Providing compassionate care as a gender clinician.

In my family practice, I take care of people rather than ideology. I greet the patient and ask, “What concerns do you have?” I listen and ask a clear question. I ask about each patient’s biological, psychological and social situation. I look into their bodies. I look back at the stories I have heard and reveal the hidden truths within them.

A few years ago, Bella, a six-year-old girl, visited my office with her mother. She requested to speak to me on her own.

“What concerns do you have?” asked Bella.

“I’m here to help my mother,” she said. “She struggles with my gender. When I was born, my mother thought I was a boy because I had a penis. I’m not a boy. I’m a girl.

“Are you upset?” I asked.

“No. Well, yes, but when my mother is upset. And when the police came. I didn’t like it.”

“How do you know you’re a girl?” I asked. Bella seemed to shruggle in surprise. “Because I know! I’ve always been a girl,” she met my gaze. “You look like one too. What about you?”

I nodded. “What do you do? you Did you know you’re a girl? ” she asked.

As a cisgender woman, I don’t know You can feel that you are experiencing gender discomfort. Also, I don’t know how I feel about being 90 years old or working in a wheelchair. I don’t have a diabetic or pig valve in my heart. I have had experience worrying about my children, but they have been adopted. I don’t know what I feel pregnant or what it’s like to bring a child like Bella into the world.

it doesn’t matter. I can still be a doctor. When they tell me about their experiences, I listen and trust my patients.

When I spoke to Bella and her mother, I learned that child protection services, not police, had visited Bella’s home. One of Bella’s kindergarten teachers had reported their mother to “dress her son at school.”

“It was causing problems,” the teacher said. “Even other children think he is a girl.” Child Protective Services threatened to take Bella away from her mother.

“I can’t wear her boy’s clothes,” Bella’s mother said.

“She breaks down. She refuses to leave the house. She knows who she is. Tears fill her eyes. “I love my child. How can I help her survive in this dangerous world?”

When I started caring for transgender patients, I read as much as I could about gender. I have discovered that sexual and gender diversity thrives in the animal kingdom. This is an area rich in biological rainbows that block the classification of creatures into clear male and female categories.

In her book Evolution RainbowJoan Roughgarden describes bullfrogs that show two male genders. There are big sexes that you call at night, and small sexes that stay silent. Bluehead Wrasse (a type of fish) has three genders, one that starts as a woman and transitions to males, causing sexual change due to changes in ecosystems or social dynamics. Sunfish have three male shapes and one female. Male Sunangel Hummingbirds exhibit feminine feathers over a range. Female spotted hyenas mating and giving birth through penis canal. 16% of kangaroo rats are intersex and have both sperm and egg-related parts within a single individual. All female species of whiptail lizards do not require men. They are engaged in clones or asexual reproduction. This process involves elaborate same-sex courtship and genital contact. I recall a pair of male penguins who hatched their chicks. I stare at my gorgeous seahorse father and make their young man pregnant.

These creatures do not encounter stigma. In their world, diversity is simply what it is. That’s normal. Given the mysterious mixture within animal species, is it surprising that humans also exhibit gender diversity?

Transgender individuals have lived in our world since ancient times. They existed long before Trump was born and will continue to thrive beyond his midterm. Trans adults often share stories like Bella, expressing that they felt something was different from their younger ages. They felt a disconnect between their inner self and their bodies. They describe pain as always present and embarrassing, making it difficult to function and connect with others in meaningful ways. “I am not introducing myself,” they reveal despair caused by social stigma. Trans people experience high rates of depression, substance abuse, risk-taking behaviors and suicide. Along with treatment, gender discomfort may be reduced or resolved.

As a doctor, how can I provide life-saving treatment to those who are looking for my care?

On January 20th, Donald Trump said, “The ideologue denies the biological reality of sex has signed an executive order insisting that men allow themselves to self-identify as women. [depriving them women] Order outlines the policy that the US government declares that it recognizes only two genders: male and female. These are based on an unchanged, fundamental and indisputable reality. Working as her true self, it overlooks the safety of imprisoned trans women, and they must live like men.

My friend asked if I was afraid after reading Trump’s executive order. I feel frightened.

I’m worried about the safety of Bella. She is currently at university and is pursuing a degree in neuroscience. Bella was taken care of at the onset of adolescence. She is not visibly a trans person and will not be “clocked” in the girl’s bathroom. But Bella is thriving as Bella’s mother stood by her side. She goes out and she is proud to be a trans woman.

Does anyone hurt Bella? My Texas colleague is worried. She is facing a lawsuit led by Texas Attorney General Ken Paxton for following the same evidence-based treatment guidelines used by clinicians around the world. We are worried that hospitals will not be able to support our programs as federal funds are lost and clinics are closed.

Trump’s executive order fails to recognize the undeniable fact that gender is complicated. Like our families, our neighbors, our educators, our religious leaders, our elected officials, our mail carriers, we exist with us, with us. How can I know? Because I am their family doctor. I listen to their truth, provide medically necessary treatment, and witness their journey to wholeness. I am breathless watching them bloom and bloom.

It was the most incredible privilege of my career to witness this way. And at the end of the day, do you ask yourself how I live my truth? Was I the real thing?

Many people have tried to change the gender identity of others, but none have succeeded. Gender diversity is normal. Humans share this incredible truth with the animal kingdom. You cannot erase trans people, but you can choose how you respond to their joys, sufferings, and human experiences.

I denounce Trump’s executive order aimed at restoring “biological truths” about gender. They will inject hatred into our already broken country and hurt those I care about and love. My role as a doctor is clear. I choose respect and compassion. I will follow the pledge of the World Medical Association. I Dedicate my life to the service of humanity and maintain the health and happiness of my patients as my first consideration. I pledge to make the world of Belas safer. I’ll support you when Bella becomes a neuroscientist.

You are also facing a choice. How do you choose to respond?

Dr. Carolyn Wolf Gould He is the founder of the Bassett Healthcare Network’s Gender Wellness Center, a rural-based, interdisciplinary center for transhealth in upstate New York. She attended Yale University School of Medicine and completed a family practice residency at the University of Rochester. She is a co-editor and contributed to the history of transgender medicine in the United States, from margins published by SUNY Press in February 2025 to mainstream.

voice Dedicated to featuring a wide range of moving personal stories and impactful opinions from LGBTQ+ and alliance communities. visit advocate.com/submit For more information about submission guidelines. We welcome feedback on your thoughts and our stories. Please email voices@equalpride.com. The views expressed in Voices Stories are those of guest writers, columnists and editors and do not directly represent the views of EqualPride, a supporter or parent company.