This interview first appeared in the Left/Right Issue (vol. 25, no. 3: Fall 2019).
I’m not sure I’d be who I am today if I hadn’t come to Atlanta in 2011. I was born in Boston, went to Harvard and lived in Cambridge. I grew up on the south side of Boston, a Catholic town, in a very traditional Christian family. I remember the first time I saw a person who was male-assigned at birth wearing dangling earrings and lipstick in Midtown Atlanta around 2012–13, and thinking to myself, oh my goodness, that’s a person that’s allowed to exist. People can express their gender in these ways.
Atlanta is a huge basin that drains a large area from the Ozarks to Florida to New Orleans. And because of that, Atlanta becomes kind of like Chicago insofar as it’s a beacon city where queer young folks go because it’s a place where they think it will be safe. Moving to Atlanta from Boston, I realized that there was such beautiful queerness in this city, such avid social justice organizing, because we have to struggle to stay alive in this region, in a region where women’s bodies are being legislated every day, where trans folks can’t identify as safely or freely. Living in the South, you have this sense that everyone is a co-conspirator in pursuing justice for all people. The South has been and continues to be an essential part of my identity and how I operate within the world. It’s become a really inspiring place to live and work.
[At Emory], I chose a lab that was focused on cell therapy. Basically, [I work to find] ways to use the body’s own immune system to become more tolerant, rather than using drugs to make the recipient become tolerant. Because those drugs have toxic side effects. When we can just use the cells of our own immune system, we can actually effect a much more holistic cure. It’s fun how the tolerance metaphors flow from that work. We were doing, at the time, bone marrow transplantation to cure sickle cell disease. When we do cell therapy to cure sickle cell, it’s a transplant of cells from one person to another. And the recipient, the person who has sickle cell that we’re trying to cure, the way that we cure that is by deleting their own personal stem cells from their bone marrow using a type of chemotherapy drug. Then, you have to put new cells back into that person, and you have to match the immune systems of the donor and the recipient. Emory cures more sickle cell than any other medical provider on the planet.
While I was using cell therapy in a laboratory to understand sickle cell disease and ways to cure it, I worked on developing a project called Sickle and Flow. I was very proud of that endeavor because that introduced me to a lot of different activist circles. It was my first entrée into multipart social justice organizing in the South. Sickle and Flow was a partnership of musicians, visual artists, rappers, soul musicians, a couple of patients who had been cured of sickle cell, and a couple of science people who were also podcasters, and together we interviewed researchers in Atlanta who study sickle cell disease, as well as patients and family members affected by sickle cell.
We organized a series of concerts in the Old Fourth Ward, which is the MLK district next to Grady Hospital. It’s a historically Black neighborhood of Atlanta that is now being gentrified, but we worked on a series of concerts where people with sickle cell spoke about the stigma of living with this disease.
Our efficacy at curing sickle cell and treating blood diseases depends upon collaboration with communities of color. Black and Brown people in the United States donate blood at a much lower rate than white people. The average cell donor on the registry is a college-educated, married white man. People who have gotten tattoos in Georgia, male-identified folks who have sex with men, are all barred from giving blood. It’s important to know that people of color don’t donate at higher rates because of a very well-documented medical racism complex that predates slavery and continues to this day. Life expectancy of a Black man with sickle cell is thirty-two, for a Black woman it’s forty-eight. In pediatrics, sickle cell patients often get the antibiotics, checkups, and preventive care that they need, but when a Black man turns eighteen, he typically can’t go to the children’s hospital anymore. In an adult hospital, he may get labeled a “frequent flyer,” an addict, all these other connotations. And that’s what complicates their access to care and hastens their early death.
As Sickle and Flow evolved, I became a lot more involved in the queer Atlanta community, and I came out more and more. Early in graduate school, I had been slowly inching myself out of the closet in terms of my trans identity. But by mid-2016, I was pretty out as a nail polish–wearing, femme-identified, queer/trans person. In a lot of ways, that expression was enabled because I was able to interact with folks doing meaningful community justice work. I was able to lobby at the state capitol, expressing my gender very femininely, and it was a real empowering thing to realize this queer community of southerners in Atlanta was composed of folks like me. I think the first time I ever went to the state capitol was during Sickle and Flow. I went and presented very femme that day. It was an empowering thing for me to partner with legislators, scientists, patients, and activists and talk about sickle cell with our state reps to help them pass a bill expanding funding for certain therapies. And there is such a powerful unity among marginalized folks here.
One of the things I’m excited about as a recent change in public health for trans folks in the South is the decentralization of gender-affirming medical therapy. About 40 percent of trans people do not desire medical hormone therapy. That said, for trans folks who do, there’s traditionally been a real hurdle in terms of finding a therapist to write a letter, getting your referral to a primary care doctor who then refers you to an endocrinologist. With all these gates and hoops, people can become frustrated, negated, and further marginalized—and remember that 0.8 percent of trans folks take their own life annually. There’s just so much at stake.
There’s been a movement in transgender health to decentralize and have primary care family medicine physicians manage this. My first gender-affirming primary care physician (PCP) was Dr. Izzy Lowell. [She] is a family medicine doctor who established a clinic in Atlanta that is exclusively telemedicine-based. She went through a lot of difficult paperwork to become medically boarded and licensed in basically every former Confederate state, such that she now sees patients on a telemedicine platform in southern Alabama, southern Mississippi, rural Georgia, and she can be their PCP, check in with them once every couple of months, send them for labs to a clinic near the patient’s hometown. If you have an emergency, please go to your local ER, but in terms of managing gender-affirming hormone therapy, she’s able to do that in a remote fashion without ever having that patient come to Atlanta. That is something that I think is a model in a lot of ways for how transgender health should be going forward.
