I came out as transgender in my post-baccalaureate years. I grew up in California and was enjoying my time in college at Boulder. Although I had been severely bullied in middle school, there were never any problems for me in the adult world.

Discrimination was not something I thought really existed because I had not seen it.

Blissfully discovering my new self, I began my social transition. I was finally coming into myself when my premed advisor told me succinctly that I needed to find the closet I had just come out of and get right back in.

The thought of crawling back into my old closet was pure insanity, or so I thought. It was not until two more instances where physicians told me that “you look too gay” and that I needed to “tone it down” that the seriousness of the situation set it. I climbed back into my closet, tossed out all of my men’s clothes, and replaced them with women’s clothes. I remember going to Express the day before my white coat ceremony trying to find something that was not “too gay.”

The façade did not last long. It was too hard to be someone else every day. Looking in the mirror and seeing what was looking back at me made me cringe. I spend hours trying to find the perfect balance between feminine and masculine. Trying for the unisex look was somewhat acceptable. After the first year of medical school, I went full butch. I let the whole school think that I was a lesbian. It was so much easier than explaining I was trans. I began to see what discrimination meant. My medical school was in the Midwest.

Being a hidden transman in a lesbian costume was a massive daily struggle. Medical school is not easy, and the added LGBTQ stress was a weight. When it came time to enter the Match with my mediocre grades and USMLE score, I was posed with the question, “Do you want to disclose your LGBTQ identity to your programs?” I did not mention it in my personal statement because I was afraid of not finding a match.

All of my activities were LGBTQ related, but I remained silent about the biggest part of myself in the most important part of my application. It had not helped that my photo had been critiqued as being too “masculine.” I had been advised to shove myself back further into my closet.

Because my application was only just mediocre, I was advised to apply to programs that might be willing to accept me. Unfortunately, many of these places are located in conservative areas. Even now, people advise me to apply to places where I know I would be unsafe living and where I know the institution would probably not want me.

And here we have the point of the article and the real question.

Where do the mediocre trans and visibly queer people go to residency?

Residency is a highly competitive process, and it is only getting worse. If you are in the top 10 percent of your class, you can certainly apply to UCSF, which is a Mecca for the LGBTQ population.

But for people like me, who are not exceptional, where do we turn? Do we choose a less competitive specialty? Now that I have fully transitioned, people tell me to go “stealth,” which means hide that I am trans and take everything off my application that might give me away. Besides having that feel like a whole different type of closet, it is nearly impossible. I have published papers in my deadname, and there is no way to change that. I have training verification letters in my deadname, and I cannot seem to have some of those changed either.

Right now, I am standing out of the closet, and the door has been padlocked shut. What a luxury to be able to apply to residency in a state that is less competitive and not have to worry if I will be harmed if I try and live there. An even bigger luxury would be the thought that a conservative institution would even consider allowing me into their residency program.

What a privilege to be able to apply wherever I want with only my credentials being considered.

What a privilege not to have to worry about my LGBTQ status affecting my application process.

But that is not reality, and I am not alone. This begs the question. What are we going to do to change things? How are we going to equalize the playing field? And I think it is going to come down to the institutions that are in “safe” places to reconsider their application practices and perhaps consider some applicants who might not have the luxury of applying in less desirable areas.

Miles McIntosh is a physician.

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