130 | Serving trans and gender-expansive clients during perimenopause with Lasara Firefox Allen

0:00 Hi there, welcome to In the Clinic with Camille. My name is Camille Freeman, and this podcast is for herbalists and nutritionists who are in clinical practice. Today, I am really excited to share with you a short interview I did with LaSara Firefox Allen. Let me just tell you a little bit about LaSara as we head into the interview. So Lissara is a certified menopause doula and coach, an IAoth accredited menopause educator, CEO and founder of Genderqueer Futures, and the author of Genderqueer Menopause, which is a book that I quite enjoyed. They host the Genderqueer Menopause Coach podcast and created the Gender-Affirming Menopause Care Certification for Providers, which you will hear them talk about a little bit at the end of this interview.

0:43 You. So I hope you enjoy this. We're going to put all the links for all the Saris things in the show notes. If you want to stay connected with them, you absolutely can. Otherwise, sit back and enjoy the conversation. All right. I am just so happy to be having this conversation. It took a little doing to overlap our schedules. So, Lissara, I'm so excited to welcome you to In the Clinic with Camille. Now that folks have gotten a little bit of a chance to hear about your background, I know you have some things you wanted to share with us about how we can go beyond just trying to work with the right pronouns for people. Like, yes, that is a great start, but what else as practitioners do we need to be thinking about when it comes to language in our clinical work?

1:25 Yeah, I love this question. It's something that I love talking about. I definitely focus on this extensively in the gender-affirming menopause care certification course that I offer. And I do that because, in my view, using patient-led language is a clinical modality. It's part of trauma-informed care which is one of the pillars that i teach from and it actually allows trans and gender expansive patients to continue with their care, in in scenarios where in other cases they might have left. And and and how how that works basically is if a practitioner, provider, caregiver is centering scientific language over preferred terminology, they are actually potentially increasing dysphoria for that patient, right?

2:23 So if a patient is trans or gender expansive and you are, and they're, let's say, assigned female at birth or born with an ovarian system, and you are using the term vagina, we use the vagina example, which is literally one of my favorite examples because it shows the built-in assumptions and commitment to, one, misogyny, and two, heteronormativity that's built into scientific language. So for those of you who are listening who do not yet know, the Latin for vagina, the term vagina actually means sheets for a sword or scabbard. And to me, what that calls to mind is penetrative. It is the function being, the container, the vessel, like all of these very sort of heteronormative, heterosexist.

3:13 Sexist, and, you know, I personally feel misogynist tropes that are built into quote-unquote scientific terminology, right? And vagina is just one example. You can also talk about, and I talk about this in my books, ad nauseum, but the origin of words like often being like the G-spot, for goodness sake, you know, named after a male, you know, scientist who quote-unquote found the spot. I'm sorry, he did not find the spot. We all found the spot before he did. So why does it bear his name? I know his name and I'm not going to say it because I don't want that to be, the link in your mind. So thinking of the G-spot, people might swap in the goddess spot or the geyser spot or whatever the other terminologies might be.

4:06 But there are other terms for it. There's erythral sponge. There's, you know, there are other terms that are actually scientific that actually mean the thing that we're talking about. So I like to point that out as well. There are scientific terms that are not front-loaded, right? So for the anatomy that we're talking about, for the vagina, for example, the term vagina is very, very, very dysphoria-inducing for a lot of transmasculine folks. Not all, but a lot. And so instead we can say genital anatomy, right? We can say genitourinary system, right? And both of those terms mean different things. And right, genitourinary system, it's a more inclusive term that means more of the geography, right?

4:57 It's still distinct. It's still scientific. It still means what it says. And even more so, right, than vagina does, right? We're using the wrong word for physiology half the time anyway. So that's one example I like to use. To go deeper into sort of the how of it, is what I teach is be in conversation with your patient. Your patient is the expert on their care. They're the expert on their physiology. They're the expert on their body. And they definitely are the expert on the terminology that needs to be used for all of that.

5:37 And so centering the person, so person-centered care is also one of the pillars that I teach from, centering the person is always going to produce better outcomes. Absolutely. So, practical question here for folks who are working on trying to make their language as inclusive as possible. I think for a lot of us, there's a relatively limited amount of actual time together. And so, a lot of times it's helpful and maybe it also gives people a chance to kind of think through it and, so forth. It can be helpful to gather this information on an intake form. Absolutely. So do you recommend kind of fill in the blank for people or do you have choices? How do you how do you navigate that?

