Networking & Consulting | 60min (Bowie Winnike) (2024-04-15 12:10 GMT-7) - Transcript
Attendees
Bowie Winnike, Dr. Crystal Beal (they/themme)
Transcript
This editable transcript was computer generated and might contain errors. People can also change the text after it was created.
Dr. Crystal Beal (they/themme): Hi everyone, welcome back to the queer See Me podcast. I'm super excited to welcome our guest Bowie or rainbow today. and I will let you introduce yourself and we'll go from there.
Bowie Winnike: Hi Yeah, I am rainbow slash Bowie. I like both names. So neither one is wrong. Last name winnikee my pronouns are they them?
Bowie Winnike: What that means is I support people who are neurodivergent and trans or queer who are going through their journey of trying to figure out their gender identity with the steps of navigating that
Dr. Crystal Beal (they/themme): Yeah, which I'm very excited to learn more about your work and we do try to focus on lifting up voices of folks with lived experience. are there any identities you feel comfortable sharing with our audience? If not, no worries. You can always edit this part. Yeah.
Bowie Winnike: Yeah, you mean for me? Yeah, I identify as trans non-binary Audi HD slash neurodivergent and…
Dr. Crystal Beal (they/themme): Yeah.
Bowie Winnike: also animistic and witchy.
Dr. Crystal Beal (they/themme): Love it. Thank you so much for sharing. And then yeah, can you? Maybe I feel like you gave a brief summary of kind of what your work is working in the neuro queer gender dualist space, but you share a little more with our listeners like what shapes out work takes or maybe? Yeah, let's start there. I feel like that's a good start.
Bowie Winnike: Yeah, so I feel like when people are going through a gender transition There's just so many different aspects to it. There's the social aspects of coming out. There's the
Bowie Winnike: executive functioning of figuring out when to schedule when what order to do things in and there's all the emotions that come along with that. So a lot of what my role is is through navigating that aspect of it. So I'm not gonna be giving medical advice but I may help someone find a doctor that can support them or navigating insurance if people really nervous about going to the doctor. It's like we can do a practice run talk through what they're gonna say. So can look a lot of different ways, but I kind of see myself as filling in kind of some of the gaps for folks who are going through process
Dr. Crystal Beal (they/themme): Rad and when people work with you I'm sure because what you do is pretty individualized to who you're working with, but is there time frame or a number of sessions or kind of Shape as specifically to the objective parts of the work.
Bowie Winnike: It is unique to each person who comes to me and what they're coming in for so some folks will Be coming in for support with Top surgery for example and will. Do the prep and then I'll maybe meet with them afterwards and a little bit of follow-up. And other folks want more ongoing support.
Dr. Crystal Beal (they/themme): And so you kind of do both episodic support and continual support.
Bowie Winnike: Yeah, yeah.
Dr. Crystal Beal (they/themme): Bad and then do you work with people in person virtually be a phone we attack the cow. Is that relationship built?
Bowie Winnike: I mostly meet over video call. but if people are in Long Beach we can meet in person to
Dr. Crystal Beal (they/themme): Okay, and then when you're like
Dr. Crystal Beal (they/themme): working to support people how do people find you actually
Bowie Winnike: yeah different ways. a lot of word of mouth or referrals some people find me online or through my writing. So yeah.
Dr. Crystal Beal (they/themme): yeah who like because it's primarily prescribing clinicians who listen to this podcast. So who do you think would be An appropriate referral recommendation from them to your services or services like yours.
Bowie Winnike: Yeah, so I would say if you're working with someone and seeing that they need some extra support. either with the social aspects of coming out to family or navigating their workplace or if they're feeling overwhelmed with because of neurodivergence the steps of how to access care things like that. I think that would be a good opportunity to refer them over to me.
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Dr. Crystal Beal (they/themme): Yeah, and do you like?
Dr. Crystal Beal (they/themme): I lost my chance that hold on. so we were just talking about appropriate referrals and
Dr. Crystal Beal (they/themme): yeah, do you know other people doing work similar to yours?
Bowie Winnike: Yeah, I do. I feel like the term gender duala is kind of like a newer. Term as far as I know, but I know. Some folks will use different terms, but I think it's kind of a emergent and growing field.
Dr. Crystal Beal (they/themme): that are there any of your colleagues that you're particularly fond of or find
Dr. Crystal Beal (they/themme): If you don't have space that's where you would send someone next kind of. building community
Bowie Winnike: Yeah. Yeah, we each have a little bit of a different Focus. But someone else that I've worked with is mix lifestyling they do.
