Dr. Minghao Liu, a New York physician who specializes in LGBTQ healthcare, recently appeared on Today. She now joins Shades of Long Island for a discussion of her work. She works at Northwell Health in New York City and serves as director for the tri-state Gerald J. Friedman Transgender Program for Health & Wellness.
We spoke with Dr. Liu, referred by The LGBT Network of Long Island, about LGBTQ healthcare in New York and Long Island. Dr. Liu, an endocrinologist, spoke with me about LGBTQ healthcare, its relationship to primary healthcare, and how stress impacts LGBTQ people’s health.
Can you tell us a little bit about the Friedman Program?
Sure! So the Friedman Program was founded in 2016 by Dr. Leonid Poretsky, who’s the chief of the undercurrent division at Lenox Hill Hospital, which is a hospital within the larger Northwell Health system. So our main locations at Suite 8B within the endocrine division, so general under print patients come to the site, but we also do have specific space for transgender people. So I’m the medical director of the program.
People who see me specifically are seeing me for hormone [replacement] therapy, for gender affirmation. But we definitely have partners in the Northwest healthcare system who do primary care, who do HIV prevention and treatment, gender-affirming surgery, voice training, and vocal cord surgery. So I think we have pretty much all of the medical provider bases covered for transgender care and for LGBT care as well.
And so the advantage of being part of a larger healthcare system is that we all have the same medical record. So that anything that I write, any tests that I order, all the other doctors in the system that I refer to or who refer to me, can see the results in the notes. So it’s very nice and centralized.
And our coordinator, who is a fantastic person, who does a lot of outreach, making appointments, and community relationships is Deeangelys Colon.
It seems that something that people ignore regarding LGBTQ healthcare is how much it’s in dialogue with primary care.
Absolutely. I’m an endocrinologist, which means that I first did training in internal medicine and primary care. So I think a lot of people really underestimate the value of primary care. So I think everybody should have a primary care doctor, even if you regard yourself as pretty healthy, who never needs to go to the hospital to see a doctor. Because there’s a point person who can refer you to different things. But also preventative care is important too. So people of all ages should be undergoing preventative care or at least have the opportunity to get that.
Yeah, I actually just watched an interview you did with the Today show a little while ago. I believe you said something along the lines of what was it? Care is prevention.
Yeah, the best medicine is prevention.
There you go.
They tell us that a lot in medical training.
In terms of LGBTQ healthcare, what is prevention? What does that entail?
That’s a great question. So specifically in men who have sex with men, a lot of people are eligible for PReP, which is HIV prevention with antiretroviral. That’s a big part of it. And then people who are assigned female at birth and still have that anatomy should be undergoing regular pap smears.
And right now we’re kind of talking about sort of people of all ages, but as people age, there’s also recommendations for people getting mammograms, for those who are assigned female at birth and still have their own breasts, and as well as other screening that may be tailored specifically to people who have male organs, like prostate cancer screening and things like that. And then for our younger population, vaccinations are very important.
STI screenings, including HIV, syphilis, gonorrhea, and chlamydia for people who engage in sexual activity or sex workers, are very important as well.
In terms of stress faced by LGBTQ folks, like, say, the more-than-150 anti-trans laws introduced this year, or say, prevalence of suicide, poverty amongst a trans people, sex workers, that sort of thing. Do you find that has a significant medical impact?
Absolutely. So I think the collective trauma and individual trauma has a huge impact on somebody’s mental health, which then translates into their physical health as well, often. So I have a lot of transgender patients, especially trans feminine patients, who are literally afraid every day of their lives because they’re coming across these very traumatic encounters. They’re getting clocked, they’re getting verbally and physically assaulted on the subways and outside.
To paraphrase what one of my patients has said, this used to be a pretty high functioning individual. And so she told me that when she has these kinds of encounters, she would be grateful if it was just a verbal and not also a physical encounter, which I think is a horrible, horrible strain to live under.
So all of this sustained stress, this mental stress, this emotional trauma, perhaps physical trauma, definitely has an impact on physical well being as well because people who have sustained high cortisol levels can have high blood pressure. They can be more at risk of developing diabetes. They can gain weight depending on how they deal with stress. So everything’s very interconnected.
