Join Sage King, fertility Naturopath and Nutritionist and LGBTQIA+ advocate, as she discusses the importance of inclusivity when working with gender and minority groups in practice.
Together with our ambassador, Dr. Michelle Woolhouse, Sage shares the importance of representation and understanding in the healthcare setting, describing the challenges and medical trauma individuals within the LGBTQIA+ communities may face when not represented or supported.
Sage and Michelle have an open and honest conversation about the different communities that form part of the LGBTQIA+ title and how healthcare practitioners can best support these patients.
Covered in this episode
[01:15] Welcoming Sage King
[03:37] When to ask patients about gender identity
[04:28] The importance of inclusivity
[05:07] Medical trauma can be experienced by this patient group
[06:28] Defining each part of LGBTQIA+
[20:15] The power of language
[23:21] Creating a safe space within our practice
[25:53] Cultivating inclusive language
[30:35] Resources for practitioners
[32:34] Thanking Sage and closing remarks
- Asking a patient about their gender identity can be confronting for the patient. Patient intake forms referring to sex assigned at birth and pronouns can support the practitioner while respecting the patient.
- Everyone deserves the right to equal healthcare and inclusivity is important. The LGBTQIA+ community have an increased rate of medical trauma that can present as fear when it comes to seeking medical help.
- L - Lesbian, represents a woman whose sexual orientation is towards the same gender, those assigned female or male at birth that identify as a woman or non-binary, non-binary people who have a connection to womanhood and are attracted primarily to women.
- G - Gay, represents a man whose primary sexual orientation is towards the male gender or individuals who are either assigned male or female at birth and identify as a man or non-binary.
- B - Bisexual, represents a person whose primary sexual orientation is towards people of the same and other genders.
- Pansexual is an umbrella term that sits under bisexual to represent people who identify as having a primary sexual attraction to a person regardless of their gender.
- Bisexual erasure - where a person who identifies as bisexual is in a heterosexual relationship.
- T - Transgender, an umbrella term representing people who’s gender is different to their sex assigned at birth, inclusive of non-binary & genderfluid communities.
- Q - Queer, a term with a negative history used as a slur. People within the queer community can use this term if they choose, those not within the community are best to seek permission before using this term.
- I - Intersex, an umbrella term referring to variations that don’t fit within the definitions of female or male sex at birth including chromosomal and hormonal variations and internal and external genital characteristics.
- A - Asexual, represents a person with varying degrees of attraction or desire for another.
- + - This is an expanding space, and allows for people who don’t identify with other definitions, including brotherboy, sistergirl and two-spirit.
- Straight Passing - refers to anyone within the LGBTQIA+ community that is NOT identifiable as such to the broader community
- AMAB - Assigned male at birth.
- AFAB - Assigned female at birth.
Resources and Further Reading
Sage King resources
|LGBTQIA+ Clinical Inclusivity Webinar|
|LGBTQIA+ Glossary & Resources|
|LGBTQIA+ Supports & Services Directory Australia|
Advocacy and LGBTQIA+ ally organisations
FX Medicine acknowledges the traditional custodians of country throughout Australia where we live and work, and their connections to land, sea, and community. We pay our respects to the elders, past and present, and extend this respect to all Aboriginal and Torres Strait Islander people today.
Joining us on the line today is Sage King, a fertility naturopath and nutritionist at Rhiannon Hardingham Reproductive Health, and self-identifying queer woman with a keen interest supporting and advocating for the LGBTQIA+ community.
Sage and I struck up a conversation regarding the emerging language and etiquette around best practice when consulting with people from this community. Many practitioners, including myself, feel a little ignorant, and, to be honest, overwhelmed with the seeming complexity of the appropriate language to use in which to not offend. But at the same time open to learning the best way to do this so that we not only safely open our clinics to this group, but our hearts and minds as well. Thanks for joining us today, Sage.
Sage: Thank you so much for having me, Michelle. And can I just say a lot of gratitude for you being so brave in hosting this conversation today. I really appreciate that you're bringing this very important discussion to the forefront.
