Unmuted: Equity in Focus — Centering Trans and Non-Binary Perspectives in Cancer Care

In this first episode of the Unmuted: Equity in Focus 🎙️ series, hosts Carly and Sabrina sit down with Dr. A.J. Lowik, a sociologist, educator, and advocate whose work centers on making health research and care more inclusive. Together, they explore why sex and gender both matter in gynecologic cancer research and treatment, and what it means to create care systems that recognize and meet the needs of trans and non-binary people. 

Dr. Lowik shares insights on the barriers trans patients face in cancer care, the impact of cisnormativity on treatment decisions, and how inclusive approaches can ultimately benefit everyone. They also explain strategies for designing more valid, reliable, and inclusive gynecologic cancer research — from rethinking data collection to ensuring representation in study design. 

From fertility considerations to gender-affirming possibilities within treatment, this conversation highlights why inclusion is essential to equity in gynecologic oncology. 

Join us as we unmute voices and perspectives that are too often overlooked — and imagine what truly inclusive cancer care can look like. 

Resources:

Article that explores trans folks, cancer and euphoria: https://pmc.ncbi.nlm.nih.gov/articles/PMC10101894/

Canadian research project looking specifically at trans gyne cancer: https://queeringcancer.ca/projects-gyne-cancer-care

Blog post from the Society of Gynecologic Oncology about creating gender-affirming care spaces: https://www.sgo.org/blog/creating-inclusive-affirming-gynecologic-cancer-care-during-pride-month-and-beyond/

Review article that looks at trans peoples gynecologic oncology needs: https://link.springer.com/article/10.1007/s13669-024-00386-x 

For more information on the Gynecologic Cancer Initiative, please visit https://gynecancerinitiative.ca/ or email us at info@gynecancerinitiative.ca

Where to learn more about us:
Twitter – @GCI_Cluster
Instagram – @gynecancerinitiative
Facebook – facebook.com/gynecancerinitiative
TikTok – @gci_gosh

Transcript

00:00:02 Intro 

Thanks for listening to the GOSH podcast—The Gynecologic Oncology Sharing Hub. We share real, evidence-based discussions on gynecologic cancers, featuring stories from patients, survivors, researchers, and clinicians. Our podcast is produced and recorded on traditional unceded territories of the Musqueam, Squamish, and Tsleil-Waututh Nations. It is produced by the Gynecologic Cancer Initiative, a BC-wide effort to advance research and care for gynecologic cancers.  

00:00:32 Disclosure 

As your hosts, we want to acknowledge that we are not experts in this area. We're learning alongside you, and we know there may be moments where our language reflects gaps in our understanding. We see these not as mistakes, but as opportunities to grow. We're grateful to Dr. Lowik for sharing their expertise and helping us move towards more equitable care. 

00:00:52 Carly 

Hello, everyone. Welcome to the first episode of Unmuted: Equity in Focus, a new GOSH podcast series highlighting stories, expertise, and community perspectives on equitable gynecologic cancer care. I'm Carly. 

00:01:08 Sabrina 

And I'm Sabrina. 

00:01:09 Carly 

And we will be your co-hosts for this episode. In this series, we'll explore often overlooked topics, handing the microphone to community members and researchers working towards more inclusive solutions. 

00:01:22 Sabrina 

Today we are joined by Dr. AJ Lowik. Dr. Lowik is a sociologist, educator, and advocate whose work centers on making health research and care more inclusive. Dr. Lowik is an assistant professor at the University of Lethbridge, where they teach courses on trans studies, youth, and queer feminism. Their research spans national projects on menopause and aging in trans people, equitable sexual health care for young people, and more inclusive approaches to pregnancy, childbirth, and cancer care. Through their research and community work, Dr. Lowik is reimagining what equity and health can look like for trans people, and in the process, helping to create better systems for everyone. Welcome to the podcast, Dr. Lowik. 

00:02:11 AJ 

Thank you so much for having me. 

00:02:13 Carly 

Welcome. We're super excited to have you on today. So let's just like get into it. Let's just start digging, right? So if someone has a form of gynecologic cancer, they must have the associated gynecologic organs like a cervix, vagina, ovaries, et cetera. Some listeners may wonder, why wouldn't this person be considered a woman? Why is it important to consider both sex and gender identity in research and care? 

