I am a retired RN. I am also a transgender woman. I lived the first 60 years of my life in the role of a man. Transgender folks face some very interesting challenges in life, and navigating the healthcare system can be one of them.

Common reasons for anyone to avoid a healthcare professional include fear and anxiety, and for the transgender person these are turned up a notch or two. For the healthcare system to reach this part of the population, we need to understand the nature of the obstacles they face and take measures to reduce those obstacles.

While I cannot speak for all transgender people, I can explain my own experience. I have passed through some fairly distinct phases. For most of my life I was totally closeted, even from myself. I denied my situation and relegated it to being a horrible secret that I never could let anyone know.

When I first began to explore the truth of my identity, I questioned everything I thought I was. I was questioning my internal knowledge of myself and the lack of congruency with my anatomy. I hated the idea that I might be transgender.

During a period of about a year, I came to terms with those feelings and realized I had no control over my identity. It was what it was. I did have control over my hormonal physiology, and there were surgical options to bring my anatomy into alignment. I set out to get my physiology to match my identity as closely as possible.

The period of my social transition was not pleasant. It was riddled with rejection, judgment, people arguing with me about who I am, and the loss of friends and loved ones. One of the most troubling aspects of that experience was that I could not take the actions I knew were right without being evaluated first by psychologists and then by medical professionals to determine whether I was capable of knowing who I am.

Then there was the general public. Most of the people I told were neutral on the issue of my being transgender, some were supportive and a few chose not to be a part of my life anymore. There is a contingent of society that is hateful and bigoted. My experience is this group is small but vocal. The most effective method I have found for dealing with these people is to avoid them and try to ignore them when they are unavoidable.

I now am living my life as the woman I am. I still have an anatomical anomaly, but the public doesn’t see it, making the problem easy to conceal — except when I need to deal with the healthcare system. Doctor’s visits and hospital procedures require me to disrobe, and then I no longer can conceal my anatomy. Anticipating a visit creates a high level of anxiety for me, even though all of my personal experiences with health professionals so far have been good.

I recently needed to have a colonoscopy. I have had a number of these through the years, but this was the first since I began my transition. To say I was nervous would be a gross understatement, even though my nursing career helps me understand the health system. I can only imagine how a transgender person who is ignorant of the system would react.

My contact with the hospital, Waterbury Hospital in Waterbury, Conn., was reassuring starting with the first phone call to the preregistration department. The lady I spoke with asked about the difference in my name now and the name she saw on my medical records. She was respectful and accepting, and did not challenge me at all. Her sensitivity helped greatly in reducing my anxiety.

Upon arriving at the hospital I was greeted by the receptionist, who immediately knew who I was when I gave my name. She asked me to have a seat and then said, "Let me have your driver’s license so I can fax a copy to the registration office, and then they can update your medical records with your new name." After she took my information she put an ID bracelet on my wrist. I looked at it and saw the F for gender, and a lot of my anxiety melted away.

My nurse was professional and caring and made me feel totally comfortable. My name was used, and I was referred to with female pronouns. At one point I asked my nurse, "How many transgender patients do you see in a year?" I was impressed with the sensitivity I was seeing in the hospital staff and thought they must care for many transgender people. She replied, "About three or four a year," not a large number at all. The hospital staff really was attuned to their patients, even the different ones.

The transgender experience involves internal identity. It is grounded in an individual’s perception of self, and as such it is beyond review from anyone but the individual. In simple terms, it is who people are inside themselves. The most effective thing a nurse can do to help a transgender person feel more comfortable is to talk to the person and not to his or her anatomy. •