Carolyn Wolf-Gould, October 30, 2021

Item

Title: Carolyn Wolf-Gould, October 30, 2021
interviewee: Carolyn Wolf-Gould
interviewer: Jarrett Hill
Date: 2021-10-30
Subject: Albany; Bassett; COVID-19 Pandemic; Gender identity; Healthcare; History of transgender healthcare; LGBT; Oneonta; Rural Healthcare; Sex work; Transgender health; Transgender students; Unitarianism
Description: Dr. Carolyn Wolf-Gould is a physician in Oneonta and the director of the Gender Wellness Center, a transgender healthcare practice that began working with transgender patients in 2007. She was born and raised in New York, attending Hamilton College and Yale Medical School for her education. After her residency in Rochester, Dr. Wolf-Gould settled in Oneonta and began a primary care practice with her husband, which evolved to include the Gender Wellness Center.

At the time Dr. Wolf-Gould began treating transgender patients, transgender individuals faced significant disparities in both the availability and quality of healthcare. The Gender Wellness Center was one of only a few healthcare locations in New York State that could, or would, treat transgender people. For this reason, many transgender people were forced to travel out of state every time they needed to see a doctor, accept subpar medical care because it was the only option, or forgo medical care altogether. Particularly for working-class transgender people and transgender people of color, barriers to travelling for medical care were prohibitive. At the time of this interview, these disparities were beginning to be addressed, but were still a significant issue in transgender peoples' lives. In 2019, only approximately 50 multidisciplinary gender clinics/healthcare facilities were registered in the United States. In this interview, Carolyn discusses the evolution of her practice to include transgender healthcare, her personal history, her experiences in Oneonta, and the changes brought about by the COVID-19 pandemic.

I interviewed Dr. Wolf-Gould at her home in Oneonta, New York. She was taking her first day off from work in many months, keeping very busy with the clinic amid the continuing COVID-19 pandemic, while also contributing to a book on the history of transgender healthcare in the territory now known as the United States.

Dr. Wolf-Gould rarely meandered in conversation, so the majority of my edits have simply been removing repetition and false starts from the transcript. For syntactical clarity, I have broken some long sentences up into separate sentences. This is for the ease of clarity when reading the transcript—when listening to the audio recordings, these long sentences are meaningful and easy to follow.
Transcription: CWG = Carolyn Wolf-Gould
JH = Jarrett Hill

[START OF TRACK 1, 0:00]

JH:
This is Jarrett Hill, interviewing Carolyn Wolf-Gould in her home on October 30th, 2021. How are you doing today, Carolyn?

CWG:
I'm doing well, Jarrett, thanks.

JH:
Great. Would you be able to tell me, how did you develop an interest in medicine?

CWG:
Oh, well, my father was a physician, my father is still living. He was a neurologist in Syracuse, and he used to take me to work with him when I was a little girl and I'd follow him around. And he was, he is still a very charismatic person, loved his job, interacting with students, loved his patients, loved his work, so I was inspired by him. And my mother was a family therapist—and also still living—and I think I sort of took a job that's between what they both did as a family doc. So, I was also inspired by her and her work with families and family systems.

JH:
Would you be able to tell me a little bit more about your family?

CWG:
My family? Yes. I grew up in Syracuse, south of Syracuse. I have a brother who is a philosophy professor, younger brother, and I have a sister who does home care. And my two parents. I grew up in an intact family, very loving family, I would say a privileged upbringing, no trauma, I was surrounded by love. I'm aware of that now as I do my work, I'm aware of what a privileged background I come from. Financially, we were always very secure, lived on a beautiful piece of land that my father had nurtured and developed, not in a fancy way, but in a very beautiful way—planting trees and digging a pond, surrounded by wildlife and beautiful nature. As a child, we would go camping for vacations, canoe trips, a very happy childhood.

JH:
Could you speak to me about your education?

CWG:
I went to high school in DeWitt, New York. Again, a very privileged high school. I went to college at Hamilton College, again a very privileged place. When I think about it now, I kind of wish I'd gone to a more radical, multicultural place, but it was where I went. It was actually an interesting place—well this is kind of a side story, but it was Kirkland College, which was a very feminist, more LGBT kind of place. And then it merged with Hamilton, which was more of a patriarchal kind of place. I was there the first year after it merged, so I did have the benefit of both of those places. Then after college, I was in the Peace Corps in Congo for two years. That was very interesting. I would say, education-wise, that was the best education I ever got. That was an incredible experience. I lived in a village in Congo, with no electricity or running water. I was doing fish farming, teaching people how to raise fish, in probably one of the most poor, damaged areas of the world. Just completely damaged by colonialism and the aftereffects of colonialism. A very difficult place, but I had an interesting and good experience there. And after that I went to Yale medical school, that's where I met my husband. So, I am a cisgender, heterosexual person. I think it is important to say that and be out about that. I met him in anatomy lab, we had adjacent cadavers and connected pretty quickly. During medical school, the two of us actually went back to Africa for a year. So, our third year we took a fellowship year and went to Ghana and did work in international health. And that is what I thought I would do initially, I thought I would be doing international health. But life takes you to different places. So, then we came back and did our residency, both of us at the University of Rochester. That was a really good experience too, very strong biopsychosocial program, so a lot of focus on family systems as part of primary care. I thought we got very good training there and after our residency, we came to Oneonta and have worked here since.

JH:
So, you mentioned that you initially wanted to go into international medicine, was that always your goal as you were moving through your education?