00:02:44 AJ 

Really important question, and it's so vital that we start with some foundational terminology so that we're all clear on who we're talking about and why it's important to do trans inclusion in this space. So yes, someone with gynecologic cancer needs to have associated organs. These are facets of sex, which is a thing that you're assigned usually at or before birth, based on what your genital configuration looks like. It's this complicated constellation of hormones and gonads and chromosomes, anatomy and physiology, what your body looks like and what your body does. And this is separate from gender, which we think of as an identity. That's that internal felt sense of self. So when I say something like woman and you look inside and you see, yes, that fits, or no, it's kind of like an ill-fitting sweater, it's not the best, or absolutely not, that's not how I identify. That's your gender and you're the authority on that. And so there's all kinds of people who have the anatomy for gynecologic cancer, but when they look inside, they don't feel like women, they don't identify as women, they aren't women. They're men, they're non-binary, they're genderqueer, they're all kinds of other things. And so it's those folks in particular that I work with and for to ensure that they get access to the care that they need. And so, yeah, we need to think about sex and gender as both vital, both important, and not always the same. 

00:04:13 Carly 

Thanks so much for clarifying that. I appreciate it. 

00:04:16 Sabrina 

So I think it's also important to consider that when people are diagnosed with gynecologic cancer, whether they're cis, non-binary, or trans, they all have that same diagnosis. What do we know about inequities in the healthcare system for trans people with gynecologic cancer, given that historically the system is designed to treat cis women? 

00:04:39 AJ 

Well, I think you just hit the nail on the head that the system, starting from medical education to the research that we conduct to the spaces that we design, are prioritizing the needs of cisgender women. And they are the majority of the patient population. And so this is not an exercise in removing them from the equation because their care is vital. But we need to recognize that from the very beginning of medical education all the way through physicians and healthcare providers who are working, that they often aren't trained in imagining someone else as their patient. And so the very fabric of gynecologic care, the very fabric of the research that informs that care, assumes that the person who needs it is a cisgender woman, often to the exclusion of other kinds of folks. And you can imagine the ramifications of that, because the way that we conceptualize cancer at its treatment, the way that we think about bodies and the people who live in those bodies, their families, their relationships, their sex lives, all assumes that the person is a cisgender woman. And there might be subtle and yet important differences for the trans patient that we need to take into account. 

00:05:54 Sabrina 

Yeah, that makes total sense. 

00:05:57 Carly 

You completed your post-doctoral fellowship at UBC exploring trans, people's health, wellness, and experiences accessing healthcare. Can you share more about this and the importance of delivering care in gender-affirming ways and what maybe barriers remain and are most pressing? 

00:06:15 AJ 

Absolutely. So my doctoral work was about reproductive care generally, and my post-doctoral work was about abortion specifically. But we find an overarching theme in both of these projects and in lots of different facets of healthcare more generally. And that is cis normativity baked into the very fabric of the care. And so I found that trans folks are having to do a lot of work to educate their healthcare providers on their specific needs, on what language to use, on how they relate to their bodies, on what they desire in terms of gender affirming care, if they want to access hormones and surgery, that trans folks are coming into healthcare spaces at a kind of educational or informational disadvantage that our healthcare providers don't really know a lot about us or about what we might want. And then there's also these kind of policy and practice implications of that erasure, that spaces aren't prepared for trans people to arrive. And you see that manifest in a lack of bathrooms or change rooms that we can use, the language used by healthcare providers to talk about all kinds of things, the pamphlets that we get given with information about what we might want to do next or what treatment options might look like or what community supports we might access, referral pathways when we send folks into community because their care exceeds what a particular clinic can do. Those often aren't trans-competent or trans-inclusive. We need to think about touch and how we touch bodies if we're doing ultrasounds or pelvic exams. And we need to think about being kind of trauma informed and gender affirming in those cases. So really, like once you start to dig into it, every clinical encounter has hundreds of tiny moments where gender affirming care is important. And when we hear the language of gender affirming care, this is used to refer to two things. And it gets a bit confusing because by having the same language for two different things, we might miss each other. So gender affirming care for some people refers to hormones and surgeries and procedures that you might do in pursuit of feeling affirmed in your gender. So we might think about gender affirming hormone therapy or genital surgeries or top surgeries. But gender affirming care is also any care that is delivered in a way that supports or affirms someone's gender identity. So this is really just patient centered care. And gynecologic cancer spaces, reproductive health spaces, abortion clinics, perinatal care, maternity wards, all of these types of spaces are already really well-versed in doing the work of gender-affirming care for cis women, because that's who these spaces are designed for. And so what the invitation is, is to think about how to be gender affirming for all the other patients who don't identify as women. So how can you do these kind of subtle communication things? How can you ensure that the art on the walls and the magazines on the table and the bathroom and changing spaces and the pamphlets that you give and the referral pathways, all of these things, how can you ensure that they attend to the fact that some small portion of your patients are gonna not be women and thus need something slightly different from that care? So that's the second kind of gender-affirming care, and that's what we're trying to work towards in cancer spaces and other spaces. 