Bowie Winnike: Gender dual to work and other types of work and could be appropriate for someone who wants to work with a person of color. Also Eli at the gender Dulas their name is his name sorry, and yeah, he tends to be kind of full though. but he has a lot of great resources as well.
Dr. Crystal Beal (they/themme): Amazing and yeah do you only work with people one ones you ever do group sessions or trainings for Community groups silly community members or trainings for organizations and institutions with Healthcare Providers or anything like that.
Bowie Winnike: Yeah, so yeah, I do a mix and I guess I didn't mention earlier that I also work with families and providers who want to learn about these things. So the one-on-one sessions I work with a lot of different folks currently for my group sessions. I'm working on one called staying true for neuro queers and we go through different things like boundaries self-care strategies finding community. So there may be more in the future, but that's what I have right now.
Dr. Crystal Beal (they/themme): That's on so Sanctuary sounds like it's very much directed at community members. How often do you run that group?
Bowie Winnike: Yeah.
Bowie Winnike: So I'm gonna have my first one next month and then I'm hoping to do it maybe a couple times a year.
Dr. Crystal Beal (they/themme): Yeah, that sounds great. I feel like boundaries and self-care. What was the other thing you said?
Bowie Winnike: and building community.
Dr. Crystal Beal (they/themme): Building Community. I think those are three things I talk to my patients about the time and it's not necessarily something that I necessarily have the time or resources or skills to offer a ton of support around right? and I think it's
Dr. Crystal Beal (they/themme): as part of this work that is so important and I think it's something that I can address in a way simply because I have lived experience that some of my Allied clinician colleagues probably feel maybe a little Even less knowledgeable about less resourced around.
Dr. Crystal Beal (they/themme): Yeah, how many sessions is that?
Bowie Winnike: Yeah, so currently it's three sessions. This is kind of like my Beta launch and…
Dr. Crystal Beal (they/themme): Yeah.
Bowie Winnike: then I think that ideally I would love to expand it and grow it from there. But yeah, I agree. I feel like for everyone right now the life is intense, so I think we all need these skills. I know for myself, even as someone who offers this and has here so experience. It's like I'm constantly. doing the daily things I have to do to maintain my self-care my boundaries my community. And constantly working to grow that and especially for folks who are going through a huge life change like a gender transition. having boundaries and self-care skills are important and being able to access Community because a lot of times people may experience changes in their Community or loss of family or community members, so
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Bowie Winnike: Yeah, that's kind of why I thought that these three weeks together would be helpful for folks.
Dr. Crystal Beal (they/themme): Yeah, I'm very excited about this one. And I hope you continue offering it because I feel like it definitely something I would recommend. widely to patients because like I said, I think these are three things I talk about a lot and I think specifically in the context of healthcare clinicians. Like I frequently asked or talk to my patients about advocacy for themselves within their home health care or setting boundaries with us as healthcare workers because the reality is that every trans person who interacts with the healthcare system is going to have someone ask an inappropriate question at some point that has to do with their transits and not their healthcare needs and right and so
Dr. Crystal Beal (they/themme): really like
Dr. Crystal Beal (they/themme): And especially now it was already bad in the healthcare system. don't get me wrong. But especially in the political climate as it exists now with the Christian Nationals really targeting People of trans experience and…
Bowie Winnike: Yeah.
Dr. Crystal Beal (they/themme): it has changed the tone even within the Greater Community that's their goal. That's like why they run these media campaigns and so I always encourage my patients. I always say consent is essential if I ever ask any questions, you don't want to answer feel free to say that it's not going to prevent my ability to prescribe to you. If I absolutely had to know that information to write your prescription. I would let you know that so you can make a decision.
Dr. Crystal Beal (they/themme): and I actually encourage you to say no to me or say no to getting your Labs John or you're vitals checked or something like that while you're working with our team because at our team we're gonna say thank you so much for setting a boundary and move on. So you get to practice that skill and a safe space where you're not In a space for your last sure about the reaction and having to use it for the first time, And so I think clinicians that's one of the examples around how I talk about. I'm just boundary setting within the content so seeking healthcare for my patients. I don't know if that prompts any thoughts that wasn't there. Questions in their belly, but I don't know that problems any thoughts from you.