6:26 I definitely recommend open-ended, fill-in-the-blank style intake as much as possible. And then the other thing that I really, really underscore extensively throughout my whole course and my other teaching opportunities is, you know, taking accurate notes. So being very clear what the requests are and this includes pronouns and you know if you're if your EHR if your health records don't allow you to override gender which hopefully it does but if it doesn't making it very very clear what this in some way whether it's a you know sticky note, what however your system functions you know there are different like pop-ups that you can use like depending on your system there will be a workaround where every time that that file comes up you you and your staff will be reminded what their pronoun is what their you know preferred terminology for their physiology is if you put that in the note so and, when you know doing your note taking in any regard you.

7:38 You know, you're going to be documenting clearly for the next provider, for your staff, you know, wherever it's needed, you're going to be documenting. What those preferred terminologies and comfortable terminologies are. Yeah, that makes a lot of sense to make sure that it's not just a token of asking, but actually implementing what the information provided in your system. Yes, because that that, you know, like having literally asking the question every time that someone's sitting in the room is not effective. Yeah, it's terrible for you. And it's terrible for them.

8:20 Like it's a time waster and it makes everyone uncomfortable. So, like, as much as possible, yes, intake forms that actually allow people to give their, you know, how they want to be referred to and how they want to be spoken to and how they want to be discussed, you know, things discussed with. And also just making sure, again, that the documentation follows through so that and, you know, when I so in my training, like often it's just the provider who's in the room and they, you know, we can do follow up where I can help them train their staff. I we do an 80 point audit in like week six of the course we do like an 80 point audit of their practice from their socials to their intake to their, you know treatment room protocols to their billing like you know everything where are the gaps where where where are those places that you might inadvertently end up misgendering or using a dead name or you know not using the terminology that's supportive.

9:24 And so we do that kind of audit. And then I do contract with people to help train their whole staff because, you know, one, someone walks into your space, you have a physical space, someone walks into your space, you are not going to be the first person they interface with. So your staff needs to be prepared to support that person just as, you know, just as surely as you do. And so, and that includes, like I said, the billing department. Right, right. All kinds of folks are woven throughout the process. Yeah, amazing. So a question I had asked you before we got on, but I think it might be helpful for other people to hear, so I'm going to re-ask it, is that sometimes when I am giving presentations, just since we're on the topic of language, I will need to present information that has been gathered in a way that, you know, I feel the language might be harmful or at least not in alignment with some or many of the folks who are listening to my presentation.

10:24 For example, they might be like, oh, this, you know, this thing occurs in X percent of men and X percent of women or different cultural or ethnic identities. They might use terms that are, by some people, not preferred terms. So I'm wondering, is there a way to handle this? Because we don't want to just. Change the research because obviously that is what they gathered so there's not we can't really change it after the fact but on the other hand I don't want to perpetuate harm in my presentation, so could you share any strategies you have for how do we kind of navigate that in classes or workshops things like that, yes absolutely and I think this is such a an interesting and important question and one of the things that I see a lot and I and I really would love the opportunity to to help people shift out of this, is where people say at the beginning of our presentation, we understand that people of all genders experience menopause, for example, and then go on to talk about women for two hours.

11:26 Right? No, that's not how you do it. That's not the way, you know, don't acknowledge it if you're not actually going to do it, right? I find myself becoming livid in those spaces as a trans-identified person and as an expert who focuses on inclusive menopause. I find myself becoming livid in those spaces. It's worse in some ways than just not acknowledging it at all. And I know people think they're trying to do the right thing, it's not the right thing. I'm sorry. So that's my little soapbox. What I do and what I think is important to do, because we do have a dearth of research, like there's not enough research on female populations, point blank.

12:12 There's almost no research on trans and gender expansive populations in any regard, except for specifically about gender-affirming care. And even that is limited. We don't have longitudinal studies out yet. We don't have a lot, you know, nothing that goes beyond 25, 30 years at this point, because that, you know, that's how long we've been doing it this way. So, like, you know, there's so much change happening so quickly. It would be great to see some of that actually being backed up by research, but it's not happening yet. The funding isn't there. The specialists aren't there. You know, like the specialists are doing the work. They're not doing the, you know, they're not being pulled to the side to do the research projects.

13:00 And they should be funded. They should be recruited, absolutely, to be doing those research studies concurrently. Ideally, research is done by the population that it impacts. That's the best practices model. And it is happening little by little. I presented at the UCSF Trans Health Summit in 25. And I met so many trans researchers there. And it was such a balm to my soul, honestly, to see a bunch of young folks, young trans folks going into research. Just amazing. So it will be coming, just maybe a little bit down the road.

13:44 That said, when I'm writing an article, when I'm writing a book, when I'm citing things in my workshops or my courses, I will say at the beginning of presenting on a thing, this research did not include our population, or this research did not include X population, whatever population it might be. Therefore, the language is limited to the sample that was used. In this case, that is, you know, A and C, right? B was absolutely not taken into the picture, right? Yeah. That said, this is the research that we have to rely on.

