*Editor’s note: Mariposa Health is now Plume. More information can be found at getplume.co
Hi!
My name is Jerrica Kirkley and my pronouns are she/her/hers. I was asked to write a guest blog by Adam-Jon Aparicio (Axis Counseling, PLLC) to share a little about myself and a recent project I have started to support the transgender community, called Mariposa Health.
I will review a couple of terms first to make sure we are all on the same page. When I use the word “trans” in this post, I am referring to anybody who identifies as not cisgender. Cisgender means the sex you were assigned at birth aligns with your gender identity. Your gender identity is who you know yourself to be, and is not a legal designation. Your gender identity is defined by you and you alone. The pronouns you use to match your gender identity are also up to you, and there is no legal designation of pronouns. This should be distinguished from your gender expression, sex assigned at birth and romantic or sexual attraction, which are all independent concepts and all exist on a spectrum from one extreme to the other. Gender expression is how you present yourself to the world by dress, hairstyle, etc. Sex assigned at birth is a designation based on your external body parts at the time of birth. Romantic or sexual attraction is how you are (or are not) attracted to other people relative to their gender and gender expression. So, in this article, if you read “trans”, I am referring to anybody who is transgender, gender non-binary, gender non-conforming, intersex or any other non-cis identity.
Now that we have some important language reviewed, I will tell you a little bit about myself. I identify as trans/transwoman/gender non-conforming and recently came out in August of 2019. You might be wondering why I am talking about trans people on a therapist’s website. While being trans is not a medical or psychological diagnosis, being trans is associated with specifically higher rates of depression and suicidality, up to 10 times that of the general population. But, it is very important to note that being trans does not cause us to be depressed or suicidal. It is the treatment by other people because we are trans, which causes depression and suicidality, including intentional discrimination and refusal to recognize our existence and unintentional refusal to recognize our existence by using the wrong name and pronouns and gender because people make assumptions about all those things. So, having psychologists and a general population that are understanding of this and make sure to affirm us all, no matter what our gender identity or expression is relative to our sex assigned at birth, is extremely important to the mental well-being of everybody.
Jerrica Kirkley, MD
I came out as trans at the age of 35, so I carried with me 34+ years of living outwardly and being perceived as a cisgender male. Over a period of two to three years leading up to me coming out, I finally had some time and space in my brain to start processing who I actually am and figuring out why I had always felt a difference about me but couldn’t quite put a name or identity to it. As I started to uncover a lot of repressed feelings and emotions it became clear to me that the difference I had been feeling all along was my gender identity, which became clear to me is feminine or female. After admitting this to myself and to others and finally expressing in a way that felt good and made sense to me, I began to feel an incredible sense of liberation. I had always carried a lot of anger, resentment and self-hatred for unknown reasons as far back as I can remember, and after coming out, this all melted away. I am happier and more peaceful than I have ever been. Of course, it hasn’t all been easy and has been very difficult to face some of the reactions of people that I have loved dearly for so long. But, internally, I am in a better place than I have ever been before. Every trans experience is different, but one thing that I believe is universal is that if we as trans people, are allowed to live as we know ourselves to be and embraced as fellow humans without hesitation, we will be happier thriving people and so will the world as a whole. Everybody truly wins.
Mariposa Health is an extension of who I am. I am a family physician who not only provides general primary care, but has been practicing gender affirming care, or prescribing medications to help align people’s body with their gender identity, since 2013. It should be noted that not all trans people desire or need hormones or surgeries to change their bodies, but for the majority of trans people, we do feel like it is vital for our existence. Medical gender affirming care for trans people is often described as HRT (hormone replacement therapy). I have created a curriculum and protocol for academic institutions and given talks on how to provide gender affirming care to academic institutions (including medical, pharmacy, social work, higher education), private medical practices, community health centers and professional associations around Colorado and the country. Gender affirming medical care is truly my passion and I have seen what it can do for people to finally start living their authentic life in a way that was previously inaccessible. There are not many things within the realm of primary care that I would truly consider to be immediately lifesaving, but gender affirming care is one of those. In providing this care, I have always come up against barriers to getting care to folks including fear of discrimination and violence, distance to the clinic and insurance restrictions and costs. I created Mariposa to take away these barriers and offer HRT to trans folks via an app on a smartphone in the comfort of their own home. That’s right. You just click the app and you are instantly connected to your doctor for lifesaving prescriptions. You never have to make an appointment. You never have to listen through a phone tree or get cut off. You never have to leave a message with an assistant that gets passed to your doctor. There are no waiting lists. The initial consult takes place via a video, but after that, you can just text your doctor directly. Currently, certain legal restrictions require that the initial consult to be in-person if you are receiving testosterone, but hopefully that will be changing soon. But for all other medications, you can get started right away from your phone. Right now we call in prescriptions to your pharmacy of choice, but eventually we will be able to ship all medications to your place of living to make it as convenient as possible. We charge patients on a monthly subscription cash fee (do not bill insurance) for this continuous, unlimited, direct access to medical care. We tried to find prices that are reasonably accessible to most and allow the service to be sustainable and scalable to a wide level. In fact, based on the current cost of healthcare in this country, our prices are relatively very affordable. But, for those that are unable to pay the full fees, we are always looking for ways to provide free and discounted care and have provided quite a bit of free care already. We have started our pilot in Colorado and will be expanding to as many states as possible, to truly be able to provide a nation-wide service. We really want this service to be for all trans people regardless of race, ethnicity, body size/shape, ability level, etc. and we also make it a point that our organizational composition reflects that as well.
I would like to end this with a call to action. A lot of people ask me what they can do to support trans people. Well, there are a lot of things, but it starts with your everyday interaction with all people, not just trans people. From now on, don’t assume the gender or pronouns of any person based on appearance or voice. If you can be one less person misgendering trans people, the world will be a much better place. Beyond that, share this information with other people. Support organizations that support trans people. Support and vote for trans political candidates or political candidates that support trans people. Speak out against people who are being harmful to trans people in their speech or actions.
Thank you for reading and thank you to Adam-Jon for sharing the blogspace to let me tell you about my story and Mariposa Health.
All the best,
Jerrica Kirkley, MD
For more info or to get started with care, check out www.getmariposa.com
Email: hello@getmariposa.com
FB/IG: @getmariposahealth