Michelle: Fabulous, thank you for that. But before we start, I wanted to acknowledge my privilege. So I am a city-born, White, educated, able-bodied cis woman, and acknowledge that I have not been overly disadvantaged in many ways. And I also wanted to acknowledge - and thanks for you to introduce that, Sage - that I'm learning, and I hope that my learning journey does not negatively impact anyone else and I apologise in advance for any mis-considerations. And through this podcast, I'm really happy to be corrected and educated and that's the point of why we're having this conversation, and I'm really thrilled to be joined by you today, too.
Sage: So my pronouns are she/her.
Michelle: Okay and should I ask about gender identity with my patients, or is that something that by asking the pronouns that gives me that information?
Sage: It's not really something that you want to be asking patients directly, especially if it's in that first consultation, and you haven't really built that rapport and safety for them. So I tend to find that I get a lot of information from new patient forms where it'll ask them their sex assigned at birth and if their pronouns are different to that, it kind of gives you a bit of an insight into them as a person.
Sage: I suppose it's really important because everyone deserves the right to equal healthcare and just equal rights in general. And we'll go through these terms later, but the cisgender community that are also heterosexual see themselves everywhere. And representation really, really matters.
So there's a lot of medical trauma with this patient group, and so there can be a lot of fear around seeking medical services. So I never set out to completely specialise in LGBT support, however, just by being visible and open to this patient group, it's just what I've attracted from there.
Sage: Yeah, of course. So if patients go to a medical professional, for example, and their gender identity may be different to what their sex is assigned at birth, many individuals have experienced prejudice in those situations where the practitioner's viewpoints on whether their gender identity is valid or not is then reflected back to that patient.
So this community really has to advocate for themselves even in really what you would consider safe space in a medical setting, where they have to then try and really advocate for them to get tests that they want or referrals for gender-affirming hormone replacement therapy, which thankfully has improved over the recent years. But I don't think many people appreciate the fact that if you're not part of this community group that you get to go and see a practitioner that you don't have to educate while you're paying for their time before they can understand and then support you.
Michelle: Yeah, absolutely. And I think also it's so tiring to have to do this. It's not just a time thing and an education, but it's tiring and exhausting to try and, I guess, show yourself and be seen.
Sage: Absolutely, absolutely. Emotional labour is a real thing.
Michelle: Yeah, it's a beautiful term as well. So I want to open this conversation up by really just exploring the acronym LGBTQIA+ and what it stands for. So how many is there? There’s eight, so we've got eight different areas to explore. So I know you do this really beautifully. So, yeah, let's go, let's start from the top, and let's start with L.
Sage: Great. I call it the LGBT alphabet because there are only so many letters missing from the LGBTQIA+. So let's start from the top.
Michelle: It's getting easier and easier. It rolls off the tongue when you say... Yep.
Sage: It does, yeah. Practice makes perfect, right?
Michelle: Yeah, that's right.
Sage: So L stands for lesbian. And this is usually a woman whose primary sexual orientation is towards people of the same gender. But it may also include individuals either assigned female or male at birth that identify as a woman or non-binary. And it also may include non-binary people who have a connection to womanhood and are primarily attracted to women.
If we then go through to G, so G stands for gay, usually, a man whose primary sexual orientation is towards people of the same gender. And again, like lesbians, also includes individuals either assigned male or female at birth that identify as a man or non-binary. Any questions on that so far?
Michelle: They're the classic ones that have been, I guess, probably on the radar for a long time in history. So, with that non-binary, just as you're saying that, tell us what non-binary means.
Sage: Yeah, of course. So non-binary is an individual that doesn't identify as male or female or may identify as both. So their gender identity can fall on that spectrum between male, female, or neither, or both. And while we're here as well, I'll just explain the assigned female and the assigned male at birth, because I think that's a really integral thing for practitioners to understand.
Michelle: Yeah, great.
Sage: And we're getting our head around primarily the transgender community which also is inclusive of the non-binary and gender fluid community, is that there's this talking about 'biological sex’ and trying to understand that. But where the language sits at the moment, the terms that we should be using around that patient group is ‘assigned male at birth’ or AMAB, or ‘assigned female at birth,’ AFAB.
Michelle: Is that a safer term than using biological sex?
Sage: Yes, absolutely. Absolutely.