CWG:
I think it was my goal after I went to the Congo. I think I just get passionate about things and it was really a deeply moving experience, and I think I've always been committed to serving underserved populations. It felt like there was such a huge need, but then it turned out that my husband was not as interested in doing that, and then we had kids and it was not going to be possible to do that, but I think about going back to it. After I retire, I think I may go back and do something at that point.

JH:
Could you elaborate a bit more about what drew you to that Peace Corps work in the Congo?

CWG:
Oh gosh, I had a friend who was doing it, she had gone and was writing to me. She was in Togo, her name was Jenny Rubin—that's another interesting story. I don't know if you want to get off on the side things, but Jenny Rubin actually grew up in Oneonta. So, she was a friend in college and had gone to Togo and was writing letters. Actually, no, she wasn't there yet. We had another friend, Melissa Chesnut, who was there who was writing, and Jenny and I were talking about it in our co-op where we lived. She said "I'm going to go to this recruiter," so I went with her. Jenny Rubin was actually murdered in her village in Togo. And I didn't know that she grew up in Oneonta until I came and went to the Unitarian church, and someone said "Oh, did you know Jenny Rubin?" She was such a beautiful soul, so coming to her hometown felt nice.

JH:
Were you drawn to Oneonta for work? For family reasons?

CWG:
My husband drew a circle between our family and his— he got one of those compasses and we're both are very connected to our families—and drew circles, and then we interviewed in the areas that overlapped. So, we were drawn to this area, a number of other physicians had done residency in Rochester, we came and met them and it felt a little bit like home. It was beautiful, we liked the colleges. We had one child at that point but it did seem like a good place to raise kids. We liked the beauty and the nature, so that's why we came. We also job shared, so that was another reason we came. They allowed us to job share. We had had infertility and when we finally got a child, we didn't want somebody else to raise our child, so we found a place that allowed us to job share. We were both family docs who wanted to come and have one job, so that we could take care of our child and subsequently, our other two adopted children.

JH:
That sounds even today like a very progressive idea of gender roles in the family. Have you always been connected with this more radical and progressive side of gender activism?

CWG:
No, not really. I don't think I was. I've always had good LGBT friends, who I loved, and so I knew about the community, but not so much in high school, and not even so much in college. Well, I'll tell you that I had a very good friend in the Peace Corps, who later transitioned, so that was my first experience with someone who was trans. That person told me a little bit about wanting to be a girl when we were in the Peace Corps, but I didn't really know what "trans" was. And several years later, when we got back, we had lost touch, but she called me up and it was a funny conversation. She said "So what's new?" and I said "Oh, you know, blah blah blah." I probably talked for ten minutes about all the stuff that was new, and I said "What's new with you?" and she said "Well, I've transitioned, and this is my name, and these are my pronouns." And I really didn't know much about it, I just love this person, very much love this person. And she just told me about her experience and to have that personal connection with somebody, I think that's honestly what makes the big difference for anyone, to have that personal connection to someone you love, who trustingly tells you their story. That was very moving for me, and I think that is actually one of the reasons that I ultimately went into the field, is that I had that experience with that person. But I've always been an ally, I would say.

JH:
Could you elaborate a little bit more on that? What was your relationship with the LGBT community before you started the Gender Wellness Center?

CWG:
It was less than it is now, I guess I just had good close friends always, who were LGBT. I had a good friend in medical school who was struggling with coming out and we talked about it a lot and I went to something with her where she was going to come out, accompanied her. I just had friends, close personal connections, yeah. But I wasn't very involved, I didn't do activism, I didn't know much and I certainly wasn't trained. I got no training in medical school. I didn't know very many LGBT people in college—I knew some, but not a lot. In medical school I got no training, in residency I got no training. Maybe a little bit on HIV, you know, that entrance into LGBT medicine but that was it.

JH:
Could you tell me about how you became involved in transgender healthcare?