Yeah, I hear that as a transfeminine person whose family is genetically predisposed to hypertension and heart issues. Sometimes I find myself walking into a city and going, is this going to give me a heart attack? In terms of access to care for these conditions, how difficult or how easy is it for people, particularly marginalized people, to get this kind of care?
I actually think it’s kind of hard to get mental healthcare in the U.S. In general for everyone, especially for marginalized people. And that’s definitely something that our healthcare system needs to fix. Because there’s so much demand and so little supply, that can be a huge challenge. For somebody who’s not familiar with the healthcare system, just searching for those resources is very difficult as well. Knowing how to find a reputable person who fits their needs.
We definitely have great community partners who have expertise in treating transgender people and LGBTQ+ people, but you kind of need to know how to look for that. In addition, another major barrier is insurance. So a lot of mental health is not covered by insurance, which is such a huge problem in our healthcare system because so many people need it and then people end up having to pay out of pocket, which is not affordable for most people, actually.
Yeah, I was going to ask about the insurance next so you got me there. How does Friedman deal with insurance? You’ve worked with uninsured patients before. Is that something that Friedman and Northwell look at?
Absolutely. We take a great variety of insurances: medicaid, Medicare, private insurance. And for people who don’t have insurance, we definitely have self-pay available. Laboratory blood work can be discounted as well for people who are self-pay.
Calling back to something else you mentioned about how most people don’t know how to look for these resources: how can they start?
That’s a great question. You can go to a website like Zocdoc and they actually have a filter where you can go to a page and search for LGBTQ+ providers. GLMA, which used to stand for the Gay and Lesbian Medical Association is an association of doctors and other medical providers. They also have a free directory on which people can search for LGBTQ+.
The New York City Controller’s Office actually publishes a guide to services and resources for LGBTQ+ people every year. That lists healthcare providers as well as other resources, like mental health services for people who are homeless. That’s a good official local resource.
In addition, I think knowing how to put in smart Google terms like “LGBTQ+ clinic,” a sliding scale if you’re self-pay. In addition, there’s Facebook groups for people, and also for Pride, where you can get referrals. That’s a little bit more authentic because they’re getting referrals from people in the same community who have experience with providers.
It’s funny. Scratch a trans person and you find several online groups.
Yeah, exactly. I think that online community is helpful logistically and practically, and obviously also in terms of building community for people who are often marginalized and a lot of whom are afraid to spend time outdoors due to trauma and targeting.
Over time, have you seen a trend of improvement or decline for trans healthcare?
I think as a country, we’re becoming more aware of these issues. Certain areas are becoming more accepting, although you know certain states are not, obviously.
I am optimistic, though I think slow changes have been made in the past few years. There’s also obviously been states where many, many restrictions on providing care for transgender people have been placed.
For example, Texas investigating the families of trans children.
Absolutely. So I think it’s mostly been stable, but I do have hope for the future.
For trans people reading this article, what would you like them to hear? Additionally, what should non-trans readers know?
Sure. I think specifically for trans people: feel empowered. You are deserving of the best care. Go out there, find a medical doctor or provider that suits your needs, and if the encounter is negative, don’t give up. We are there for you. Our contact info for Friedman is on our website.
Just letting them know there are allies for trans people out there, and that we as medical providers care a great deal about this population. We’re trying to do our best. Sometimes there’s going to be hiccups. We’re definitely aiming not to misgender anyone — or at least I can say for myself and my clinic that our intentions are good
For non-transgender people – that’s a good question. I guess if we’re going from a medical point of view, if they do work in healthcare, I highly encourage them to do the training for dealing respectfully with transgender and LGBTQ+ people.
Also, just out in the community, provide support for your transgender neighbors and LGBTQ+ people in the community. These assaults and instances and even microaggressions happen everyday. Don’t be silent. Help out. Show your solidarity. That’s the best thing you can do for your fellow humans.
Thank you, Dr. Liu. It’s lovely to talk to a cisgender person who knows the word “clocked.”
[laughs] Like I said, we try, and hopefully, we’re in touch.