00:09:41 Carly 

That's amazing because as a two-time vulvar cancer survivor myself, just being diagnosed with such a cancer was hard enough; I can only imagine somebody who was trans to deal with that diagnosis and their identity within the medical system would add even so much more pressure and emotions, mental health, everything into the bucket. It would just be a lot. 

00:10:02 AJ 

Absolutely. And if you think about that self-advocacy work that you have to do, that's already like everyone's doing it all the time and you're doing it from the space of vulnerability, of sensitivity, of being newly diagnosed or grappling with the implications of the last test result or that kind of thing, cis women are already doing that work and it's so laborious. And then yeah, just imagine an additional layer on top of that of being kind of misrecognized. It's like a death by 1,000 cuts. A lot of it can be really small, it can be seemingly mundane, but it adds up. Then importantly, there are also more extreme examples of things that happen. It's not just misgendering or misnaming or administrative errors. There are trans people who tell us that they have been told that they are not welcome, who have been removed from care spaces because the spaces are for women who have both personal experience and they carry a legacy of community experience of being denied access to healthcare from providers who say, well, I don't know how to treat you, so go find someone else. And so you're being passed off and passed along. And when you're dealing with such a potentially life-changing diagnosis, imagine being told that someone can't help you in sending you down the hall or to a different clinic or to a different hospital. 

00:11:26 Sabrina 

Thank you for explaining all that. I feel like you gave such good tangible examples of how this like lived experience can be for people in cancer care. I've actually heard you speak on this topic once before and one example that really stood out to me in that presentation was your discussion of how in gynecologic cancer treatment, there's often a careful balance between choosing an effective treatment and also preserving fertility. And you mentioned that for many trans people and non-binary people, pregnancy might not align with their identity and they might have no desire to conceive. And I found it interesting to learn that physicians don't often take this into consideration when they're recommending treatments, which would directly influence the care that they're receiving and potentially their outcomes and survival. And to me, this really highlighted another tangible example of how the experiences of trans or non-binary people in gynecologic cancer care can really differ from those of cis patients. Based on your research, can you tell us more about what we know about trans people and cancers generally and what's unique about trans people's cancer care needs that people might not otherwise realize? 

00:12:35 AJ 

Yeah, well, the first thing I'll say, Sabrina, based on what you just described is a presumption even among cis women that they desire fertility. A presumption that this is a thing that you're supposed to want, you're supposed to desire, you're supposed to grieve if it's a thing that you can't maintain which isn't true for a lot of cis women as well. And so can we separate gendered personhood from fertility desire? And can we ask someone how they feel about their fertility, about their procreative potential, about their capacity for pregnancy? Because it could be that for lots of cis women, actually, this isn't a thing that they're weighing. They are perfectly happy with never having kids. And yet we have this narrative that you're supposed to want them. This is what it means to be a woman. So like, let's start by shattering the myth that all cis women want kids. And yeah, it's complex for trans people too, because there are many trans people who actually have profound desire for fertility and that is rejected. It's like, well, how do you want to be a pregnant trans man? That doesn't make any sense in our kind of imagination of things. And so they would either never have their fertility considered, or as you described, they're assumed to want to be fertile and to be procreative and to have children. And so can we just separate gender from reproductive capacity and desire? And can we meet the person in front of us where they are? One of the things that we need to think about when it comes to trans folks and cancer specifically is the potential for some cancer treatments among some trans people to actually be sites of euphoria or joy. And this is not the narrative that you typically hear, that treatment for gynecologic cancer or for chest or breast cancer is seen as something that is distressing, and it is and can be for many trans people, do not get me wrong. But for some folks, the treatment itself might kind of look similar enough to gender affirming bottom surgery. And so it might actually be a site of potential joy. And it's complicated, right? Because on the one hand, you have cancer and that can be incredibly distressing. And on the other hand, the treatment for that cancer might be something that you really want. And so we have folks who are kind of living in that tension space where it's complicated. It is not one thing or the other. It is both at the same time. And we might find that, again, for cis folks too. But there's something unique about some trans folks' experience where the thing that treats this cancer might actually be a site of being more affirming than distressing, while at the same time grappling with the implications of diagnosis. 