CWG:
I'd been doing regular family practice since 1994. We initially started out doing obstetrics, we took care of our patients in the ICU. We did inpatient, outpatient, and eventually stopped doing obstetrics after we adopted our third child. I was just in my office and one of my staff members came up and said "Oh, a transgender man has reached out and wonders if you could be his doctor, so can you call him?" I didn't know much at all, so I called this person and said "What do you need?" and he said, "I transitioned ten years ago and need somebody to fill my testosterone prescriptions, and I can't go to the Mazzoni Center in Philadelphia every time I need to see a doctor, would you be willing?" And I said "I'm so sorry, I don't know anything about transgender medicine, I can't help you." And he said, "Oh, come on, please—you could learn! I can hook you up with some people who could teach you what you need to know!" So, this is a very common experience for transgender people. And I said, "Oh, I don't know how to even start." And he said "You have a safe space sticker on your door"—which we did have, some members of our staff had done safe space training and asked if they could put one up, and I was really pleased that they put that up, because we had been offering care to LGBT people before that and wanted them to feel safe. So he said—"You've got a safe space sticker! There's no one else in town I can ask. And I asked around and they said you are the only one they would even think about asking." So I said "Let me look into it and see what I can find out." I called one of my administrators, and I will say that there have been some administrators who have been very supportive and others who have not, in my career, but I happened to contact a woman named Sandy Sherenko, who was our administrator, and said that I had just got that call. She said "This is really important, Carolyn, this is really important, I'm glad you reached out to me. Whatever you need to learn, why don't you look around and see, maybe there's some organizations you can join, we will pay for that." At that time, there were no trainings—now you can get CME [Continuing Medical Education] training in transgender health, but there was nothing at that time. So, I really had to self-learn. I did join the World Professional Association for Transgender Health—they had a listserv, so I reached out to the listserv and said "I have this patient, I don't know what to do." It's an amazing community, the trans community is amazing, and the professional community that cares for trans people is also a very amazing community. I think people who work with marginalized populations do become passionate about their work, because they see how necessary it is. So, immediately, people reached out to me and said they would help me, "here's what you need to read, here's some articles." I did some literature searches and started to care for that patient. The next year, I think I got one more, another trans man, perhaps a referral from this person. And over the next five years, I had five transgender men and I was figuring out how to take care of transgender men, all young and healthy. The thing about that first patient was that I read and read and read—I read for three months, because he wasn't coming for three months—and when he came in, I was all set. I had this cultural competency and knew how to do T, testosterone, and manage the hormones, but really what he wanted to talk about was quitting smoking and arthritis in his knee. So, that was another lesson for me—he had transitioned ten years ago, it was old news, it was not even really on his mind. He was a guy and he just needed his testosterone filled. So all the other people I was taking care of had also already been started on testosterone and I was just continuing it. And then, I got somebody new—a college student—who wanted to start. I had never really had an experience starting someone, and they were seeing a therapist in Albany, Choices Counseling and Consulting is a therapy group that specializes in LGBT and especially T, the transgender population. I reached out to them and said that we had a shared patient and that I had never really started anybody, and there was a process. At that point, there was a process—you had to have letters before you got hormones, which is no longer the case. I said that I didn't really know about the letters. I reached out to the Mazzoni Center and got some information about how to start somebody. So, Arlene Lev, the therapist up there, asked me to come up and meet their team. She said "We would love to meet you. We need doctors who will care for this population, we don't really have many places to send our patients." So, I went up there and I just loved it, it was so much fun, to be with that group of people. It was a really interesting group. There were many LGBT therapists, interesting cases, we had case conversations—so that was when I really started to learn more about the LGBT community. I learned about the resources there were for my patients, but it was still all in Albany. Then, I became their consulting physician, so they were sending patients down from Albany to see me, so all my patients came from Albany and a few local students, for many years. Am I wandering too much?

JH:
No, I think it's all very interesting.

CWG:
So, I just remember driving, I started getting more and more patients during that time—this is around 2012—and Arlene asked me to start giving talks at trans networking conferences, and also suggested that I go to the World Professional Association for Transgender Health Biannual Symposium, which was in Georgia. That is all over the world, so that's been really interesting. So, I did those two things. There was a social networking conference for transgender people called the Empire Conference, and they asked me to give a talk about hormones, so I had to learn about feminizing hormones to give that talk. I went to the conference and I just stayed, and I think that was the first time that I really spent time in one of these conferences with lots of transgender people. The welcoming that I received from the trans community is just overwhelming, beautiful, and for me, it was like learning another culture, to learn the language and the struggles that people were having. It was an immersion experience, and I made friends with other professionals who were caring for the population and transgender people at this conference, where I wasn't the physician, I could just be myself. I was a speaker physician, but I wasn't the physician for these people. That was really great, and then going to the World Professional Association, I'm just going to refer to that as WPATH. WPATH was great, I met people from around the world and learned what was happening with mostly trans—but some other LGBT people—all over the world. At that point, I started getting lots more referrals, and the practice started to grow. I remember once, driving back from Albany, thinking "This is very strange—I'm seeing all these transgender people in Oneonta, and they all come from Albany. I'm never going to have anybody from Oneonta come to me—there are no transgender people in Oneonta." I had that thought in 2012, ten years ago, and now we just have so many people from the local community coming to our Center. I think there just were not opportunities, and it was a different time. People were not as able to come out as they are now, and I had no children as patients. Maybe I'll stop there—I don't know if you want me to keep going.

JH:
I was interested when you talked about how you trained yourself. One of the elements was the cultural competency—could you speak a bit more about how you developed that?

CWG:
Part of it was going to the therapy sessions and finding out—they were very up front about language, and the language, as you know, is always evolving. So what is appropriate at one time period is no longer appropriate now. People used to be called transsexuals, and that's how people identified. Now that's kind of a pejorative word, although some people still like that word, because they grew up in that time and that's how they identify. So, to learn the language, to learn just basics, like how important it is for me to say "Hi, I'm Dr. Carolyn and my pronouns are she and her." I've learned how to do that. I learned from case discussions, people just talked about how people lived and then I met the patients who talked to me about how they lived. It was a slow process, and it took me a while to really get it down. Now that I'm training other people, I realize how for some people who have not really had that exposure, it's definitely a slow process. It's learning another culture and learning how to be competent in another culture. Gosh, and the networking conferences were also really helpful because I was in a social environment with people, who later became my friends, and then I was just hanging out with them and could ask questions—"What's this like for you?"—or they would tell me about their experiences. A slow process, but I do think that being immersed in the trans community is a really important way to learn cultural competency. It's maybe not enough just to attend a cultural competency training. Or maybe that's a start. The other part is that there are all these subcultures in the trans community, and it is important to recognize that. What an older trans woman experiences is very different than what a young non-binary person is experiencing in a school that has gender-neutral bathrooms and a GSA. So, these older people grew up at a time where they had no internet, how they formed their culture with other people is very different. Obviously, people of color have had very different experiences, so all of these intersectional ways that all of the different subcultures interact is something that I also began to appreciate over time, not right away.