14:26 And so I'm using the research with the assumption that some of this may carry over to our population. While research has not yet backed that up, this is the only sample that we have to work with. Right the other thing that i do is i have like a four-year guideline in my own like my personal i have my own style guide at this point right for my own work so i have a four-year guideline for studies, except in the case of trans and gender expansive populations i will use any study, from any time period for our population because there's so little research and i do note that In my, you know, generally speaking, I note that in my bibliography at the end, I'll say, you know, these are my guidelines for how I use research.

15:15 You can't kick out a 15-year-old study on trans health when there's no two-year-old study on trans health, you know. So that is how I do it. And also another thing that I do in my bibliography is I always say, you know, for those of you who are getting ready to chase down the source materials, like these, the majority of these studies are not gender affirming. So be forward, right? Because if someone is trans, and they're going to look for information on menopause, and they're going to read, you know, eight studies, and, you know, seven of them are about cis women, you know, I don't want them to come out of that feeling harm.

16:00 Right. Yeah, that makes a lot of sense. Amazing. Thank you for these tips. I feel like these are just small, practical things that people can start implementing. And I know for many people, it's a journey to just do these little things one at a time to try to, you know, try to make their practice a little bit more inclusive as they go, step by step, piece by piece. But I know you also have additional resources for folks who are maybe ready to go a little bit faster than just a teeny step by teeny step by teeny step. Do you want to share a little bit about your upcoming program that's, I think it's happening in just a few weeks, if I'm not myself? Yes, it is. It is. Yeah. Thank you for asking. So my gender-affirming menopause care certification course, which is the only one of its kind, and it is accredited through International Association of Therapists.

16:51 We're very thankful to have their accreditation. I'm also going to be offering some CEs for the course starting with this iteration. So not all the material, but some of the material will be CE accredited. And so that course is starting November 17th. The next iteration is starting November 17th. We go over everything. It's an eight-week bonus ninth-week course. And like I said, we do an 80-point audit. But that's kind of toward the end. We start where you are. We start where you are. And every step toward growth is going to be helpful, for the population you're hoping to center and serve.

17:37 I also help with like messaging, like how do you let people know that you're available to the population? We also talk about safer spaces. We talk about like one of the things that I like to say is there's always something that's within reach. And one of the examples that I like to use in that regard is bathroom access. So I just ask, if you have a physical space, is your bathroom accessible? And what I mean by accessible is, you know, are folks who are otherwise abled accessible? And is it accessible to trans and gender expensive folks? If I walk toward your bathroom, am I going to have to make a selection between male and female?

18:19 If it is still binarist, can you take down the signage and put up gender neutral signage? Because in a lot of cases, that's all it takes. You can actually get signs that have gender-neutral bathroom urinal, gender-neutral bathroom stalls. You can get those signs. People can go into whichever they feel comfortable in knowing it's a gender-neutral bathroom. And then if you can't do that, because some people cannot do that, right? If you can't take down the signage and put up inclusive signage, can you, at minimum, make sure that there are menstrual and safer sex supplies in every stall?

18:59 Every stall, right? And every stall because if someone is stealth, if someone's passing as masculine and doesn't want to be outed, they do not want to go to the, machine, they don't want to go to the counter, they want to be in their stall and have access to the supplies that they need. Little measures like that are going to make a huge yield. And so I teach it all from where are you starting, where do you want to end up, and how do we close that gap? And, you know, just like today's material, focus on, you know, person-centered care, trauma-informed care, which is essential with a trans and gender-expensive population, and gender-affirming care. Those are the three pillars that we teach from.

19:41 I also have amazing guest instructors who come in who are all graduates of the course. We teach a prescribing unit and we teach that prescribing unit as a spectrum, not a binary. So menopausal hormone therapy to gender affirming hormone therapy as a spectrum, not a binary. I love that. Just a couple of follow-up questions about this from maybe two different perspectives. One is, if somebody is, you know, maybe like interested sort of academically, but it's like, I don't really know a lot of people in this population. Maybe I should step aside and let people who are part of this population be the practitioners. How do you approach, like, what might you say to folks who are like, oh, you know, like, maybe I'm not qualified to step in here and do this. That's right.

20:26 I hear that. And I would say, one, there are not enough trans and gender expansive providers to offer care to our whole community. There just aren't. And there aren't enough trans and gender expansive specialists. There aren't enough, you know, GPs. Like, I have had one gender expansive healthcare provider in my life. And they were a pelvic floor PT. And I thank, the, the, you know, the powers that be daily, that they were gender expansive, because it really did change my relationship with, with, you know, that, that modality. Pelvic floor PT with someone who was cis would have been a very, very different experience. I'm super grateful that I got to have that experience.

