I'm a Nonbinary Medical Social Worker Serving the Trans Community

Why visibility matters in medicine

With Beatriz Ruiz LMSW, Social Worker at the Center for Transgender Medicine and Surgery at Mount Sinai

Beatriz Ruiz

What is your role at the Center for Transgender Medicine and Surgery?

I'm a social worker for the Center for Transgender Medicine and Surgery. I've been doing queer health work with queer and trans folks for about seven years.

Do your trans patients appreciate that you are trans and nonbinary?

I'm a queer Mexican from the southside of Chicago. I'm also trans and nonbinary. My pronouns are she, he, and they, and I ask folks to switch them up. As a queer and trans nonbinary person, it's vital to work with folks in my community, and also to see and be seen by folks who look like me, because it's definitely not the experience that I've had myself as a patient. It's been incredibly important and healing work.

What’s the most rewarding part of your job?

I love when trans folks come into the center. They look at me and they see my lipstick or my hair and my jewelry, and they're like, "I see you." I see them seeing me, and it makes them feel comfortable to talk to me about different things about their bodies without feeling the need to explain things to me or teach me in the same way that they might have to teach other health care providers.

If you're trying to get medical health coverage as a trans person, what are some things you might not know about that process that might help you secure the funding you're applying for or the insurance you need?

If you're seeking care and all you have is a primary care provider, definitely go to see an endocrinologist, because they are likely to have more experience providing gender-affirming hormones. If you are seeking surgery, they might hopefully be able to point you in that direction as well. 

For surgery to be covered, you often need letters of support from medical or mental health providers, so it’s a good idea to establish those relationships so that the one from your medical provider will be from someone who knows you and has been providing hormones for you. For the mental health letter, attending therapy so that you have a long-standing relationship can help, but it’s not as necessary because I can also provide those letters for folks as their medical social worker.

It's not necessarily to prove that you’re “trans enough,” but it's just to demonstrate that it is a medically necessary procedure so that insurance will cover it.

Seek out gender-affirming medical care in other areas of your life as well. For example, if you want to go to a gynecologist, pick one who has experience working with trans folks. Find a trans-affirming dentist. There are all types of trans-affirming health care and health care providers in every specialty of medicine.

How can trans and nonbinary patients find gender-affirming healthcare practitioners if they don’t live near a trans center or city?

Crowdsource your resources and ask queer friends for recommendations. I've found lot of really good gender-affirming HCPs from my friends' recommendations. That's how I ended up with a gender-affirming dermatologist, optometrist, and gynecologist. Especially with something that's so personal like a gynecologist. Trans patients shouldn't have to explain to their gynecologist why they don’t need birth control if they can’t get pregnant.

What are the benefits of having a dedicated medical social worker for trans patients?

An abbreviated version of what I do is that I help folks get from beginning to end for their gender-affirming surgeries. That includes all gender-affirming surgeries including breast augmentation, top surgery, and bottom surgeries of all kinds, which include vaginoplasty, orchiectomy, metoidioplasty, phalloplasty, hysterectomy, and voice feminization. I help trans patients get their appointments scheduled. I can also arrange medical transportation and other services for them around those appointments, because you can’t take public transit and be jostled around after surgery.

I also help them identify who in their life is supportive, because the recovery process after the gender-affirming surgery is lengthy, so they do need to have at least one person who is going to be able to take care of them during that time. So, if a trans patient says, "No one’s going to pick me up from the hospital after surgery," we'll work on getting some social supports in place because it’s not surgery that you can recover from alone.

The feedback that I've gotten from patients is that it's been really helpful for them to have a transition-dedicated social worker. I've had people ask me really candid questions, and it's an honor to have patients discuss them with me. Sharing aspects of a trans nonbinary identity opens up the possibility for them to discuss things that they might not want to ask their doctor or another HCP who is not trans.

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