Michelle: Yes. Okay, cool.
Sage: So AMAB and AFAB are what practitioners should be using.
Michelle: And so, obviously, for the listener, too, we're going to have some examples of these, what we've discussed. So perhaps even like a printout that...almost like a cheat sheet as we start to become more familiar. We're going to go back to that acronym in a second. But what I've noticed even through our conversation and then speaking to my teenage kids who are all over this, and just the education and just noticing my unconscious bias and my automation, my brain automation, trying to change that brain automation takes some time. So with conscious effort...
Sage: It does. Yeah. And it's not something that...I'm not that young, I suppose. I'm 33. I grew up with a very...
Michelle: Come on, Sage, you're young.
Sage: I know, I know, but still comparatively to your teenagers, they have that...
Michelle: Yeah, that's right.
Sage: ...language down pat. But for me, it was still a very much learnt thing, a conscious decision that I had to make to really change the way that I thought through the binary and the language that I used around that. And I've definitely made mistakes with patients and I've definitely said the wrong thing. But I think it's just about being open and willing and comfortable and knowing that you might say the wrong thing. And that's okay. Trying is the best possible thing that you can do.
Michelle: Yeah, that's fabulous advice. So, okay, we're up to B.
Sage: We're up to B for bisexual. So a person whose primary sexual and affectional orientation is towards people of the same and other genders. And we may have heard the term pansexuality, and that's an umbrella term that sits under bisexual. So if you're pansexual, which is what I identify as, is a person whose primary sexual and affectional orientation is towards people regardless of their gender. So bisexual tends to sit still within that binary of ‘I'm attracted to men and women,’ whereas pansexual is just attracted to people regardless of their gender.
Michelle: Okay, got it. And there's a term called bisexual erasure. Am I saying that right? Y eah, tell us about that. You can explain it better than me. Yeah.
Sage: Of course. So bisexual erasure is a real issue both within the LGBT community and the broader community. And it's where you may identify as a bisexual, however, potentially, you're in a heterosexual presenting relationship. So maybe you're a bisexual woman and you're in a relationship with a man. And so it's that thing of, well, bisexual, their identity doesn't exist because of the current relationship that they're in, and so their identity gets erased in all of that...
Michelle: I see. Yep.
Sage: ...as well. There's been a long line history of like "Well, just pick one. If you like both, then why not just pick a side?" I think that group, it's really a lot harder to navigate when you are just attracted to people. I think it's much easier for people that don't identify as part of the LGBT community to get their head around being attracted to same-sex or opposite sex.
Michelle: And again, it comes back to that exhausting...it must be exhausting having to kind of explain these things or even need to explain these things.
Sage: Yeah. Look, it really is. But I feel like, for myself and my lived experience, I get away with a lot of that external bias because I present as a heterosexual woman, even though I'm not what we in the community calls straight-passing. Whereas my partner's...
Michelle: What's that?
Sage: ...gender fluid. And you can absolutely tell that she is gay. And so she definitely gets a lot more harassment in the external world. So I find it not as taxing on me to advocate for this community group versus others within it.
Michelle: Okay. So, transgender, tell us about transgender.
Sage: So transgender is an umbrella term for individuals whose gender is different from cultural expectations based on their sex assigned at birth. So an example of that is an individual assigned female at birth, but they identify as a man. It can also describe someone who identifies as a gender other than woman or man. And that's what I was mentioning earlier like the non-binary, genderqueer, or no gender community also sit underneath the transgender umbrella and underneath transgender as well as trans. So trans tends to be the word that we hear most at the moment, but it's a more inclusive term for gender non-conforming and non-binary folks.
So transgender is thinking individuals who still sit within that binary, however, it is different from the sex assigned at birth, whereas trans is more anyone that suits other along that scale or neither of them.
Michelle: And so it doesn't necessarily mean somebody's transgendering as in like their gender is being changed. It could just be an identity. Is that right?
Sage: Yes, correct. So you can be a trans man, for example, however, you don't need to have gender-affirming hormone replacement therapy to be trans. It's just an identity. And some people want to then physically transition to affirm their gender and others are still quite comfortable in the way that they present in the world. It's very different for each individual.
