The World Was Not Built for Us: Improving Access to Care for Transgender Youth

* Abbreviation: LGBTQ — : lesbian, gay, bisexual, transgender, and queer > In our November issue, we shared with you the winning submission to our annual essay contest—this year focusing on access to care—by Dr Michael Mattiucci. We are pleased to publish the other competition finalist, written by Drs Sarah Bernstein and Holly Lewis. Bernstein and Lewis's essay explores another aspect of access to care. They argue that "access" is not just about helping to get patients through the door, but about providing culturally-sensitive and affirming care. The authors conclude by offering up several practical suggestions that can help providers to create office and hospital environments where all patients—particularly those who identify as LGBTQ—feel welcome and supported. Expelling a heavy breath, Emily discarded the plush towel clinging to her waist and pressed her toes into the icy tile. Inhaling the sterile scent of Lysol, she shifted awkwardly in front of the mirror; staring down at her scrotum, she tried to reconcile what she saw externally with what she knew internally. “Brian! Hurry up!” her father shouted. Glancing around the bathroom, she noted that everything was intentionally blue and deliberately masculine. Despondent, she conjured the image of Picasso’s Old Guitarist, the disjointed figure, the loneliness, and the despair. It would be several years before she would learn the words “queer” or “transgender” and longer still before she was able to fully claim her identity. During that time, she would struggle with isolation, depression, alcohol addiction, and drug abuse. Sitting solemnly in clinic, staring at the thick scars of self-harm etched into her forearms, Emily looked up at me and sighed, “Had just 1 doctor … Address correspondence to Sarah M. Bernstein, MD, MHA, Department of Pediatrics, Children’s Hospital at University of Illinois, 840 S. Wood, Room 1421, MC 856, Chicago, IL 60612. E-mail: sarahbernsteinmd{at}gmail.com