As a lot of trans people do, especially early in transition, I found a support group. We would be sitting there and people would be talking about their traumatic experiences with the medical field, and a majority of the time it was radiology.

I’m Rachel Gerson. This is the Tunnel of Truth podcast. We jokingly refer to the CT scanners as the tunnel of truth in radiology because they tell you all the answers. Today’s episode features Dr. Micah Weir, an interventional radiologist turned teleradiologist.

I do like to start by pointing out that I’m recording this on the sacred ancestral lands of the Pennacook people. So my gender identity is transmasculine, non-binary and my pronouns are they them. Gender is a spectrum. So there’s binary, male and female and then there’s everything in between. And I fall on the masculine side of in between. When I use the term cis, that is someone who was biologically assigned male or female at birth and their gender identity conforms to that assignment. So then trans is someone whose gender identity does not agree with their sex assigned at birth. And also I’m only an expert in my own trans experience and I do my best to use words that are appropriate.

And when you started your journey in radiology, you were female presenting, is that right?

I was female presenting, but also gay, and medical school for me was very difficult because of that.

Can you tell me a little bit about that? Are there specific experiences that stand out to you or …

Well, a lot. It wasn’t a particularly safe time or place to be out and I was outed very early in medical school and my response to that was to just be very out. So that presented problems in multiple ways. I would get on an elevator, everybody else would get off. I worked in the library. If I was at the front desk, people would go away to the back of the stacks to find someone else to help them. There used to be, and I hope it’s not there anymore, but on evaluations, there used to be a morality section, so all the rest of my evaluation would be fine. And then they would make comments about my morality being unfit for a physician.

Actually in your record?

Yes, in my record. And thankfully the dean at the time, that it was time to write letters and bring all of that information together for letters for residency, he just wrote it in a way that sort of took that out of there because I would get honors in some of the harder rotations and then family medicine I would get dinged for my morality. The worst was surgery. They would make homophobic jokes and comments on rounds. I had one attending that I stopped scrubbing in with because he threw an instrument at me and yelled homophobic slurs at me. And of course no one in the room is going to say anything because their jobs and reputations are all on the line.

There was one case that haunts me to this day where they knew that the patient was gay, a gay male, and I don’t think adequately sedated him and they were doing something painful and they were laughing. It was horrible. I mean that was not legal, but all could think to do was to get close to him, and I was just trying to run my hands through his hair and talk to him and both of us were crying. So just things like that. But there were some good. My mentor, we had assigned mentors, was a very religious man, was a medical missionary, but didn’t treat me any differently despite the fact that that sounds like it could have been a set up for issues. He was disappointed that I wasn’t going into internal medicine. When I went to him to tell him I wanted to go into radiology, he wrote letters for me and so kudos to him.

What was your experience like as you moved both location and moved into residency and training?

So residency was very different and you probably had this experience too where you went to interview for residency and you’d be the one female presenting person in the room of 25 identical, suited, cis-appearing males.

I know that situation.

And I was asked every time if my husband was going to move with me and of course I’m not going to come out in that environment. The residency program director was Jeanne Baer. She was one of the original giants of a female in radiology. It was very well known and there were two females per class and I don’t know, I assume that was on purpose, but part of the country was better and me being gay was not really an issue. And being female was only an issue in that when you have a female attending, they push you harder because you have to be better than your male counterparts.

Radiology is sort of traditionally somewhat like surgery, a pretty male dominated field. And then within radiology you ended up picking interventional, which particularly at the time you were picking it was heavily male dominated. What was that like?

I did do that and you’re right, at that time there were probably less than 100 female interventional radiologists in the world likely. And you’d go to meetings and be the only female presenting person in the room who wasn’t a tech or a nurse. My first job, because I was in interventional radiology, I went to a very, very busy interventional radiology practice within a radiology practice, but I was very young in comparison. And so I would get some of that. I had a surgeon consult with me and then pat me on top of the head as he was leaving.

Yeah, that’s weird.

Yeah, that was weird. There was one surgeon there. My fellowship was very heavily vascular focused. So much so that I had not really done a declot when I hit my practice. For a while, they probably questioned their choices because it took a while. But there was one surgeon there that had arterial cases a lot and it took me a while to of convince him that I should be doing his cases.