Bowie Winnike: yeah, and I was thinking about this too when I was thinking about preparing for this podcast because consent is important for providers and In some ways I think to me because I have a social work background. It feels very kind of basic but I also have heard so many stories of folks who? Have gone to Medical providers and haven't had consent being honored. So I definitely feel like if anyone's listening to this that Hasn't learned about that. that's a great thing to Deep dive into and I really appreciate your share about how you do it because
Bowie Winnike: for people who are in these positions of authority. creating spaces where people can say no and honor their boundaries can be really healing and
Bowie Winnike: yeah can just be really powerful in healing and opportunity for someone to change just like you said, so yeah, I'm glad that you mentioned that.
Dr. Crystal Beal (they/themme): Yeah, and I think that. I love the language. This is a safe space to say no. I feel like I might. Borrow that from you and working with patients because that's like, Rate Healthcare species do not feel like safe places to say no because when we are seeking Healthcare, we're vulnerable in the people. We're seeing have something we need right and so there's so much fear that if we say no we won't be able to access…
Bowie Winnike: Yeah.
Dr. Crystal Beal (they/themme): what we need. Even if it violates our boundaries, right and
Dr. Crystal Beal (they/themme): and so this is such a huge part of both trauma-informed work and cultural humility asks that we actually work to Flat in that power differential that exists between a provider and a patient and rate trauma informed work really one sauce to have every interaction Beach driven by consent and that means even for me right that mean that starts before I even start asking questions, that's like I'm gonna explain the framework of our visit and what I'm trying to accomplish with our visit at the beginning so you can consent to that before we even start versus just waiting to ask for consent for my patient when I'm about to do a physical exam or prescribe a medication. which is more of the framework. I was taught as a learner.
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Dr. Crystal Beal (they/themme): And so I just think that's really powerful making.
Bowie Winnike: Yeah.
Dr. Crystal Beal (they/themme): A safe space to see no.
Bowie Winnike: And I feel like it also is really important for neurodivergent clients. Especially people who are Having an awareness of what you're getting into and just communicating expectations. So people know For folks in advance what to expect when they're going into a session or meeting with a provider can be really really helpful.
Dr. Crystal Beal (they/themme): Yeah, That's a really good point. we're been working on whenever goals are anti racism trainer we work with was really encourage us to make more video content so that information was available and multiple formats and that's accessible to people who need information and different formats, which is
Dr. Crystal Beal (they/themme): we're striving to do I would say I was a small business with a small team in limited budget definitely we are slow and in achieving that goal, but we are working towards it but I think a really good addition would be like we have people do a free 15 minute introductory session before they see a medical clinician the kind of explain how the clinic works, but I think maybe a little video clip of what to expect at your first medical appointments would be I really lovely addition and maybe going up over some of these things it's a safe place to stay now. And this is what the flow of the visit usually looks like and this is what usually happens and
Dr. Crystal Beal (they/themme): would be really rad to have. But thanks for thinking that I'll put it on my list of videos to make.
Bowie Winnike: yeah, absolutely.
Dr. Crystal Beal (they/themme): yeah. I'm like now that we're on this topic. Do you have any other suggestions what are the things you wish? prescribing clinicians new about our community we're working with us.
Bowie Winnike: mmm
Bowie Winnike: yeah, okay what feels relevant I feel like I could go in a bunch of different directions with that but yeah, I guess on the topic of just neurodivergence because a lot of queer and trans people are also neurodivergent. So I think it's really important to the educated on that and to learn about that. So there are some basic things like we said like providing information in advance.
Bowie Winnike: also maybe considering
Bowie Winnike: The sensory needs of a space so everyone's sensory needs are going to be different. and I know that a lot of providers are working within their own limitations, but if it's possible, it's like ask people in advance what accommodations might you need. and also, thinking about overhead lighting sometimes can be overwhelming for folks so if people know in advance, maybe the court like a hat or sunglasses something to help with that, loud machines can be overstimulating So if there's things you can't control letting people in advance can be helpful if they're things you can change to make it more friendly, that's great, too and then knowing a lot of people when they come into
Bowie Winnike: A session I keep saying session because I'm coming from the mental health field. But yeah,…
Dr. Crystal Beal (they/themme): Great, it's great.
Bowie Winnike: we all have our little lingo but when people come into see a provider
Dr. Crystal Beal (they/themme): Yes.
Bowie Winnike: just the point leading all the things that had to happen before someone even comes to a doctor and says I want to try. Testosterone or hormone therapy or whatever their requesting? There's so much that had to happen before that point.
