{"id":13610,"date":"2019-05-07T08:23:37","date_gmt":"2019-05-07T15:23:37","guid":{"rendered":"https:\/\/familymedicine.uw.edu\/medex\/?post_type=post&#038;p=13610"},"modified":"2022-04-04T18:55:58","modified_gmt":"2022-04-04T18:55:58","slug":"id-like-to-change-that","status":"publish","type":"post","link":"https:\/\/familymedicine.uw.edu\/medex\/magazine\/2019\/05\/07\/id-like-to-change-that\/","title":{"rendered":"I\u2019d Like to Change That"},"content":{"rendered":"<p><span class=\"dropcap\">A<\/span><strong><span style=\"font-size: 18pt\">lex Shaffer is working under<\/span><\/strong> Dr. Alan Thomas at <em>Puget Sound Orthopedics<\/em> in Lakewood, WA. \u201cIt\u2019s fantastic,\u201d he says. \u201cWe\u2019re seeing lots of patients.\u201d Dr. Thomas is an orthopedic surgeon specializing in the upper extremity: hand, arm, elbow.<\/p>\n<p>There are two surgery days at the clinic.<\/p>\n<p>\u201cOn Fridays, I get to scrub in and help out, doing whatever is needed. It&#8217;s great. I&#8217;m having a blast and I&#8217;m learning a lot. This is a really nurturing place.\u201d<\/p>\n<p><iframe loading=\"lazy\" title=\"Alex Shaffer MEDEX Seattle Class 51\" width=\"1020\" height=\"574\" src=\"https:\/\/www.youtube.com\/embed\/8MiAaURhHQw?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen><\/iframe><\/p>\n<p>Alex is a clinical year PA student in MEDEX Northwest\u2019s Seattle Class 51<strong>. <\/strong>Trained as a combat medic with the Oregon Army National Guard, he\u2019s not a stranger to medicine. In the civilian world, a combat medic is the equivalent of an EMT. \u201cDuring times of war, we\u2019re practicing medicine through the US Army on the battlefield doing whatever it takes to save lives,\u201d he says. \u201cOtherwise we see people coming in with everything from coughs, colds, and sniffles to broken bones.\u201d<\/p>\n<p>Alex\u2019s interest in medicine came early, well before becoming a combat medic.<\/p>\n<p>\u201cMy mom finished nursing school when she was about my age,\u201d Alex explains. Back in junior high school, Alex used to help his mother study by quizzing her with flashcards. \u201cI think she was 42. She worked as a nurse for 20 years before medically retiring due to a back injury.\u201d<\/p>\n<p>From 2000 to 2003, Alex worked as a phlebotomist. But he always wanted to do more. And so, at the age of 30, he enlisted in the Oregon Army National Guard as a combat medic. He was supposed to be deployed to Afghanistan but got injured in training and required neck surgery.<\/p>\n<p>\u201cI have two titanium discs and four screws, C5 through C7,\u201d he tells us.<\/p>\n<p><span class=\"dropcap\">T<\/span><span style=\"font-size: 18pt\"><strong>here were two factors<\/strong><\/span> that prevented Alex from getting his physician assistant training through the military.<\/p>\n<p>\u201cI wasn\u2019t qualified for the IPAP program because of my age and injuries,\u201d he says. \u201cAt 42, I\u2019m old and broken. I needed an age waiver, and I didn&#8217;t qualify to pass the physical to go into that program. I can try to commission after I graduate, which is my goal.\u201d<\/p>\n<div><div id=\"amw_galleria_slideshow_1\" class=\"amw-galleria-slideshow\"><\/div>\n<script type=\"text\/javascript\">jQuery(document).ready(function(){ jQuery(\"#amw_galleria_slideshow_1\").galleria({\"dataSource\":[{\"image\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/A5-Alex-Shaffer-1024x683.jpg\",\"big\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/A5-Alex-Shaffer-1024x683.jpg\",\"thumb\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/A5-Alex-Shaffer-150x150.jpg\",\"title\":\"A5-Alex 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Born a female, Alex is officially, legally a male everywhere: birth certificate, driver&#8217;s license, military, everything. Going forward, he\u2019ll use the male locker room and be housed with males.<\/p>\n<p>\u201cUnless you live under a rock, everybody knows what the word \u2018transgender\u2019 means,\u201d he says.<\/p>\n<p>But when Alex was growing up, he&#8217;d never heard the word.