00:15:18 Sabrina 

That's so interesting. I think you explained that so well, and it makes total sense when you say it in the simplified form. You just laid it all out for us, but it's something I've definitely never considered. So I think that'll be great for our audience to hear and to start thinking more about. 

00:15:34 AJ 

Yeah, there's an incredible publication. I'll get the name of it so that I quote it specifically, and you could maybe put it in the liner notes of this episode. So, credit to researchers out of Australia who gave us that insight into the potential euphoric implications of cancer treatment for some folks. And so, yeah, folks want to read more about that. There is a journal article or a book chapter, I think, that's been written about this. 

00:16:02 Carly 

And I just want to add to that, what you just said just really resonated with me because when I was going in for my surgery, which is called pelvic exenteration. I knew I was going to have basically my vulvar tumor removed, rebuilt and all that. And I had tears in my eyes. And the medical professional asked me, was I crying because I was going to have the surgery and get a colostomy? I said, no, I'm worried about my identity, right? And that they're going to rebuild my vulva. And they said something very powerful to me. They said, if we can reassign gender at this hospital, we can fix you. And I've never forgot that, because like you just mentioned, how we identify is, and when that identity has changed, it changes us in other ways. And it's so much to handle. And that one moment in time made it a lot easier for me. Am I the same as I was before? I'm going to be perfectly honest. Absolutely not. So, I can understand what you were just saying about how it helps people kind of in their transition, if that's the right word for it, because I am definitely not the same. I will never be the same, but I have come to terms with it. So I hope more people who are going through these types of surgeries can get to those, can get to that space too, because it's really hard to go through. 

00:17:22 AJ 

Yeah, definitely. Thanks for sharing that, Carly. Transition is absolutely the right word. And yeah, I think really at the crux of your story of lots of people's experiences of trans folks experiences is that gender is not genitals, right? Like for many women, having a vulva, having a clitoris, having a cervix, having fallopian tubes does become a part of their womanhood. And I don't mean to say that you shouldn't do that, but you can be a woman and not have certain body parts that like, This has been the work of feminists right since the 20s 30s 40s all the way through to second wave in the 70s has been to suggest that you can be a woman and never be a mother, these are not the. You can be a woman and not have a cervix. You don't have to menstruate. Like these are not so quintessentially tied to womanhood, that your womanhood becomes fractured if you don't do them anymore. And yet for many of us, that's a journey, right? To like, get to the place where you're like, aha, I am still confident that I am who I am, even as my body changes, even as these diagnoses come, as these treatments come, as menopause comes, that can be such a mental journey for folks. And I think trans folks really show us that. And that has been true for cis women all along, that womanhood doesn't require you to have a vagina, to have a vulva, to have a cervix. Yeah, you can find womanhood in so many other parts of who you are beyond just what your body does or looks like. 

00:18:54 Carly 

Absolutely. And I think for me, I don't know about other people out there, the thing that got me the most is what cancer made me make those decisions and figure out those feelings before I was ready to figure that out. And that was really hard, you know, but it also makes you tough. It also gets you to look at the different side of the coin like you're just talking about. 