Bowie Winnike: So I think just one honoring that just being energetically just knowing that's a big deal and honoring that feels really big.
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Bowie Winnike: yeah, I think anyways to just provide that little extra a bit of compassion and Care can go really long way and some folks. may feel more comfortable communicating through writing.
Bowie Winnike: or may need timed Answer questions about things so even if people have questions in advance. that can be helpful or just allowing people to not feel necessarily rushed if possible. So those are all things I think could be helpful. I mean and I'm also thinking in the past. I was an ASL interpreter, so Just remembering that ASL interpretation is something someone might ask for so having a system requesting that can be helpful. If you're working at a front office and you get a call and someone says hi, this call is being interpreted by. ASL interpreting service, it's not spam. Someone's using an interpreter. It may sound a little spammy. So.
Bowie Winnike: That's a side thought that came up as I was talking. But yeah.
Dr. Crystal Beal (they/themme): Yeah, I absolutely One of my team members at our Clinic said something to me that is one of those things that I feel like maybe shifted a little bit how I think about the world and stuck with me. It's like lives rent free in my brain, I guess as maybe the younger people say, I don't know. I'm 41 now, but they said the difference between
Dr. Crystal Beal (they/themme): something you truly accessible versus having accommodations is you don't have to ask when it's accessible and when We offer accommodations that people have to ask for them and that was in they actually said it a little more gracefully than me. I'm gonna need to ask them to repeat it one day but
Dr. Crystal Beal (they/themme): I think clinicians that was really meaningful to me in the space and it makes me think a lot about what Bowie's saying just and if our goal is to create truly inclusive and accessible spaces, eventually we will hopefully have spaces where people won't necessarily have to ask for some of these things like overhead lighting or
Dr. Crystal Beal (they/themme): a decrease in additional auditory stimulation and things that our clinics will be designed to include them right from a perspective of Universal Design, but until then is helping people understand what to expect and offering what accommodations we can is is our good in between strategy and so
Dr. Crystal Beal (they/themme): I think it's like
Dr. Crystal Beal (they/themme): it's super great if that's something that You can put in the sticky note on someone's chart. they're sticking out pop up or something like that doesn't have to be part of their permanent medical record, but that's just dim the lights or use lamps when this client comes in or right? It's like they don't have to ask every time because it's really exhausting right? Maybe not for everyone definitely is for me and so right and
Dr. Crystal Beal (they/themme): Right. We kind of all have a limited amount of energy that we have for existing in this world and doing the things that we want or need to do and the thing about trans and neurodiverse people is we spend so much of that energy just great deal deal with the stress of being a marginalized Community rate. And so then we have less energy for the actual doctor we have less energy for the actual counseling appointment or session with our NP. and we're to get less out of it. We're able to remember less from it. we're able to accomplish Less in that time frame because we're distracted by the evil overhead lights or right we were missionary seven times. Just getting to that appointment, in the past couple hours and so I think
Dr. Crystal Beal (they/themme): What Bowie was saying about honoring how much has happened before a patient or client gets into your little tiny sphere of the system, I'm sure you maybe. when I first heard you say that I was thinking about all the forms they had to fill out and making sure they like finding an affirming provider like doing all the research to find that provider and then all the forms they had to fill out to access that appointment and scheduling that appointment and then giving everyone their insurance information. I'm making sure their insurance is gonna pay for it if they're lucky enough to have insurance and understanding what they're copy is gonna be right like all of these things. That's really what I was thinking about. when you first said that but I think the bigger framework for that is actually all of that other minority stress that happens in the context of coming to that appointment and rate are coming to that session and I think that's just like
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Dr. Crystal Beal (they/themme): that accessibility versus accommodations and that inclusivity component that is
Dr. Crystal Beal (they/themme): A framework that I feel like for me continues to expand and grow.
Dr. Crystal Beal (they/themme): And I didn't ask for it. I'm the baddest podcast interview because I'm not asking questions. I'm just like I'll make a statement and can you tell this is my nerd diversity. I'm not the best with follow-up questions. I make a statement and…
Bowie Winnike: We're just flowing with it.
Dr. Crystal Beal (they/themme): then you make a statement and then we just switch. This is how we have a conversation.
Bowie Winnike: Yes. Yeah,…
Dr. Crystal Beal (they/themme):
Bowie Winnike: I mean I think.
