Charting a Path for Transgender Health and Policy

Duke symposium on transgender health highlights differences in needs, but support for a community that is increasingly vulnerable.

Published March 25, 2022, last updated on March 28, 2022 under Around DGHI

Written by Alicia Banks

Kiran Sundar, a junior at Duke who identifies as a transgender man, began to feel “off” during puberty.

“There was cognitive dissonance there, and it wasn’t how I wanted to continue living my life – perceiving myself as a woman,” he says.

As a teenager, Sundar began transitioning. He understood the support he received from his high school administrators and parents wasn’t necessarily the norm for transgender youth in the U.S. South, where several states have adopted or are considering legislation restricting access to gender-affirming care.

“I knew if I went to any public places, it was very possible I would be denied access to a bathroom or misgendered because people didn’t understand my identity or read my birth certificate,” says Sundar. “Transitioning came along with this additional burden that I have to prove who I am.”

Sundar shared his story during a session of a two-day symposium on transgender health organized by the Duke Sexual and Gender Minority Health Program, which took place on March 21 and 22 titled Trans & Gender Diverse Policies, Care Practices & Wellbeing, the virtual event brought together professors,  physicians, policy experts, advocates and transgender individuals to explore a range of topics affecting transgender health and care. Panelists discussed issues around teens going through gender transition, sports participation for transgender athletes, LGBTQ experiences for those with autism, and the intersection of transgender identity and race and religion.

While speakers represented a broad range of experiences and perspectives, many underscored the need to support individuals who not only are facing a deeply complex personal journey, but now find themselves at the center of what has become a hot-button social and political issue.

“We need to continue to advocate strongly for the most vulnerable in our community,” noted Admiral Rachel Levine, the U.S. assistant secretary for health and the first openly transgender person to serve in a Senate-confirmed position, in the symposium’s opening remarks. “Addiction and mental health issues are higher in transgender communities, and it’s not being transgender that increases these, it’s the bullying and harassment that leads to these mental health outcomes.”

Scroll down for highlights from panel discussions. 

Addiction and mental health issues are higher in transgender communities, and it’s not being transgender that increases these, it’s the bullying and harassment that leads to these mental health outcomes.

Admiral Rachel Levine — U.S. Assistant Secretary of Health



On teen transitions

Leigh Spivey-Rita, a clinical associate in Duke’s Department of Psychiatry and Behavioral Sciences

“Access to gender affirming care improves mental health outcomes for adolescents that are gender diverse, without a doubt. [And] timely access is associated with decreases in depression and suicidal thoughts, behaviors and anxiety. [One] thing that’s been really clear from science is the impact of family. Support from parents and family more broadly is the strongest protective factor for gender diverse youth.”

Marci Bowers, M.D., a pelvic and gynecological surgeon in California - who is also a transgender woman - recognized as a pioneer in the field of Gender Affirming Surgery and the first woman worldwide with transgender history to perform such surgery

“Can we avoid puberty and get good adult results and secondly, how do we assure someone that they’ll be sexually responsive? Do we remove blockers in the course of their adolescence and let a little bit of puberty come back, or do we delay it a little bit, maybe into Tanner Stage 3 or 4? These are questions I’m very interested in, and I’ve been very active in trying to promote this. That’s why doctors [and clinicians] need to make these decisions, not governors and people that want to roll back the clock and put everyone back in their gender cages.”


How race and gender diversity intersect

Candis Cox, public speaker, activist and educator

“If you want to know how I was born and how I identify, please understand that it is always going to come under the umbrella of Black. I was born a Black man. I’m a Black trans woman. I’m never going to just be a trans identified individual.”

Elle Lett, MBiostat, M.A., Ph.D. - postdoctoral fellow, Perelman School of Medicine

“The bottom line is there is no such thing as a trans experience separate from a Black experience, if you’re a Black trans person.”


Sports participation involving transgender athletes

Liam Miranda, Duke alum and former Division I athlete, who is transgender, and researcher with The Inclusion Playbook

“The body of literature specifically about trans folks in sports is tiny; it's flawed, and it's really, really specialized. Yet we see it get generalized, and really inappropriately. So, we're seeing practices like studies that look at cis men and cis women trying to draw some conclusion about trans women on hormone replacement therapy, which is not the same thing. They’re not studying that population.”

Jaime Schultz, professor of kinesiology at Pennsylvania State University

“Each time that policy has said, ‘This is how we define womanhood, and this is what we're going to do to test female athletes,’ its failed. It's always collapsed under its own weight. And I think that's really important to keep in mind: that any attempt to define womanhood is ultimately bound to fail, and I think we're going to see that with testosterone, which is where we are now.”


Discussing the intersection of aging and sexual and gender minorities (SGM)

Katie Fasullo, director of population health and health equity, Chicago Methodist Senior Services

“Unfortunately, LGBTQ older adults are more reliant on long-term care facilities for a number of reasons. We know they’re two times more likely to be single; two-times more likely to live alone; four times more likely not to have children; and for those reasons, and many other reasons, they tend to rely on families of choice rather than biological families. Their peers are aging at the same rate that they are, and they can’t always be the care givers that biological children (who would be much younger) could, and so that can present them into nursing homes earlier and at higher rates than cisgender and heterosexual counterparts.”

Ames Simmons, senior lecturer, Duke University School of Law

“There was a qualitative study in 2021 that really brought out a theme that trans people are worried about a lack of agency - whether that’s real or not, it’s perceived – and that a lot of those concerns center on dementia, and the impact (in particular for trans people) that dementia might have on our ability to continue living as a transgender person. So that’s why you see some of the closeting or masking . . or detransition even, for some people.”


Pushing the Boundaries in SGM Health

Abdullah Antepli, associate professor in Duke’s Sanford School of Public Policy and the Divinity School

“Religion, religious communities and people’s faith could be part of the solution, part of the reconciliation, part of the healing for gender and sexual-orientation diverse communities. It’s no secret - at best - religious voices are not present around these conversations. I hope we have a whole different conference about religion and inclusion of gender and sexual-orientation diverse communities at the Sanford School of Public Policy.”

Amar Saxena, Ph.D., a licensed psychologist at Transform Psychological Services

“Unfortunately, you do see there is active harm being done. I have clients, who by the time they come to see me, I hear stories about past therapists, misconceptions and all sorts of messages they’ve been told. And it’s awful. A classic example is body-based mindfulness that might be really distressing or harmful for some of our trans folks, and mindfulness is a big component in lots of therapies… Only good things can come from research, which I hope will lead to more resources and reduce barriers.”


Queer experiences of autism

Maxfield Sparrow, autistic artist and advocate

“My experience as a queer, autistic person has been that society will sometimes allow you to be different, but only in one way at a time. … When I first went to the gender clinic to start testosterone, I hid my autism from them. I was afraid that if they knew I was autistic, it would throw a monkey wrench in the works. I was going through an informed consent model and I was afraid they would say that I didn't have the capacity to make an informed decision.”

Nick Walker, associate professor of somatic psychology, California Institute of Integral Studies

“The big challenge … is getting the providers to actually listen to their neuro-minority patients … The whole discourse is dominated by this idea that we are not qualified to speak on our own experience, that autistic people are lacking in this … capacity for self-knowledge … So, the crucial thing really is for healthcare providers to get over that.”