Do you think that would’ve been different than for a male interventionalist or do you think it just took him longer to trust you or …

I do think it was different because I started at that practice at the same time with a cis male who is the same, I don’t know about age, but same age training-wise. And he would go to him before me. I think a lot of us experience that a clinician will ask our opinion and then go ask a male radiologist’s opinions. And that happened to me right up until people started thinking that I was male. So the practice that so far I’ve spent the most time in up here was 11 years and I was a partner, normal partnership track for years and years. And that would happen all the time if someone had a case. And especially if I said no and I was one of the more aggressive interventionalists, especially if I said no, they would go to one of my male colleagues.

Do you think your male colleagues noticed that? Would they say, “Go back to her, she knows what she’s talking about”?

There was one who was supportive in that, don’t come ask me if you’ve already asked her. Don’t do that because why would I say yes, you’ve already consulted somebody.

It’s like a teenager who goes from one parent to the other.

And it feels like that there were a couple of members of the group who were cis males who were prior interventionalists who had switched to diagnostic. And for one of them he was highly regarded and so I get it, very well known. He’d been there forever. So if you’d also been in the hospital forever, you knew him, you guys were buddies. That feels a little different. The other guy, I don’t know, I guess he did interventional, but it had been a long time and they would ask me something and then if he was the only other option, go ask him.

Even though he wasn’t currently even doing interventional.

And hadn’t for a long time. So I did finally have a conversation with him about don’t say any procedure is possible unless you’re going to do it, because things change and it’s been so long and now that people will ask me, “Do you think this can be biopsied? Do you think they can treat this?” And I always say, “You’ll have to consult the interventionalist on call.” Because I don’t ever want someone to be in a position where they feel like they have to do something that’s not safe just because someone else said so. But I experienced, there was one surgeon in particular, a vascular surgeon. I came to that practice with the most experience and the most training in arterial work because I’m at that stage where more and more fellowships were losing all of their vascular training. Whereas I had done almost entirely vascular training and I had done it with my first job.

I had done lots of arterial work and there was a vascular surgeon who would not send me cases, period end. And it was again, a cis male, same generation that was there. And he would take all cases to him and except in emergencies he’d have no choice and he would call. But the crazy thing is he would call other people to try to get them to come in to do cases when I was on call. But part of his issue was initially it was that I was female and then he found out that I was gay. For him, that was like a no-go. He would not send me cases.

Wow. Do you feel like you noticed that at all in your residency or practice? Differences in how patients who might be gay or transgender were treated?

Yeah, I think unfortunately people would make comments, not usually in front of the patient, but I very clearly remember one in the prior job that was an African American trans woman, a black woman, trans woman. And she was not treated well at all and needed a biopsy and unfortunately had many struggles and had HIV and Hep B and was a high risk patient as well. But she was very much treated as a pariah. So I did the biopsy. I found a nurse out of her nurses that would be caring and supportive and I can only imagine what the rest of her stay was like.

That’s the reason why when there are laws in some states like Texas, where it’s legal for medical professionals because of religious reasons to deny treatment. My parents live in Texas, but I will not go there. And it’s because people will say, I get, “Oh, but that would never happen.” Well yeah, it will. I’ve seen it. And I also know other stories of trans people even dying because they refused treatment. And now in Texas it’s legal.

Can you tell me any more specifics about that story? Did people refuse to treat her or delay her treatment?

I do think that her treatment was delayed. She wasn’t able to take her medication, so her viral load was very high and she had enlarged lymph nodes and they’re trying to figure out is this lymphoma or is this HIV or is this something else? And there were colleagues who didn’t want to touch her and there were comments made by staff and physicians. So I ended up doing that biopsy. She was pretty clear with me that people hadn’t been nice to her and she was so thankful to that nurse and to me because we had treated her a human, because she is. It was very disturbing.

I didn’t at the time understand, despite the fact that starting with puberty, I felt like I was living in a skin suit, you have to think about my age. And even Ellen Degeneres wasn’t out as a lesbian, much less any trans people. And I didn’t understand what was going on. So I didn’t identify or understand that I was trans at that time. But just the way she was treated was really heartbreaking. And I think sadly that there’s still a lot of that in the medical community, which is why I think it’s so important for people to talk about it and why I think RSNA and the ACR both have a huge diversity inclusion push right now. And I think it’s really important what they’re doing. My experience transitioning within the workspace was good though.

