In a region that often struggles to find enough doctors willing to serve rural patients, Dr. Jennifer Burnett was a rarity. She made a career of treating people in small towns, including for nearly a decade at Adventist Health Community Care in Selma. Rarer still, she developed a specialty in caring for transgender people — a specialty made dearer to her because she is a transgender woman herself.
Now, after nine years in the Valley, after serving about 150 transgender patients between San Francisco and Los Angeles, Burnett is moving on. She treated local residents as a family doctor in addition to trans people from across the Valley at an outpatient clinic and a hospital in Selma. She also taught medical students and family medicine residents in the rural family practice track at UCSF-Fresno, based in Selma.
Last week, Burnett, 62, traded Selma for Seattle to be closer to her children.
She left in October after Adventist closed its maternity ward at the Selma hospital and moved those services to the Family Birth Center in Reedley. She also hoped to spearhead a transgender medicine certificate program or formal elective course at UCSF, but university leaders said providers are already working on a transgender curriculum and couldn’t justify creating such a position for her.
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Burnett’s departure means transgender people in the Valley must find appropriate care through different avenues. Former patients, LGBT advocates and other medical professionals said she was the only family doctor near Fresno trained in transgender medicine.
Dr. Alex Moir, chief of the department of family and community medicine at UCSF-Fresno, said the number of competent trained physicians providing transgender care is miniscule outside of certain urban cities.
“Having access to all kinds of medical care is a challenge in rural communities,” he said. “Transgender care is almost nonexistent in this kind of setting and depended here on the fact that we had a skilled, rural physician who was also competent in transgender care.”
Transgender people identify differently from conventional notions of the sex they were assigned at birth. Many take prescribed hormones to change their bodies. Some undergo surgery as well.
The Williams Institute, a think tank at the UCLA School of Law that specializes in sexual orientation and gender identity law and policy, estimates that 700,000 people in the U.S. are transgender. But statistics on transgender people are rough estimates at best because there are no national surveys.
Trans people are at high risk of suicide and many suffer rejection by family and friends, discrimination, victimization, violence or death. A Williams Institute study last year found that among respondents who were turned away by a doctor because they were transgender or gender-nonconforming, 60% had attempted suicide at some point in their lives.
Valerie Bevens, Burnett’s friend and longtime patient, said it’s especially critical for transgender people to see a doctor who knows what they’re going through during the transition process. People wanting to transition are recommended to seek counseling and live for one year as their true gender before undergoing body modification procedures, if they choose to.
Bevens, 64, drove from her home in Los Angeles for appointments with Burnett.
“It’s so rare to find good resources,” she said. “I have talked to doctors that are clueless. A lot of them are fascinated by it, but they’re not informed.”
Burnett’s own story is one of perseverance.
She remembers feeling different from the other kids as early as age 3 or 4.
“I just said, ‘Why don’t I have a body like all the rest of the girls?’ ” she recalled. “Many children will be manifesting their gender identity even at the age of 2.”
Talking about it infuriated Burnett’s father, so she learned to hide it and, as with many trans people, suppress her feelings. Instead, she built a masculine facade.
In medical school at the University of Southern California, Burnett read all the early articles on transgenderism. She learned how to medically transition but found herself living with parallel thoughts: “I am a male, and I am a transsexual.”
Burnett found success as a male doctor, working at family practices in small towns throughout California, Idaho and Oregon. Burnett married a woman and had two children. Living as a man, she said, she was a model Christian.
“For a long time I could deny everything, because, look how successful I was as a male doctor,” she said. “It’s like carrying two 90-pound bags of cement on your shoulder — you can do it, but it’s really hard and eventually you just can’t hold it together anymore.”
By 1984, Burnett realized she could no longer continue living as a man and started on hormones and electrolysis for permanent hair removal. But after just six months, she said God told her to put the transition on hold for her children.
Six years later, the couple divorced and Burnett won sole custody of the children.
“Had I not been walking the straight and narrow, I may have lost custody of them,” she said. “The judge could have possibly said, ‘These kids can’t be with either parent so let’s put them in foster care.’ ”
‘Transition or die’
Burnett remarried in 1999 to a woman who knew Burnett planned to transition from male to female. Burnett said the wife never expressed reservations about it.
By the time her son graduated high school in 2004, Burnett said, she couldn’t bear living as a man anymore.
Burnett calls it the “transition or die” period. She started taking hormones again and began to see a gender doctor in Portland.
“They say, ‘You’re very brave to transition.’ No, not so. I am merely doing the only thing that I can to survive because I cannot hold a male facade together anymore,” she said.
Just before her son left for a summer job and to start college, Burnett made the announcement to her family. She was 52.
“I sacrificed 19 years of my life so that I could raise my children in a stable environment and not subject them to those upheavals,” she said. “There was a lot of anger initially.”
Burnett said she was so successful at acting like a man that when she did transition everyone was horrified.
“They thought I had gone nutso,” she said. “Here I was manifesting as a female when they’d always known me as male.”
In less than 24 hours, Burnett lost her house, spouse and job at a medical clinic in Hermiston, a rural community in eastern Oregon. In the years since her announcement, her relationships with her son and daughter, though strained at times, have improved.
Burnett remained unemployed for nine months. She applied for jobs at several small town clinics. She said the interviews went well — until she told them she was transgender. She felt obligated to tell potential employers because she had not yet undergone gender confirmation surgery.
Finally, Burnett landed a temporary gig at a county clinic in Tillamook, on the Oregon coast. In 2006, she found the opening through the Central California Faculty Medical Group to teach at UCSF-Fresno and practice in Selma.
‘One of us’
Burnett thrived at UCSF. Though hired for her rural health expertise, she told university leaders she is transgender and knowledgeable in transgender medicine. They were supportive.
California law protects transgender employees from workplace discrimination.
She started her transgender medical practice after the first year and lectured university residents and faculty on topics including transgender medicine, lesbian, gay, bisexual and transgender health care disparities, and obstetrician basics. Among other awards, she received a certificate of recognition from the California Senate in 2009 for her work with the trans community in the Central Valley.
Dr. Benjamin Huang, a second-year UCSF family medicine resident, said Burnett was one of the main reasons he applied to the program. Huang said he comes from the LGBT community as well and wants to specialize in caring for people like himself.
“As a primary care provider you have to care for the entire patient — not just (administering) hormones, but getting appropriate resources,” he said. “It’s hard enough for any patient to be comfortable with a primary care provider, especially when you come from a stigmatized minority.”
Without the guidance of a doctor, Burnett said, many transgender people purchase hormones on the black market. But self-treatment can be dangerous, she said.
Many of Burnett’s patients saw her as a fellow sister, helping them through the process of shedding bodies that didn’t fit for ones that felt like home. She was often one of the few people her patients could confide in, and she felt heartbroken to leave them.
“So many of them would break down in tears telling me about the pain they were going through,” she said. “So many said, ‘If it wasn’t for you, I wouldn’t be here today.’ ”
Rachel Bowman, 70, used to carpool with other transgender women from Fresno to see a doctor in Los Angeles before Burnett started practicing in Selma. She said it will be much harder to find adequate care in the Valley from now on.
“She is very excellent and, of course, she’s one of us: she’s a trans lady,” Bowman said.