JH:
Do you have a large variety of demographics in the patients that come and see you?

CWG:
You know, we do somewhat, but not as much. Our catchment area is huge, very big, and our patient population does not reflect the demographic of Albany, where a lot of people come from. I think we have a wider demographic than the usual Bassett population, our trans practice does, but it doesn't reflect the wider community. So no, I think that because people have to travel to see us, it is harder for some demographics to get to us. If you're poor, it's hard to get transportation. Some people get Medicaid cabs, but it's sometimes a fight to get that. We have some diversity, but not as much as we'd like.

JH:
You mentioned that your catchment is very large. Why do you believe that is?

CWG:
Because people can't get care elsewhere, or at least when we started, there was hardly any other place to get care. Over the last seven years, there's been a real sea change in trans visibility in the culture and also, much more awareness of the healthcare disparities that transgender people face. Several organizations have stepped up to offer care, so Planned Parenthood, for example, began offering care, I'm not sure when, 2015? I wish I had that date in my head, but I don't. So, local Planned Parenthood offices began to offer transgender care. Rochester didn't have anything when I started, so people from Rochester were coming down. Now, Rochester has a trans program and they offer care in a number of different places. Albany still has a couple places you can get care, but now I think it's because of our reputation that people really appreciate the care that they get. We have interdisciplinary care at our Center, we have mental health, we have medical for adults and youth, we have some of the basic surgeries that people can get in one place. I think we're kind of unique in upstate New York for that.

JH:
You mentioned that one of the reasons you think that this first transgender man was comfortable reaching out to your practice was because of your safe space sticker. Do you believe there is any other reason that people feel comfortable coming to you?

CWG:
Gosh, you'd have to ask my patients that, I think. You know, not all my patients like me—some of them don't. I think I connect well with them. I really care about them, and I think if you really care about somebody, they feel that. I don't treat people as a number, I take time to get to know them. We spend an hour and a half in initial intake so that we can really know who someone is and who their supports are, what their struggles are as they transition, or what their joys are as they transition. For example, we collect genograms of all our patients as part of the intake—I'm not sure if you know what that is—it is a way that we diagram who someone is in their social space. Who's your family? Who're your supports? It's a visual depiction of that. It truly allows us to get to know someone in a different way. I think people do not feel they are a number at my practice, they feel seen and heard. Our practice and our staff—we have fabulous staff. Now there's a whole bunch of people doing the trans medicine, it's not just me. So, I wish all people felt this way, but most people feel well cared for in our practice. We don't advertise. I think that our advertising is word-of-mouth in the trans community, so we're very much aware of that. We ask people how they heard about us and "So-and-so transitioned and told me this was the place to go."

JH:
Have you faced any difficulties with administrators or people who are higher up in healthcare organizations?

CWG:
Definitely, yeah. Like I said before, some people have been very supportive of me, and others have not. I'm not sure I want to get into the details of that, but just to say that yes, there have been some people who did not believe that what we were doing was worthwhile. One administrator kept saying that we were discriminating against our cisgender patients because it was a little easier to get into our practice as a new patient if you were trans. Our mission was that we need to serve this marginalized population, who can't get care anywhere else, but they said that we were discriminating against cisgender people. So, I think that's a complaint that many who are trying to serve underserved populations get, but that was very hard for me. It made me very angry, and that got picked up by other people, including our staff at the time—that was many years ago, but that was very hard. I've been told by colleagues that what I was doing was "weird" or that my patients were weird. I had some people with religious objections to what I was doing, who would be very vocal at talks that I would give, respectfully, but that was very difficult. So yes, huge problems convincing—I had one Bassett administrator tell me that what I was doing "icky." Icky. I said "Why aren't we getting any publicity?" "Well, it's icky, people don't want to hear about it." I would say that that has changed, those people are no longer at Bassett and, to me, it feels like over the last couple of years, I felt like I was pushing with a bulldozer against a brick wall for the most part, with the exception of those very supportive people who have been there all along. Those people have really helped, but in general, push, push, push, without moving. And then recently, with changes in administration, it feels like things are giving way in a very different way and the support is very different. I mean, similarly, we got grants— when I started this work, the field was in a different place and there was no money for this…

[START OF TRACK 2, 0:00]

…because the grant people had that perception that this was "icky," which was out there in the larger culture, as well. There's a wonderful man named Craig Pennell, who works at the Department of Health AIDS Institute, and when I started speaking at conferences, he became aware of what we were doing and he called me up and said, "Me and Carmen Vasquez"—she died, she was another woman at that Institute—"would like some input from various people about what you need to continue doing this work." And, you know, we didn't have any grants at that point, we didn't have anything. He asked what we needed, and I said we needed mental health services so badly because people can't get it, we need free mental health for our trans patients. So then, the next year, there was this grant opportunity. I reached out to the grant writers at Bassett and told them I wanted to apply for this grant. They had somebody that they hired who told me we would never get this grant, they said we didn't have what it took—I said that I thought we did, because we were one of the major people in the area. So, I wrote the grant, and we got it. A $750,000 grant to cover our mental health services for five years, so now we can offer free mental health services. That someone would reach out to me and say what do you need and then create this grant, and then we got the grant. Those kinds of things were really so helpful to developing the Center.

