Madden takes her 9-year-old Yorkshire Terrier, Abby, and her lovebird, Peaches, for a short walk near her family practice in Amherst. Madden takes her 9-year-old Yorkshire Terrier, Abby, and her lovebird, Peaches, for a short walk near her family practice in Amherst.

Dr. Jennifer Madden sits for a portrait at her family practice in Amherst. Being a transgender woman, Madden has a special interest in providing care to other transgender individuals; many starting their transition seek her out. Elizabeth Frantz / Monitor staff

Dr. Jennifer Madden kisses her lovebird, Peaches, in her office in Amherst. More than a decade after she became Jennifer, Madden is content with her identity. She hopes she can bring that peace of mind to her patients. Photos by ELIZABETH FRANTZ / Monitor staff

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When Dr. Jennifer Madden gets a new transgender patient at her practice, she pays close attention.

“Most patients, whether they are seeing you for a sore throat or they’re uncomfortable with their gender, want a doctor willing to listen to them,” Madden said.

She’s in a unique position to give advice. Madden is transgender, starting her transition from male to female nearly 12 years ago when she was 48, after decades of struggling with her gender identity.

Dressed in strappy sandals and a flowery blue dress as she took a lunch break in her Amherst office, Madden said she finally feels free.

“I feel like I don’t have to carry this lie inside of me,” Madden said. “I can do a lot of the things I felt uncomfortable doing before.”

Now she goes to ballet and tap classes. She can buy shapely pink ballet pointe shoes and ask the shopkeepers how to sew the laces correctly.

“I don’t think I would have been comfortable doing that as a man,” she said.

More than a decade after she became Jennifer, Madden is content with her identity. She hopes she can bring that same peace of mind to the couple of hundred transgender patients she’s seen at her family practice over the years.

She doesn’t exclusively see transgender individuals, but many who are starting their transition seek her out.

“I’m clued into what they’re thinking,” she said. “I know where you’re at, I’ve experienced that.”

Barriers to medical care

Transgender individuals face unique challenges trying to navigate a medical world that is still in the early stages of understanding them.

Often, they have to advocate for themselves to get hormone treatment and gender reassignment surgery, and they can face barriers with insurance (or lack thereof), as well as doctors who aren’t well-versed in transgender issues.

Changing genders is a new world for patients, and it’s often a whole new world for their doctors. Transgender medicine is an emerging field, one in which few medical school students receive training.

National statistics show that getting medical care can be very difficult for transgender individuals. A 2011 survey of 6,000 transgender Americans showed 19 percent were refused health care and many more didn’t seek medical care for fear of being discriminated against.

In 2010, 70 percent of transgender individuals nationwide reported their doctors denied them health care by refusing to touch them, using harsh or abusive language, using the wrong name, or prohibiting them from using the bathroom that matches their gender identity.

Madden said barriers to health care stem more from a lack of understanding than doctors being outright opposed to transgender people.

“I think a lot of physicians feel uncomfortable prescribing hormone therapy to transgendered patients,” Madden said. “It’s not necessarily because they’re against it; it’s just that they’re unsure of how to do it.”

Some of Madden’s patients come in knowing they want to start taking hormones and pursue gender reassignment surgery. Others aren’t as focused on taking action; they just want a welcoming place where they can come in and talk about the feelings they’re experiencing.

“I try to get them to understand that being male or female is more than the pill that you take,” Madden said. “Gender’s a cultural term . . . whereas sex is your plumbing, what you were given when you were born.”

Figuring it out

Before Caitlyn Jenner and the internet, many transgender people felt confused and isolated, living in an era where they weren’t accepted.

The first recorded instance of a transgender patient was in the 1930s, although doctors and experts believe there were many more before then.

Jack Turco, an endocrinologist at Dartmouth-Hitchcock Medical Center in Lebanon who started the state’s first transgender clinic, said it took many of his early patients 10 or more years to figure out what they were feeling.

“They knew something was different,” Turco said.