Michelle: I feel like even just this discussion alone is just really helping clarify. That's really important. Thank you.
Sage: My pleasure.
Michelle: So, queer, tell us about Q.
Sage: Yes, queer. So queer is a word that was historically used as a slur against people whose gender or gender expression or sexuality didn't conform to societal expectations. However, in recent times, queer is definitely a term that's been reclaimed by some as a celebration of not fitting into these norms. So I tend to use this term for myself quite a lot. However, not all who identify as part of this community use queer to describe themselves. And it is still, a term that is considered hateful when it's used by individuals who don't identify as LGBTQIA+. So it's one of those things where it's okay for us to say it, but it's not okay for others.
Michelle: And so like with you, Sage, if you identify as queer, if you and I were friends, would that be okay, or what's the boundary there?
Sage: Yeah, totally. I think it's just all about consent. So if you use a term to describe me, for example, or if I've come forward and said I identify as a queer woman, it would be okay for you to repeat that. But if there's anything that you wanted to use in relation to me in a conversation, just ask. And that's what I do with my patients as well, like, "Is it okay if I ask you blah, blah, blah?" And they can either say, "Yes, sure," and give you the answer, or they'll be like, "No, I don't feel comfortable discussing that." And then no harm, no foul.
Michelle: Okay, great. Fabulous. This is such good information.
Intersex is the I.
Sage: So intersex is an umbrella term that's used to describe a range of natural body variations that don't, I suppose, neatly fit into conventional definitions of male or female sex at birth. And these variations can include, but I suppose aren't limited to things like chromosomal compositions, hormone concentrations, and also external and internal genital characteristics. So this population makes up...I think it's about 1.7% of the overall population.
Michelle: Of the overall LGBTQIA community population or overall population?
Sage: No, of the entire population.
Michelle: Right. That's quite a lot, isn't it?
Sage: Yeah, it is quite a lot. Yeah.
Michelle: So the last one, except for the plus, we're going to get into the plus because that's really interesting as well.
So we're getting to A, I know, asexual. So tell us about that.
Sage: Yes, asexual. So asexual is...how do I describe it simply? Basically, it's characterised by varying degrees of sexual attraction or desires for partnered sexuality. I suppose people think asexual and they think along the lines of celibacy, where they don't want to have sex with anyone at all. However, it still sits on a spectrum where they still may want to experience other forms of intimacy, whereas other people may not want to experience any of that at all.
Michelle: That's interesting, too. I think from a sexual health perspective, it's still really...if someone's identifying as asexual, it's important we don't assume that they haven't had any sexual intimacy contact. So that's really important for practitioners too.
Michelle: So yes, the +, that's a newer addition. Is it? Or is it just a way of saying, "Okay, this is an expanding space and..."?
Sage: Yes, so the + stands for an expanding space because this community group is forever evolving and changing. And I have no doubt that within another year or so, there's going to be a change to what is safe and not safe for this population group.
But other terms that I just wanted to make mention of that also fall within that + umbrella are the terms, brotherboy, sistergirl, and two-spirit. So, brotherboy is for our Aboriginal and Torres Strait Islander transmasculine individuals. So they're gender-diverse people who have what they call a male spirit and take on male roles within the community as to what the consensus is, I suppose, as to what men's and women's roles are within the community. And sistergirl is the same but for those with a trans feminine identity, so take on female roles within the community with a female spirit.
And the two-spirit community is an indigenous trans identity for those over in Turtle Island or the States, and they have what they call both masculine and feminine spirit. So, similar to non-binary, except they harness both of those energies. I suppose these gender identities have actually been around for a really, really long time. They've been a part of our indigenous communities forever. And it's just that way as Westerners are really catching up in terms of the language that we have to describe this community group.
Michelle: I think that's really fascinating from a cultural and historical perspective that is there because I think that there's a prejudice of why there are so many new gender identity expressions coming out within the community. But in fact, it's a coming out rather than it's not that it hasn't been there all along.
Sage: Exactly, exactly. And so I think, especially if we use the non-binary group, for example, we've only just really had language to describe people who don't feel male or female on the inside and didn't know what that meant for them and were so lost by their identity. But now that we have the language, they can be like, "Oh my God, that's me! I've been feeling like that forever."