Bowie Winnike: Yeah, I'm just thinking of stories of people I know who've gone to ask for. Some type of gender affirming care and it's like it took so much to even get there and then ask and then to be told no can feel really devastating or even not right now. So I know sometimes, there are medical reasons why that happens but yeah, I think just Having compassion resources for that if that is something that needs to happen. And I'm also thinking about just I know when you told me about this podcast you were talking about Haze and yeah, I've been thinking a lot about
Dr. Crystal Beal (they/themme): Yeah.
Bowie Winnike: yeah, just how common Eating Disorders are in our communities and
Bowie Winnike: it feels pretty dangerous to me. I think to tell someone that they need to lose weight to access care and I'm not a doctor so I can't say that whether or not that's medically necessary, but
Bowie Winnike: I just think it's important for people to know that that can have some really intense and dangerous effects on clients. And just doing the research to figure out is it actually medically necessary for someone to lose weight to access this care and are there other accommodations that could happen so they could still access care? Without having to lose weight because a lot of times that can lead to people to disorder eating so people can access care that they feel is life-affirming.
Bowie Winnike: So yeah, that's been on my mind a lot recently.
Dr. Crystal Beal (they/themme): Yeah, I am way too lead into my pre-visit questionnaire. So thank you so much for keeping us on topic and we just did a training with radical Health Alliance and any is really lead over there and they do I think
Dr. Crystal Beal (they/themme): I think her tagline is a champion. That's a hard one for me. I do have a little bit of a Fanatics processing thing but championing health for fat people and they do a lot of size inclusive like wait bias training and for all kinds of organizations definitely for healthcare organization and simply we were just very specifically doing training on this last month and I think One for me.
Bowie Winnike: Yeah.
Dr. Crystal Beal (they/themme): I am a medical provider and I will say that there is no absolute Contra indication to gender affirming care and they're right we're primarily talking to prescribers, but for any community members and contraindication means a reason to not do something right an absolute contraindications and Healthcare are And they're non-negotiable right this is the right until I have a kink background this is the hard limit but right it means the thing that matter what other Healthcare items we're talking about. this is too risky and
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Dr. Crystal Beal (they/themme): I think the concept of absolute contraindications is important in healthcare, but I definitely don't think they exist in gender affirming care. I don't know that I think they should exist in the framework of healthcare period because if really what we want as a shared decision-making model that individualizes Healthcare based off of the person in front of us values and goals and bodily autonomy then they get to decide even if the thing right for example, someone has an estrogen thread breast cancer and they want to continue estrogen therapy because that's more important to them than the length of the life that they're gonna have left on this planet right like that is their choice and greatly I think
Dr. Crystal Beal (they/themme): that's why having enough time for visits that don't feel rushed for people so they can have a really thorough informed consent process. So they really do feel like they have all the information they need to make the decision that's best for their body. Right because there are times I had a patient, recently who wanted to induce lactation and also was having some heart palpitations and the primary medication we use for lactation induction can cause some heart stuff. I really don't think I was like, I can't even really counsel you around the risk until level we know more about what's going on with your heart. I really think you should have a heart work up before we start any of this, and
Dr. Crystal Beal (they/themme): but my policy as I start from a place of yes, so whatever my patients asking I just say Ultimately, if that's what you decide is best for you after we talk like that is what we will do. I'd like to give you some more information right after I better understand your goals so you can make the best decision for you, right and that really changes the tone of the conversation for people because when we're so focused on I've already heard a no from someone in the past I'm so fixated on just getting the thing. I feel like I need and I like my brain is chaos. Stay sorry, but just I think
Dr. Crystal Beal (they/themme): coming back to what Bowie was saying I think. Starting from a place of especially in gender affirming care is really really important. we as a medical community have harmed trans and gender diverse people and then anyone with any intersectional identity has been like that has been Amplified fat people black people brown people the medical community has systematically repetitively traumatized people from these communities for our own knowledge and interest and so That exists in the room when we are in the room with that patient. s and to not acknowledge that and to
Dr. Crystal Beal (they/themme): continue to exist in this place where I'm starting from a paternalistic. I have the power and I'll decide what you need and is antithetical to my personal values, but also what I want to see in healthcare and I also think it's antithetical to share decision making if this is a concept that we truly Embrace as a field and as a specialty Then that really means letting the individual really lead the experience and in decision-making.