Some of those patients first expressed themselves as gay men because they were fearful they could not live openly as transgender women.

“They acquired a lot of baggage,” Turco said. A common theme he heard from patients was, “I know I’m not (male), but culture won’t accept me, so I’ll force myself to live as male.”

Turco started seeing transgender patients as a young resident at Dartmouth-Hitchcock back in the 1970s. He remembers the hospital getting a call from a man named Tricia who said he wanted to live as female. No one knew where to send Tricia, until someone looked at Turco and said, “(He’s) a pretty open-minded person.”

“That’s when my education started,” Turco recalled.

More than 30 years later, “it’s clearly the most satisfying part of my practice,” he said. “I’ve done some good for some people.”

There are a handful of practices in the state that cater to the medical needs of transgender people, including Madden’s, Turco’s and the Equality Health Center in Concord. The number of doctors interested in providing hormone therapy and surgical options for transgender patients at Turco’s clinic is growing, he said.

“The medical community has an onus on them. We’ve got to make medical care trans-friendly, not be an obstacle,” Turco said.

A personal process

Jennifer Madden was born with her father’s name, Henry Joseph Madden Jr. When she started transitioning at 48, she was married with two children.

Madden had felt like a female since an early age but continued to live as a male for decades.

“You can’t see it with your eyes,” she said. “You struggle with what’s going on in your head for many years trying to understand it. I used to tell my therapist that there were two people inside of me, one male and one female. I still feel that way.”

Her biggest fear was how coming out was going to affect her relationships with her family and friends.

“That was definitely a struggle for me, I always kept my focus on being positive and trying to show people I was happy,” she said.

Madden has two grown sons; her transition came as a surprise and was tough for one son to process, but she said she still has a good relationship with both.

“I think it’s made him a stronger person,” she said. “They are fine young men now, and I am very proud of them.”

Still, her journey had its twists and turns.

Madden describes the process right after transitioning as going through a “second puberty.”

Picture your middle school years, a time of experimentation with clothes and styles, Madden said. “You probably wore some pretty outlandish outfits and (your) makeup was a mess.”

That’s a little bit like what rediscovering the world as a different gender is like in the early stages.

“When you’re first coming out, you want everyone in the world to know, you want to tell everyone,” Madden said. “You want to be up-front about everything.”

It took some time for her to realize that not everyone wanted to hear the story of her transition, blow-by-blow.

“Sometimes you want to talk about your transition a lot,” she said. “You’re so focused on yourself, this is such a big deal, that you forget you need to focus on other people.”

Madden used to be much more of an activist a few years ago, even publishing a book about her life experiences. But being so visible caused her to struggle with depression and fears she was being too narcissistic.

“People either admired me for my courage or hated what I stood for,” she said. “It didn’t often seem that there was a middle ground.”

These days, Madden lives a quiet life. On top of her busy schedule at her family practice, she loves doing all the girly things she could not do openly for the first 48 years of her life.

“I like that I can be myself, wear a funny hat, listen to Abba or take a ballet class,” she said. “No one looks at me twice about that anymore.”

Coming out was at times a painful, but Madden said it has made her a better person and strengthened her relationships.

“My parents and I have found new ways to love each other, and I like to think that I’ve taught my children some important lessons about how best to live one’s life,” she said.

Madden’s work as a doctor has been one of the ways she’s tried to help other transgender individuals in New Hampshire.

“Over the years, I have found that focusing on other people’s lives, rather than my own, is most important,” she said. “The best way to influence other people is to let them see that you care about them, that you’re fair-minded, and that you believe in their inherent goodness.”

The philosophy she tries to apply in her personal and professional life is one of positivity.

“Next year I’ll be 60, and so I figure I only have 20 years plus or minus before I die,” she said. “That’s not a long time. I’d like to use that time to accomplish some good.”

(Ella Nilsen can be reached at 369-3322, enilsen@cmonitor.com or on Twitter @ella_nilsen.)