00:19:13 AJ 

Yeah, definitely. And I mean, I'm sharing this as a perspective that doesn't come from living experience as a person with cancer. Like I have not been diagnosed with cancer. And so I'm speaking perhaps in a way that suggests that this is an easier journey than it actually is. So thank you for reminding us, Carly, that yeah, like this force that thing that we might believe intellectually, but then it becomes emotionally true before we're ready. And it becomes a thing that you actually do have to grapple with and consider and come to terms with and grieve. Absolutely. And yet, you know, you are a woman sitting before us who has gone through this and a woman you still are, even if, you know, your body is now different, your relationship to your body is now different. And so that's so true for trans folks as well, right? They do not become women because they have gynecologic cancer. They, you know, the fact that they have these body parts does not tell us anything about their identity and their journey of gender is going to follow maybe similar lines as cisgender women's because there's going to be a journey of gender, but it's just gonna be a different one. It's gonna look a little bit different and gonna be kind of personal and unique. 

00:20:25 Carly 

Absolutely. I'm just so inspired by what you've already said. Like, I wish I'm, this is just so powerful. So let's just kind of talk about making care more inclusive, because I think some cis women may think that the care would be switching, you know, to look differently than what it was before when we're making it more inclusive. So is there something that maybe you've seen or reflected along with your research that could be meaningful for the inclusivity for trans people without minimizing things for cis women? 

00:20:58 AJ 

Yeah. One of the things that I've seen done that's been particularly effective is a preferred language form, because all people have preferred language. There's some folks who, you know, even among cis women who would prefer you didn't use highly medicalized technical language when talking about their body parts. They want something different. And so this would provide everyone an opportunity to say, these are the words that I use for my body, for my cancer, for my partners, for my relationships, for my kids, for my fertility, for whatever you put on that form. And then that also opens the door for trans folks to disclose things that will make a more affirming care experience for them. And so it's these types of shifts that actually make care better for everyone. So gender affirming care is something that benefits everyone. It's not as though we're taking from one group to give to another. We're just opening the door a little bit more widely so that more folks can walk through it. And I think one of the things that I've seen happen is cisgender women's health is understudied, underfunded, undervalued, absolutely. And yet I think we unfortunately get into this kind of scarcity mindset of like, well, if we open the door to more people, then what's going to happen to our few and limited resources, spaces and services? And unfortunately, what we then do is we turn to the people who are asking to come through the door and say that they are the problem. When in fact, the kind of patriarchal institution of healthcare is the reason that cisgender women's health is so underfunded and so under-resourced. And so instead of kind of saying, well, these folks, if they come in, they're going to take something from me. Can we instead look to the system that is making us have so little to begin with? And can we challenge that system to do more for more people? It might seem scary to have some of the language change. And so in a lot of the work that I do, we might say pregnant person or person who needs abortion or person with a cervix or person who needs gynecological cancer care as opposed to woman. And that might seem scary for folks because it seems as though the word woman is being taken and replaced with something more neutral. I think what's important here is to remember that the Venn diagram still includes women. It's just speaking to only a specific subset of women, because not all women have gynecologic cancer. And so we're only speaking to the ones who do when we say people who have gynecologic cancer. And we're just also speaking to other people who aren't women who have it. And so if we picture these kinds of bubbles or buckets of gender identities, we were actually misspeaking when we were using women in place of something more precise. And so by just saying pregnant person or a person who needs a pap smear or a person with a cervix, what we're doing is including all of the women who qualify and we're also including all of the men and non-binary people and gender queer people who fit that criteria as well. And in our language, when we're talking about the women among that group, we can continue to say women. So if we have a space that is for women who have breast cancer or women who have gynecological cancer, or this is a space specifically for mothers to come grapple with what this means for their families, fantastic. It's just not that every single space is for that subset of people, because women are an important, vital, and large subset of the people who have gynecological care, and so we can create spaces and services for them. And we can use language that suggests that it's not just them. And so again, it isn't scarcity, it isn't a piece of pie that we need to fight over. We're just getting more precise with our language so that we can be more inclusive with our language. And there are always going to be moments where we can be specific with our language, including when we talk about women. 

