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For nonbinary and transgender patients seeking reproductive health care, medical family therapists play unique role

Stories | 10.27.22

Gabrielle Gebel was working as a medical family therapist at an integrated primary care clinic when she met Sam, a nonbinary person who was looking to become pregnant via assisted reproductive technology.

Sam, who uses they/them pronouns, had a uterus and needed a sperm donor since they had a partner who also had ovaries.

The primary care doctor Sam had been seeing in the clinic referred them to Gebel to work on processing their history of sexual trauma. It didn’t take long for Gebel to learn that throughout Sam’s interaction with the reproductive health care system — Sam also received OB-GYN services from another provider — they often experienced microaggressions by being called the wrong name and were often misgendered by their providers, including by the front desk staff.

Gebel, a Ph.D. candidate in the Adler University Doctor of Philosophy in Couple and Family Therapy program, saw how her patient visibly shut down. During their therapy sessions, Gebel learned how these experiences triggered Sam’s trauma reaction and exacerbated their gender dysphoria. This experience stood out to Gebel as she began exploring what roles medical family therapists can play when in reproductive health for those who are transgender or nonbinary.

Gebel highlighted the case vignette of Sam — an amalgam of different clients that she has seen over the few years to protect client identities — in her research article, “The Role of Medical Family Therapists in Reproductive Healthcare Settings Serving Gender Diverse Patients: A Reproductive Justice Approach,” published in the September issue of the International Journal of Systemic Therapy.

Throughout the article, Gebel explores how transgender patients seeking reproductive health care services experience discrimination in unique ways through micro- and macroaggressions within the health care system. She also offers specific recommendations for how medical family therapists can improve these systems by integrating trauma-informed care aligned with a reproductive justice framework.

When asked why it was important for her to write this research paper, Gebel said it all comes down to social justice.

“If I were to summarize it in just a sentence, I would say I wanted to use my privilege, as someone who is highly educated and a cis person, to improve the care that people who don’t have that privilege get,” she said.

In 2017, an estimated 0.39% of the U.S. adult population identified as transgender. Transgender and gender non-conforming people have historically been discriminated against when accessing reproductive rights and faced discrimination, prejudice, and transphobia in health care settings.

According to Gebel’s research article, discrimination in health care can present in many ways for trans and gender non-conforming patients. These include health care professionals refusing care, refusing to touch them or using excessive precautions, using harsh or abusive language, and blaming them for their health status. A 2010 Lambda Legal study found that 70% of transgender and gender non-conforming respondents had one or more of these experiences.

For Gebel, medical family therapists are in a unique position and have a role to play through education, empowerment, advocacy, and policy change.

In Sam’s case, Gebel met with the other providers, including the OB-GYN and clinic staff, to educate them on the importance of addressing Sam with the correct name and pronouns. She also connected Sam with a queer-allied doula who can further advocate for them in spaces Gebel was not present, such as the hospital during birth.

Gebel hopes those in charge of making systemic and hospital-level changes can implement her recommendations to help address the challenges transgender and nonbinary patients face

“I’m hoping that those who read [the research paper] can recognize some of their biases,” Gebel added. “While it may not be intentional, there are things they could be doing better.”

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