Tell me about that experience and what made it a supportive environment. Because I think that can be instructive too.

I had gone through at least a year of difficult personal work, figuring out that I was trans and that’s what was going on. And then I needed to take steps to transition. And also making that decision meant the end of my marriage. So my personal life was extremely difficult, but when I figured out, okay, this is my name, these are my pronouns, I’m going to be making some moves towards transition and I can’t just not say anything at work. The first thing I did actually, because in our practice most of the time I was working with my techs and nurses and my team and I sat down with them and told them first. And they had lots of questions, which is good, but I think, and I am open to questions, so it was fine. I think that that could be hard for some people to be rapid fire questions at you.

But I was prepared for that and ready to answer the questions. I was willing to answer and they were very supportive and very few mistakes were made with my name, those that address me by my first name. And there was one nurse in particular who either couldn’t or refused to switch. And so then I just made it where I wouldn’t answer unless she called me Dr. Weir. So that was an easy way to fix that. They them pronouns are hard so I gave everybody the choice for he him or they them. And there was one guy I think that just honestly struggled with it, one of the radiologists. So he just called me Dr. Weir after that of his own accord, just so that he didn’t make that mistake. Which is handy in a radiology practice if you’re dealing with a physician, all else fails.

Right, use the title. I certainly know a lot of female radiologists who struggle to get someone to use doctor.

And there was a radiologist who was really bad about that. For some reason one of my female colleagues in particular, one of our other, we’re all partners here. And he would say, well ask and her first name to clinicians, to technologists to nurses. And I would overhear it and just always correct him. But I think one of the most supportive things that for me was it was either a non-issue or it wasn’t addressed constantly. People weren’t constantly coming up to me about it. People have a tendency when they mess up your pronouns to just follow over themselves apologizing. And that puts it on the misgendered person to feel like they have an obligation to say, Oh that’s okay. Which is kind of uncomfortable and it’s not really, I mean it’s okay that you made the mistake, you know what I mean?

And it is just sort of uncomfortable and it just makes it more of a thing than it needs to be. Because pronouns are hard, and somehow they knew to just mess it up, use the right one and move on. And I did have surgery and they were very supportive when I needed time off for that surgery. Also, because I have a tendency to be an educator, that tech started to come to me with questions, What about this patient? But what do I do in this situation?

You mean when a patient might be transgender?

And I think one of the things that was dismaying to me, as a lot of trans people do, especially early in transition, I found a support group. It was a trans-masculine support group, although I doubt this is specific to the trans-masculine community, but we would be sitting there and people would be talking about their traumatic experiences with the medical field. And a majority of the time it was radiology. And that was dismaying to me. And of course the reason is transmasculine people in particular, a lot of people have dysphoria around their chest and have to have medical care, have to have mammograms.

So they’re going into a traditionally quote unquote female space and trying to be seen for who they are. And a lot of people, a lot of patients get misgendered, have the wrong names used. If you put me in that space, it’d be uncomfortable for me, but it’d be uncomfortable for them also. So then I’d be sitting there feeling bad because I know that that woman with nothing but a gown on is uncomfortable because some guy’s sitting there, she doesn’t know anything about me. So there’s a lot around the mammogram department and ultrasound.

Tell me about ultrasound, how that plays out in that.

This is true, I think for any, I say AFAB assigned female at birth or biologically female community. There’s a lot of trauma in that community. And then you have transmasculine folks who have dysphoria perhaps. Many do have dysphoria around those organs, but part of care is to do pelvic or transvaginal ultrasounds. And if you have abdominal pain and you’ve got ovaries, somebody needs to look at those ovaries. But if you go in and you’re misgendered and they don’t ask you your preferred name or your pronouns and they’re not used and then you have to go in and have potentially traumatic for you or scary medical procedure. That is talked about over and over and that’s probably one of the worst. In a support group I run, someone was talking about this and it feels like sexual assault.