JH:
Has your relationship with Bassett and that resistance that you described changed in more recent years?

CWG:
Oh, definitely. Definitely, yes. I'll just say that we got a new CEO a year and a half ago and then the pandemic hit, so there's been a lot of conflicting priorities, and we're all just trying to stay afloat at this point. But at that point, everything changed for me. It became a much more supportive environment. I haven't felt that the administration has had time to really meet with me to discuss sustainability of the Center, and that is something I have been really pushing for, but we do have a meeting for that set up in a few weeks, so I'm looking forward to that. My husband and I are reaching the end of our careers and are really hoping for sustainability of our Center. That is something that is way up in the air right now and I don't feel confident that we have a sustainable Center at this time, so I'm hoping that we can work with administration and make that happen.

JH:
[Laughter at gesture made by Carolyn] How has the pandemic affected your work that you've been able to do?

CWG:
In very interesting ways. As physicians, it was just a roller-coaster ride, so I'm not going to go into all the details of that, but one of the things that happened was right away we got telehealth. They had a telehealth program that was going to be rolled out slowly over time. We were looking forward to it, maybe we would be able to see transgender patients who travelled two and a half, three hours to visit, and we would be able to see them via telehealth. We were told that maybe in a year or two we would have telehealth, but Bassett—wow, did they put that together! Everybody had telehealth in two weeks, so that was amazing. Now we're able to take care of people. People who had to drive hours and hours no longer have to drive, we can see them via telehealth and provide telehealth care, so that's huge. I would say that the healthcare disparities that transgender people face played out with the pandemic. So, people were more likely to be isolated and depressed and unable to get care, so we did see that as well. But our practice has boomed, and I think many people who were home during the pandemic talk about having time to address their gender dysphoria in a way, maybe they were forced to, or maybe they had the opportunity to because of the time at home. Our business has been booming, yeah.

JH:
What reasons would you give for that boom in business?

CWG:
I think, just our reputation has grown, we now are able to offer free mental health services, I think that is huge if you can't get mental health services. Unfortunately, now we have a nine-month waitlist because of that, but that brings people in. I think our reputation has grown, we're seeing a lot of youths, we take care of children and youth—we don't do medical interventions for children, but adolescents we do. I think we have gotten a reputation for being a good place for that because of our patient-family-centered approach and youth are across the country presenting for care in greater numbers. So, we're just seeing that surge is also happening in our office. Our surgical providers have stepped up in a really beautiful way to offer care. We have three excellent plastic surgeons, who just provide sensitive, excellent care. They don't do everything, they do top surgeries, some facial feminization, body contouring, tracheal shave, but we've just had a huge input of people requesting plastic surgery services. We have a gynecologist who has stepped up to do minimally invasive hysterectomies and a couple of women's health providers who asked to be trained so they could provide culturally-competent GYN care to both trans men and trans women. We have had several urologists who stepped up to offer gender-affirming urologic care, including orchiectomy. Other physicians at Bassett have stepped up in ways or become sensitive providers, so patients from Albany come to get their colonoscopy at Bassett because the surgeons have learned how to offer sensitive care. The OR was trained, the operating room got trained so that everybody in the operating room would provide culturally-competent care. I think because of those things, a reputation develops and people want to go where they are treated well.

JH:
I was very interested when you said that being at home has allowed a lot of people to face gender dysphoria and similar identity considerations. Could you speak a bit more about that?

CWG:
For some, I think it was really painful, so maybe it wasn't an opportunity, maybe it was forced on them. You can distract yourself, you know, I distract myself, I'm so busy. I told you, this is the first time I've sat in my living room in probably a year, just really sat and talked to somebody. You can distract yourself by being busy. Many people say it's like a rock in the shoe, it never goes away, but if you're home and you can't go out, it might be a prison for someone. But for others, it might be an opportunity, to be home and dress the way they feel more comfortable and say, "This is who I am, I'm more comfortable this way, I'm working from home, I don't have to present in any expected gender norm." So, I think it was different for different people, but many people have told me, "During the pandemic, I had this experience and decided it was time."

JH:
Taking a few steps back, could you tell me what led you to open the Gender Wellness Center in Oneonta?

CWG:
Well, it never opened, it just evolved. We are a family practice, and the Gender Wellness Center is embedded in the primary care practice. It's not like you go to a gender clinic; our mission is to bring transgender health from the margins to the mainstream. Historically, transgender health was offered in gender clinics, where people went and were sort of "othered" by getting care in a specialized clinic. Over time, it found its home more in primary care offices. Many of the big federally-qualified health clinics, like Callen-Lorde, the Mazzoni Center, these are LGBT-federally-qualified community health centers embed care within primary care. So, in a place like Oneonta, where we were initially only seeing five patients, you couldn't have a gender center, you just needed to make it part of primary care. And all along, I have felt that gender care should be part of primary care, you can learn to take care of transgender people—hormones are not rocket science at all, it's actually very simple. The harder part is the cultural competency, learning how to assist people through the struggles that accompany gender transition or getting surgery. We have always been committed to keeping it in primary care. You can come to us for your high-blood pressure, you can come to us for your diabetes, you can come to us for your high cholesterol, you can come to us for your hormones, you can come to us for all of those things together—your depression, we're going to treat it in one spot. You can get your pap test—if you're a man, you can get your pap test in our office, so you won't have to sit in a pink room with pictures of nursing mothers on the wall. So, that's always been very important to us. I also think that financially, we couldn't be a separate clinic, but that's something that's enabled interesting things to happen in our waiting rooms. You know, people are mixing in the waiting rooms. I'm sure we have lost some patients who are not happy about that, but we've also gained other patients who really support that. I've had people, cisgender people, come in and tell me that they had a meaningful experience with a transgender person in the waiting room and that that changed their heart in some way. That's been really nice to hear.

