Next steps for transgender, nonbinary, and gender nonconforming belonging in veterinary medicine.

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Content submitted by PrideVMC, a dvm360^® Strategic Alliance Partner

The Gender Identity Bill of Rights (GIBOR) for the veterinary profession was released by Pride Veterinary Medical Community (PrideVMC) in June 2021.¹ This document was written and reviewed by a team of gender-diverse voices and allies with different perspectives and backgrounds. The purpose of the document is to provide the core rights needed for the existence of transgender, nonbinary, and gender-nonconforming individuals in the veterinary profession. The following standard concerns are highlighted: correct name and pronoun use, bathroom access, and protection from discrimination and harassment. Additionally, important concepts such as freedom from explanation, right to advocacy, and freedom from gender affirmation timelines are included.

In the months since GIBOR was publicized, there has been mounting commitment for implementation from individuals, affinity groups, professional organizations, industry, and educational institutions. A follow-up PrideVMC effort called the Gender Diversity Guide is in the works to discuss background, implementation, and compliance for these rights to help the gender-diverse community thrive in the veterinary profession. While we wait for this guide to be produced, this article will provide insights beyond the basic rights included in GIBOR.

A repeated question from the gender-diverse community and allies is “What comes next?” As with other underrepresented groups, defining specific paths to belonging is complex. The Trans Agenda for Liberation² (Transgender Law Center) states the necessity of providing a home for individuals in all groups including, but not limited to, those who are Black, Native American, Alaska Native, Native Hawaiian, Indigenous, Asian Americans and Pacific Islanders (AAPI), and migrant peoples with the goal of “the freedom of movement to seek out our own belonging.” This article highlights areas in which we can represent, support, and sustain gender diversity in the veterinary profession while honoring intersectionality as a core focus.

Achieving inclusion within the profession

Representation in the profession requires an approach from multiple angles of interaction. Following are several suggestions.

Decision-making representation

To achieve changes within the veterinary field that benefit equity, inclusion, and belonging for transgender, nonbinary, and gender-nonconforming individuals, there must be members of this community involved in decision-making. This includes leadership teams, committees, task forces, working groups, and all other bodies that gather to consider and make decisions that impact our profession. It is important to note that this direction does not come at the exclusion of other underrepresented communities. We must include this as a consideration when filling decision-making positions in organizations and associations in which gender-diverse individuals, especially those within the Black, Native American, Alaska Native, Native Hawaiian, Indigenous, Latinx, AAPI, and migrant communities as well as those with neurodiversity and diverse abilities, are underrepresented.

Representation and consideration in recruitment

Nondiscrimination in hiring does not always mean active effort for inclusion of candidates. Requiring recruitment and admissions committees to undergo training related to diversity, equity, and inclusion with specific information about bias, intersectionality, and the transgender, nonbinary, and gender-nonconforming community is essential for reducing both conscious and implicit bias. Although GIBOR provides foundational information, in-depth understanding comes through training programs, exposure, and engagement.

If individuals involved in recruitment have the opportunity to listen to gender-diverse voices, it will help expand perspective on candidates’ backgrounds. Although it is not legal to ask about gender identity and sexual orientation, for some this is highly visible when pronouns first enter a conversation. Also, when possible, involving transgender, nonbinary, or gender-nonconforming (they/them) individuals, particularly those from underrepresented minority populations, in admissions and recruiting should have a positive long-term impact on inclusion in the field.

Pathways to leadership

For members of many underrepresented minority communities, the road to leadership may be difficult or only partial, with many hitting a glass ceiling. If the profession is committed to the livelihood of transgender, nonbinary, and gender-nonconforming veterinary professionals, then there must be intention around development of leadership from this community that results in tangible upward advancement rather than lateral moves. Such efforts are already being made for other underrepresented communities. Including gender diversity as a priority when building mentorship and leadership advancement programs will lead to optimized outcomes that result from identity diversity and the subsequent cognitive diversity bonus.³

Transgender, nonbinary, and gender-nonconforming individuals have a resilient and valuable perspective for leadership. This outlook encompasses unique lived experiences of gender discrimination, navigating the health care system, and raising children as a professional. The community deserves equal pay and opportunities regardless of racial, ethnic, socioeconomic, neurodiversity, diverse ability, religious, or immigration status. Additionally, gender diversity should be seen through the lens of gender equality (which often does not happen) as defined by more than cisgender White individuals.