21:13 And pelvic floor PT with someone cis would have been better than none at all. Especially if they were an ally who had taken the time to learn how to offer care that made sense to me as a trans and gender expansive person. So we welcome allies. We welcome folks who are not trans or cis or not trans or gender expansive and are cis identified. Absolutely. And I also like to point out, like. Gender is a spectrum. And the gender journey, as far as I'm concerned, you know, like I like to say, I hope that by the time that I die, I'm still on my deathbed asking what's next.

21:57 You know, that's how I feel about gender, too. Like, what's next? I'm not static, and no one needs to be. And, you know, just because you're cis identified doesn't mean that you don't have some relationship with your gender that might be more fluid. And, you know, stay open to the possibility. Who knows what this training will do to your own. And we do a lot of deep personal work in the training too around identity. Not specifically around your identity, but around the concept of gender and identity in general. And I do have people coming out of the course with a different relationship, with gender as a concept. And so that's been amazing. And I do have people coming out of the course who are still absolutely 100% cis-identified, who are some of the strongest, bravest, loudest allies, that I have ever seen.

22:52 I invite people to check out Dr. Claire Phipps, who is a GP from the UK. She's a graduate of my course, and she's an absolute, absolute champion. Love it. Amazing. And then I assume this course is also great for folks maybe who are trans-identified and maybe do already have like quite a bit of experience. It sounds like there's still things for those folks to learn as well. Is that fair to say? Yes, 100%. I do. For those of us who are community members, and I have grants available, trans folks on average make less than cis people. So I do have grants available for trans folks who want to take the course who can't afford the full amount.

23:37 And for trans, BIPOC, you know, and anyone who falls outside of that narrow spectrum and needs the assistance, they can absolutely apply for a grant. And there is definitely a lot to learn. If you specialize in gender-affirming care, this will teach you more about, how menopause is different for trans and gender-expansive populations than for cis people, and there are a lot of ways that it's different. If you specialize in menopause care, this will teach you how to apply gender-inclusive, not just terminologies, but mentalities and foundations to the work that you do.

24:20 So, you know, it's open to folks who are interested in gender affirming care, folks who are interested in menopause care. And regardless, even if you're not specializing, if you specialize in a, like an older adult population, if you specialize in queer populations, I want to say too, if you specialize in queer populations, and you think you don't need menopause training, you are wrong because we can enter menopause at 22. You and I talked before the podcast started about gender-affirming surgery and how that can actually induce surgical menopause at any age, right?

25:01 Chemical menopause is also a thing that can happen. Gender expansive and trans folks can experience menopause-like experiences more than once in our gender trajectory due to chemical suppression of estrogen. Like there are a lot of ways that it's different for us. So, you know, if you, if you do not know, you know, you just don't, you don't know what you're missing. And I invite everyone to, to come and check it out. If you have any questions, please reach out to me personally and myself or my assistant will get back to you. And, you know, if it's something that, that I, that I can help you to understand about the course, please reach out to me and we'll get back to you.

25:43 I had something else, which was just about wanting folks to know that it doesn't matter where you're starting. You can start exactly where you are. And, you know, at times, you know, when you did the 80 point audit, you might be like, oh, what the actual, you know, but there's always something within reach. Exactly. I love that. If somebody happens to be listening to this after the fact, or maybe right now is not the time, is there a way they can stay in touch and maybe find out the next time you're running this course or just going to stay in connection beyond the thing? Absolutely. There are a ton of ways folks can stay in touch. I'm very active on the socials.

26:27 I try to stay really, really engaged on Instagram, trying to be better on TikTok, although that's a lot. And so meta, as terrible as meta is, I am active on the meta platform. So that includes Facebook and Instagram. Again, TikTok, LinkedIn is great. Also, I do have a newsletter. I would love it if you signed up for my newsletter. I don't send out a whole ton of emails, but I do send out emails when they're important and when there's something going on that I want you to know about. So if you're thinking now is not the time, but you'd like to later, then the newsletter is a great way to do that. Or, you know, definitely Instagram if you're active on there. I'm very active on Instagram.

27:13 Great. And we'll get these links into the show notes along with the link to sign up for the course if now is the time and this sounds like something you could use in your life. Amazing. Lissara, thank you so much for coming on here and also for just doing this work. It's so great to have this resource out there for people who are ready to... Keep growing as practitioners. Yes, it's a delight. And, you know, honestly, like, I feel so passionate about being able to help close this gap as a trans and gender expansive person, but also as an activist and advocate. This work is my whole life at this point. Yeah. Yeah. It's amazing. Well, thank you. I hope the course goes really well. And we can't wait to have you next year as part of the Perimenopause Deep Dive. So I'll see you then, if not before.

28:03 Yes, amazing. Thank you so much for having me today, Camille. It's been great. You're welcome.