Dr. Crystal Beal (they/themme): and I think so often people part of our oath to kind of justify saying no to prescribing something that might cause someone harm and ultimately we can't actually decide what is more harmful for them if it's that medication or if it's the lack of that access and the very next line says did you know harm which includes not depriving people of the goods of life so that oath continues on and it continues on to have space for this possibility that someone's going to define the goods of life differently than we do and I just think I have gotten very lost in talking for a very long time, but I think yes,
Dr. Crystal Beal (they/themme): we should start from a place of yes, and that Lake this should be about letting people decide what's best for them and their framework not what's best for me and my framework and that's a pretty rical. stance as a healthcare provider and it can feel scary as the person signing the prescription but I
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Dr. Crystal Beal (they/themme): I just think that's where the space should be going, especially with that history of abuse and Trauma we** up real bad. Expression. Yeah.
Bowie Winnike: yeah, it feels very radical and it also feels like I mean, I truly believe that As the world is changing. Hopefully, I mean there's I think a lot of resistance to change but we each have our role no matter what job we're in we can be a part of that change and that larger systemic change and
Bowie Winnike: yeah, myself and I know so many people who have experienced barriers to accessing healthcare related to gender transition and it does impact us and even just knowing that we're in control like you said
Bowie Winnike: It feels different to know I can't take this medication because my doctor won't let me versus. I'm choosing not to take this medication because of the risks until I get more information like that is a total shift in power and Feels very different I think as someone who's receiving care. and that's why when I am working with people I really do strive to support them in what they need and support them and coming back to what they want and what they need because I do feel like often. There's so many people trying to tell you what to do.
Bowie Winnike: And it's just such a complicated time right now with.
Bowie Winnike: I mean I came out as trans 10 years ago and since then. So much has changed for better and worse on one hand. There's so much more awareness. There's people who get they/them.
Bowie Winnike: Me people who? Are trying to erase us and eradicate us. And so I think coming out as Trans in this climate can feel really confusing because it can feel like you really have to justify who you are. you're coming in from a place of feeling like you have to justify who you are to the world. And then it feels like if you are wanting to transition you have to fit this box. You have to do all the things you always had to know you had to always be like This I remember my family being like but you liked playing with dolls. Are you like doing this and it's okay, but I also did these other things but also why am I? having to go Point by Point through my whole life to justify this anyone can play with dolls anyone can wear makeup anyone we can be complex
Bowie Winnike: I can want to change my name but not want to go on hormones or I can want to go on hormones and still want to dress exactly the same there's just so much pressure to feel like you have to take it all or none of it in that way. It feels very we're trying to break out of this binary system. where we're being forced into these boxes and
Bowie Winnike: I think it can be replicated in trans communities. As well. So yeah, I think having Choice having agency and then having providers who because when I was first wanting to go on hormones it felt like I wanted to go to my providers and with them talk through the pros and cons but it felt like if I had any doubt or wasn't sure. Then I wouldn't be given access to that. So. I hit a point where someone kind of told me. They're like you have to decide whether or not you want to do this and be sure and then go in. Tell them like this is what I want.
Bowie Winnike: So I think that's a little bit of what I offer folks. It's like figuring that out navigating the questions, but it can also be helpful to talk to your doctor who knows more in depths of physically What are the risks what are
Dr. Crystal Beal (they/themme): Yeah.
Bowie Winnike: So yeah, I'm grateful for everything you said and how you framed that it feels really important.
Dr. Crystal Beal (they/themme): I think it's such a big stress in how Healthcare has been framed and Particularly Western Healthcare. I shouldn't, be This is a very us Centric conversation and right but
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Dr. Crystal Beal (they/themme): rate, I think that that shift feels really affirming and right because our history is so full of misogyny and white supremacy and harm cause to marginalized communities. I don't want to continue doing the things that I was trained to do, that have this generational history of harm, and I think
Dr. Crystal Beal (they/themme): believe brought up some other points out. just totally because my brain is low a little stupid today. But around rate being denied careless because of size and beans and I care for other medical reasons again particularly for hormonal interventions. I don't think there's any reason someone should ever be to donate outside of lack of capacity. So if they don't have the capacity to make an informed decision rate, And so then working with the people who do have their medical decision making capacity and working as a team to support them is I think really really important.
Dr. Crystal Beal (they/themme): again, I think that's a whole other Nuance conversation because we do have a history of assuming lack of capacity for people who probably have it and in this country specifically around things for sterilization and race but just I think outside that capacity there is no medical contractions. And then I think where we see size restrictions come up so often as accessing surgery, right and…
Bowie Winnike: Yeah.