<\/p>\n<figure id=\"attachment_13636\" aria-describedby=\"caption-attachment-13636\" style=\"width: 167px\" class=\"wp-caption alignright\"><a href=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/Vert2-2012atdrillinSalemORPre-T.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-thumbnail wp-image-13636\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2019\/05\/Vert2-2012atdrillinSalemORPre-T.jpg\" alt=\"\" width=\"167\" height=\"250\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2019\/05\/Vert2-2012atdrillinSalemORPre-T.jpg 800w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2019\/05\/Vert2-2012atdrillinSalemORPre-T-200x300.jpg 200w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2019\/05\/Vert2-2012atdrillinSalemORPre-T-683x1024.jpg 683w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2019\/05\/Vert2-2012atdrillinSalemORPre-T-768x1152.jpg 768w\" sizes=\"auto, (max-width: 167px) 100vw, 167px\" \/><\/a><figcaption id=\"caption-attachment-13636\" class=\"wp-caption-text\">Alex in 2012 at a National Guard drill in Salem, OR.<\/figcaption><\/figure>\n<p>\u201cI was born in 1977 and knew I was different. When I was little, I always thought I was going to grow up and be a big boy like my dad.\u201d<\/p>\n<p>In conversations with his mother, she reports that she viewed him as different by age 4, and that she knew he was a boy by age 8.<\/p>\n<p>\u201cBut we didn&#8217;t have a word for it, and you didn&#8217;t hear about it,\u201d Alex says. \u201cI mean, it was really taboo to even be gay at that point. And so, I didn&#8217;t know how to communicate how I was feeling, and my mom didn&#8217;t know what to do about it.\u201d<\/p>\n<p>All this made growing up in rural Oregon a struggle for Alex, with puberty an especially difficult time.<\/p>\n<p>Finally, around age 20, he read something about people feeling that they were born in the wrong body. Alex\u2019s response was, &#8220;Oh, that&#8217;s me. That&#8217;s what I am. That&#8217;s what&#8217;s going on.\u201d<\/p>\n<p>\u201cIt just clicked with me,\u201d Alex says. \u201cI did a lot of research, and realized that\u2019s who I am.\u201d<\/p>\n<p><span class=\"dropcap\">T<\/span><span style=\"font-size: 18pt\"><strong>he 2013 American Psychiatric Association\u2019s<\/strong><\/span> <em>Diagnostic and Statistical Manual of Mental Disorders, 5<sup>th<\/sup> Edition<\/em> \u2013 commonly referred to as the DSM-V \u2013 classifies this condition as gender disorder.<\/p>\n<p>\u201cAt that time, you had to see a therapist for a full year before you could start hormone treatment.\u201d<\/p>\n<p>In his late 20s, Alex was living in Texas, then moved back to Oregon. He enlisted in the military.<\/p>\n<p>\u201cMy thinking at the time was, \u2018Well, I can have one dream or the other.\u2019 So, I just kept hiding who I was except from my mother and a very few close friends.\u201d<\/p>\n<div><div id=\"amw_galleria_slideshow_2\" class=\"amw-galleria-slideshow\"><\/div>\n<script type=\"text\/javascript\">jQuery(document).ready(function(){ jQuery(\"#amw_galleria_slideshow_2\").galleria({\"dataSource\":[{\"image\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/C1-2018DrillinSalemOR-1024x683.jpg\",\"big\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/C1-2018DrillinSalemOR-1024x683.jpg\",\"thumb\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/C1-2018DrillinSalemOR-150x150.jpg\",\"title\":\"C1-2018+Drill+in+Salem,OR\",\"description\":\"\",\"altTag\":\"\"},{\"image\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/C4-AlexwithhisDadPre-transition-1024x683.jpg\",\"big\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/C4-AlexwithhisDadPre-transition-1024x683.jpg\",\"thumb\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/C4-AlexwithhisDadPre-transition-150x150.jpg\",\"title\":\"C4-Alex+with+his+Dad+Pre-transition\",\"description\":\"\",\"altTag\":\"\"},{\"image\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/C5-52018July4withmyfamilycelebrating5yearssoberforme-1024x683.jpg\",\"big\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/C5-52018July4withmyfamilycelebrating5yearssoberforme-1024x683.jpg\",\"thumb\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/C5-52018July4withmyfamilycelebrating5yearssoberforme-150x150.jpg\",\"title\":\"C5-52018+July,+4+with+my+family+celebrating+5+years+sober+for+me\",\"description\":\"\",\"altTag\":\"\"},{\"image\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/C6-Alex-with-Kirk-Harris-1024x683.jpg\",\"big\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/C6-Alex-with-Kirk-Harris-1024x683.jpg\",\"thumb\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/C6-Alex-with-Kirk-Harris-150x150.jpg\",\"title\":\"C6-Alex