Because I work in surgery, there is something about surgery where you have to be at the hospital for that to happen. I see this in my own transgender surgical aftercare. I had gender-affirming breast augmentation and vaginoplasty in September 2018, and it was covered by insurance—well, the vaginoplasty was—and I had a few post-op visits, which were all covered just fine. But I’m at a point now where my surgeon, who’s an excellent doctor who I respect so much—we’re in a setup now where if I happen to be passing through New York City, maybe I can drop by and have him or his PA look at my surgical site, and we can talk about it. But I’m not often in New York City, and it’s not infrequently that I have questions. It sure would be amazing if my transgender clinical staff could follow up every three to six months to check in. Yes, you’re technically healed with regard to your surgical wound, but how are things going? How’s the after-care? I’m actually having difficulties riding a bicycle, and am seeking a new bicycle seat. It would be great to have a telemedicine surgical appointment just to have my provider check in with me on those things. I think that expanding telemedicine is an innovation that we need to bring to surgical healthcare.
When I think about my future moving forward, I hope to become a surgeon in either transplantation or plastic surgery. In the long run, I may get involved in gender-affirming surgical research too. I’m fascinated by pelvic surgery, chest surgery, understanding ways to transplant organs from one person to another. I believe it’s important for trans voices to be represented in that work. I am proud to be a trans person in medicine—but I am not all trans people in medicine. It’s important for me going forward over the next seven to ten years of my training to continue to engage with my queer community.
I’ll give you a concrete example. There’ve been some publications in the public health literature [saying] that, among transfeminine people that desire some type of surgical intervention—now, you can be a transfeminine person and not desire surgical intervention—but among transfeminine people who are interested in surgical therapy, about 80 percent of transfeminine folks desire vaginoplasty. In contrast, among transmasculine folks who desire a surgical therapy, only about 30 percent will ever pursue a phalloplasty, fashioning a penis out of tissues derived from the forearm or thigh. I’ve seen this disconnect on pelvic surgery desirability ascribed to differences in, quote, “trans psychology,” but I often wonder if this might be motivated instead by the availability of surgical therapies and that vaginoplasty may be a more easily accomplished surgery than phalloplasty.
One of my really close friends is a trans man, and he recently sent me an article he’d found on PubMed, our repository for medical research. The article was about penis transplant, a basic anatomical study describing the technique with a cadaver. I love that this trans dude sent this to me to say, look at this, do you think this is something that people could do one day? It surprised me that even as a trans person in medicine, I had never heard of that. And it reframed my thoughts about participatory medical research with trans people. Because unless all these voices are represented, unless we’re listening, we’re never going to actually understand those differences in referrals and health outcomes.
I’ve gotten a lot more involved in the reproductive movement as well. I’ve had a number of days where I’ve gone and lobbied and protested for reproductive rights. Going to the state house, going to community organizing meetings, and learning the language to speak with legislators about abortion access, about expanding Medicaid, [has] allowed me to leverage my background as a medical scientist and has given me entrée into certain spaces where other folks don’t have access. I loved being at legislative brunches with senators and state reps to talk with them about why we need to expand Medicaid, and stop these Targeted Regulation of Abortion Provider (TRAP) laws, and how these disproportionately impact folks of color in the South. Wealthy white women who need abortions are always going to be able to access them. They are going to be able to fly somewhere, going to have access to the resources, but it’s poor Black and Brown folks living in the South that are most impacted by these regulations. It’s been my privilege and I think my duty to go to these political places, talk about access, lobbying for folks who might not want to show up at the state capitol. But when those folks are there, I love joining our voices together in advocacy.
A lot of transmasculine people who use a he/him pronoun, who are survivors of sexual assault, need abortions. A lot of transmasculine people become pregnant and carry a child through pregnancy because they want to. Reproductive justice is about choosing to use your body in the way you want to use it. That could mean having a child, that could mean having hormones to modify your body, it could also mean abortion access. Reproductive justice is about bodily autonomy, and that’s one of the things I love about abortion advocacy circles in Atlanta that view abortion access through an intentionally queer lens that is inclusive of trans and queer people, because these issues impact all of us in our community.
I hope to remain a part of a community that is queer and trans and living in the South. But as a first-year resident, I simply won’t have the time to do social justice organizing. I frankly won’t have energy to go to a state capitol and lobby, or take part in protests on campus. My job now is to work as a surgeon and represent Duke Health. In some ways, my social activism is going to become less vocal in terms of public spaces and social organizing. That said, my mere existence as a health care provider at Duke just doing my job, just showing up to work, walking into a room and saying, “Hi, I’m Dr. Lewis, we’re getting ready to bring you back for surgery,” is an act of visible transgender activism. Whether or not I’m wearing a pronoun pin, my existence in the health care setting is radical and important and I take that very seriously. I’m going into this new job as a physician recognizing that my first and foremost duty is to my patients, and to provide them the best care possible. I’m not at Duke to be a community liaison. I’m not running their LGBT center. I’m not training folks on transgender cultural awareness. My job is to be an advocate for my patients. I’m hoping to train in the practice of medicine; I just happen to be doing so as a transgender person living in the South. I am encouraged by the fact that, even though I don’t organize public events, it’s still meaningful for me to exist as a healthcare provider. For me to quietly do my job is an important part of becoming a transgender leader in healthcare.