Dr. Crystal Beal (they/themme): Bowie's point is, a spot on link trans people have Eating Disorders at four times the rates of our six peers. right and definitely
Dr. Crystal Beal (they/themme): then telling someone even without the history of an eating disorder that they can't access care because I've sizes particularly high risk of harm and sugaring like unhealthy unsafe habits to access that care. and so, do you think that's really really important and so I often talk on this podcast and other trainings I do that. I think it's really really essential for
Dr. Crystal Beal (they/themme): referring clinicians to have vetted anyone they're going to refer patients too so that we don't send them to people who are gonna turn them away because someone who just you were talking about all those steps that go in to getting to that appointment. Someone right is going through all these steps to get in front of the surgeon to access some surgery and that's been a long journey already and then they get to that surgeon's office and they think it's actually finally happening and they're so excited and then that surgeon says no because your body's too big right how harmful is that on so many levels and so really knowing before you refer someone if it's going to be a successful referral for that person or not a safe referral for that person or not. Great. And if you don't know that information and don't have time or capacity to figure it out letting the patient know that and in advance so they can try to do it.
Dr. Crystal Beal (they/themme): to find that out before they're sitting in that hopeful and optimistic themselves and rate I think is really An essential part of what we do as referring providers.
Dr. Crystal Beal (they/themme): Absolutely. and same thing size around race sending someone to a surgeon…
Bowie Winnike: are
Dr. Crystal Beal (they/themme): who is not experienced working on darker skin and Lincoln have more difficulty with scarring or who is going to potentially put White features on a black face and that's not the patients' goals. that's not what they want for their own body. And so really thinking about these things in the context of How we can support our patients in a safer referral process?
Bowie Winnike: Yeah, absolutely.
Dr. Crystal Beal (they/themme): And having them work with someone like Bowie who might help them walk through all of these steps right around. Lake meeting their surgeon or picking out a surgeon or figuring out. all of those things that you support your clients. kind of in this process
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Dr. Crystal Beal (they/themme): or just knowing they have someone to talk to you if it does go poorly and I think is so.
Dr. Crystal Beal (they/themme): Helpful, someone who is probably had some negative experiences themselves.
Bowie Winnike: Yeah. Yeah.
Bowie Winnike: there's definitely
Bowie Winnike: so many layers to this. but yeah, I feel like for folks who do have negative experiences like
Bowie Winnike: that's when it's really important to have a support plan for folks and
Bowie Winnike: I mean avoiding the experiences in the first place is the can we avoid negative experiences? sometimes like they happen and it's like how can we support folks and make sure that they have either, a support network trans call that they can be on people they can talk to
Bowie Winnike: for autistic, folks what are their special interests that can bring them Comfort or sensory Comfort? all of these things are the things that I think about I guess from my background when people are navigating this What can help people to move through these systems because even if everything goes it's still hard. So what is needed navigating all of that? And another thing that's coming to mind too is just
Bowie Winnike: being clear with folks in advance especially for surgeries about how much after care they'll need and how to ask support from folks and if you know of any resources, that's great, too, but I think that. That's like a common struggle was asking for help after surgery and knowing what to ask for and navigating that too.
Dr. Crystal Beal (they/themme): Absolutely, I think. It gets back to the course you're teaching on Boundary self-care and Community, right? Those are all things like that will help us navigate negative experiences when they do happen right like I had a negative experience with a clinician who?
Dr. Crystal Beal (they/themme): ultimately was fairly dismissive of me and told me everything that was wrong with me and my whole treatment plan without ever asking me any questions or doing an exam, and then at the end of it she was like, okay, I'm just gonna do a brief exam now and I'm a physician. So I knew she was doing it just for billing purposes not because she was actually paying attention to my body or cared because she had already literally already told me what was wrong with me and what the plan was right? So this is just cross the tees so I can send my bill and get paid and I kind of like I was like, no you're not gonna touch my body, and
Dr. Crystal Beal (they/themme): and she was washing her hands and she's like, it's no big deal just be quick and I was like do not f** touch my body, and knowing that about I know that boundary right and so it felt really
Dr. Crystal Beal (they/themme): even though it's scary to set a boundary and scary to advocate for Myself I knew the action I was taking was lined up with my values and my goals for myself. And so it made it not much more accessible to me because I had had some experience learning about these things and thinking about them and planning for them right and ways that we don't necessarily all do before we go into a healthcare experience, but great I have
Dr. Crystal Beal (they/themme): I've experienced sexual assault, and I've experienced sexual assault and harassment by colleagues. And so the clinicians that I let touch my body now are few and far between and so I know I am very grounded and what my values are around this if I do not feel safe with you you do not touch my body and you don't actually just get I think you're going to be a safe person just because you're a healthcare worker Pratt in my book, you have to prove that you're a big person to me and this person did not do that. And so I mean I set the boundary first without a curse word, and she try to dismiss it and walk over it and just knowing looking back on that experience and having
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Dr. Crystal Beal (they/themme): It was a bad Healthcare experience. I reported her to her institution. I didn't end up getting any of what I needed out of that Healthcare experience and I got misgendered the whole time. I was there everything about that experience was bad but I didn't feel about it. I didn't have nearly as much trauma if I had participated in that exam and I didn't have weight and when I think about it, I actually have pretty good feelings about setting that boundary and maintaining it right and feeling like what a different experience that was for me at that point in my life compared to write how I would have done that when I had last experience and had thought about those things last.