There’s a group of us that have done a presentation at RSNA and are doing that again, and there’s somebody else who’s really spearheading working on wording and reports because now everybody gets their reports in MyChart probably before their physician does. So things like not putting gender in your history, because why. The organs are out of there or they’re not talking about that, doesn’t matter. I say that the patient is status post hysterectomy instead of using the word uterus, I talk about an oophorectomy, perhaps, instead. People have said, “Well, but that’s just the anatomy.” Well sure it is the anatomy, but we have, if anything, even more technical terms to use that maybe remove that from it.

I think there are some transmasculine people who don’t mind the term breast, but many do. And so if you know that a patient is transmasculine, using the word chest is an easy way to avoid that. There is a transgender care center that is sort of associated with the hospital and they supported me in bringing in the head of that center to have him come in and educate. And actually it ended up the laboratory was interested as well, which is good, because the laboratory’s another place that’s frequently complained about. And I think it’s because radiology and the lab are both front facing places that trans patients have to go. And so we did a lot of that. I wanted pronoun pins available for those who are willing to wear it. We put signage up, rainbow flag signage, or just a little, basically you’re safe here. And it just sets the stage because so many people are so afraid of medical care.

Yeah, I think that speaks to the importance of representation in the field in general, that knowing someone who is trans or gay or whatever the situation is, helps people to consider these issues.

I guess the caveat to that would be, of course. I was very open, you know may have a colleague who comes out as either gay or trans, but not be generally open about it. So you wouldn’t want to be putting all the education on them or sending some random administrator to their office to talk about signage. Right?

Right, there’s the issue of burden too. You don’t want to have to be the token person who has to carry the burden. But I do think there’s value in seeing yourself or seeing someone who reflects a patient situation and knowing them personally. That helps people be more open-minded.

I had a Locums job at the time and I have an intersection there. They have an infertility program at that hospital. And so for Parasteps and infertility, you have to have HSGs and there were only male presenting radiologists that day and myself included. And I was far enough along that sometimes in public people would be trying to figure me out, but still, most people, their brain has binary choices in its head. And most people would look at me and think male.

But there was a patient who came in who really wanted fertility treatments and had to have this HSG, but they were a survivor and there was supposed to have been a female radiologist, but it had switched out. That had switched out for some reason. And I was out to the staff and everything and then the nurse came to me and she’s like, the patient was very upset. The nurse came to me and she’s like, “I’m totally overstepping my bounds. I don’t know what to do. And I know if you say no, I’ll just go back and say there’s no other options, but can you come talk to her and see are you willing to come out to her and see if she’ll let you do this?” I was like, “All right.” Typically I don’t share a lot of personal information with people.

Sure, with patients, right?

But I did, I went in and as soon as I walked in she was angry and upset and ready to leave because she had been very clear and I said just give me a minute. And so I explained to her, told her that I had had fertility treatments, I’d had to have an HSG, that things are not what they appear. And then she gave this big hug and cried all over my shirt. Actually I had makeup all over my shirt.

Yeah, it’s interesting and it kind of segues because you have that dual perspective. How has your experience as a radiologist been different now that you present as a male? Or has it?

I’m questioned less. If I’m on the phone with someone and I’m clearly uncertain about what I’m telling them and I’m open about being uncertain, they just accept it. As a female presenting radiologist, if I was calling with unexpected findings, it wasn’t uncommon for them to ask me how I know or am I sure. That never happens now. One that sticks out in particular is a very well trained body radiologist who was female, who was trained at one of the best places in the country, very knowledgeable.

She was looking at a pancreatic mass with a clinician who was a cis male clinician. And I walked in because I needed to talk to her. She was telling him all about the possibilities, how do we work it up further or whatever. And then he turned to me and said, “What do you think?” And I looked at it it’s a pancreatic mass, and I said, “There’s a pancreatic mass.” And I scrolled up and down and I said, “And I can’t get a needle to it safely.” And he was like, “But I mean, what do you think about the mass?” And I said, “I think whatever Dr. X thinks about it. She’s the expert, don’t ask me.” And then I just turned around and walked out.

You did mention to me when we talked earlier that there was a specific surgeon who you felt kind of treated you differently or maybe didn’t even recognize that you were the same person when you transitioned. Can you tell me that story?

