cautious about sharing details about my personal life with providers, always trying to balance the question: will this affect my ability to get the care that I need?
While I was in high school, I worked with an organization called PATCH (Providers and Teens Communicating for Health). Along with a team of other Teen Educators, we held workshops, primarily for providers, on building better relationships with teen patients. We also occasionally held workshops for teens on advocating for themselves with their healthcare providers. Surprisingly, I found it a bit easier to get up and speak in front of a group of adults than a group of teens my age!
I felt something surprising happen when I presented at workshops. Providers were engaged and asked questions about things like pronouns, and how they could better connect with teen patients. My opinions and experiences were valued, and I watched providers put these workshops into practice when we put on goofy skits with audience volunteers to demo “positive” and “negative” patient/provider interactions.
One of these skits included a conversation where a provider dismissed a teen patient’s feelings about their relationship, because it “must not be that serious at their age.” Unfortunately, this seemed to be a common experience for teens to have; worrying that their feelings or concerns about their relationships wouldn’t be taken seriously, so they avoided talking about it altogether. From the providers’ perspective, it sometimes felt awkward to bring up dating and relationships with teen patients.
Healthy relationships are a key part of our wellbeing. Having the kind of open and trusting relationship where we can talk about relationships with our providers is one strategy to build a support network and mitigate harm if instances of dating violence occur. It’s great when we do have those relationships, but for trans and queer teens, these conversations might be more complicated.
It’s not as simple as being asked about our relationships; it’s also deciding whether we’re in a safe situation to share that we’re in a queer or non-monogamous relationship, or that our partner is nonbinary and uses they/them pronouns, or that we can’t be open about our relationship(s) with our family members. Sometimes it means outing ourselves about our sexuality or gender identity when we’re not ready to do so. What might feel like a simple, standard question to a provider could mean a whole lot more to a teen patient.
In addition, having conversations about sexual health and risk factors may be different for trans folks, whose bodies might need different types of protection or barriers than non-trans folks. These conversations are also often difficult for trans folks of all ages to have with providers, and even more so when we’re teenagers who are just beginning to explore our relationships and sexuality.
February is Teen Dating Violence Awareness Month, a time to raise awareness about the prevalence of dating violence among teens. Teen dating violence is more prevalent than you bmight expect: 1 in 3 U.S. teens will experience physical, sexual, or emotional abuse from someone they’re in a relationship with before becoming adults. Trans youth are even more likely to experience dating violence–a study by the Urban Institute Justice Policy Center found that 89% of trans youth experienced dating violence. Having conversations about healthy relationships, especially between teens and trusted adults, is an important strategy for reducing violence.
For suggestions for how to start these conversations, check out this safety card and poster from Futures Without Violence.
I thought about what this post might include: a list of actions that providers can take to build trust with teen patients when talking about relationships? Strategies that teens might use to start conversations about relationships with their providers? These things might be useful, but don’t really reach the core issue of building trust between healthcare providers and young people that’s needed as a foundation for having these conversations in the first place.
And, building trust is often more complicated for trans youth, who have likely experienced trauma at the hands of medical institutions. This seems to be changing in some ways—I’ve now had the experience of working with some wonderful, trans-affirming providers, and I’m so glad that trans youth may have their healthcare experiences shaped by these providers from the start.
In other ways, it feels like things are moving in the opposite direction of progress. With anti-trans legislation that further restricts young peoples’ access to gender-affirming care, policies that allow providers to deny necessary care to trans patients, and public debates about whether or not trans youth should have access to gender-affirming care at all, trans youth end up carrying more responsibility than ever to advocate for their needs.
While having to defend your basic right to healthcare often leads us to be cautious about what kinds of information we share, there are also some wonderful providers out there working to ensure that trans youth have access to the medical care they need, and have space to talk openly about relationships and dating.
There isn’t a simple, easy, linear checklist for building trust in relationships with providers. It’s an ongoing process, and not an easy one for those of us who have experiences that have led to mistrust with providers. It’s a collection of small actions that build up over time, like:
- Providers explaining why they ask about certain personal health information we might otherwise be uncomfortable sharing
- Asking for clarification when we need it, on both ends of the patient/provider relationship
- Providers sharing their own pronouns, and inviting patients to share theirs
- Bringing notes with us about what we want to address, to make sure nothing gets missed
- Asking for what we need
- Changing providers when something isn’t working
- Letting our providers know when something they said was inaccurate or hurtful
- Bringing a support person with us to help us advocate for our needs (or having someone on the phone with us during an appointment)
Working with PATCH taught me that there are providers out there who care deeply about building trust with their teen patients, and are committed to being part of their support networks around relationships and other big life decisions. I think about how important that support must have been for other teens, whose experiences may have opened the door to ongoing conversations about healthy relationships into young adulthood. Building trust between providers and patients can help to mitigate harm from teen years and beyond.