Dr. Crystal Beal (they/themme): and I a little bit lost the thread there. But I just think Bowie's class around. boundaries self-care and Community those are things that are so important right and in navigating these experiences, whether they're positive or negative and setting people both talking about certain people up with the support that they need for navigating these experiences when they're positive or negative and I think that's people like Bowie People doing this gender dual at work, That's and how everyone builds their support system is going to look a little differently but I absolutely love community and peer support groups.
Dr. Crystal Beal (they/themme): And not a lot of people don't love groups. They're like, I don't want to go to a group and right that's fine. That's why there's options like Bowie and so they can have one on one support and maybe it's a I'm a non-binary mental health provider or an affirming one all the way you really think again people lived experience can support in a slightly different way that can be really beneficial rate and it might be building out. this Greater Community and that's really essential and really important after things like surgery because you do need
Dr. Crystal Beal (they/themme): Meals and dog walking in the cat litter box scooping and all those things And so we definitely have a lot of resources on the career DOC website for patients about what to expect with a surgery and checklist for how to prepare for surgery and stuff like that and there's definitely a few organizations now that are doing post-operative care support a couple of them are geographically bound. I think in California and New York and that are really completely volunteer around so I think they're at no cost to the person recovering and then there's another
Dr. Crystal Beal (they/themme): Organizations doing it that it is paid on a sliding scale and they will travel they do it locally, but then they will also travel to you as well, and so those are resources available on the career DOC website and all the surgery information. I've gone over time and I want to respect your time though. It really appreciate having you as a guest And final words there are listeners.
Bowie Winnike: yeah, I'm just taking in like everything we said and I mean I feel like the theme. that is coming up is just consent and allowing people space to express themselves and
Bowie Winnike: make choices for themselves and directing people back to their own awareness and I do feel like each of us. Sometimes it can feel overwhelming because the systems can feel really hard and I think there can also be shame when we do make mistakes. So I want to hold space for anyone who's listening and thinking no I did that
Bowie Winnike: I think a balance of knowing You were trained a certain way you were set up to work a certain way. And you can change.
Dr. Crystal Beal (they/themme): Okay.
Bowie Winnike: And just having compassion for that.
Bowie Winnike: I lost my third thought.
Bowie Winnike: Yeah, I guess and I guess I also just want to say that with each point of contact whether someone's coming to me or coming to a provider. every time someone's coming into contact and talking about their gender their feelings about their their transition like that is an opportunity for someone to feel seen and witnessed and cared for so just thinking about touch even there's a whole school of somatic therapy where it's like people just holding and touching someone's body and asking them gently what they're feeling, there's a lot of other aspects to it, but that can be really a powerful for folks too. So even if you're touching clients in a session like consent and care and feeling compassion for the person you're working with. I feel can be really powerful.
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Bowie Winnike: And make maybe a challenging experience less challenging and also can be healing. yeah, and if folks want to learn more about my work.
Bowie Winnike: My website it's going through a change currently. It's Chrysalis coaching.com. I'm in the process of trying to change it to Rainbow winiki.com. But yeah, you can follow me. I have my newsletter where I share a lot of just different thoughts things. I'm learning resources.
Bowie Winnike: And yeah, you can feel free to email me reach out and like I said I'm available for consultations to
Dr. Crystal Beal (they/themme): amazing and when is there a place people can refer patients or clients to the Group sessions that you're going to be doing is that on your website as well?
Bowie Winnike: Yeah, that's also on my website.
Dr. Crystal Beal (they/themme): Super excited. Thank you so much for your time. I hope you have a fabulous day.