with Kirk Harris\",\"description\":\"\",\"altTag\":\"\"},{\"image\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/C2-2016withRicardoLocketteofSeattleSeahawkspre-T-1024x683.jpg\",\"big\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/C2-2016withRicardoLocketteofSeattleSeahawkspre-T-1024x683.jpg\",\"thumb\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/C2-2016withRicardoLocketteofSeattleSeahawkspre-T-150x150.jpg\",\"title\":\"C2-2016+with+Ricardo+Lockette+of+Seattle+Seahawks+(pre-T)\",\"description\":\"\",\"altTag\":\"\"},{\"image\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/C3-2009duringmobilizationtraininginFortStewartGApre-T-1024x683.jpg\",\"big\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/C3-2009duringmobilizationtraininginFortStewartGApre-T-1024x683.jpg\",\"thumb\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/C3-2009duringmobilizationtraininginFortStewartGApre-T-150x150.jpg\",\"title\":\"C3-2009+during+mobilization+training+in+Fort+Stewart,+GA+(pre-T)\",\"description\":\"\",\"altTag\":\"\"}],\"width\":\"auto\",\"height\":0.76,\"autoplay\":false,\"transition\":\"slide\",\"initialTransition\":\"fade\",\"transitionSpeed\":0,\"_delayTime\":4000,\"_hideControls\":false,\"_thumbnailMode\":\"grid\",\"_captionMode\":\"on_expand\"}); });<\/script><\/div>\n<p>On June 30, 2016, Secretary of Defense Ash Carter announced that transgender individuals would be able to serve openly in the U.S. armed forces.<\/p>\n<p>\u201cFinally, I&#8217;m not living a lie anymore,\u201d says Alex. \u201cAnd I decided to be myself.\u201d<\/p>\n<p>Alex talked to his commanding officer to obtain permission. Her response was, &#8220;Yes, please. Go, be who you are.&#8221;<\/p>\n<p>Alex\u2019s family was very supportive through it all. He started taking testosterone on April 1st, 2016. \u201cIt&#8217;s the VA Endocrinology that gives me my hormone treatment,\u201d he says. On August 21<sup>st<\/sup>, 2017 Alex had top surgery during his clinical year at MEDEX.<\/p>\n<p>For his required Capstone Research Project, Alex chose to write on the challenges in healthcare for transgender people.<\/p>\n<p>\u201cYou know, there is discrimination,\u201d he says. \u201cBut a large part of it is just ignorance. Everybody thinks it&#8217;s really difficult to handle hormones when, in reality, managing insulin for a diabetic is much more complicated. There&#8217;s very little education about transgender care in medical school, PA school and among healthcare provider schools.\u201d The focus of Alex\u2019s capstone is primary care of a transgender patient.<\/p>\n<p>Alex notes the lack of focus on trans healthcare issues in the current MEDEX curriculum.<\/p>\n<p><span class=\"dropcap\">\u201cW<\/span><strong><span style=\"font-size: 18pt\">e got very little instruction<\/span><\/strong> about transgender healthcare,\u201d he says. \u201cMostly, I would give the class my perspective as a patient. At least I can help there. I\u2019d like to change that.\u201d<\/p>\n<p><a href=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/Vert1-2010atJBLMwhileAlexwasinTheWTBwarriortransitionbattalionwhenIhurtmyneckPre-T.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-13635\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2019\/05\/Vert1-2010atJBLMwhileAlexwasinTheWTBwarriortransitionbattalionwhenIhurtmyneckPre-T.jpg\" alt=\"\" width=\"250\" height=\"250\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2019\/05\/Vert1-2010atJBLMwhileAlexwasinTheWTBwarriortransitionbattalionwhenIhurtmyneckPre-T.jpg 900w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2019\/05\/Vert1-2010atJBLMwhileAlexwasinTheWTBwarriortransitionbattalionwhenIhurtmyneckPre-T-300x300.jpg 300w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2019\/05\/Vert1-2010atJBLMwhileAlexwasinTheWTBwarriortransitionbattalionwhenIhurtmyneckPre-T-150x150.jpg 