Evelyn Carroll, MD, had planned on coming out as a transgender woman to her colleagues at the Mayo Clinic for the better part of a year. She was understandably nervous about it. Her fear that she couldn't be a doctor if she was trans was a major reason why she had hidden her identity from others — and even herself — for most of her life.
The radiology resident had already told her program directors and some of her closest co-residents that she was a woman, but she still presented as a man at work. She hated it. In the summer of 2020, she could wait no longer. On a Friday afternoon, she sent out a broad email to her radiology colleagues introducing herself with her new name, new pronouns, and new identity. She braced for the reaction.
When responses poured in, Carroll was overwhelmed by the support she received. "I cried so much. I was so happy," she says. "It was such an emotional overload for me." Carroll took several days off for Mayo Clinic's system to update with her new information.
When she came back, she finally presented as her authentic self at work. She documented her return on Twitter, and her post went viral. She received some support from strangers, but she also got hateful messages from transphobic trolls.
A few days later, without her knowledge or consent, publications began writing about her experience, publicizing the personal moment. The spotlight stressed Carroll out. She called her sister and cried again. This time, not out of happiness. She felt as if she had lost control of her own transition.
At work, things went much better. "The beauty of the day was that it was actually pretty uneventful," she says. "It was like any other day, except people were referring to me as my affirmed name and pronouns."
Self-Acceptance and "Death by 1000 Cuts"
Although Carroll experienced feelings of gender incongruence at a young age, she didn't have the language to understand and share her own feelings. She liked playing dress-up with her sister, but after being scolded by her parents for doing so, she shoved those feelings aside. In high school in the mid-2000s, she heard the word "transgender" for the first time in health class. Although many trans people express relief when they finally put a name to the gender dysphoria they have felt, when Carroll realized that the word applied to her, she panicked at the potential implications.
"I wanted to be a physician. I was a really good student, and I thought it was going to ruin my life, potentially, if I came out as transgender," she says. For many years, she kept her revelation to herself, afraid that it would ruin her social life and future career. "I essentially suppressed my gender identity moving forward for many years and developed a lot of self-loathing."
When those feelings became too much to bear, she started seeing a gender therapist. By that time, she was already a resident at Mayo Clinic. Soon, she reached a new level of self-acceptance and began to consider the idea of coming out.
In late 2019 and early 2020, Carroll came out to her family and close friends. Her parents, although loving, struggled with accepting her. Her friends, many of whom are her co-residents, were much more understanding. She told them about her true gender by showing up at a dinner party presenting as a woman. There, she explained that she was starting to transition.
"I think we were all surprised. But we were all happy for her," says Alicia Chen, MD, one of Carroll's co-resident friends. "It was a really nice moment for all of us. And I'm happy she felt comfortable sharing with us."
Around that time, Carroll also told her program directors so they could help her prepare to transition at work in June. She needed the time to get ready mentally, to work through logistics with human resources, and to buy a new wardrobe, which can be both expensive and time-consuming. Luckily, Carroll didn't have to pretend to be a man that whole time.
In February 2020, she left Minnesota for a four-week radiology conference in Washington, DC. Other than a few co-residents she had already come out to, she didn't know anyone at the conference. It was a unique "dream situation" that allowed her to spend a few weeks living fully as a woman for the first time before coming out at work. "It was such an amazing month because I was living my authentic life. And it was so freeing," she says. Then she returned home and had to go back into the closet. "I was devastated. Like, how am I going to live going to work as a male for three or four more months?"
To her knowledge, Carroll is the first resident to come out as transgender and transition at the Mayo Clinic. She worked with her program directors and a diversity and inclusion officer to figure out how to make it happen. The clinic did have a gender transition toolkit, which includes guidelines, policies, and procedures that they used to create a plan.
The process was mostly smooth. Still, Carroll did face some hiccups along the way. For example, she had trouble legally changing her name to Evelyn because the COVID-19 pandemic shut down the courts. Without a legal name change, Mayo Clinic couldn't update her email address. That was a problem because it included her "deadname," the traditionally male name she was assigned at birth. It took about a month to fix the issue.
After coming out, everyone in the radiology department was positive, Carroll says. Although no one said anything explicitly rude or offensive, some peers did slip up on her name and pronouns. "Being misgendered is like death by 1000 cuts," she explains. "One little misgendering doesn't hurt too much. But it accumulates and it wears you down mentally after a while." As a nonconfrontational person, she found it difficult to correct her colleagues, so she sometimes ignored the mistakes. Eventually, she had to learn how to remind them in a way that wouldn't cause a scene.