00:25:03 Carly 

Yeah. And what you just said has already made me think differently because I was one of those patients in the beginning that felt alone and I was scared and shame. But if we're broadening the spectrum of care, we can actually bring more attention to that care and improve that care because we're bringing in more people to get proper care as a whole. So instead of just staying in this small little box, if we expand that box, we put a bow on it, right? I love bows. I'm just going to add a bow on everything. We can maybe make it even better than it is now? Because like you said, it's just not enough right now. 

00:25:37 AJ 

Absolutely. And there are many trans people who are part of this research space, part of this clinical space doing this work. And so they are in solidarity and allyship with the cis women who have been championing advances in this space. We are not in competition with one another. We are actually stronger together. 

00:25:57 Carly 

Yeah, our cancers are the same. We may look different, but our cancers are the same. 

00:26:01 AJ 

Yeah. And I imagine that if you were in a shared space with other cis women who are survivors of cancer, that you're all different too. 

00:26:08 Carly 

Yeah. 

00:26:09 AJ 

And so can we, instead of having a kind of us and them mentality, can we actually recognize that it's all of us together and that we have lots of things in common and we're actually all unique from one another, even if we're the same, if we have the same gender identity, you're not like the cisgender woman with cancer sitting next to you, you're different from one another. 

00:26:31 Carly 

Absolutely. 

00:26:33 Sabrina 

That was so powerful. And so I feel like you just explained things really well and that people can like come and be like, oh, women are different or whatever their argument is. But the way you just explained it is so simple and so like clear that it's hard to even argue anything otherwise, not that I ever would, but that it's just such a great like basic walkthrough of all of this information so people can really understand where people are coming from with all of this. So thank you for that. 

00:27:01 AJ 

Yeah, I hope so. I hope that I explain things in a way that invites people in and that kind of takes down some of the fear or insecurity or worry. And I completely understand why folks are afraid, especially if you've never met trans people before, if you are living in a community that's inundated with all of this misinformation about who trans people are. If, you know, like you are feeling resource scarce and you are feeling like actually the community I live in, the cancer center where I go is struggling, it's going to feel threatening to have people ask to walk through the door. But we've been in already, we have been sitting next to you, getting our chemo or having radiate, like we're already here. It's just that we've been invisibilized. And so really what we're doing is just shining a light on a patient population who maybe have had to pretend that they're not trans to get care, who have had to be kind of invisibilized in order to feel safe. And so we're just creating more opportunities for them to be safe and out loud. 

00:28:06 Sabrina 

After hearing all of this research-informed knowledge that you're sharing, I think the next logical step is to ask about the importance of accuracy and precision and inclusion when it comes to sex and gender conceptualization in health research. Do you mind sharing some strategies for how we can design more valid or reliable or even just inclusive gynecologic cancer research? 

00:28:30 AJ 

Absolutely. And I think this brings us back to where we started, which is that we need research that attends to the complexity of sex and the complexity of gender and the fact that these are different things. So there will always be a place for the gynecological cancer research that looks at women's experiences of care. Absolutely. And we also need research that attends to the gynecological cancer experiences of all people, recognizing that it is not just women. And so if we can start to remember that female sex assignment, having ovaries, having fallopian tubes, having a vagina, having a vulva is not the same thing as being a woman, that there are women who don't have these body parts and that there are all kinds of people who have these body parts who are not women, that our research will get better. And so some of this is about how we conceptualize a research project from the beginning, who we imagine as the eligible participants, and then how we communicate that eligibility when we're recruiting participants to a project. So maybe we'll have one set of recruitment materials that'll say, are you a woman with? Are you a woman who? And another set that will use more neutral language or that will explicitly ask, are you a trans or non-binary person who has had this experience, please come talk to us. Some of it will be how we measure things in a project. So if I'm having you fill out a socio-demographic questionnaire so that I know a little bit about who you are, what questions are we asking?And there's all kinds of resources, including one that I led called the Gender and Sex in Methods and Measurement Research Equity Toolkit that provides you with measures that you can use to ascertain who the people are who are participating in your research study; to then how we analyse the results on the back end. So if we have a substantial portion of trans people within a sample, of research participants who live with gynecologic cancer, can we look at their data separately so that we can disaggregate them so we can see what's unique about their experiences? And maybe what we'll find is actually they have lots in common with the cisgender women. And we'll find things that are unique and specific, and we'll run an intersectional analysis. Because gender modality, whether one is cis or trans, is just one thing we can look at gynecological research to make it better. We could also look at race and ethnicity, we could also look at age, we could also look at all of these different things. This just becomes one more variable that we can tease out. Ultimately, what will happen is that our science will be better. Because if we understand that someone's treatment outcome is actually related to their gender identity, to how they think of themselves, how they walk in the world, and it actually doesn't have to do with their genitals, then we can design a better intervention, we can design a better support system, a better service. And so when we confuse sex and gender in this space, what we end up with is data that says, well, females experience X. What is it about femaleness? Is this gonadal? Is this hormonal? Is this chromosomal? Like what is happening in femaleness? When maybe actually what they mean is there's something about womanhood that is actually about gender. And if it's about gender, well then how are trans men faring? Because is their experience different? Because for them, their cancer is related to their manness. And so this kind of precision allows us to dig deeper into what we're seeing as a difference in the data, and then we can treat it better. We can design an intervention or a service that actually gets at the root cause of a difference or a disparity or an inequity. 