Inclusion in marketing to clients and/or business partners

Transgender, nonbinary, and gender-nonconforming individuals rely on and inhabit the veterinary field as clients and business partners. In addition to efforts within the veterinary field that are described in other points, it is important to have outward-facing gender-diverse visibility. This is an important message to millions of individuals in the country who may not feel traditionally welcomed in business settings. Marketing and commercial campaigns for veterinary products can include transgender, nonbinary, and gender-nonconforming individuals and be met with success and approval. Additionally, mindfulness around the business supply chain to include distributors that engage with diversity, equity, inclusion, and belonging (DEIB) should be a priority.

Access to education

Transgender, nonbinary, and gender-nonconforming individuals often have some combination of socioeconomic disadvantages that may be compounded by being unsheltered while bearing the costs of transition, other health care expenses, counseling, and referrals for care. This is in addition to the impact that socioeconomic status can have on educational performance. Acknowledging these financial disadvantages and working to improve access to both veterinary and veterinary technical/nursing education is a priority that benefits from a growth mindset and may require innovative thinking on scholarships and preveterinary education. Efforts should also focus on pathways to specialization, including internships, residencies, and veterinary technician specialization.

Inclusion in STEAM educational efforts

STEAM (science, technology, engineering, the arts, and mathematics) educational efforts have been a significant step forward in developing the future of veterinary medicine in younger generations. Representation of traditionally underrepresented groups has been a successful and important emphasis of programs introducing individuals to the veterinary field. Outreach that includes examples of transgender, nonbinary, and gender-nonconforming individuals with diverse racial/ethnic and other identities (eg, ability, nationality, etc) in veterinary medicine is a vital component of inclusion in the field. This honors another portion of the Trans Agenda, which demands “the freedom to define ourselves and our futures, free of nonconsensual...gatekeeping.”²

Developing support within the profession

Support in the profession requires a broad degree of understanding that does not necessarily exist everywhere. The following are several ideas to help deepen understanding.

Equity in DEIB discussions

Transgender, nonbinary, and gender-nonconforming individuals are not homogenous and come from many backgrounds and inhabit multiple facets of intersectional identities. As the veterinary field moves forward with trying to include and listen to the needs of underrepresented communities, it is important that gender diversity receive equity in these discussions. The transgender, nonbinary, and gender-nonconforming community has battled a lack of existence in multiple spaces, giving no ability to pursue meaningful changes particularly within the Black and Indigenous People of Color (BIPOC) and Latinx communities. Now that legal protections and support exist, we as a community should have a voice in the conversation about DEIB in the profession.

Coalition building as a 2-way street

Many in the transgender, nonbinary, and gender-nonconforming community experience bias and discrimination across their social identities (eg, race/ethnicity, class, sexual orientation, nationality, ability, neurodiversity, etc); therefore, support for gender diversity should be met with equal support as would be given for other underrepresented and marginalized communities. In this work, we do nothing in a vacuum or alone. We are all working together to make the profession more inclusive and just. As a place is built for transgender, nonbinary, and gender-nonconforming individuals in the profession, the caretakers of this space should mindfully, deliberately, and continually ensure that the space is one where all identities and backgrounds are welcome.

Top-down and bottom-up support

To nurture gender-diverse communities within the profession, there needs to be a holistic approach to help. This means education, leadership, and help at all levels of an organization. We have all seen examples where support fails because either there is only ground-level or only executive-level support for transgender, nonbinary, and gender-nonconforming individuals. Unless commitment is uniform, it will be very difficult for efforts to succeed. To this end, we must commit to relevant training for all team members on a routine basis, beyond merely during onboarding and career advancement transitions.

Development of educational initiatives

The Purdue University Human-Centered Veterinary Medicine⁴ and American Veterinary Medical Association Brave Space⁵ programs are examples of existing DEIB education that helps to educate around the needs, issues, and interaction with underrepresented communities in the veterinary profession. The development of additional educational resources (eg, web modules, articles, the Gender Diversity Guide, and podcasts) is essential to providing opportunities for self-education. Programs like these also provide a baseline understanding of what information individuals have been exposed to regarding issues around DEIB.

Sustaining the community

Sustaining the community is not easy. Attempts are under way to shore up support for transgender, nonbinary, and gender-nonconforming individuals who rightfully demand the freedom to thrive with “active community support in building lives for ourselves” (Trans Agenda).² Following are ideas for sustaining those needs.