JH:
How has the Oneonta community received the opening of this—

CWG:
Oh, so you asked me about opening! So it never opened, it just evolved.

JH:
…Yes, the evolution. How has the—

CWG:
It evolved, yeah, it evolved. I'll say at one point, I can't remember what year, 2015, 2013? I asked a very supportive John Remillard, an administrator, "Could we have a sign?" That was our first thing, was that when we opened, when we put a sign out? So, instead of saying Susquehanna Family Practice, it said Susquehanna Family Practice and Gender Center. I will say about the evolution; in 2015, I think I had three hundred and sixty patients at that point. I had gone from five to three hundred and sixty in three years. And The Guardian ran an article about our Center, and at that point, I just realized we needed more help. We needed a lot more help. I had one therapist, who had started seeing patients in her private practice, but she had gotten some training as well. So, we applied for a grant through the Robert Wood Johnson Foundation, called the Clinical Scholars Grant, actually a three-year leadership grant. But we had to make a team and have a project, so our project was to create a rural-based center of excellence in transgender health for upstate New York. So, that was the first time we had an intention with a plan. So, our group created a strategic plan and implemented the strategic plan. That, I would say, was a bigger organizational step to creating the Gender Wellness Center. But I can't really tell you when we created it. Community support, I have not had much negative response from the community. I have not personally experienced it. I am sure it is out there, but I have not personally experienced it. I have had some people tell me that they believe what we are doing is, they object to it for religious reasons or moral reasons. I've had a few people tell me that, but my experience has mostly been one of support. And I've seen that the community has changed also. When we started, there was no Pride organization, and now there's a Pride organization. A really good community Pride organization. The schools were not equipped, the high schools, the elementary schools, the colleges were not equipped to meet the special needs of transgender people, and we went and spoke at all of these areas early on. We went to the kindergarten for a kid who was socially transitioning, we spent a lot of time, but now the culture has changed and offering opportunities for trans people is what's expected in schools. We sort of watched that happen. That's been really beautiful to watch, and we did contribute to that. I'm aware sometimes students will come to Oneonta because of the Gender Wellness Center. The churches have really embraced what we do. So, I have seen a change in the community as well, and I think it's become more affirming. That is not to say that trans people do not face discrimination in Oneonta, because I don't want to lead anyone to believe that, I think discrimination happens everywhere, but I do think the culture of Oneonta has changed, in part because of our work.

JH:
Could you speak a bit more about how there have been changes in the churches and the schools, in the community as your practice has continued?

CWG:
I just remember, probably ten years ago, I had a young trans girl who had been very consistent, insistent, and persistent with a feminine gender identity from as soon as she could talk. She was going to kindergarten and the mother wanted her to be safe in kindergarten, and the teachers had never come across this, and what do you do, and what's happening? So, we went to the kindergarten and talked to the teachers and talked a little bit about what it was, what this phenomenon was, and how to make the child comfortable in school. And the teachers just did it, and the school just did it, but nobody had really come and talked to them about it. And I'm sure there was stuff that happened in the school and that it took them a while to figure it out, but the experience for the child was very good. And I no longer have to do that, you know, now I think it's the expectation that in New York State at least—and I would say that we are very lucky in New York State, this is not the case in other states at all—now Oneonta has a GSA, they have gender-neutral bathrooms. Even two or three years ago, they had at graduation the girls wore yellow gowns and the boys wore blue gowns, now everybody wears the same color gowns. I've just seen a lot of those things. And our trans kids who attend the local schools feel supported in the schools. I believe the students who go to the colleges here now feel they have resources. It's a huge change since I started in 2007, huge.

JH:
Would you be able to elaborate a bit on the attitude of the churches in the region?

CWG:
Sure, yeah. I attend the Unitarian church, and that church has always been what is called a "welcoming congregation." To be a welcoming congregation, you go through special steps to make sure that you are aware of disparities—not healthcare in this case—and aware of how to be a welcoming place for LGBT people. Not just T, but LGB. There's another church, the Methodist church, which is also a welcoming congregation, so they had taken those steps. In our church, a prominent person shared his transition with the congregation and transitioned in the church. He just shared what was happening with him, and the whole church was part of—not intimately connected, but in some way connected—with this transition. The minister that we had at the time was very supportive, Reverend Craig Schwalenberg. Very supportive of the trans community, so more and more trans people started going to that church. And you know, now, with COVID, the churches have all had a hit, but I watch that and watch more people come to the church and feel supported in the community. I don't know what specifically has happened in the Methodist church, but I believe they've gone through a similar journey. I don't know about trans people in that church necessarily, but I know it is a welcoming place for LGBT people.

JH:
You mentioned earlier that, in the three-year span since you first started taking trans patients, you went from five patients to over three hundred. What do those numbers look like now, in 2021?

CWG:
Oh my gosh, yeah. We have served well over a thousand, well over. I count at the end of the year and last year, I think, we were up to nine hundred or eight hundred. That was just the medical patients. But then, the mental health has hundreds and surgical has hundreds too. I don't have those numbers, but it's gotten quite large. Our trans practice is about thirty-three percent of our patients at the Susquehanna Family Practice at this time, so it has gotten quite big. We get about one hundred and fifty new transgender medical patients each year.

