Ashley Anderson is an RN and charge nurse in the neurotrauma ICU at a hospital in northeast Indiana. A year ago, she took an extended leave from her post to complete something she's thought about since she was a child - gender confirmation.Assigned male at birth, Ashley didn't feel right in her given body as she was growing up, but she never thought it was a real possibility to change it. To her, it was as far off as having a superpower. So, she lived for years letting the world believe she was a man - eventually getting married, having children and finding her calling in the family business as a nurse. There came a time, however, when Ashley realized she couldn't keep hiding her true self; and thus began her transformation.
It has been a year since you underwent gender confirmation surgery from male to female. How has this last year been for you?
It's kind of profound. It's not so much a new experience, as it was finding peace. One of my friends once likened it to a hissing background. This body I was born into was like a hissing radio in the background - in your mind all the time. It felt like a constant noise that was always on and would never let me have any peace. And having the hormones turned it down. Having the breast augmentation definitely turned it down. Now, I know I'm getting to the point where I might not be able to hear it anymore. Just seeing what I have so far, I think to myself, "Whoa, this is what it's like to be normal. Awesome."
You have a unique understanding of the diverse healthcare needs for transgender patients. What would you tell other nurses?
I would stress the point that transgender patients are in a uniquely vulnerable position. A lot of us have various things about our bodies that we may not feel comfortable with, but in a clinical setting, we have been disarmed of all of that. For instance, I know from my recent experience being a hospitalized patient for my surgeries that I felt very self-conscious in front of some of the nurses due to my hairline. Day-to-day I have found ways to compensate for it, but when you have to completely disrobe for a surgery, or you're hospitalized for a week post-op, your bedside clinical staff will inevitably see everything.
Particularly, I can imagine for patients in a critical care setting, who did not come to us of their own volition, the vulnerability is magnified. I would expect an increased level of irritability and distrust from such a patient. We sometimes hear about deficiencies in transgender healthcare and patients being disrespected or even denied proper treatment. Therefore, it stands to reason that a patient might be distrustful of us at first, and it will be incumbent upon the nursing staff to try to temper that situation.
On a practical level, I would also bring up the potential side effects of hormone replacement therapy (HRT) that a good clinician should be aware of. Specifically, changes in mood and clotting risk factors. The latter might even be reason enough to withhold HRT during hospitalization. However, nurses and other healthcare providers should be aware of the tremendous amount of anxiety and mental strain that being denied HRT will cause a transgender patient. While it may be prudent to pause treatment for various reasons, doing so should not be taken lightly, and efforts should be made to ensure the patient understands why it is necessary.
What has your personal transition been like?
I feel like trans people would be the best sleeper cell agents. We can go decades in character and never break. In 2001, I did come out as trans for the first time. I only told a small handful of people, my parents among them, and they were supportive, but shortly thereafter, I went back in the closet and tried to pretend that didn't happen. I was afraid of being alone and ostracized the rest of my life.
Eventually I got married and we had two children. I continued to have thoughts about my true identity, but I had kept a promise to my wife. After some personal hardship, the marriage ended, and it was at that point that I decided to come out for good. I went to a grief counselor for the marriage, but it just so happens the person was also a gender identity therapist. I received the mental and emotional support I needed and then began HRT. The process of coming out to the kids was hard, but they are my biggest cheerleaders these days, so I'm comfortable with that.
How has being transgender impacted your journey as a nurse?
Growing up, I had a ton of respect for nurses, because my mother and my aunt are ICU nurses. I actually looked at my mother like she was a hero - she saved lives for a living. In high school, I thought it would be really cool to be a critical care nurse, but I didn't think I could actually do it. I didn't think I was good enough. Well, I should have done it right off the bat. After college, I worked in other professions, but I didn't feel like those jobs had meaning - like it didn't really matter. Now, after nine years as a nurse, I know my work really matters, and it is definitely something I feel comfortable with. It's rewarding.
For someone going through transition, being a nurse is amazing. When I first started on the floor, I got to come in and have a new, completely random stranger to care for every day. One of the reasons I decided to go with the name Ashley was you could shorten it to Ash, and Ash is kind of gender neutral. So, I intentionally did not use any gendered pronouns when I was with these patients. I just want to see what their reaction was to the person they saw. It was really validating.
What was your experience like when you came out to your colleagues?
I wrote a message on a communal Facebook board that our team of nurses uses. In the message, I said, "This is who I am, and I'm not going to explain the whole thing here. If you do want someone to help you understand it, here are some resources from different transgender groups. If that doesn't help, you can come ask me."
I didn't get any negative comments, and everyone was super supportive. There were people who had questions because they didn't understand certain things, but they asked with kindness. I remember distinctly, the next time I went to the nursing shift huddle, one of my big, tall nursing colleagues was there. He literally picked me up in a bear hug and said he was proud of me.
What advice do you give to people who may be unsure of the sensitivities to consider with individuals who are transgender?
I am fortunate that my hospital already has policies and training in place regarding transgender individuals. There is signage at registration and throughout the emergency department noting that if your gender identity differs from your sex assigned at birth to let us know so that we can make note of it. We have forms we add to the physical chart to make people aware of what pronouns and names to use in that case.
On a personal level, I told my colleagues, "If you want to talk about gender confirmation surgery, I will happily tell you everything I learned. I'm cool with it, but a lot of people aren't." That's the one thing I have to keep emphasizing to them; if you have any questions, I'm fine if you come to me, but as a rule, most transgender folks would not appreciate it. You're probably going to make them feel uncomfortable.
What would you tell other nurses who may be transgender but haven't come out?
I would tell them to start by taking a deep breath. You're coming out among a group that is almost solely defined by highly educated, intelligent individuals. I think that made a big difference and is why I didn't feel much resistance with telling them. They were smart and compassionate enough to understand what was going on.
The second suggestion I have is to go to management and human resources first and get them on your side before telling your colleagues. That gave me an idea about what to do if I did experience any harassment at work. As I began telling my colleagues, I felt much more confident doing it, because I knew where I stood with HR. They weren't going to put up with any discrimination or harassment.
Why do you feel visibility for transgender nurses is important?
If I had had better access to data or to this community of people who were invisible to me when I was 20, I would have gone full force with my transition without blinking an eye. The only reason I waited so long was that I felt I was just too tall and masculine to become who I wanted to be. I want people who may have questions about their gender identity to see, here's someone like me who transitioned late, and not under the ideal circumstances, and still was able to achieve what I set out to do.
Not only did I do all that, but also I love my life now, and it changed me dramatically. I want other people who were in my shoes as a young person to see that I am a well-paid professional doing a job I love with co-workers who respect me. I want people to see that life after transition can be normal, or at least, as normal as you want it to be.
Editor's Note: If you have additional questions for Ashley or want to learn more about her journey, connect with her on Instagram at @transnursehere.