Michelle: That's right.
Sage: So I just think it's really great that this language is evolving.
Michelle: And I think not feeling like you belong or are different is incredibly confronting for human beings because we kind of... we're born to belong, we're born to be social and connected. And just that sense of not belonging just marginalises people from their communities and that exclusion and ignorance and suffering all of that disadvantage. So, have you noticed...I've noticed with my teenagers over the last sort of 10 years, it's come to my attention through them and, obviously, through information such as you're bringing to the table as well, but is it making a noticeable difference for this community?
Sage: Well,I suppose I can't speak on behalf of the entire community because my lived experience isn't one that is gender fluid or I'm not transgender. So I can't speak on behalf of them, but from the friendship groups that I have and those that are dear in my life that are of that identity, yes, I genuinely think so. And even with my patients, something as simple as writing a referral letter to their GP, I always ask, "What pronouns do you want me to use on your referral letter because I don't want to out you to another medical practitioner if you don't feel safe?" Even something as little as that, they're so grateful for because of that, "Well, no one's actually ever asked me that before."
Sage: And being seen as who you are would do wonders for anyone, I think.
Michelle: I totally agree. Recognising and being seen or not being seen. Most of us know the feeling of not being seen, but not being seen by our greater community would be even more distressing in many ways.
And also, language is such an amazing thing really too. Just having a word, even though it may not be 100% perfect, even getting closer and closer to, "Yes, I can understand that meaning," has an effect on our neurology as well. It gives us a safety within our neurology, and that is a really powerful healing aspect as well.
Sage: Absolutely, absolutely.
Michelle: So I loved actually how you kind of used the term ‘outed.’ Tell us a little bit more about that. Because, obviously, is still a long way for us to go as practitioners to really create that safe space, even if we're well-intentioned because when you're from a community that has been less than perfectly understood, for want of a better word, it takes a while to develop trust. So, how do we start the learning? How do we as practitioners grow from here? What are some simple things that you think like, "This is a great place to start"?
Sage: Good question. The important place to start is just starting. I think being open to it and I think just understanding that you are going to say the wrong thing, and that's okay. It's just about how you recover from that. So I find even in my own personal experience in talking to others, or trying to educate other practitioners that come to me like, "What do I do?" It's that thing of not centring yourself in that moment. So if you were to say something to me and I just corrected you on it, it's not something that you need to make this really big apology, and, "Oh my goodness, I'm so sorry. And I did this because blah, blah, blah." It's just, "Hey, thanks for correcting me. I'm so sorry. I'll try to use the right pronoun in the future," or something like that.
Michelle: If someone corrects you, could that be seen as a sign that they feel safe enough to correct you?
Sage: Absolutely. Yes, for sure.
Michelle: And so in some ways to help centre yourself if they're confident enough to correct you, then from a practitioners point of view, if we can create that and just find that safety within ourselves, the safety of making a mistake, because we're...most practitioners are always trying to do their best. And so that could be a way of sort of reframing of like, "Well, the consciousness is growing." So, it's a good thing.
Sage: Yeah, I completely agree. Yeah, reframing it like that is really important. And if you feel uncomfortable in that moment, I also like to think about how uncomfortable the patient is in that moment, having to bring something to someone they may not know at that stage. So it's just uncomfortable for everyone. And that's cool. And it's just a, "Hey, thanks. I'm going to try to do better next time.” And then you can move on.
Michelle: We spoke about the power of language. But there's also the power of language in terms of signage within the clinic, patient intake forms, website information, and those kinds of things. Because, again, what do you mean, and is there some really good clear suggestions that you have for us that we can do really easily?
Sage: Sure. So if you think about all of those things that you've just mentioned, there needs to be some signifier of safety for this community. So if we think about it from a marketing perspective, what language are you using on your website when you describe women's health? What language are you using when you're maybe doing an Instagram Live or a video, and you always greet everyone with "Hi, guys"? Just looking at how exclusive your language is. And it's not about removing...and I suppose this is a really key point that I want to get across to everyone today. Inclusivity isn't about removing other minority groups such as women. It's just about giving everyone a seat at the table.
