STORIES
January 26, 2018

Nurse With Transgender Expertise Helps People Live Authentic Lives

By Lee Nelson

The wait list of young people wanting to get help at the Center for Transyouth Health and Development in Los Angeles runs usually at over 100 people long. These children, teens and young adults come from everywhere to seek support.

“I like being part of the team that helps them get to that place of being who they are,” says Bianca Salvetti, pediatric nurse practitioner and HIV and transgender health specialist. 

The center she works at is located at the Children’s Hospital Los Angeles. Salvetti coordinates and implements HIV clinical research and medical care activities within the Risk Reduction Program. She provides primary care to teens and young adults, as well as specialty care to transgender youth and young adults living with HIV.

Where did you start your career as a nurse?

Salvetti started at the Children’s Hospitals in the pediatric ICU and stayed there for seven years before becoming a pediatric nurse practitioner in 2012.

How did you get interested in working with transyouth?

During her own nurse practitioner training, Salvetti shadowed a nurse practitioner who worked with homeless youth.

“Something about that drew me in. You worked with young people, and it was more laid back, not so formal. It was just a conversation, and I liked that,” Salvetti adds.

When the job opened up in the transyouth clinic, she knew she had to apply. 

What does your job entail with transyouth?

She handles the HIV clinical research and medical care coordination. But she also began seeing her own patients about four years ago. 

“I’m adding five to six patients per week. I’m not their medical nurse care manager, but I make sure they have answers to their medical questions,” she says.

She also sees them for other reasons like rashes and provides hormone self-injection teaching and medical care to transgender and gender non-conforming patients.

Why are you getting such a big waiting list?

“It’s a mix of a lot of things such as the television shows that feature a transgender person and Bruce Jenner. It’s more out in the media than ever before, and people are writing books about it all the time,” she says. 

She believes more young people might have had feelings for a long time. They wondered what it is called, and perhaps felt something but don’t know how to articulate it to their families or medical caregivers. 

“Some of the kids we see are very tech savvy, and they want to pursue medical treatments to change them,” Salvetti says. 

According to a study by The Williams Institute at UCLA, it is estimated that 1.4 million Americans identify themselves as transgender with 218,000 of them in California.

What does Children’s Hospital Los Angeles provide for transyouth?

The hospital provides hormone treatments, puberty blockers, implants with outpatient surgery, counseling and more. The hospital doesn’t have anyone yet to do gender confirmation surgeries. 

Most of the transyouth males want a removal of breast tissues. 

“Luckily in California, a law says that any sort of medical treatment for transgender-identified that the cost is covered. We are lucky that most of our patients can access surgical procedures if they want to,” she says.

What are the biggest highlights and sometimes downfalls of being a nurse in this highly specialized job?

“When they first come in, many of them feel no one really understands them,” she says. “A lot of what they will have to deal with is a challenge. They don’t see the happiness at the end of the tunnel.”

They have to overcome obstacles with their parents, insurance companies and within themselves, she says.

“After we get through all of that, I tell them that they will be able to breathe easier,” Salvetti says. “I do a lot of hormone shot teaching. I give them that education and skills. Their bodies align with how they feel and see them come back in a month and they look different.”

They begin to love how things are going.

She sees parents come in and using the wrong pronoun to describe their own child. The language can be a tricky part of it all, Salvetti says. 

“They visually look like one gender. They may present a look of masculinity, but they want you to call them her or she,” she adds.

Is there one of your patients that stands out for you?

“I have one transgender boy that I think about because he was very persistent, insistent and consistent with identifying as male but his parents were never supportive,” she says.

The parents finally agreed to their child starting testosterone but the parents were never engaged in care.

After about one year of hormone therapy, the parents wanted to go to a family reunion but they would not let him present male or use a male name/pronouns. So, he had to decide if would see his family or present as himself. He ended up choosing to dress like a girl so he could go to the family reunion.

When he returned, he told his therapist that he was going to continue dressing female and live life as a female because it was easier for the family.

“I never heard from him again, and I wonder if he is still living his life for his family or for himself,” Salvetti adds. 

Where are jobs for transgender nurses?

The jobs can be limited, Salvetti says.

“However, there are definitely more trans programs opening up which opens up more opportunities for nurses and medical providers. I think this is due to the visibility of trans and gender non-conforming folks on TV and social media. 

She also believes that young people are pushing for more acceptance and medical care access. 

“My plan is to stick with this job. But the hard part is if I ever decided to move from Los Angeles, it would be limited where I could go,” she says. “I’m from Oklahoma originally. My thoughts are that maybe I could buy a house there. But I’m sure the jobs for my skills don’t exist there yet.”

Next Up: Interview With A Health Policy Nurse: The Healthcare Change Leader.

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