Sustainable benefits for gender affirmation

Transition takes many different forms and may require the assistance of therapists, endocrinologists, surgeons, and other specialties. Medical therapy, if elected, may be lifelong. To move forward with integrity, we need to ensure that hormone therapy and endocrine monitoring are affordable, and that the benefits for transition are treated similarly to other medical benefits including deductibles and maximum out-of-pocket benefits. Setting low limits on coverage precludes many from surgical transition, which leads to mental health strain, suicide risk, and potential dropout from the profession. Following on the Trans Agenda, Black trans individuals should have “equitable access to health care,” as should other

Black and Indigenous People of Color (BIPOC) and Latinx individuals who have been historically denied this right. Provision of mental health services is a vital benefit for all veterinary professionals, including transgender, nonbinary, or gender-nonconforming individuals as they encounter societal prejudices that disproportionately impact mental health.

Sustainable benefits for leave

Transition takes many different forms dependent upon the medical needs of the transgender, nonbinary, or gender-nonconforming individual. Some aspects of transition require significant leave to allow for healing prior to returning to physically active duty, such as for mastectomy, breast reconstruction, pelvic and prostatic surgery, and necessary facial reconstruction. If the profession wants to have transgender, nonbinary, and gender-nonconforming individuals survive and thrive, then treating these events in transition with care and sensitivity is essential. Precedents exist for care of cisgender individuals in the profession who have undergone similar procedures. This same support should be equitable for all individuals in the profession regardless of intersectional identity.

Sustainable benefits for preventive and prenatal care

To sustain transgender, nonbinary, and gender-nonconforming members of the profession, preventive and prenatal care require attention through a gender-diverse lens. It is important, for instance, that regardless of pronoun or gender marker, individuals continue to receive coverage for necessary mammogram, pelvic, and prostatic care, and appropriate prophylaxis and sexually transmitted infection prevention. It is also important that prenatal, pregnancy, and postpartum care continue to be provided in benefits regardless of gender identity. Being transgender, nonbinary, or gender nonconforming should not be a reason to be deprived of lifesaving care, nor should it affect fetal or newborn health. From the standpoint of benefits and insurance, this is also common sense, and yet these needs may break down on the insurer or the provider end. To be an equitable field, advocacy and consideration from human resources on the employer side to prevent insurance gatekeeping is essential.

Conclusion

These are a few initial ideas of how we begin to include and grow the transgender, nonbinary, and gender-nonconforming veterinary professional community while paying particular attention to Black, Native American, Alaskan Native, Native Hawaiian, Indigenous, Latinx, AAPI, and migrant peoples, as well as those with neurodiversity and diverse abilities. Some of these steps are easy whereas others require significant work. Hopefully, we can generate conversations around gender diversity as multiple efforts to promote inclusion, belonging, and justice expand throughout the veterinary profession.

Authors:

Ewan Wolff, PhD, DVM, DACVIM (they/them); Kat Martinez, PhD, Assistant Dean, Diversity, Equity and Inclusion, University of Arizona College of Veterinary Medicine (they/them); Ellen Williamson, DVM (she/her); Kate Toyer, BVSc, MANZCVS (Surgery) (she/her); Mia Cary, DVM (she/her); Dane Whitaker, DVM, MPVM (he/him); Aaron Lopez (he/him); Finnegan S. Ware (he/him)

Editors:

Jenna Ward, DVM (she/her); Mia Cary, DVM (she/her); Kristin Olsen, DVM, DACVIM (she/her); Ryanne Heiny, CVT (she/her); Finley Wolff (he/him)

Content reviewed by:

Avenelle Turner, DVM, DACVIM (Oncology); Mariana Pardo, MV, BVSc, DACVECC; Lillie Davis, DVM, DACVIM (Oncology); Nicole Jefferson

References

1. Gender Identity Bill of Rights for the veterinary profession. PrideVMC. June 2021. Accessed January 28, 2022. https://pridevmc.org/gender-identity-bill-of-rights/
2. Trans Agenda for Liberation. Transgender Law Center. Accessed January 25, 2022. https://transgenderlawcenter.org/trans-agenda-for-liberation
3. The Diversity Bonus. Mellon Foundation YouTube page. Accessed January 28, 2022. https://www.youtube.com/watch?v=gvKXtOK6Gyw
4. Advancing inclusion through human-centered veterinary medicine. Purdue University College of Veterinary Medicine. Accessed January 28, 2022. https://vet.purdue.edu/humancenteredvetmed/
5. Brave Space Certificate Program. American Veterinary Medical Association/Axon. Accessed January 28, 2022. https://axon.avma.org/local/catalog/view/product.php?productid=125