So I work in fertility, so I talk about reproductive health all day every day. And you can talk about women's health, but you can also talk about and the health of all people that have a uterus and all menstruators. So I think reassessing the language that you use around that. I support mothers who breastfeed and actually all parents who chestfeed as well. And if they can see themselves within that language, you are a safe space for that community group. Another really simple thing is just adding your LGBT flag, Torres Strait Islander flag, and indigenous flags to the bottom of your websites. Potentially like I have it also in my email signature, just, again, a virtual signifier of safety and inclusivity for these community groups.
Michelle: Just a note on breastfeeding because one of the things that came to mind with that is that men have breasts and women have breasts. Is that for the gender non-binary when we say chestfeeding, for example?
Sage: Yes. Perfect, yeah. Good pick up, Michelle. That's great. Yes, some of the non-binary community have had their breasts removed and they don't...I suppose it's a point of...what's the word I'm looking for now? I can't remember.
Michelle: A distinction, just a point of distinction, is it? Or?
Sage: So say your body looks and feels different to how you feel on the inside, there's a specific phrase for that term. But anyway, yeah, it's just so it's not triggering for them because they don't have breasts, therefore, they're not breastfeeding. Just an all-inclusive term for everyone, really.
Michelle: And I think also even just breaking down, you mentioned reproductive health and menstrual health, but it's actually more distinctive really. Women's health is an umbrella term anyway. And what does that actually mean? And why do we distinguish it so much from men's health? Obviously, there's a genital area and those kinds of things ,they call it “bikini medicine.” But really, the health of a woman or people identifying as women is also neurological. And there's distinctions in characteristics and cultural identity and social health that are really important as well. And by saying women's health, we're actually excluding a lot of that or creating, I guess, a smaller term, really. Do you know what I mean?
Sage: Yeah, I do. I think also, though, in that women have had to fight really hard to get where they are. They're definitely their own minority group within themselves. And I think as I said, it's about recognising everyone and giving everyone a seat at the table because, at the end of the day, we're on the same team. We have similar disadvantages, they all have their own individual challenges. But, yeah, it's so important that women have their own language, but it's never at the detriment of any other community.
Michelle: It's kind of that thing of power with rather than power over. There's no group that's any more important or significant than any other group. And by bringing everybody to the table, we're creating much more diversity, but much more empowering group because diversity is the key to any ecosystem. It's the key to rainforest healths and biodiversity, is the key to environmental health. So diversity within the human community is clearly where we're going to get some real gold.
Sage: Absolutely. Yeah, sure.
Michelle: Sage, this has been absolutely fantastic and I've learnt so much. How can we learn more as practitioners? Is there some resources that we can utilise to really embrace this as we move forward?
Sage: Yeah, absolutely. So I actually did a free half-hour presentation on all of this in much greater detail and it's available on our website. So I'm pretty sure I've given FX Medicine the link to that. So it'll be provided for listeners if they want to follow up from there.
Sage: But also, there's a really great pictograph that I use all the time when I present, and it's on the website called transstudent.org. And from there, they've got a really great but relevantly up-to-date list of all of these terms and resources. So that if a term does come up in practice and you're like "Oh, I don't know what that is," just pop onto their website and you'll be able to find it there.
And other resources that we look for locally, I know ACON, so just A-C-O-N, has some really great resources online. And they also do what I love, which is a Diversity Days program. So they have free resources for every single LGBT celebration day on the calendar each year, and they've got pre-made marketing materials and resources for each day as well that are just good to go for practitioners to use. So if you're not really knowing how to make yourself visible from a social media perspective, for example, that's a really great place to start.
Michelle: It's amazing. And it's so great that we can share these resources to really build up that language and that connection, but also the commitment to diversity that I think we all hope for.
Sage: Thank you so much, Michelle. And thank you, as I said earlier, for being brave to hold a discussion such as this when you're not feeling all confident in navigating it. And I hope it's really inspiring for other practitioners to be able to feel like they can do the same.
Michelle: Thank you, everyone, for listening today. Don't forget that you can find all the show notes, transcripts, and other resources from today's episode on the FX Medicine website. I'm Dr. Michelle Woolhouse, and thanks for joining us. We'll see you next time.