Dr. Danielle Kaufman, formerly David Kaufman, is a board certified radiologist at Kaiser Permanente in Santa Rosa, California, where she is chief of nuclear medicine. After 20 years of marriage, Dr. Kaufman came out as gay to his wife, who surprised him by coming out at the same time as a lesbian. They divorced, but remain close friends and parents of their children. After living for three years as a gay man, Dr. Kaufman had another realization: she was transgender, and now calls herself Danielle. Dr. Kaufman is the author of a critically acclaimed book, Untying the Knot: A Husband and Wife’s Story of Coming Out Together (Addicus Books, 2013).
I talked to Dr. Kaufman about some of the professional ramifications of her gender identity transition.
What effect did coming out at gay, and then as transgender, have on your medical practice?
Truthfully? None, whatsoever. Being gay doesn’t show and patients would have no way of knowing my sexual preference. It was actually frustrating at times because I felt I was going through this huge positive change and no one could even tell.
I did change my style of dress going from straight to gay to be a little more feminine and flamboyant, but I don’t think that was that big a deal. My gender expression change does show, of course, but I’ve only gotten one patient comment. A middle-aged male patient asked what was wrong with my voice. I just said, “This is my voice.”
I am a radiologist, though, and only briefly see one or two patients per day. One of my colleagues said point blank, “We don’t care whether you’re a man or a woman. We only care that you can read films.” Honestly, my general impression is that nobody really cares. It’s just left for me to sort out.
How did you talk to your coworkers and colleagues about your sexual identity?
I sent an email to my colleagues in radiology and all the doctors in the medical center. I received so many positive replies (none negative) that it took me two days to respond to all of them.
Of course, coming out gay didn’t really change my appearance; [since] changing to female gender expression, I’ve found that most of the time, people who knew me as David don’t even recognize me at all as Danielle. This has held true throughout the medical center.
Initially, when I spoke to my radiology colleagues, I briefly said, “I realized I’m transgender and I need to transition to female gender expression.” I emphasized two things: First, the pain of gender dysphoria [the formal "diagnosis" psychiatrists use, formerly known as gender identity disorder] is almost beyond comprehension; it’s far worse than one would think. Second, this has absolutely nothing to do with sex. This is about my identity, who I am as a person. Whom I’m attracted to is way down the road and quite unimportant right now.
I take not being recognized as Danielle as a supreme compliment: Danielle is so different from David that you wouldn’t even recognize me. Truly, the difference between coming off looking like a man or looking like a woman is far vaster in scope than most people realize. There are profound differences between the genders in how we do or say pretty much everything. Just wearing women’s clothes is a small thing. Having feminine mannerisms is probably a much bigger deal (and it’s much harder to master). Most of my female coworkers (radiology techs) wear androgynous medical clothes; they look definitely female because they have feminine mannerisms (and pretty feminine faces).
How have patients reacted?
My perception is that patients can tell, but accept me anyway. I was actually quite worried that patients would be upset and want a different doctor, but that hasn’t happened. The Kaiser Permanente organization has been extremely supportive, and they basically suggested I just ride with whatever reaction I get.
During my transition, at times I was flamboyantly female even while still presenting as a man. I often appeared as a man, but with bright red fingernails and makeup. If patients asked about my fingernails, I did what the human resources person advised: “Just tell them you like red fingernails.” The KP organization didn’t seem worried about it at all, so I tried to stay calm. For the most part, it’s a total nonissue.
What advice do you have for other professional people and businesspeople who’ve arrived at a life-changing realization about their gender identity?
Okay, here are some tips.
1. Work on permanent whisker removal early on. Permanent whisker removal is very time consuming and tedious and will ultimately take many months. The sooner you start, the sooner you can have a whisker-free face and then present in public as female. It’s awkward trying to present in public as female with whiskers (and they have to show, a 3-4 day beard, in order for electrolysis to work).
I figure if a little child runs away from me toward his or her mother screaming, then I’ve crossed the line. I’ve felt that for the most part, I need to be either male or female, but not an obvious combination (I couldn’t resist doing it a little though). Different transpeople have different levels of need or intensity about how strongly they need to transition. My need, once I truly got who I was, was overwhelming. It felt absolutely, totally necessary. There was no real alternative for me to transitioning as hard and fast as possible.
2. Understand that this is really difficult for the people around you. I found my gender identity was an enormous shock to those around me, but not me; I really kind of always knew it was true. Plus, I get the unspeakable joy of my transition; those around me don’t get that joy. They just have to get used to my changes. They have to call me “Danielle” instead of “David” and “she” instead of “he.”
3. Don’t transition in isolation; go out in public. Understand that adaptation to your true correct gender takes a long time and you can’t do it out of sight on your own. All you can really do is just grit your teeth and go out in public with your correct gender expression. Time and endless practice will improve your performance, and you will tend to pass better after a while.
I initially ventured out in public dressed as a woman because I desperately needed to express who I am, even though it was scary. I was amazed at how quickly it stopped being scary. Honestly, I think I was running errands and shopping as a woman for a couple weeks and then it was no big deal. I am absolutely adamant that I am not cross-dressing; I’m a woman wearing women’s clothes, and there is nothing strange about how I dress or look (although I do worry about my fashion sense!).
4. Find smart resources and support. For MTF transpeople, I found a couple great resources. TSRoadmap.com is a fairly comprehensive website about MTF issues, and they have a set of DVDs for purchase that go over the issues of clothes, speech, makeup, and so on. Danae Doyle, in San Mateo, California, works as a consultant for transwomen (MTF transgender) and has an excellent set of DVDs with extensive instruction on movement issues, in particular.
5. For gays and lesbians, you don’t have to say that much. As my wife Cat pointed out, whom I sleep with is my business. Beyond actual sexual orientation, gays and lesbians aren’t necessarily all that different, and you can be discreet about whom you tell. For transpeople, it’s more difficult because, particularly at the beginning, it’s hard to pass well and people are going to figure it out. I would suggest trying to cultivate an attitude that you won’t talk about it too much (this is hard for me), but you’re very willing to answer questions.
6. Give yourself a lot of self-validation and believe in yourself. As a transwoman, my own personal attitude about this is critical. I am absolutely convinced that there is nothing wrong, bad, or inappropriate about me or what I’m doing. Out in public I am a woman dressed in women’s clothes; this is totally normal and natural. It was a little uncomfortable at first (months ago), but I don’t think about it at all now. I’m probably just as comfortable in public in women’s clothes as any born woman. I use the lady’s restroom because I’m a lady and I belong there. This isn’t the time to be politically correct and self-effacing. You’re a gift to the world, let it show!
How did coming out affect your emotional health and/or confidence as an MD?
Starting my transition into female gender expression was emotionally helpful. The pain of gender dysphoria is overwhelming and I had it bad for decades. But now I’m free to be who I really am, and that’s an incredibly wonderful thing. I have literally been driving down the road with tears streaming down my cheeks, tears of joy over being who I am and being able to be who I am.
While both of my transitions had very profoundly positive effects on mental and emotional well-being, I don’t think they influenced the performance of my career much. In fact, while everything else around me was changing fast, my radiology practice stayed the same and was comforting. Having colleagues relate to me essentially the same no matter whether I look like a man or a woman was reassuring.
I think I’m lucky to be a physician, we tend to be socially aware as a group. I’m definitely very lucky to work for Kaiser Permanente and live in Sonoma County.