150w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2019\/05\/Vert1-2010atJBLMwhileAlexwasinTheWTBwarriortransitionbattalionwhenIhurtmyneckPre-T-768x768.jpg 768w\" sizes=\"auto, (max-width: 250px) 100vw, 250px\" \/><\/a>\u201cYou could have a patient come to you that needs their yearly physical, or they&#8217;re sick, and the fact that they&#8217;re transgender can play a significant part,\u201d he says. \u201cWhat if you have a man sitting in front of you that still has a cervix and is sexually active? They&#8217;re still going to need pap smears. Or you have a female that could have prostate cancer. We need to be more aware and realize that people are people and treat them for the body parts that they have. Yes, hormone therapy can change things like cardiovascular risk. We need more education.\u201d<\/p>\n<p>Alex believes that knowledge is power. \u201cWe&#8217;re not necessarily going to eliminate bias and discrimination. But the more we can educate people or put a face on things, the better we can overcome ignorance.\u201d<\/p>\n<p>Even within his own National Guard unit, Alex has seen changes since Secretary of Defense Carter\u2019s announcement. \u00a0With the official announcement in 2016, some soldiers pushed back, expressing concern about sharing shower facilities with transgender individuals. As a member of Oregon MEDCOM, a medical unit, Alex spoke out during one of the official educational sessions.<\/p>\n<p>\u201cIt\u2019s not about that,\u201d Alex says. \u201cI told them, \u2018Hey, you know what? It&#8217;s not like anyone will be checking you out or flashing their genitals. We are more uncomfortable with those body parts than you are.\u2019\u201d<\/p>\n<p><span class=\"dropcap\">W<\/span><span style=\"font-size: 18pt\"><strong>ithin the Oregon National Guard<\/strong><\/span>, Alex has become the spokesperson on transgender issues. He consults with military providers on trans healthcare issues.<\/p>\n<p>\u201cI still take some flack,\u201d he says. \u201cI do encounter people that have an issue serving with me. But I just say, \u2018You don&#8217;t have to be okay with who I am, just like I don&#8217;t have to be okay with who you are. We are required to respect each other&#8217;s rank, uniform, and work together.\u2019 That&#8217;s all.&#8221;<\/p>\n<div><div id=\"amw_galleria_slideshow_3\" class=\"amw-galleria-slideshow\"><\/div>\n<script type=\"text\/javascript\">jQuery(document).ready(function(){ jQuery(\"#amw_galleria_slideshow_3\").galleria({\"dataSource\":[{\"image\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/B4-Alex-Shaffer-1024x683.jpg\",\"big\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/B4-Alex-Shaffer-1024x683.jpg\",\"thumb\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2019\\\/05\\\/B4-Alex-Shaffer-150x150.jpg\",\"title\":\"B4-Alex 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Before that can occur, he\u2019s got a 4-month family medicine preceptorship with Dr. Kirk Harris in Tumwater, WA. That will be followed by an inpatient trauma rotation at <em>Legacy Emmanuel Hospital<\/em> in Portland, OR.<\/p>\n<p>\u201cI\u2019m coming full circle here because, when I totaled my Harley on September 3rd, I was a patient for two days at the same place,\u201d he says. Alex will be learning from the same people who treated him when he had his motorcycle wreck. His final preceptor will be Jonathan VanHorn. \u201cThat\u2019s Lieutenant Colonel VanHorn to me, because he&#8217;s in the Oregon National Guard as well and I&#8217;ve worked with him throughout the years.\u201d<\/p>\n<p>After graduation and certification, Alex looks forward to returning to his home state of Oregon and a job with the National Guard.<\/p>\n<p>\u201cWell, the military would just be part-time,\u201d he says. \u201cMy ultimate goal is to find a good job in a small town in rural Oregon, buy some property, be close to my aging parents, help to take care of them, and adopt kids.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Alex Shaffer is a combat medic within the Oregon National Guard and a current clinical student at the MEDEX physician assistant program. 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