JH:
Do you have any particular memories from your time practicing that you'd like to share?

CWG:
Oh, that's a really good question [sighs]. There are so many memories, and I'll just say—I say this often, that it's a real privilege. People talk about privileges, when you're a doctor, you apply for privileges, you send in all your files and they check your fingerprints, make sure you're not a felon, and then they give you privileges. And I didn't really understand what that meant until I started trans care. But it is a privilege to have a birds-eye view into the life of someone who is actively seeking to be their authentic self. It is a beautiful process to watch, and a beautiful process to bear witness to as a clinician. It is inspiring. If you're with someone who is trying to be their authentic self, then you go home in the evening and you think: "Gosh, how am I doing with being my authentic self? Am I being honest in how I present myself to others and the world? Am I speaking my truth?" You have to think about those things, and so I am constantly inspired by the stories of my patients. I would say every day I have an experience with someone who opens my world. I also think that once you blow the lid off thinking of gender as a binary, that the world just starts to sparkle. It's just so much more colorful and then you start challenging how you thought about so many things in your world. You're asking for a specific story, and I am a little careful because I need to respect the confidentiality of my patients, but I'm not sure if I can actually do that.

JH:
I understand completely.

CWG:
I think I have to leave it at that, just to say wow! The stories are beautiful, painful. We have had suicides, so also just incredibly painful what people experience in this world when they don't conform to gender norms. But the freedom and joy people feel when they do begin to feel that they are expressing their authentic self is like watching a flower bloom. And how many doctors get to do that every day in their office? That's my life.

JH:
Could you speak a bit more about how you have changed as a person as you've been involved in this practice?

CWG:
Yes. I've just grown in so many ways, I've learned so much. I've learned a lot about privilege, about race, about intersectionality. I've learned how to be a political activist and an effective organizer. I think people who go into this kind of work are wanting to help, and you go from wanting to help to learning how to create an organization that supports that work. We created an organization and an organizational structure that allows this work to take place. That was through the Robert Wood Johnson Foundation, and that was huge. How to speak truth to power. We have to talk about making money—are we financially solvent? Do we bring revenue into Bassett? Because those are important things to consider if you are running an organization, and I didn't know anything about that. I've learned how to become an effective public speaker. I just got asked to review the Excellus Medicaid policy for New York State for gender health. And I know how to do that now and advise healthcare bodies how to ensure that the needs of populations are met. Professionally and personally, I have grown immensely. And as I look at trying to keep this Center afloat as I retire, how to train other people to do these things, I'm sort of aware of how I've developed a lot of skills that I need to now pass on.

JH:
How has race played into your practice?

CWG:
In huge ways. I have a racially mixed household, so I would say that personally, I have a Puerto Rican child that we adopted and a Chinese child that we adopted. We began thinking about race as a family and thinking about taking steps to make sure that we would understand what our children would face in the world and help them understand their backgrounds a bit. So personally, that journey started there. And my journey with race also started in Africa, when I was living there. Learning about race, learning about colonialism, learning about the effects of colonialism on slavery in the US, and learning about critical race theory. All of those things have been part of my journey. Part of the Robert Wood Johnson Foundation—one of the most important parts was education on working with racial issues in this kind of work. So, all of us, all [the people on] the project, we all learned about race. So, how we approach our patients, how we learn about their lives, how we learn how to take care of sex workers, perhaps, of all races. How we learn to approach people who just have no opportunities because of their intersectional identities with race, gender, poverty, whatever it is. We really have taken time to look at that, think about it. I wish our office were more racially diverse. I guess we have looked at diversity of our office staff as well. One of the things that people say often is "nothing about us, without us." If you're going to serve a population, you can't do it without us. So, while we haven't always been able to employ directly in the Center people of all the diversity that we wish we had, we do reach out, we have a community advisory board that we reach out to and try and make sure we have diverse people on that board to help us. They've been involved in some of our planning things, but do we make mistakes? Yes, we make mistakes. Looking at those mistakes, there have been some painful mistakes that I personally have made. Again, I don't think I can give you the details, but I'll just tell you—yeah, I've made some mistakes. Made people uncomfortable when I was trying to be one way, trying to be supportive, but it turns out I wasn't. Taking time to think about it, talk about it, that's just part of what we do in our practice, with each other, with our colleagues.

JH:
If you're comfortable speaking about it, would you tell me a bit more about how your practice approaches treating sex workers and taking them on as patients?

CWG:
Yes, yes, yes. We are sex-positive. We look at sex work as a form of employment that many people often don't have a choice in. Some people choose it, that's fine too. So, we have a sex-positive and look at it as a form of employment. And we want to make sure that our sex workers have what they need to stay healthy. So, we've learned how to prescribe PrEP—pre-exposure prophylaxis for HIV. We actually don't have a huge HIV population in our practice, which is unusual, because rates of HIV are very high in especially transgender women and transgender women of color. But when we do get someone who is HIV-positive, we have ways of expediting their care with the Infectious Disease people at Bassett. We work with public health officials, we have free condoms in the office, we know how to screen for and treat sexually-transmitted diseases, so it's just routine, I would say. It's a routine part of our care to make sure we know how to take care of those people.

JH:
Are there any current projects that you're working on that you'd like to speak about?

