Amy D'Arpino's child was assigned the sex male at birth. But at a very young age, the now 13-year-old expressed to her mom that she identified as female.
It was time for D'Arpino to begin searching for resources that would facilitate her child's transition. But after all the research she ended up doing, she'd wound up educating health providers about how to care for her child.
Especially things like a checkup freaked them out—the uncertainty of the doctor's reaction when reading paperwork with D'Arpino's daughter's legal name and sex assigned at birth.
"That's pretty traumatizing, when you go into a doctor's office and you are treated with hostility, told to leave because they don't agree with who you are," she says.
D'Arpino, who's been a years-long presence at Southern Arizona Gender Alliance's trans parents support group, was happy to hear the first (yes, the very first) clinic and health and wellness center geared toward lesbian, gay, bisexual, transgender, questioning and intersex patients in Arizona would be opening in Tucson.
Living Out Loud, located on Broadway Boulevard and Country Club Road, opened last month and is a branch off CODAC Behavioral Health Services, which is no stranger to LGBTQI friendly services.
What right now are mostly offices with desks, a few chairs, some clinic equipment and a lot of white walls, is expected to be fully staffed by the spring with primary care doctors, therapists, psychologists and other health and wellness providers who'll be able to care for LGBTQI adults and children as young as 6 years old. (There are a handful of psychologists already seeing patients.)
All staff and volunteers are LGBTQI-identified and allies who have worked with the community. Some of them will be transferring to LOL from the Southern Arizona AIDS Foundation and other CODAC facilities.
The LOL center is filling up a huge gap of health needs in the community.
For many LGBTQI people in the region, fear of discrimination or a health provider's lack of knowledge for how to care for them–this is especially true for transgender and gender nonconforming patients–is what has been keeping them from even going to the doctor.
Many primary care clinic questionnaires don't even include questions relating to gender identity and sexual orientation.
An October 2010 survey by the National Transgender Discrimination Survey and the National Gay and Lesbian Task Force says that out of more than 7,000 LGBTQI people surveyed, close to 30 percent postponed visiting the doctor and that same number reported being harassed at a health center. Half of them said they ended up having to teach the doctors and health providers about transgender care and 19 percent said they were refused care due to their transgender and gender nonconforming status.
"I have heard of other families in town who have had to leave the pediatric office because the doctors weren't supportive of kids who are trans, they didn't want to work with them, not because of lack of skill, but because they don't believe in supporting kids who are gender diverse," D'Arpino says, who is also a member of the Southern Arizona LGBTQI Behavioral Health Coalition.
The center's gender confirmation services stood out to D'Arpino. Her child receives hormone therapy, which is helping her block puberty. That type of care is something many in Tucson have had to search for in other cities and other states, where there have been centers focused on the LGBTQI population for way longer.
However, soon, the LOL center hopes to house an endocrinologist, or hormone specialist. The center is working with other community programs and with the UA to recruit at least a few specialists. (The UA and LOL are also collaborating to train new clinic staff in things such as HIV/AIDS care.)
"With an integrated care model, it's not just about getting the hormones or getting the therapy. It's about helping a person, who is receiving hormones, also figure out a balance in their life," says Chad Mosher, LOL's program coordinator. "We are also aware of some of the other factors that need to go on, maybe help seeing a wellness coach to help offset some of the side effects of hormone therapy or developing a plan around what a transition might look like for that individual."
To Mosher and the rest of the LOL team, opening an integrated care clinic and wellness center for LGBTQI people is also about civil rights issues.
"There are multiple barriers, multiple societal barriers to be healthy ... LGBTQI individuals, friends, families, there is a lot of stigma," he says. "There are a lot of societal pressures to not validate people's lives and holistic wellness ... and still maintaining who you are, whatever identity that might be."
LOL aims to be the backbone for confronting coming out at work, to family member and everything physical and emotional that goes on in a transition–and not being able to afford it won't be a barrier.
The center accepts commercial health insurance, as well as AHCCCS. But for those who don't have insurance or have limited healthcare, LOL has been awarded grants that can help with the costs.
"They are filling in those holes, focusing on LGBTQI young adults who are homeless and making sure they have easier access to services, such as food, housing and obviously behavioral health and other health services," says Aimee Graves, vice president of resource development at CODAC.
Graves says LOL was recently selected to be a part of a national learning community called Centers for Innovative Health Solutions—part of the Substance Abuse and Mental Health Services Administration and the Health Resources Services Administration—which for the next few months will "help integrated healthcare teams define what services they want to provide, what source of venues and for which populations," meaning all those who come through LOL's doors will receive care that is tailored to them, not a one-size-fits all method.
LOL is merely a month old, but they're already anticipating growing out of their current space.
"There have been families who have had to travel to (Los Angeles) to a specialty center for gender, having the LOL center here in town, for folks who also may want to come here from Phoenix and other parts of Arizona," D'Arpino says. "With my daughter, when visiting a new doctor, she always has the questions, 'Are they going to know about me? Do they support me?' Having the LOL center takes off a lot of pressure, takes off a lot of stress."