Caring for Transgender Patients

A conversation with Paula Neira, as told to Alex Bowers

Published in Dome - June 2015

Nurse educator Paula Neira brings an unusually rich portfolio of experiences to her job overseeing new nurse orientation, coordinating in-service training and tracking required regulatory instruction in the Emergency Department. Before she made the decision to transition, accepting that her gender was different from the one assigned to her when she was born, Neira graduated from the U.S. Naval Academy and served as an officer in the 1991 Gulf War. After leaving the military, she became a registered nurse and then pursued a law degree. A nationally recognized expert on LGBT military issues and transgender military service in the United States, she helped lead the efforts to repeal the “don’t ask, don’t tell” policy and serves as an advocate for the transgender population.

In March, she hosted a webinar titled “Caring for Transgender Patients: Raising Awareness in the Health Care Environment” for the Institute of Johns Hopkins Nursing. Neira recently discussed transgender awareness and health care issues.

What exactly does transgender mean?

Transgender, a word coined in the 1970s, is an umbrella term that describes individuals whose gender identity — how they perceive themselves — is different than the gender they were assigned at birth. Transgender people may also include some who may not identify themselves exclusively as either male or female.

When did you decide to transition?

I had my first conversation about my gender with my mom when I was 11. She freaked out, so we did not discuss it again for a long time. The next significant conversation was in my early 20s, in the middle of my time at the Naval Academy. I love the Navy — it was my calling — and I went on to serve in Operation Desert Storm. The hardest thing I’ve ever done was to leave the Navy, but I made the decision that I had to transition. Once I left, I started going through the process of changing my name legally and living as a female.

You’re a former naval officer, a lawyer, a nurse and advocate for the transgender population. What motivated you to follow such an unusual career path?

I was raised and educated with the belief that “To whom much is given, much is expected.” A Jesuit high school and the Navy both reinforced this concept. This background also gave me the moral courage, tenacity and resilience to deal with the challenges of transition. Later, what eventually got me to nursing school was the discrimination I faced in civilian employment. Job offers disappeared once the employers looked at my background. I’ve never had an issue with discrimination in nursing.

Do transgender people have special health care needs?

Appropriate medical care can vary widely for people who are actively transitioning. The standard of care has several components — hormone therapy, psychological therapy and surgery — and some combination of that will apply. After transition, transgender patients will have some health needs that are legacies of their gender at birth. For example, even though I had gender-confirming surgery, I may still need to have my PSA (prostate-specific antigen) levels checked as I age.

What advice do you have for staff members who work with transgender patients?

If you don’t know what name or pronoun to use, ask. Say: “I’d like to interact with you respectfully. What pronoun would you like me to use? What name would you like me to use?” Then use the ones they give you. Secondly, meet your patient where he or she is. Some transgender people will be questioning their gender identity and will not have begun transitioning. Some will be actively in transition. Then there are people like me, who transitioned 20 years ago. Now it’s a part of my medical history.