00:32:10 Sabrina 

Amazing. Thank you for sharing. 

00:32:11 Carly 

Yeah. And I'm just like listening to you. I'm ready to recruit you for my team, Dr. Lowik. Like you're just like an amazing advocate and person because even though I identify as a woman, I struggled to consider myself a woman through this cancer battle. And so just hearing what you're saying right now is really hitting a chord with me. I think I need to reach out and make a bigger community around me because I know that it's easy to just hide in your normal and push things aside, but I think it's, we all just have to not push things aside and make change and make things more inclusive, And I guess that leads up to kind of one of our last questions for you is like, what are you up to next? What's next on your agenda? Are you doing any research projects? What are you championing? And tell us a little bit more about what's coming down the pipe for you. 

00:33:03 AJ 

First, I just wanna say that's so kind of you, Carly, and I'm so glad that the way I talk about these things makes you feel like I'm reflecting your experience, like I'm speaking to your experience, and like I'm challenging, you know, maybe the way you think about things to expand ever so slightly. That is like so affirming for me to hear, so thank you. What I'm currently working on is two projects. One is about trans older adults who use hormones and menopause and andropause considerations, as well as other health implications and impacts of being an older trans person who use hormones. We know very little about this area of life. I'm working with clinicians and with trans community members to set a research agenda. What is it that we don't know and what is it that we want to know about being an older person being on hormones and what that mid-to-later life health trajectory might look like? That's the first thing. And then the second thing in a completely different area is I'm working with trans youth to understand the health implications of misinformation. And so unfortunately in Canada right now, trans health misinformation is rampant. We have governments using it to advance anti-trans policies, and this is having a profound impact on the mental health of trans youth. So a kind of completely different project with a different population, but those are my two main projects right now. 

00:34:33 Carly 

Fantastic. Thank you so much for joining us today. Sabrina, do you have any wise closing words here for Dr. Lowik as we get ready to sign off from this powerful.... like, I'm holding back tears, I'm not going to lie. Like, I just don't want to be crying on a podcast right now. So I'm going to put it to Sabrina to close us off. 

00:34:50 Sabrina 

Oh, I mean, Carly, I don't think you're alone in that. I think so many people are going to listen to this conversation and learn so much, even if they thought they understood sex or gender identity, I think that this like, is going to open that conversation even more. And I think it'll hopefully encourage people to have more conversations about gender identity in their life in general, which I don't think there's any negative side. I think it only creates positivity and creates more welcomeness and openness. So thank you so much for joining us and having this conversation and sharing your own experiences as well as what you've learned through your research. This is so powerful. And I think so many people are going to learn so much from it. 

00:35:30 AJ 

Truly my pleasure. And the listeners of this podcast can certainly consider me a resource. My e-mail inbox is open to questions and queries. And if you need some literature, I can probably track it down the little bits that are available out there. So yeah, very happy to be a part of this conversation and to have this be the beginning of a conversation. 

00:35:54 Outro 

Thanks for joining us on the GOSH Podcast. To learn more about the Gynecologic Cancer Initiative and our podcast, make sure to check out our website at gynecancerinitiative.ca.