At just 5 years old, Leo Fulp was already wrestling with his identity, but it wasn’t until years later that he knew why. Leo is transgender. He remembers his breaking point – a chance interaction with a transgender person who attended the same high school.
“That was my final straw and my final break in character,” Leo said. His gender at birth may have been female, but he was not.
Transgender is a term for people whose gender identity (the personal sense of their own gender) does not match their biological sex at birth. The transgender community experiences higher rates of suicide and is less likely to have health insurance or access to a doctor.
Novant Health is addressing this gap with a campaign called “Tell Us More.” Patients are now asked about their sexual orientation and gender identity so that care is personalized. Understanding a patient’s whole story allows Novant Health to provide the best possible care.
Call me Max
Leo, today a 22-year-old college student, was born as Courtney Elizabeth to parents Kerry and Kristen Fulp of Kernersville, North Carolina.
By the time he was five, Leo would put on a hat and ask friends to call him a more masculine name, like Max or Buddy.
“That was just the start of what I would later find out: I'm trans,” said Leo.
Leo was a typical kid. He loved playing outside and was obsessed with all things Lord of the Rings. At the height of his obsession, Leo inadvertently shot an arrow into a neighbor’s house.
It wasn’t until puberty that Leo started thinking about his gender identity. “I started to feel a lot worse about myself because all those changes were happening,” he said, “and I didn't feel comfortable.”
Living his truth
Leo’s journey hit a big milestone in his teens. It was freshman year of high school when he first told friends and family that he thought he was gay.
“I was really dumbstruck,” said Kristen Fulp, Leo’s mom. “My thoughts were all over the place.”
But Leo still felt off, like his “skin was crawling,” something that can be attributed to gender dysphoria. People who experience gender dysphoria feel strongly that their biology does not match their gender. In Leo’s case, the dysphoria caused anxiety and even heart palpitations.
“When I saw guys, I wanted what they had. I wanted to get facial hair. I wanted a lower voice.”
Over the next couple of years, Leo discovered a collection of YouTube videos by Skylar Kergil, also a transgender man. He started to realize he was transgender. A conversation at a high school party where he met someone who is transgender compelled him to start telling other people.
“I didn't want to have breasts. I didn't want to have the body I had,” he said. “I didn't feel comfortable at all with the skin I was in because it didn't match me. It didn't match what was in my head.”
Leo’s mom struggled with the news, in part, “because of my conservative upbringing.” She is a Southern Baptist who regularly attends church. “Your mind goes in a million different directions,” Kristen said. “It was scary because I didn’t want to react poorly. I needed to think about and absorb this.
“There was a lady in my church who had a trans son and she threw her son out of the house, because she felt it was wrong. Her child was homeless,” Kristen said. “I can't do that. I don't think that's what Jesus would want. I love my child.”
Kristen loves Leo and tells him often but said it’s important that people understand it’s a difficult journey.
“I gave birth to a daughter and for 18 years I raised a daughter. There is a definite grieving process and it is not easy for a mom’s mind to align the newly-bearded son with the former daughter.”
'Someone who's embracing life'
Leo began seeing a gender therapist at 18. He wanted to talk through how he felt, but said he also needed a letter from the therapist to receive testosterone. Hormone therapy stimulates physical changes to help sync a person’s body with their gender identity. In Leo’s case, his voice got deeper, and he grew a beard.
In 2018, a few years into taking hormones, Leo saved up the money to have a double mastectomy.
“It felt completely freeing to do that. I was able to swim, which I haven’t been able to do in years,” he said. “I went to Alabama with my girlfriend and we went to the beach. For the first time I got to swim without having to wear a girl’s bathing suit. It was like the best feeling in the world.”
Kristen noticed the change in her son. He went from “somebody who was incredibly unhappy and turned into someone who's embracing life instead of hiding from it,” she said.
A bright future
Leo is studying both history and education at the University of North Carolina at Greensboro and lives with Kat, his girlfriend of two years. He feels more like himself than ever.
“I’m not necessarily just trans anymore. I'm becoming myself instead of just that specific identity, which I was for quite a while,” Leo said. “I'm finally becoming Leo and just being a person. It's not quite important for people to know that I'm trans. I like to put it out there so people know that they have someone they can talk to, but it's not the only thing about me anymore.”
‘Tell Us More’
Leo and Kristen, who works in guest relations at Novant Health Forsyth Medical Center, recently shared their family’s story with dozens of women’s health care providers in Winston-Salem. It was part of Novant Health’s commitment to achieve health equity.
“Health equity is about creating an inclusive environment where everyone can get the care they need,” said Tanya Blackmon, an executive vice president and chief diversity, inclusion and equity officer at Novant Health.
To better personalize care, Novant Health will begin collecting less visible characteristics of diversity, such as sexual orientation and gender identity, in addition to visible characteristics like a patient’s race or gender.
“For us, the beauty of looking at both the less visible and visible characteristics is that you see the whole person. Not just what you see, but what you can’t see, as well,” Blackmon said. “Seeing those differences allows us to create environments where there’s trust, commitment and a mutual respect for each other.”
This is important because the LGBTQ community is up against unique health risks, public health experts agree. They cite a lack of insurance coverage, a higher chance of getting certain sexually transmitted diseases and a greater risk of suicide among those who are LGBTQ.
Transgender people also experience additional barriers to health care such as a lack of clinical research, and providers who either don’t understand them or want to treat them.
In addition, health care research suggests that understanding how a patient identifies helps providers know which health screenings to order and health assessment questions to ask, leading to better care.