CWG:
Well yeah, I'm actually working on a book. A history book, it's called From Margins to Mainstream: A History of Transgender Medicine in the United States. I'm working with three other editors, who are all trans-identified. The history of transgender medicine greatly impacts all of the healthcare disparities that are happening currently and how…

[START OF TRACK 3, 0:00]

…to work towards addressing those healthcare disparities. So, the book goes back to precolonial times and how gender diversity was viewed in various areas, including American Indian communities. One of our authors is an American Indian transgender woman who speaks to that, what it was like before colonialism, what happened with gender before colonialism. Most of modern-day practices originated in Europe, so we go to Europe—Magnus Hirschfeld, all of the sexologists in Europe, looked at gender, gender-diverse people and tried to answer the questions: What is this? Why are people like this? And what do we do about it? How do we help these people? Over the centuries, people have asked those questions and come up with different answers, very much influenced by the culture that they lived in. The history comes from one that looks at gender diversity as a very pathologic process; pre-colonialism, maybe not. Maybe the cultures saw it as just a normal thing, but then Europeans made it very pathologic and then the colonization brought that pathologizing view to various places. That view then came to the United States, then there were people that challenged it, like Harry Benjamin, who is considered the father of transgender medicine. He approached his transgender patients with understanding, compassion. He said this is a real thing and we need to help these people feel better, like we do for everything else, for every other human condition we encounter as physicians. We look at that, we look at Harry Benjamin, we look at what happened with Christine Jorgensen, who transitioned and came back to the United States in 1952, and it became this media blitz, bringing trans people into the public eye. We look at what happened before that, when there were gender-diverse people out west, in the Wild West, or just settling into various communities. There's a very interesting story about a transgender man named Joseph Lobdell, who actually lived in this area. Just learning and presenting that in book form has been a tremendous journey, a hard one—it's a lot of work. We have lots of different authors writing the stories, so we're hoping that that will be submitted soon for publication. We have a contract with SUNY Press and we're hoping to get that submitted soon.

JH:
You said you were an editor on that book?

CWG:
I am an editor and I'm writing some of the chapters.

JH:
Could you tell me about the research process for those chapters that you wrote?

CWG:
Oh my goodness, yeah, it was huge. Did you see the pile of books when you came in? That's one pile related to the book; I have other piles all over the place. Lots of reading, lots of talking to people, sometimes we're gathering oral histories from people and writing things down. What have I specifically learned about? I worked on the surgical chapter, so I spoke with surgeons, I read about the early surgeries, I've read about what Hirschfeld did over in his Institute for Sexual Science that he opened in 1919. I learned about what happened when the Nazis came and burned his books and everybody had to flee. Lots of reading, lots of talking, our editorial group meets once a week and talks about what we're learning. So that's been a huge eye-opener for us, all of us.

JH:
Is there anything else you'd like to share while we're on the recording still?

CWG:
Gosh, just that when we finished our Robert Wood Johnson fellowship, people asked what our legacy would be. And I guess, just to say, I'm not sure the Gender Wellness Center will continue. I don't know if we have the ability to recruit the people we need to keep it going. I hope we do, and I hope that Bassett will take that on as a really important project, but there's some uncertainty. So, as I approach retirement, I'm thinking, well, what if we don't continue here? And one of the things we've also committed to is training people. We have had hundreds of students—doctors, nurse practitioners, PA's, high school students rotate through our office. And most of them have come away from that experience feeling a commitment to provide affirming care wherever they work, whatever it is. We have internal medicine students come through and they're going to be a hospitalist, and they say "Yes, when I'm a hospitalist and a trans woman comes in with pneumonia, I will know what to do, how to make that experience affirming for her." So I guess I hope that will be our legacy. When I started in 2007, I had no idea what the Gender Wellness Center would be, but I remember saying in 2012, that my goal is when I retire, there will be people all over New York State trained—and I have not trained all of those people—but there are people all over New York State and I have trained some of them. So I'm proud of that and I guess I just hope that my commitment to providing affirming and competent care will inspire others to do the same moving forward.

JH:
Thank you so much for speaking with me today, I've really appreciated this.

CWG:
I have enjoyed talking to you, Jarrett. Thanks.
Coverage: Upstate New York; Oneonta, NY; 1961-2021
Creator: Jarrett Hill
Publisher: Cooperstown Graduate Program, State University of New York-College at Oneonta
Rights: Cooperstown Graduate Association, Cooperstown, NY
Format: audio/mpeg
50.4mB; audio/mpeg
2mB; audio/mpeg
10.3mB; image/jpeg
6000 x 4000 pixel
Language: en-US
Type: Sound; Image
Identifier: 21-008
Abstract: Track 1, 0:00 - Early Life and Education; Track 1, 11:26 - Transgender Healthcare; Track 2, 11:10 - Oneonta Community; Track 2, 29:25 - Personal Scholarship

Item sets: CGP Community Stories

Site pages: Landing Page

Media: Carolyn Wolf-Gould_Jarrett Hill_ Photo; Carolyn Wolf-Gould_Jarrett Hill_10-30-21_Full Interview_Track_1.mp3; Carolyn Wolf-Gould_Jarrett Hill_10-30-21_Full Interview_Track_2.mp3; Carolyn Wolf-Gould_Jarrett Hill_10-30-21_Full Interview_Track_3.mp3; Carolyn Wolf-Gould_Jarrett Hill_Interview Transcript.docx