Because Carroll specializes in radiology, she doesn't practice much longitudinal care with patients. She didn't have to see the same patients before and after her transition, so she didn't have to explain being transgender. With new patients, it's hard for her to tell if they can gauge whether she's trans or not. She says she hasn't faced any issues. Being a woman is just part of her usual routine now. She doesn't have to think about her gender at work. That's just how she likes it.
Transitioning During Medical Training
Coming out during medical training presented some inherent challenges. Both residency and transitioning take up enormous amounts of time and energy. Doing them at the same time was tough. She saw two therapists, an endocrinologist, and had other medical appointments to boot. Like all residents, she worked long hours — but at least she wasn't in surgery, she says. Fortunately, her residency program let her leave for an hour or two at a time to get the care she needed.
Although Carroll has a better understanding of the medical system than most, even she has had difficulty with the logistics of her transition. For example, Carroll wants to use a specific doctor for a gender-affirming surgery, but her insurance company is balking at her choice of an out-of-network doctor. If they won't cover the procedure, it could cost tens of thousands of dollars out of pocket, a price she can't afford. "Even though I am a physician and understand the way this works, I'm emotionally and mentally exhausted," she says. "And I've barely even started."
Carroll has also been asked to perform a lot of time-consuming invisible emotional labor. After her post about coming out went viral, she gained a following on social media. On the one hand, it has allowed her to connect with other trans doctors. On the other, she gets many requests from people on Twitter who want her opinion or help, which can be overwhelming given her responsibilities during medical training. She has been asked to give talks and join boards, but her demanding schedule and emotional exhaustion have made such things difficult.
Carroll does enjoy advocacy work and hopes to steer her career toward helping trans people. After she graduates from her residency program this summer, she has two separate, yearlong fellowships lined up: one in body imaging and intervention, the other in breast imaging. Using this training, she hopes to design better evidence-based breast cancer screening guidelines for transgender women.
"That takes a long time because we need a large population of trans women to figure out what percentage are getting breast cancer, what type of breast cancer they're getting, how old are they when they get it? Were they on hormone replacement therapy? If so, for how long? What drugs were they on? Was it just estrogen, or estrogen and progesterone? There's so many things that need to be studied," she says. "And none of those questions have been answered yet."
Although the science of transgender health is progressing slowly, the politics around it are advancing faster. The swearing in of Rachel Levine, MD, as assistant secretary of health at the US Department of Health and Human Services is a clear win. "She's gotten a lot of transphobic comments on Twitter and elsewhere in the media simply for being a trans woman. It's obviously infuriating to see that," Carroll says. "But I'm so happy for her and I'm happy that Joe Biden picked her, and I think she'll do a great job no matter her gender identity."
President Biden hasn't stopped there. Shortly after taking office, he issued an executive order to combat discrimination against LGBT people. "Honestly, we should have had that years ago," Carroll says. The executive order is the most far-reaching federal action to protect queer and trans people yet. The Equality Act, which is on the floor in the Senate, would further extend protections against discrimination for LGBT people.
Despite these gains, the trans community faces plenty of new hurdles. At least 30 states are considering bills that would bar transgender women and children from women's sports. Many of these states are also considering bills that would make gender-affirming medical care illegal for minors. On March 29, Arkansas became the first state to pass such a bill, which threatens doctors with losing their license for providing trans youth puberty-blockers, hormones, and surgery. "I am firmly against banning gender-affirming healthcare for transgender youth," Carroll says. "Medicine should be performed by medical professionals, not politicians."
Although national and state policies can help or hurt transgender people in all areas of life, including healthcare, medical professionals still have many ways to support transgender patients. Carroll says an easy way to do this is simply by asking patients their gender and pronouns without making assumptions. "I think that's the most important thing," she says. "Ask the patient and put them more in control of their own identity and situation."
Carroll's experience also serves as a reminder that trans people aren't just patients — they're peers too. "I think sometimes physicians forget that they even have transgender physician peers," she says. "In general, doctors can be supportive of their trans colleagues in exactly the same way they are supportive of their trans patients. They can treat us with respect by using our affirmed name and pronouns, not making transphobic comments, and avoiding microaggressions."
Tara Santora is a freelance science journalist based out of Aurora, Colorado. They are a Contributing Editor at Fatherly and have written for Scientific American, Undark, Business Insider, Psychology Today, and many more. Follow them on Twitter at @Tara_Santora .
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Cite this: Transgender Resident at Mayo Clinic Speaks Up on Coming Out in Medicine - Medscape - Apr 19, 2021.