At 5-years-old, Leo Fulp was wrestling with his identity, but it wasn’t until years later that he knew why. Leo is transgender; his gender at birth may have been female, but he was not.

He remembers his epiphany, a chance interaction with a transgender person who attended the same high school. “That was my final straw," Leo said. "It inspired me to be myself."

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.

By asking patients to "Tell Us More" about their sexual orientation and gender identity, Novant Health can better support patients who identify as LGBTQ. Understanding a patient's whole story allows health care providers to offer the care people need and deserve.

Call me Max

Leo at 3 years old
Leo at 3 years old.

Leo, 24, was born as Courtney Elizabeth to parents Kerry and Kristen Fulp of Kernersville, North Carolina.

In early childhood, 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,” he said.

In many ways, 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.”

Leo in 2004.

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 could finally put a word (and a face) to how he felt.

“I didn't want to have breasts. I didn't want to have the body I had,” Leo 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.”

It compelled him to start telling people that he is transgender. Leo’s mom struggled with the news, in part, because of her "conservative upbringing.” Kristen is a Southern Baptist who regularly attends church.

“Your mind goes in a million different directions,” she 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. I can't do that. I don't think that's what Jesus would want. I love my child," she added.

Kristen loves Leo and tells him often but said it’s also 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.”

'The best feeling in the world'

At 18, Leo began seeing a gender therapist. 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.

Leo Fulp new
Leo Fulp, 24, shared a recent photo of himself.

Leo, a "people person" who lives with his family in Kernersville, thrives in his job at CVS. He also plans to re-enroll at the University of North Carolina at Greensboro in the fall. His ultimate goal is to become a history teacher.

"I had several teachers who helped me throughout my time in high school that really made an impact on me. I want to be able to do that for other students. Just kind of be a safe space and also have fun teaching," Leo said.

Making a difference

When Healthy Headlines caught up with him in May, two years after he first shared his story with Novant Health, he said he's happier than ever.

"Sharing my story was one of the most amazing things I've ever done," Leo said. "I'm a pretty average person, I think. So, to be able to do something like that and make any difference at all just made me ecstatic."

The positive feedback he received after sharing his story helped boost his confidence, as well. "Part of the gift that you gave him is a large portion of self confidence," Kristen said. "It took a lot of guts to be vulnerable and it was one of the first times he ever spoke out about it."

Kristen has come a long way, too, Leo said. "She's made amazing strides in learning more about what it means to be LGBTQ. She's always been supportive of me, but it's been awesome to see my mom grow in this situation, as well. And I think she's proud of me as a son, to see me excel, work hard and be a voice for other families in our situation," he said.

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In the last two years, Leo has lost weight and is a lot more confident (and comfortable) in who he is. "My beard has grown in, my voice is deeper and I don't get misgendered anymore, which is great," he said.

Leo has also been working on his mental health, something he highly suggests for anyone struggling with their gender identity or sexual orientation.

Leo Fulp 2022
Leo Fulp smiles for a photo with his beloved cat.

"You can't expect things to change overnight. I've been on testosterone for five years, so it takes time to see the changes you're excited for," he said. "And you really have to work on your mental state. Seek therapy if you need it. Find a good support group. There are a lot of resources out there for transgender people. There are hotlines that you can call and there are so many LGBTQ communities to connect with, especially online."

LGBTQ affirming care

Leo and Kristen, who works in guest relations at Novant Health Forsyth Medical Center, have shared their story with dozens of team members. The more health care providers know about their patients, and understand their unique needs and challenges, the better they can care for patients.

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 people who identify as part of this group.

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.

Novant Health patients who identify as LGBTQ are encouraged to look for the LGBTQ care symbol when searching online for a care provider.

When creating your medical record, many organizations ask for basics such as your sex, age and medical history. That’s a start but sometimes not enough. It's why Novant Health asks patients to 'Tell Us More,' particularly if they identify as lesbian, gay, bisexual, transgender or queer/questioning.

Collecting information about sexual orientation and gender identity helps caregivers offer appropriate health screenings and assessments, arrive at an accurate diagnosis and recommend effective treatment.