Yeah, that’s bizarre because my last name didn’t change, but he is the one that when I came to my practice, clearly the most qualified to be helping him with his vascular patients, wouldn’t send me patients. And that continued for years, even when I had emergency cases that I had that he had no choice and I had to do them. He just never would come to me with anything. And if I was in the room when he walked in, it was my day and he didn’t realize it and he came in, he would just turn around and walk out. And so after transition, he eventually started sending me cases. And that was one of the weirdest, I don’t understand the psychology there, but to me that tells me that to him it is worse to be a female than to be someone that he considers a heathen.

I’ve always been a feminist, but it’s even more so now because I’ve been on both sides and I’m treated differently day to day and treated differently professionally. And so when cis males say,” Oh, it’s not really that bad, is it?” Or they just say, “This happens.” I was like, “Yes, because it does.” Because I know, I’ve experienced both. Pediatrics has kind of always been leading the way. OB GYN now is really pushing as far as training goes to be training physicians. So I think as we have new generations of physicians coming out that have been trained more in LGBTQ care, that patients and other physicians who may be LGBTQ, we will all benefit from that. But I think there’s a long way to go. There’s a lot of transphobia professionally and just in life in general. And even within the gay community and the straight community, there’s just a lot of misunderstanding and transphobia.

And so I know other trans radiologists who are out and others who are not. And I do understand being very nervous about being trans and being out and it can’t always be avoided. My last practice, which was my first teleradiology practice, there was a hospital that was trying to not credential me because not all of my documents have my name on them, my current name on them, my legal name. It’s really hard to change them all. And so they became aware that I was trans and they were trying not to credential me because it’s in a conservative place. And so my practice just pointed out to them, what you’re doing is either breaking the law yourselves or you’re forcing us to break the law and we’re not going to do that.

I had one last question I wanted to ask about. Did you have any patients ever who came to you both as a female presenting and as a male presenting physician?

So there was one guy, he liked to come to me. I was the only female presenting interventional radiologist. He was kind of skeevy. He would always schedule with me. He insisted on seeing me and he would say things that weren’t necessarily appropriate about how he loved me and was I married and he wanted to marry me and things like that. And where is that pretty Dr. Weir, things that he would make comments like that. And after I transitioned, he never really put two and two together. And so he would say, Well, what happened to that other doctor Weir? I really liked her. And I would get that question sometimes, “Oh, are you related to, there used to be this other Doctor Weir here and what happened to her?” It so that is a little uncomfortable because I’m not going to run around coming out to people nonstop.

What did you do? What would you say?

Most often I would say, “I’m glad that you like Dr. Weir and I’m here today.” Patients are dealing with their stuff, which as long as they’re getting good care and I’m as nice and I listen as well as at other Dr. Weir, it’s all that matters, I guess. I would have cis female patients that didn’t know me were more shy and cis male patients that didn’t know me were just more willing to talk about just random stuff that they wouldn’t just come out with or, “Oh, she’s so pretty,” talking about one of the other techs and don’t you think she’s pretty, Dr. Weir?” Just comments that cis males make to people they think are cis males that they don’t make to women. And so that would happen. As a female presenting physician, people would ask me when the doctor was coming or if there was a male staff member, they would assume that that person was the doctor, that I wasn’t the doctor. That happens all the time. That didn’t happen anymore unless the nurse misgendered me, in which case they were actually looking for a female physician and then I walked up.

It speaks to the importance of getting pronouns right, those kinds of things, because patients don’t need any more confusion.

Well, it is, and it is about them. That moment is about them and they need to be as comfortable as possible. And if we’re having to have it so often with patients, staff would use male pronouns. And I had even suggested that, because they them pronouns are confusing and if any of them happen to catch it, they’re going to be like, “Wait, what?” And that’s just not the time or the place. It is about them at that moment and they don’t need to understand. It doesn’t matter.

Your gender identity is not the business or the issue at hand.

Right, right.

Tunnel of Truth is partially funded by the Washington State Radiological Society’s Committee on Women and Diversity. We are also a proud recipient of a 2022 American College of Radiology chapter grant. If you’d like to share your story on this podcast, visit our website, tunneloftruth.com. These stories can be difficult to tell. We create a comfortable recording environment and can keep your identity private should you wish to maintain anonymity.